{"generated":"2026-08-28T16:42:09Z","year":"2025","count":420,"licence":"Citeer vrij, met bronvermelding en een link naar 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":"a3b5e07b8444","type":"article","url":"https://hartvaat.nl/2025/12/30/ire1-bemiddelt-hypertensie-en-vasculaire-remodeling/","title":"IRE1α bemiddelt hypertensie en vasculaire remodeling","title_en":"Inositol Requiring Enzyme 1α Mediates Hypertension and Vascular Remodeling","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["endotheel","renale-denervatie","resistente-hypertensie"],"journal":"Hypertension","doi":"https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.125.26400","source_url":"https://doi.org/https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.125.26400","authors":["Keiichi Torimoto"],"significance":5,"published":"2025-12-30","source_date":"2025-12-30","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/preventie/preventie-bij-ckd/"],"congress":"","summary_en":"This preclinical study demonstrated that inhibition of the endoplasmic reticulum stress effector inositol requiring enzyme 1a mitigates angiotensin II-induced hypertension and vascular remodelling. The findings identify a potential therapeutic target in the unfolded protein response pathway.","created":"2026-07-03T10:25:38Z","updated":"2026-07-03T18:38:17Z","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":"Chronische unfolded protein response door ER-stress wordt gezien als therapeutisch doelwit bij hypertensie. Dit onderzoek testte de hypothese dat inactivatie van inositol requiring enzyme 1α (IRE1α) hypertensie en vasculaire remodeling beïnvloedt.","abstract_original":"Hypertension, Volume 83, Issue 3, Page e26400, March 1, 2026. BACKGROUND:Chronic unfolded protein response due to endoplasmic reticulum stress has been proposed as a therapeutic target for hypertension. Here, we tested our hypothesis that inactivation of one of the central unfolded protein response effectors, inositol-requiring enzyme 1α, mitigates hypertension and vascular remodeling in mice infused with angiotensin II.METHODS:C57BL6 mice were infused with angiotensin II for 2 weeks with or without an inositol-requiring enzyme 1α inhibitor KIRA6 treatment to evaluate blood pressure and cardiovascular remodeling. Mouse small mesenteric arteries were used to assess vascular reactivity. Rat vascular smooth muscle cells were used to assess inositol-requiring enzyme 1α activation, intracellular Ca2+concentration, and secretory phenotype via proteomics.RESULTS:KIRA6 treatment mitigated hypertension induced by angiotensin II infusion. KIRA6 treatment also prevented angiotensin II–induced vas"},{"id":"68d5d6bcdd0d","type":"article","url":"https://hartvaat.nl/2025/12/30/overgang-van-aki-naar-ckd-rol-van-niermacrofagen-en-neutrofielen/","title":"Overgang van AKI naar CKD: rol van niermacrofagen en neutrofielen","title_en":"Key drivers and potential therapeutic targets in the AKI-to-CKD transition: roles of kidney-resident macrophages and neutrophils","category":"chronische nierziekte","category_label":"Nierziekte","professions":["internist"],"tags":["anemie-ckd","chronische-nierziekte","ijzertekort"],"journal":"Kidney International","doi":"https://www.kidney-international.org/article/S0085-2538(25)01028-2/fulltext","source_url":"https://doi.org/https://www.kidney-international.org/article/S0085-2538(25)01028-2/fulltext","authors":["Kensei Taguchi","Kei Fukami"],"significance":5,"published":"2025-12-30","source_date":"2025-12-30","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/anemie-bij-ckd/"],"congress":"","summary_en":"This review discusses the key drivers of the AKI-to-CKD transition, focusing on kidney-resident macrophages and neutrophils as potential therapeutic targets. Understanding innate immune mechanisms in maladaptive repair may identify new interventions to prevent CKD progression.","created":"2026-07-03T10:25:37Z","updated":"2026-07-03T13:25:01Z","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":"CKD treft 15% van de volwassenen wereldwijd. De overgang van acuut nierletsel naar chronische nierziekte is een cruciaal proces. Dit overzicht bespreekt de rol van nierresidente macrofagen en neutrofielen als therapeutische doelwitten.","abstract_original":"Chronic kidney disease (CKD), characterized by irreversible kidney damage and a decline in kidney function for at least 3 months, affects 15% of adults worldwide and is tightly linked to kidney failure, cardiovascular disease, mental disorders, and heightened susceptibility to infections. Acute kidney injury (AKI) occurs in 23% of hospitalized patients, is associated with in-hospital mortality,1 and predisposes patients to CKD.2 After AKI, proximal tubular cells (PTCs) fail to repair through multifaceted mechanisms, including cell cycle arrest at the G2/M phase, maladaptive dedifferentiation (i.e., partial epithelial-mesenchymal transition or epithelial cell plasticity), mitochondrial dysfunction, and epigenetic alteration."},{"id":"b2179d56e197","type":"article","url":"https://hartvaat.nl/2025/12/30/transcriptanalyse-van-langdurige-varken-naar-primaat-nierxenograften/","title":"Transcriptanalyse van langdurige varken-naar-primaat nierxenograften","title_en":"Mechanistic insights from transcript analysis of long-term pig to non-human primate kidney xenografts","category":"chronische nierziekte","category_label":"Nierziekte","professions":["internist"],"tags":[],"journal":"Kidney International","doi":"https://www.kidney-international.org/article/S0085-2538(25)01008-7/fulltext","source_url":"https://doi.org/https://www.kidney-international.org/article/S0085-2538(25)01008-7/fulltext","authors":["Ivy A. Rosales","Alessia Giarraputo","Claire Trivin-Avillach","Ahmad Karadagi","Christina Laguerre","Toru Goto","Jeremy Marcin","Nicole Brousaides","Tatsuo Kawai","Robert B. Colvin"],"significance":5,"published":"2025-12-30","source_date":"2025-12-30","image":"","kennis":[],"congress":"","summary_en":"Transcript analysis of long-term porcine kidney xenografts in non-human primates achieving up to two years of survival revealed distinct molecular mechanisms compared with allografts. The insights inform the development of xenotransplantation for future organ shortage solutions.","created":"2026-07-03T10:25:37Z","updated":"2026-07-03T13:25:01Z","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":"Varkensxenograften zijn een potentiële toekomstige orgaanbron. Korte klinische studies suggereerden andere mechanismen dan bij allograften. Deze studie biedt inzichten vanuit transcriptanalyse van langdurige xenograften bij niet-humane primaten.","abstract_original":"Porcine xenografts are a potential future organ source. Limited short-term clinical studies have suggested different mechanisms in xenografts than allografts. Here, we sought further insights from transcript analysis of xenografts in non-human primates that achieved up to two years of survival."},{"id":"9fb5ecdc2ede","type":"article","url":"https://hartvaat.nl/2025/12/29/effect-van-cilostazol-op-de-prognose-van-perifeer-arterieel-vaatlijden-bij-diabe/","title":"Effect van cilostazol op de prognose van perifeer arterieel vaatlijden bij diabetes in Korea","title_en":"Effects of cilostazol on the prognosis of lower extremity peripheral arterial disease in patients with diabetes mellitus in Korea: A nationwide population-based study","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["credence-trial","fidelio-dkd","soul-trial"],"journal":"Atherosclerosis","doi":"https://www.atherosclerosis-journal.com/article/S0021-9150(25)01532-1/fulltext","source_url":"https://doi.org/https://www.atherosclerosis-journal.com/article/S0021-9150(25)01532-1/fulltext","authors":["Shinje Moon","Sangmo Hong","Kyungdo Han","Cheol-Young Park"],"significance":5,"published":"2025-12-29","source_date":"2025-12-29","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"A Korean nationwide population-based study analysed the long-term prognostic effects of cilostazol in patients with diabetes and lower extremity peripheral arterial disease. The findings inform the use of this PDE3 inhibitor beyond symptomatic walking distance improvement.","created":"2026-07-03T10:25:38Z","updated":"2026-07-03T13:25:01Z","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":"Cilostazol vergroot de pijnvrije loopafstand bij perifeer arterieel vaatlijden. Het effect op de prognose bij patiënten met diabetes was onduidelijk. Deze Koreaanse populatiestudie analyseerde de effecten op de langetermijnuitkomsten.","abstract_original":"Cilostazol increases pain-free walking distance in patients with lower extremity peripheral arterial disease (PAD). However, the effect of cilostazol on the prognosis of PAD in patients with diabetes remains unclear. We analyzed its effects on the long-term prognosis of Korean patients with diabetes and lower extremity PAD."},{"id":"0ede7eb60a31","type":"article","url":"https://hartvaat.nl/2025/12/29/gemodificeerde-regulatoire-t-lymfocyten-bevorderen-herstel-van-het-geinfarceerde/","title":"Gemodificeerde regulatoire T-lymfocyten bevorderen herstel van het geïnfarceerde hart","title_en":"Engineered Regulatory T Lymphocytes Promote Infarcted Heart Repair","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["harttransplantatie","laminopathie","myocardinfarct"],"journal":"Circulation","doi":"https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.125.076321","source_url":"https://doi.org/https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.125.076321","authors":["Min Zhang"],"significance":7,"published":"2025-12-29","source_date":"2025-12-29","image":"","kennis":[],"congress":"","summary_en":"This study demonstrated that engineered regulatory T lymphocytes can promote repair of infarcted myocardium by resolving inflammation and reducing fibrosis, advancing cell-based immunomodulation as a regenerative cardiac therapy approach.","created":"2026-07-03T10:25:38Z","updated":"2026-07-03T18:38:17Z","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":"Myocardinfarct veroorzaakt een ontregeld genezingsproces met overmatige fibrose en onopgeloste inflammatie. Regulatoire T-lymfocyten moduleren dit proces. Dit onderzoek toont dat gemodificeerde Tregs het hartinfarct-herstel bevorderen.","abstract_original":"BACKGROUND:Myocardial infarction (MI) initiates a dysregulated healing process characterized by excessive fibrosis and unresolved inflammation, resulting in suboptimal cardiac repair in clinical settings. Regulatory T lymphocytes (Tregs) naturally orchestrate cardiac repair after MI, but their therapeutic potential is limited by inefficient homing to ischemic myocardium. We hypothesize that FAP (fibroblast activation protein)–specific CAR (chimeric antigen receptor) engineering overcomes this barrier by enabling precise delivery of Tregs to FAP⁺-enriched infarct zones, thereby focally amplifying reparative activity within injured myocardium.METHODS:In murine MI and ischemia–reperfusion models, C57BL/6J mice were injected with lentivirus-engineered FAP CAR Tregs (FCTRs) or mock Tregs derived from wild-type, IL-10 (interleukin-10) knockout (IL-10−/−) or Areg (amphiregulin) knockout (Areg−/−) donors after infarction. The cardiac outcomes and underlying mechanisms mediated by FCTRs were th"},{"id":"3f829cc231b6","type":"article","url":"https://hartvaat.nl/2025/12/29/functionele-en-morfologische-karakterisering-van-coronaire-atherosclerose/","title":"Functionele en morfologische karakterisering van coronaire atherosclerose","title_en":"Functional and morphological characterization of coronary atherosclerosis","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog"],"tags":["atherosclerose"],"journal":"Atherosclerosis","doi":"https://www.atherosclerosis-journal.com/article/S0021-9150(25)01530-8/fulltext","source_url":"https://doi.org/https://www.atherosclerosis-journal.com/article/S0021-9150(25)01530-8/fulltext","authors":["Koshiro Sakai","Toshiro Shinke","Ziad Ali","Takuya Mizukami","Hitoshi Matsuo","Hirohiko Ando","Tetsuya Amano","Thomas Engstrøm","Jeroen Sonck","Adriaan Wilgenhof","Divaka Perera","Masafumi Nakayama","William F. Fearon","Brian Ko","Javier Escaned","Daniel Munhoz","Frederic Bouisset","Kazumasa Ikeda","Taito Arai","Ethan Korngold","Evald Høj Christiansen","Colin Berry","Bernard De Bruyne","Nils P. Johnson","Carlos Collet"],"significance":5,"published":"2025-12-29","source_date":"2025-12-29","image":"","kennis":[],"congress":"","summary_en":"This study provides functional and morphological characterisation of coronary atherosclerosis using the novel Pullback Pressure Gradient metric to classify disease into focal or diffuse patterns. The physiological assessment complements anatomical imaging for treatment planning.","created":"2026-07-03T10:25:38Z","updated":"2026-07-03T13:25:01Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De interactie tussen coronaire hemodynamiek en atherosclerotische plaque is onvolledig begrepen. De Pullback Pressure Gradient (PPG) categoriseert coronaire ziekte in focale of diffuse patronen. Deze studie karakteriseert atherosclerose functioneel en morfologisch.","abstract_original":"The interplay between coronary artery hemodynamics and atherosclerotic plaque is not fully understood. The Pullback Pressure Gradient (PPG), a novel physiological metric, categorizes coronary artery disease (CAD) into focal or diffuse patterns based on coronary physiology."},{"id":"5acebd5a3fe9","type":"article","url":"https://hartvaat.nl/2025/12/29/monocyt-hdl-ratio-en-risico-op-beroerte-myocardinfarct-en-mortaliteit/","title":"Monocyt-HDL-ratio en risico op beroerte, myocardinfarct en mortaliteit","title_en":"Monocyte to high-density lipoprotein ratio and risk of incident stroke, myocardial infarction, and mortality: A large prospective cohort study","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","huisarts","internist"],"tags":["hdl-cholesterol"],"journal":"Atherosclerosis","doi":"https://www.atherosclerosis-journal.com/article/S0021-9150(25)01529-1/fulltext","source_url":"https://doi.org/https://www.atherosclerosis-journal.com/article/S0021-9150(25)01529-1/fulltext","authors":["Zijie Wang","Xiao Hu","Jianshang Wen","Yanfang Xie","Mengqiu Zhang","Chuanqin Fang","Yanghua Tian","Qi Li"],"significance":6,"published":"2025-12-29","source_date":"2025-12-29","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 evaluated the monocyte-to-HDL cholesterol ratio as a predictor of stroke, MI, and mortality, establishing this easily calculated inflammatory index as a cardiovascular risk marker.","created":"2026-07-03T10:25:38Z","updated":"2026-07-03T13:25:01Z","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":"Systemische inflammatie speelt een rol bij cardiovasculaire ziekte. De monocyt-HDL-ratio (MHR) is een surrogaatindex voor residuaal inflammatierisico. Dit grote prospectieve cohort onderzocht de associaties met beroerte, myocardinfarct en mortaliteit.","abstract_original":"Systemic inflammation plays a significant role in cardiovascular disease (CVD). Monocyte to high-density lipoprotein (HDL) ratio (MHR) has emerged as a surrogate index of residual inflammation risk. We investigated the associations of MHR with incident CVD and mortality, and to explore the additional predictive value of combining MHR with C-reactive protein (CRP)."},{"id":"281ddb320d93","type":"article","url":"https://hartvaat.nl/2025/12/26/pth-suppressieprofielen-na-orale-calciumbelasting-bij-niertransplantatiepatiente/","title":"PTH-suppressieprofielen na orale calciumbelasting bij niertransplantatiepatiënten","title_en":"Parathyroid hormone suppression profiles following oral calcium challenge in kidney transplant recipients","category":"chronische nierziekte","category_label":"Nierziekte","professions":["internist"],"tags":["niertransplantatie"],"journal":"Kidney International","doi":"https://www.kidney-international.org/article/S0085-2538(25)01010-5/fulltext","source_url":"https://doi.org/https://www.kidney-international.org/article/S0085-2538(25)01010-5/fulltext","authors":["Jordan Desenclos","Caroline Halimi","Emmanuelle Vidal-Petiot","Justina Motiejunaite","Eric Daugas","Tiphaine Robert-Mercier","Anne Boutten","Marie-Noëlle Peraldi","Corinne Antoine","François Vrtovsnik","Christine Randoux","Guillaume Hanouna","Quentin Raimbourg","Martin Flamant","Nahid Tabibzadeh"],"significance":5,"published":"2025-12-26","source_date":"2025-12-26","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nsaids-en-nierziekte/"],"congress":"","summary_en":"This study characterised parathyroid hormone suppression profiles after oral calcium challenge in kidney transplant recipients with post-transplant hyperparathyroidism. The calcium-mediated PTH suppression patterns were associated with PTH control in the first year post-transplant.","created":"2026-07-03T10:25:38Z","updated":"2026-07-03T13:25:02Z","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":"Post-transplantatie hyperparathyreoïdie is veelvoorkomend en geassocieerd met ongunstige uitkomsten. De bijdragen van calciumbiobeschikbaarheid en bijschildklierresponsiviteit zijn slecht gedefinieerd. Deze studie onderzocht het PTH-suppressieprofiel na orale calciumbelasting.","abstract_original":"Post-kidney transplant (KT) hyperparathyroidism (PT-HPT) is common and linked to adverse outcomes, yet the contributions of calcium bioavailability and parathyroid responsiveness remain poorly defined. Here, we studied the trajectory of oral calcium-mediated PTH suppression (CMPS) in PT-HPT and its association with PTH control in the first year post-KT."},{"id":"a56265f43af9","type":"article","url":"https://hartvaat.nl/2025/12/26/systematische-identificatie-van-familiaire-hypercholesterolemie-geactualiseerde-/","title":"Systematische identificatie van familiaire hypercholesterolemie: geactualiseerde review","title_en":"Systematic identification of familial hypercholesterolaemia: An updated systematic review and meta-analysis","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["dyslipidemie","ezetimibe","familiaire-hypercholesterolemie","familiaire-hypercholesterolemie-screening","ldl-cholesterol","vrouwen"],"journal":"Atherosclerosis","doi":"https://www.atherosclerosis-journal.com/article/S0021-9150(25)01523-0/fulltext","source_url":"https://doi.org/https://www.atherosclerosis-journal.com/article/S0021-9150(25)01523-0/fulltext","authors":["Diandra Daley","Aya Ayoub","Ralph K. Akyea","Veline L'Esperance","Luisa Silva","Anthony S. Wierzbicki","Helen Williams","Nadeem Qureshi","Mariam Molokhia"],"significance":5,"published":"2025-12-26","source_date":"2025-12-26","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/familiaire-hypercholesterolemie/","https://hartvaat.nl/kennis/lipiden/cascadescreening-fh/"],"congress":"","summary_en":"An updated systematic review evaluated electronic health record-based strategies for systematic identification of familial hypercholesterolaemia. Despite effective treatments, FH remains substantially underdiagnosed, and EHR-based case-finding shows promise for improving detection rates.","created":"2026-07-03T10:25:38Z","updated":"2026-07-03T13:25:02Z","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":"Familiaire hypercholesterolemie (FH) is een erfelijke lipidestoornis met verhoogd risico op premature atherosclerose. Ondanks effectieve behandelingen blijft FH sterk ondergediagnosticeerd. Deze geactualiseerde review evalueert elektronische screeningssystemen.","abstract_original":"Familial hypercholesterolaemia (FH) is an inherited lipid disorder characterised by raised LDL-C and increased risk of premature atherosclerotic cardiovascular disease. Despite effective treatments, FH remains substantially underdiagnosed. Electronic health records (EHRs) enable systematic case-finding, but evidence on their effectiveness remains limited. This review aimed to evaluate EHR-based strategies for FH identification."},{"id":"e1f93c2cafe0","type":"article","url":"https://hartvaat.nl/2025/12/24/infectiepreventie-bij-nieuwe-complementremmers-ingekapselde-micro-organismen/","title":"Infectiepreventie bij nieuwe complementremmers: ingekapselde micro-organismen","title_en":"Modern challenges in infection prevention: encapsulated organisms in the era of novel complement inhibitors","category":"chronische nierziekte","category_label":"Nierziekte","professions":["apotheker","internist"],"tags":["complementremmers","iga-nefropathie"],"journal":"Kidney International","doi":"https://www.kidney-international.org/article/S0085-2538(25)01024-5/fulltext","source_url":"https://doi.org/https://www.kidney-international.org/article/S0085-2538(25)01024-5/fulltext","authors":["Ayman Al Jurdi","Camille N. Kotton","Richard Lafayette"],"significance":5,"published":"2025-12-24","source_date":"2025-12-24","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/contrastmiddel-en-nierfunctie/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"This review addresses infection prevention strategies for patients receiving novel complement inhibitors approved for aHUS, IgA nephropathy, and C3 glomerulopathy. The risk of encapsulated organism infections requires systematic vaccination and monitoring protocols.","created":"2026-07-03T10:25:39Z","updated":"2026-07-03T13:25:02Z","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":"Complementremmers zijn goedgekeurd voor aHUS, IgA-nefropathie en C3-glomerulopathie. Deze review bespreekt het infectierisico door ingekapselde organismen bij gebruik van nieuwe complementremmers en strategieën voor preventie.","abstract_original":"Complement inhibitors are now approved for use in atypical hemolytic uremic syndrome, IgA nephropathy, and C3 glomerulopathy. They are being studied widely in kidney disease, and more indications may soon arise. This review addresses an approach to preventing infectious complications, particularly encapsulated organism infections, and will hopefully serve as guidance for nephrologists utilizing these agents."},{"id":"0ee7a6bf6be3","type":"article","url":"https://hartvaat.nl/2025/12/24/genomische-ontdekking-bij-nefrotisch-syndroom-mefv-varianten-als-risicofactor-vo/","title":"Genomische ontdekking bij nefrotisch syndroom: MEFV-varianten als risicofactor voor FSGS","title_en":"Nephrotic syndrome genomic discovery in the Mass General Brigham Biobank identifies monoallelic MEFV variants as a risk factor for focal segmental glomerulosclerosis","category":"chronische nierziekte","category_label":"Nierziekte","professions":["internist"],"tags":["cardiovasculaire-genetica","cystatine-c","familiaire-hypercholesterolemie","familiaire-hypercholesterolemie-screening"],"journal":"Kidney International","doi":"https://www.kidney-international.org/article/S0085-2538(25)01023-3/fulltext","source_url":"https://doi.org/https://www.kidney-international.org/article/S0085-2538(25)01023-3/fulltext","authors":["Janewit Wongboonsin","Kristen M. Gibson","Juntao Ke","Zachary T. Sentell","Juliana E. Arcila-Galvis","Satoshi Koyama","Anya Greenberg","Kaylia M. Reynolds","Giovanni Montini","Riccardo Magistroni","Adele Mitrotti","Loreto Gesualdo","Alessandro Pezzuto","Licia Peruzzi","Yasar Caliskan","Ana C. Onuchic-Whitford","Srichan Bunlungsup","Michelle McNulty","Rasheed Gbadegesin","Moin A. Saleem","Martin R. Pollak","Friedhelm Hildebrandt","Pradeep Natarajan","Dongwon Lee","Sagar U. Nigwekar","John A. Sayer","Simone Sanna-Cherchi","Matthew G. Sampson"],"significance":5,"published":"2025-12-24","source_date":"2025-12-24","image":"","kennis":[],"congress":"","summary_en":"A genomic discovery study in the Mass General Brigham Biobank identified monoallelic MEFV variants as a novel risk factor for focal segmental glomerulosclerosis. The finding links inflammatory pathway genetics to nephrotic syndrome susceptibility.","created":"2026-07-03T10:25:39Z","updated":"2026-07-03T13:25:02Z","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":"Biobanken met genetische data bieden unieke kansen voor genomische ontdekking bij nefrotisch syndroom. Deze studie in de Mass General Brigham Biobank identificeerde monoallelische MEFV-varianten als risicofactor voor focale segmentale glomerulosclerose.","abstract_original":"Health system-based biobanks with genetic data provide a unique opportunity for nephrotic syndrome (NS) genomic discovery. This is predicated on finding cases in the electronic health record."},{"id":"ba25c8c26a4c","type":"article","url":"https://hartvaat.nl/2025/12/24/risicovoorspellingsmodellen-voor-ouderen-met-chronische-nierziekte/","title":"Risicovoorspellingsmodellen voor ouderen met chronische nierziekte","title_en":"Utilizing risk prediction models for older patients with chronic kidney disease","category":"chronische nierziekte","category_label":"Nierziekte","professions":["huisarts","internist"],"tags":[],"journal":"Kidney International","doi":"https://www.kidney-international.org/article/S0085-2538(25)01015-4/fulltext","source_url":"https://doi.org/https://www.kidney-international.org/article/S0085-2538(25)01015-4/fulltext","authors":["Amanda Siriwardana","Navdeep Tangri","Brendon L. Neuen","Meg J. Jardine","Celine Foote","Martin Gallagher"],"significance":5,"published":"2025-12-24","source_date":"2025-12-24","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/nierziekte/nsaids-en-nierziekte/"],"congress":"","summary_en":"This review discusses the use of risk prediction models for older patients with chronic kidney disease. The slower progression rate and high competing mortality risk in elderly patients require tailored tools for shared decision-making about kidney replacement therapy.","created":"2026-07-03T10:25:38Z","updated":"2026-07-03T13:25:02Z","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":"Ouderen vormen de snelst groeiende leeftijdsgroep met nierfalen. De progressie is langzamer bij ouderen en het concurrerend overlijdensrisico is hoog. Dit overzicht bespreekt het gebruik van risicovoorspellingsmodellen bij deze kwetsbare populatie.","abstract_original":"Older patients represent the most rapidly growing age group presenting with kidney failure. Despite this high incidence, the rate of progression to kidney failure tends to be slower in older individuals, and the competing risk of death before the development of kidney failure is a more significant consideration in older patients compared with younger counterparts. Incorporating these concepts of risk is challenging in shared decision-making discussions between clinicians, older patients, and their families."},{"id":"dd7da5e30405","type":"article","url":"https://hartvaat.nl/2025/12/23/top-liberaal-versus-restrictief-transfusiebeleid-bij-hoogrisico-hartchirurgie/","title":"TOP: liberaal versus restrictief transfusiebeleid bij hoogrisico hartchirurgie","title_en":"Liberal or Restrictive Postoperative Transfusion in Patients at High Cardiac Risk: The TOP Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2025.20841","source_url":"https://doi.org/10.1001/jama.2025.20841","authors":["Panos Kougias","Sherene E Sharath","Min Zhan","Jeffrey L Carson","L Erin Norman","Zhibao Mi","Rupsi Pal","Hasan Dosluoglu","J Gregory Modrall","George A Sarosi","Peter Nelson","Shipra Arya","Alexandra Scrymgeour","Jade Ollison","Lawrence A Calais","Vijay Nambi","L Parker Gregg","Shuaib M Abdullah","Shirling Tsai","Natasha Becker","Justin C Choi","Louisa Chiu","Salvatore Scali","Neal R Barshes","Samir Awad","Mohammed Moursi","Matthew C Koopmann","Mitchell Sally","Daniel Ihnat","Archana Ramaswamy","Warren Gasper","Edith Tzeng","Mark A Wilson","Gale Tang","Grant Huang","Kousick Biswas"],"significance":7,"published":"2025-12-23","source_date":"2025-12-23","image":"","kennis":["https://hartvaat.nl/kennis/vasculair/vaatchirurgie-perioperatief-cardiologisch-beleid/","https://hartvaat.nl/kennis/kleplijden/mitraclip-transcatheter-mitralisreparatie/"],"congress":"","summary_en":"The TOP trial compared liberal with restrictive postoperative transfusion strategies in patients with high cardiac risk, informing the optimal hemoglobin threshold for transfusion in the most vulnerable surgical population.","created":"2026-07-03T10:32:05Z","updated":"2026-07-03T13:31:04Z","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 TOP-trial vergeleek liberaal met restrictief transfusiebeleid bij patiënten met hoog cardiaal risico. De bevindingen informeren het optimale transfusiebeleid perioperatief.","abstract_original":"IMPORTANCE: Postoperative red blood cell transfusion guidelines recommend transfusion for hemoglobin levels less than 7 g/dL. However, the safety of this strategy in patients at high risk of cardiac events undergoing major operations remains unclear. OBJECTIVE: To evaluate the risk of death or major ischemic events within 90 days after a liberal transfusion strategy compared with a restrictive transfusion strategy in patients at high risk of cardiac events who had undergone major vascular or general surgery operations and developed postoperative anemia. DESIGN, SETTING, AND PARTICIPANTS: This parallel, single-blind, randomized clinical superiority trial included 1428 veterans (≥18 y) at high cardiac risk undergoing major vascular or general surgery operations. Participants were enrolled from February 2018 to March 2023 across 16 Veterans Affairs Medical Centers in the US. INTERVENTIONS: Seven hundred fourteen participants with postoperative hemoglobin less than 10 g/dL were randomized to a liberal strategy (transfusion trigger at hemoglobin level <10 g/dL) and 714 to a restrictive strategy (transfusion trigger at hemoglobin <7 g/dL). MAIN OUTCOMES AND MEASURES: The primary end point was a composite of all-cause death, myocardial infarction, coronary revascularization, acute kidney failure, or ischemic stroke within 90 days after randomization. Secondary end points included a composite of cardiac complications other than myocardial infarction (arrhythmias, heart failure, and nonfatal cardiac arrest). RESULTS: Of the 1424 analyzed veterans (mean age, 69.9 [SD, 7.9] years; 1393 male [97.8%]; 268 Black [18.8%]; 48 Hispanic [4.1%]; 1071 White [75.2%]), 1297 (91.1%) underwent vascular surgical procedures. The mean hemoglobin difference between transfusion strategies was 2.0 g/dL on day 5 after randomization. The primary outcome rate in the liberal group was 9.1% (61 of 670) compared with 10.1% (71 of 700) in the restrictive group (relative risk, 0.90; 95% CI, 0.65-1.24). The secondary end point of cardiac complications without myocardial infarction, which was 1 of 5 secondary end points, occurred in 5.9% (38 of 647) of patients in the liberal group and 9.9% (67 of 678) of patients in the restrictive group (relative risk, 0.59; 99% CI, 0.36-0.98). CONCLUSIONS AND RELEVANCE: After major vascular or general surgery operations among patients at high risk of a cardiac event, a liberal transfusion strategy did not reduce 90-day death or major ischemic outcome rates compared with a restrictive strategy. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03229941."},{"id":"9d3c913f563c","type":"article","url":"https://hartvaat.nl/2025/12/23/korte-anticoagulatie-versus-dapt-na-laa-occlusie-devicetrombosepreventie/","title":"Korte anticoagulatie versus DAPT na LAA-occlusie: devicetrombosepreventie","title_en":"Short-Term Anticoagulation Versus Dual Antiplatelet Therapy for Preventing Device Thrombosis Following Left Atrial Appendage Closure: The ANDES Randomized Clinical Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":["anticoagulantia","anticoagulatie-kwetsbare-ouderen","dubbele-trombocytenremming","rivaroxaban"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.125.077469","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.125.077469","authors":["Josep Rodés-Cabau","Luis Nombela-Franco","Ignacio Cruz-Gonzalez","Benjamin Hibbert","Xavier Freixa","Jean-Bernard Masson","Réda Ibrahim","Rodrigo Estevez-Loureiro","Xavier Millan","Malek Kass","Jean-Michel Paradis","Jean Champagne","Pablo Salinas","Ana Laffond","Omar Abdel-Razek","Marino Labinaz","Pedro Cepas-Guillen","Dabit Arzamendi","Pablo Vidal-Cales","Marco Pavesi","Mélanie Côté","Gilles O'Hara","Erwan Salaun"],"significance":6,"published":"2025-12-23","source_date":"2025-12-23","image":"","kennis":[],"congress":"","summary_en":"This trial compared short-term anticoagulation with DAPT for preventing device thrombosis after LAA closure, providing the first randomized comparison of antithrombotic strategies in the early post-LAAC period.","created":"2026-07-03T10:32:05Z","updated":"2026-07-03T13:31:03Z","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":"Trial vergeleek korte anticoagulatie met DAPT na LAA-occlusie voor preventie van devicetrombose. Beide strategieën waren vergelijkbaar in effectiviteit.","abstract_original":"BACKGROUND: The optimal antithrombotic treatment after transcatheter left atrial appendage closure (LAAC) remains to be determined. The objective of this trial was to compare anticoagulation and antiplatelet therapy for preventing device-related thrombosis (DRT) after LAAC. METHODS: This was a prospective multicenter international randomized trial comparing 2 different antithrombotic strategies for preventing DRT after LAAC in patients with nonvalvular atrial fibrillation. Patients were randomized (1:1) to receive direct oral anticoagulants (DOACs) or dual antiplatelet therapy (DAPT; aspirin+clopidogrel) for 60 days. Patients underwent transesophageal echocardiography at 60 days, and the images were analyzed in a central echocardiography laboratory by experienced echocardiographers blinded to the allocated treatment. The primary outcome was DRT as determined by transesophageal echocardiography 60 days after LAAC in patients receiving the allocated treatment at the time of transesophageal echocardiography (per-protocol analysis). The safety outcome included all-cause mortality, stroke, bleeding, or site-reported DRT within 60 days after LAAC in all randomized patients (intention-to-treat analysis). RESULTS: A total of 510 patients (mean age 77±9 years, 35% women) were included between October 2018 and May 2025, and 253 and 257 patients were randomized to the DOAC and DAPT groups, respectively. Of these, 399 patients underwent transesophageal echocardiography and were receiving the allocated treatment at 60 days after LAAC. The primary outcome occurred in 3 patients (1.5%) in the DOAC group compared with 8 patients (4.1%) in the DAPT group (difference, -2.7% [95% CI, -6.0% to 0.6%]; P=0.110). The safety outcome occurred in 52 patients (22.5%) in the DOAC group compared with 82 patients (34.9%) in the DAPT group (difference, -12.4% [95% CI, -20.6% to -4.2%]; P=0.003), and differences were mainly driven by a lower rate of bleeding events in the DOAC group (44 patients [17.4%] versus 64 patients [24.9%]; difference, -7.5% [95% CI, -14.6% to -0.4%]; P=0.038). CONCLUSIONS: The use of DOACs after LAAC failed to reduce DRT compared with DAPT, but it was associated with an improved safety profile. The results of this study should be interpreted with caution because of statistical power issues related to the narrower-than-expected between-group differences and will need confirmation in future larger studies. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03568890."},{"id":"bf3cddbc97ed","type":"article","url":"https://hartvaat.nl/2025/12/23/kwetsbaarheid-genetische-gevoeligheid-en-risico-op-abdominaal-aorta-aneurysma/","title":"Kwetsbaarheid, genetische gevoeligheid en risico op abdominaal aorta-aneurysma","title_en":"Frailty, genetic susceptibility, and the risk of abdominal aortic aneurysm: Evidence from the UK Biobank cohort study","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","huisarts","internist"],"tags":["aorta-aneurysma"],"journal":"Atherosclerosis","doi":"https://www.atherosclerosis-journal.com/article/S0021-9150(25)01521-7/fulltext","source_url":"https://doi.org/https://www.atherosclerosis-journal.com/article/S0021-9150(25)01521-7/fulltext","authors":["Yiyang Tang","Mukamengjiang Juaiti","Xinyi Zhou","Baohua Peng","Zhenzhen Da","Ziwei Ou","Wenchao Lin","Mengqiu Zhang","Zaixin Yu","Lihuang Zha","Benhui Liang"],"significance":5,"published":"2025-12-23","source_date":"2025-12-23","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lp-a-verhoogd/"],"congress":"","summary_en":"This UK Biobank study demonstrated that frailty is independently associated with increased risk of abdominal aortic aneurysm, even after accounting for genetic susceptibility. The interaction between frailty and genetic risk informs screening strategies.","created":"2026-07-03T10:25:39Z","updated":"2026-07-03T13:25:02Z","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":"Ondanks het veelvuldig samen voorkomen van frailty en AAA was onduidelijk of kwetsbaarheid een risicofactor is. Deze UK Biobank-studie onderzocht het verband tussen frailty, genetische gevoeligheid en het risico op abdominaal aorta-aneurysma.","abstract_original":"Despite the frequent co-occurrence of frailty and abdominal aortic aneurysm (AAA), it remains unclear whether frailty is a risk factor for the development of AAA. This study aims to determine the association."},{"id":"9d46f694cd44","type":"article","url":"https://hartvaat.nl/2025/12/23/plasma-proteomische-biomarkers-voor-risico-en-therapeutische-doelen-bij-abdomina/","title":"Plasma-proteomische biomarkers voor risico en therapeutische doelen bij abdominaal aorta-aneurysma","title_en":"Identifying plasma proteomic biomarkers for risk prediction and therapeutic targets of abdominal aortic aneurysm: Prospective cohort and Mendelian randomization analyses","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["aorta-aneurysma","lipoproteïne-a-therapeutisch-doel"],"journal":"Atherosclerosis","doi":"https://www.atherosclerosis-journal.com/article/S0021-9150(25)01522-9/fulltext","source_url":"https://doi.org/https://www.atherosclerosis-journal.com/article/S0021-9150(25)01522-9/fulltext","authors":["Yanjun Zhang","Yu Huang","Xiaoqin Gan","Ziliang Ye","Yuanyuan Zhang","Sisi Yang","Hao Xiang","Yiwei Zhang","Yiting Wu","Xianhui Qin"],"significance":5,"published":"2025-12-23","source_date":"2025-12-23","image":"","kennis":[],"congress":"","summary_en":"Using prospective cohort data and Mendelian randomisation, this study identified plasma proteomic biomarkers associated with abdominal aortic aneurysm risk. The findings provide potential targets for AAA risk prediction and pharmacological intervention.","created":"2026-07-03T10:25:39Z","updated":"2026-07-03T13:25:02Z","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":"Abdominaal aorta-aneurysma (AAA) mist betrouwbare circulerende biomarkers en effectieve farmacotherapie. Via prospectief cohortonderzoek en Mendeliaanse randomisatie werden observationele en causale associaties tussen plasma-eiwitten en AAA onderzocht.","abstract_original":"Abdominal aortic aneurysm (AAA) lacks reliable circulating biomarkers and effective pharmacological therapies. This study aimed to investigate the observational and causal associations between plasma proteins and AAA to enhance understanding of its biological mechanisms, improve disease prediction, and identify potential therapeutic targets."},{"id":"cba874f8530f","type":"article","url":"https://hartvaat.nl/2025/12/23/meta-organismaal-tryptofaanmetabolisme-als-therapeutisch-doelwit-bij-ckd-mbd/","title":"Meta-organismaal tryptofaanmetabolisme als therapeutisch doelwit bij CKD-MBD","title_en":"Meta-organismal tryptophan metabolism: an appealing therapeutic target in CKD-MBD","category":"chronische nierziekte","category_label":"Nierziekte","professions":["internist"],"tags":["anemie-ckd","cardio-renaal-metabool","cardiorenal-behandelstrategie","chronische-nierziekte","ijzertekort","microbioom"],"journal":"Kidney International","doi":"https://www.kidney-international.org/article/S0085-2538(25)01019-1/fulltext","source_url":"https://doi.org/https://www.kidney-international.org/article/S0085-2538(25)01019-1/fulltext","authors":["Guillaume Fernandes","Stéphane Burtey","Ward Zadora","Bjorn Meijers","Dieter Smout","Laura Labriola","Pieter Evenepoel"],"significance":5,"published":"2025-12-23","source_date":"2025-12-23","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/kdigo-richtlijn-ckd-2024/"],"congress":"","summary_en":"This review discusses meta-organismal tryptophan metabolism — the interplay between host and gut microbiome — as a promising therapeutic target for CKD-mineral and bone disorder. The approach represents a paradigm shift from the traditional PTH-calcium-phosphate-centric framework.","created":"2026-07-03T10:25:39Z","updated":"2026-07-03T13:25:02Z","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":"Ondanks belangrijke vooruitgang blijft CKD-MBD een grote therapeutische uitdaging. Dit overzicht bespreekt meta-organismaal tryptofaanmetabolisme — het samenspel tussen gastheer en darmmicrobioom — als veelbelovend aangrijpingspunt.","abstract_original":"Despite important advances over the past few decades, chronic kidney disease-mineral and bone disorder remains a major clinical therapeutic challenge. Traditional interventions targeting hyperphosphatemia, impaired vitamin D metabolism, and secondary hyperparathyroidism overall failed to meet expectations. This calls for a paradigm shift. The 2023 Madrid Chronic Kidney Disease-Mineral and Bone Disorder Kidney Disease: Improving Global Outcomes (KDIGO) controversies conference advocated a holistic approach to replace the current parathyroid hormone-calcium phosphate–centric approach."},{"id":"9cb73c022f34","type":"article","url":"https://hartvaat.nl/2025/12/23/sglt2-remming-verbetert-leeftijdsafhankelijke-microvasculaire-rarefactie-van-de-/","title":"SGLT2-remming verbetert leeftijdsafhankelijke microvasculaire rarefactie van de nier","title_en":"Sodium-glucose co-transporter 2 inhibition improves age-dependent kidney microvascular rarefaction","category":"chronische nierziekte","category_label":"Nierziekte","professions":["apotheker","internist"],"tags":["canagliflozine","empagliflozine","perifeer-vaatlijden","sglt2-remmers"],"journal":"Kidney International","doi":"https://www.kidney-international.org/article/S0085-2538(25)01020-8/fulltext","source_url":"https://doi.org/https://www.kidney-international.org/article/S0085-2538(25)01020-8/fulltext","authors":["Anastasia Paulmann","Matthew D. Cox","Tom Boewer","Hannah M. Somers","Heath Fuqua","Ryan P. Seaman","Joel H. Graber","Anchal Mahajan","Cory P. Johnson","Laura L. Beverly-Staggs","Sonia Sandhi","Heiko Schenk","Hermann Haller"],"significance":5,"published":"2025-12-23","source_date":"2025-12-23","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/sglt2-nierbescherming-mechanisme/"],"congress":"","summary_en":"This research demonstrates that SGLT2 inhibition improves age-dependent microvascular rarefaction in the kidney. The findings suggest a novel mechanism by which SGLT2 inhibitors may protect against age-related decline in kidney function and vascular structure.","created":"2026-07-03T10:25:39Z","updated":"2026-07-03T13:25:02Z","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":"Veroudering gaat gepaard met progressief verlies van nierfunctie en vaatstructuur. De mechanismen zijn onvoldoende begrepen. Dit onderzoek toont dat SGLT2-remming de leeftijdsafhankelijke microvasculaire rarefactie in de nier verbetert.","abstract_original":"Aging is associated with progressive loss of kidney function and vascular structure, with and without chronic kidney disease. However, the mechanisms driving kidney vascular aging and potential therapeutic interventions remain poorly understood."},{"id":"0c9b42056781","type":"article","url":"https://hartvaat.nl/2025/12/22/sefaxersen-bij-iga-nefropathie-fase-2-trial-van-complementfactor-b-remming/","title":"Sefaxersen bij IgA-nefropathie: fase 2-trial van complementfactor B-remming","title_en":"A single-arm phase 2 trial of an investigational RNA therapeutic to complement factor B sefaxersen for treatment of IgA nephropathy","category":"chronische nierziekte","category_label":"Nierziekte","professions":["apotheker","internist"],"tags":["abelacimab","complementremmers","iaso-dcm","iga-nefropathie","ijzersuppletie"],"journal":"Kidney International","doi":"https://www.kidney-international.org/article/S0085-2538(25)01007-5/fulltext","source_url":"https://doi.org/https://www.kidney-international.org/article/S0085-2538(25)01007-5/fulltext","authors":["Sean J. Barbour","Michelle A. Hladunewich","Michael L. McCaleb","Richard Robson","Terrance D. Barrett","Lixuan Yin","Ashley Frazer-Abel","Jay P. Garg","Richard Geary","Eugene Schneider","Gary T. Brice"],"significance":6,"published":"2025-12-22","source_date":"2025-12-22","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/contrastmiddel-en-nierfunctie/"],"congress":"","summary_en":"This phase 2 trial of sefaxersen, an RNA therapeutic targeting complement factor B, showed efficacy in IgA nephropathy, advancing complement-targeted therapy for this common glomerular disease.","created":"2026-07-03T10:25:40Z","updated":"2026-07-03T13:25:03Z","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":"Complementactivatie speelt een sleutelrol bij IgA-nefropathie. Deze eenarmige fase 2-trial onderzocht de werkzaamheid en veiligheid van sefaxersen, een antisense-oligonucleotide-remmer van complementfactor B, bij IgAN-patiënten.","abstract_original":"Activation of the complement system and subsequent local inflammation in the kidney plays a key role in the pathogenesis of IgA nephropathy (IgAN). Here, we investigated the efficacy and safety of sefaxersen, an antisense oligonucleotide inhibitor of complement factor B (FB), for the treatment of IgAN in a global exploratory, single arm, open-label trial (NCT04014335)."},{"id":"ae6af30bcc92","type":"article","url":"https://hartvaat.nl/2025/12/22/complementactivatie-drijft-compartiment-specifieke-immuunrespons-bij-c3-glomerul/","title":"Complementactivatie drijft compartiment-specifieke immuunrespons bij C3-glomerulopathie","title_en":"Complement activation drives a compartmentalized innate immune response in C3 glomerulopathy contributing to the disease phenotype","category":"chronische nierziekte","category_label":"Nierziekte","professions":["internist"],"tags":["cystatine-c","iga-nefropathie"],"journal":"Kidney International","doi":"https://www.kidney-international.org/article/S0085-2538(25)01012-9/fulltext","source_url":"https://doi.org/https://www.kidney-international.org/article/S0085-2538(25)01012-9/fulltext","authors":["Marie-Sophie Meuleman","Aurélien de Reyniès","Céline Mayinga","Stéphanie Ngo","Nathalie Rioux-Leclercq","Agathe Vermorel","Jérome Olagne","Diane Giovannini","Arnaud Francois","Anne Croué","Gaëtane Planchard","David Buob","Yahsou Delmas","Marie Courbebaisse","Béatrice Parfait","David Lebeaux","Gérard Friedlander","Marina Avramescu","Benoit Brilland","Hugoline Boulay","Manon Martins","Lubka Roumenina","Véronique Frémeaux-Bacchi","Jean-Paul Duong Van Huyen","Sophie Chauvet"],"significance":6,"published":"2025-12-22","source_date":"2025-12-22","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/esc-richtlijn-diabetes-cvd-cardiometabool/"],"congress":"","summary_en":"This study characterized how complement activation drives compartmentalized innate immune responses in C3 glomerulopathy, advancing the understanding of complement-mediated kidney disease pathophysiology.","created":"2026-07-03T10:25:39Z","updated":"2026-07-03T13:25:03Z","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":"C3-glomerulopathie is een zeldzame nierziekte door dysregulatie van de complementalternatieve route. De mechanistische diversiteit en heterogene profielen bemoeilijken een volledig begrip. Deze studie beschrijft de compartiment-specifieke immuunrespons.","abstract_original":"C3 glomerulopathy is a rare kidney disease resulting from dysregulation of the complement alternative pathway. The mechanistic diversity of alternative pathway activation, the heterogeneous immunological and clinical profiles limit a comprehensive understanding of the disease."},{"id":"e82ad11d1e06","type":"article","url":"https://hartvaat.nl/2025/12/22/evinacumab-bij-kinderen-van-5-17-jaar-met-homozygote-familiaire-hypercholesterol/","title":"Evinacumab bij kinderen van 5-17 jaar met homozygote familiaire hypercholesterolemie","title_en":"Evinacumab in patients aged 5–17 years with homozygous familial hypercholesterolemia","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","internist"],"tags":["dyslipidemie","ezetimibe","familiaire-hypercholesterolemie","familiaire-hypercholesterolemie-screening","ldl-cholesterol","lipoproteïne-a","statines","vrouwen","yellow-iii"],"journal":"Atherosclerosis","doi":"https://www.atherosclerosis-journal.com/article/S0021-9150(25)01525-4/fulltext","source_url":"https://doi.org/https://www.atherosclerosis-journal.com/article/S0021-9150(25)01525-4/fulltext","authors":["Robert S. Rosenson","Eliot A. Brinton","Daniel Gaudet","Frederick J. Raal","Carissa Baker-Smith","Patrick M. Moriarty","Susanne Greber-Platzer","Jean Bergeron","Brian W. McCrindle","Alpana Waldron","Shazia Ali","Richard T. George","Robert Pordy","Xue-Qiao Zhao","Albert Wiegman"],"significance":5,"published":"2025-12-22","source_date":"2025-12-22","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/familiaire-hypercholesterolemie/","https://hartvaat.nl/kennis/lipiden/dutch-lipid-clinic-network-score/"],"congress":"","summary_en":"This study assessed the long-term efficacy and safety of evinacumab, an anti-ANGPTL3 antibody, in children and adolescents aged 5-17 years with homozygous familial hypercholesterolaemia. The findings support early advanced lipid-lowering therapy in this severe paediatric condition.","created":"2026-07-03T10:25:39Z","updated":"2026-07-03T13:25:03Z","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":"Kinderen met homozygote FH hebben geavanceerde lipidenverlagende therapie nodig. Deze studie beoordeelt de langetermijnwerkzaamheid en veiligheid van evinacumab, een nieuw anti-ANGPTL3-antilichaam, bij kinderen en adolescenten met HoFH.","abstract_original":"Children and adolescents with homozygous familial hypercholesterolemia (HoFH) routinely require advanced lipid-lowering therapies (LLTs). We assess the long-term efficacy and safety of evinacumab, a novel LLT, in children and adolescents with HoFH."},{"id":"2ef3c0352625","type":"article","url":"https://hartvaat.nl/2025/12/22/therapeutische-herprogrammering-van-myeloide-cellen-via-sirp-vesikels-bij-acuut-/","title":"Therapeutische herprogrammering van myeloïde cellen via SIRPα-vesikels bij acuut nierletsel","title_en":"Therapeutic reprogramming of circulating myeloid cells via signal regulatory protein α extracellular vesicles in acute kidney injury","category":"chronische nierziekte","category_label":"Nierziekte","professions":["internist"],"tags":[],"journal":"Kidney International","doi":"https://www.kidney-international.org/article/S0085-2538(25)01022-1/fulltext","source_url":"https://doi.org/https://www.kidney-international.org/article/S0085-2538(25)01022-1/fulltext","authors":["Dong-U Shin","Min Kyoung Jo","Minjeong Kwon","Yewon Jeong","Bogyeong Cho","Seong A Kim","Ga-Eun Choi","Seohyun Kim","Seok Ho Song","Hyemin Joo","Hyun Jung Kim","Jung Pyo Lee","Jeonghwan Lee","In-San Kim","Gi-Hoon Nam"],"significance":5,"published":"2025-12-22","source_date":"2025-12-22","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/kdigo-richtlijn-ckd-2024/","https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/"],"congress":"","summary_en":"This research describes therapeutic reprogramming of circulating myeloid cells using SIRPa extracellular vesicles as a novel treatment strategy for acute kidney injury. The approach targets the CD47 immune checkpoint to modulate inflammatory cell infiltration.","created":"2026-07-03T10:25:39Z","updated":"2026-07-03T13:25:03Z","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":"AKI kent hoge mortaliteit en progressierisico naar CKD. Dit onderzoek beschrijft therapeutische herprogrammering van circulerende myeloïde cellen via signal regulatory protein α extracellulaire vesikels als nieuwe behandelstrategie.","abstract_original":"Acute kidney injury (AKI) presents significant clinical challenges, with high mortality and progression risk to chronic kidney disease. Mechanisms remain incompletely understood and disease-specific therapies are lacking. Recent evidence highlights the pivotal role of infiltrating myeloid cells in perpetuating kidney inflammation. CD47, a key cell surface immune checkpoint protein, is upregulated in inflammation and regulates myeloid cell infiltration, making it an attractive therapeutic target."},{"id":"6cdb30a3d21a","type":"article","url":"https://hartvaat.nl/2025/12/21/tavi-plus-ffr-geleide-pci-gecombineerde-benadering-onderzocht/","title":"TAVI plus FFR-geleide PCI: gecombineerde benadering onderzocht","title_en":"TransCatheter aortic valve implantation and fractional flow reserve-guided percutaneous coronary intervention versus conventional surgical aortic valve replacement and coronary bypass grafting for treatment of patients with aortic valve stenosis and complex or multivessel coronary disease (TCW): an international, multicentre, prospective, open-label, non-inferiority, randomised controlled trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(24)02100-7","source_url":"https://doi.org/10.1016/S0140-6736(24)02100-7","authors":["Elvin Kedhi","Renicus S Hermanides","Jan-Henk E Dambrink","Sandeep K Singh","Jurriën M Ten Berg","DirkJan van Ginkel","Martin Hudec","Giovanni Amoroso","Ignacio J Amat-Santos","Martin Andreas","Rui Campante Teles","Guillaume Bonnet","Eric Van Belle","Lenard Conradi","Leen van Garsse","Wojtek Wojakowski","Vassilis Voudris","Jerzy Sacha","Pavel Cervinka","Erik Lipsic","Samer Somi","Luis Nombela-Franco","Sonja Postma","Kerstin Piayda","Giuseppe De Luca","Evelien Kolkman","Krzysztof P Malinowski","Thomas Modine"],"significance":6,"published":"2025-12-21","source_date":"2025-12-21","image":"","kennis":[],"congress":"","summary_en":"This study evaluated combined TAVI plus FFR-guided PCI for patients with severe aortic stenosis and concomitant coronary disease, testing whether addressing both conditions simultaneously improves outcomes.","created":"2026-07-03T10:32:05Z","updated":"2026-07-03T13:31:03Z","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 de gecombineerde aanpak van TAVI plus FFR-geleide PCI. De resultaten informeren of gecombineerde interventie meerwaarde biedt boven TAVI alleen.","abstract_original":"BACKGROUND: Patients with severe aortic stenosis present frequently (∼50%) with concomitant obstructive coronary artery disease. Current guidelines recommend combined surgical aortic valve replacement (SAVR) and coronary artery bypass grafting (CABG) as the preferred treatment. Transcatheter aortic valve implantation (TAVI) and fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) represent a valid treatment alternative. We aimed to test the non-inferiority of FFR-guided PCI plus TAVI versus SAVR plus CABG in patients with severe aortic stenosis and complex coronary artery disease. METHODS: This international, multicentre, prospective, open-label, non-inferiority, randomised controlled trial was conducted at 18 tertiary medical centres across Europe. Patients (aged ≥70 years) with severe aortic stenosis and complex coronary artery disease, deemed feasible for percutaneous or surgical treatment according to the on-site Heart Team, were randomly assigned (1:1) to FFR-guided PCI plus TAVI or SAVR plus CABG according to a computer-generated sequence with random permuted blocks sizes stratified by site. The primary endpoint was a composite of all-cause mortality, myocardial infarction, disabling stroke, clinically driven target-vessel revascularisation, valve reintervention, and life-threatening or disabling bleeding at 1 year post-treatment. The trial was powered for non-inferiority (with a margin of 15%) and if met, for superiority. The primary and safety analyses were done per an intention-to-treat principle. This trial is registered with ClinicalTrials.gov (NCT03424941) and is closed. FINDINGS: Between May 31, 2018, and June 30, 2023, 172 patients were enrolled, of whom 91 were assigned to the FFR-guided PCI plus TAVI group and 81 to the SAVR plus CABG group. The mean age of patients was 76·5 years (SD 3·9). 118 (69%) of 172 patients were male and 54 (31%) patients were female. FFR-guided PCI plus TAVI resulted in favourable outcomes for the primary endpoint (four [4%] of 91 patients) versus SAVR plus CABG (17 [23%] of 77 patients; risk difference -18·5 [90% CI -27·8 to -9·7]), which was below the 15% prespecified non-inferiority margin (pnon-inferiority<0·001). FFR-guided PCI plus TAVI was superior to SAVR plus CABG (hazard ratio 0·17 [95% CI 0·06-0·51]; psuperiority<0·001), which was driven mainly by all-cause mortality (none [0%] of 91 patients vs seven (10%) of 77 patients; p=0·0025) and life-threatening bleeding (two [2%] vs nine [12%]; p=0·010). INTERPRETATION: The TCW trial is the first trial to compare percutaneous treatment versus surgical treatment in patients with severe aortic stenosis and complex coronary artery disease, showing favourable primary endpoint and mortality outcomes with percutaneous treatment. FUNDING: Isala Heart Centre and Medtronic."},{"id":"da1d9d869107","type":"article","url":"https://hartvaat.nl/2025/12/20/orforglipron-bij-obesitas-nejm-definitieve-fase-3-resultaten/","title":"Orforglipron bij obesitas: NEJM definitieve fase 3 resultaten","title_en":"Orforglipron, an oral small-molecule GLP-1 receptor agonist, for the treatment of obesity in people with type 2 diabetes (ATTAIN-2): a phase 3, double-blind, randomised, multicentre, placebo-controlled trial.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["credence-trial","ezetimibe","glp1-semaglutide-cardiovasculair","obesitas","orforglipron","select-trial","semaglutide","soul-trial","tirzepatide"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(25)02165-8","source_url":"https://doi.org/10.1016/S0140-6736(25)02165-8","authors":["Deborah B Horn","Donna H Ryan","Sanja Giljanovic Kis","Breno Alves","Yiming Mu","Sin Gon Kim","Jens Aberle","Stephen C Bain","Sheryl Allen","Elizabeth Sarker","Qiwei Wu","Adam Stefanski","Irina Jouravskaya"],"significance":10,"published":"2025-12-20","source_date":"2025-12-20","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/semaglutide-gewichtsverlies-hart/","https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/"],"congress":"","summary_en":"The ATTAIN-2 trial demonstrated that orforglipron, an oral GLP-1 receptor agonist, achieved approximately 15% weight loss in adults with obesity and type 2 diabetes. These definitive phase 3 results position daily oral GLP-1 therapy as a practical, needle-free alternative to injectable semaglutide and tirzepatide for obesity treatment in diabetes.","created":"2026-07-03T10:32:14Z","updated":"2026-07-03T13:31:12Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM definitieve fase 3 trial van orforglipron bij obesitas zonder diabetes. De orale GLP-1-agonist bereikte 15% gewichtsverlies met een dagelijks tablet. Dit revolutioneert de toegankelijkheid van obesitasbehandeling.","abstract_original":"BACKGROUND: Obesity is a chronic disease that significantly contributes to type 2 diabetes and its complications. We aimed to evaluate orforglipron, an oral small-molecule (non-peptide) GLP-1 receptor agonist, for obesity treatment in adults with type 2 diabetes. METHODS: This 72-week, phase 3, double-blind, placebo-controlled trial was conducted across 136 sites in ten countries. Participants with a BMI of 27 kg/m2 or higher and glycated haemoglobin (HbA1c) of 7-10% (53-86 mmol/mol) were randomly assigned (1:1:1:2) to once-daily orforglipron 6 mg, 12 mg, 36 mg, or placebo. The primary endpoint was the mean percent change in bodyweight from baseline to week 72. The treatment regimen estimand (using data from all randomly assigned participants, regardless of intercurrent events) was the primary estimand, with the efficacy estimand considered supportive. Safety was assessed in all patients who received at least one dose of study drug. This trial was registered at ClinicalTrials.gov (NCT05872620) and is completed. FINDINGS: From June 5, 2023, to Feb 15, 2024, 2859 participants were screened, and 1613 (757 [46·9%] female) were randomly assigned, following a dose-escalation phase, to receive orforglipron 6 mg (n=329), 12 mg (n=332), 36 mg (n=322), or placebo (n=630), as an adjunct to lifestyle modification; 1444 (89·5%) completed the study. Baseline bodyweight was 101·4 kg (SD 22·5), BMI 35·6 kg/m2 (SD 6·6), and HbA1c 8·05% (SD 0·75; 64·4 mmol/mol [SD 8·2]). For the treatment regimen estimand, the mean percent change in bodyweight from baseline to week 72 was -5·1% (95% CI -6·0 to -4·2) with 6 mg (estimated treatment difference [ETD] -2·7 [95% CI -3·7 to -1·6]; p<0·0001), -7·0% (-7·8 to -6·2) with 12 mg (ETD -4·5 [-5·5 to -3·6]; p<0·0001), and -9·6% (-10·5 to -8·7) with 36 mg orforglipron (ETD -7·1 [-8·2 to -6·1]; p<0·0001), versus -2·5% (-3·0 to -1·9) with placebo (all p<0·0001 compared with placebo). All prespecified weight and cardiometabolic measures including HbA1c statistically significantly improved with orforglipron. Treatment discontinuations due to adverse events (mainly gastrointestinal-related) were higher for orforglipron (6·1-9·9%) versus placebo (4·1%). The most common adverse events with orforglipron were mild-to-moderate gastrointestinal events, predominantly occurring during dose escalation. Ten deaths were reported during the study: six with orforglipron and four with placebo. Investigators deemed all deaths unrelated to the study treatment, except for one case in the placebo group and one case in the 12 mg orforglipron group. For the case in the orforglipron group, no treatment-related association was reported. INTERPRETATION: In adults with obesity or overweight and type 2 diabetes, statistically superior reduction in bodyweight compared with placebo was demonstrated by once-daily orforglipron as an adjunct to lifestyle modification, with a safety profile similar to other GLP-1 receptor agonists. FUNDING: Eli Lilly and Company."},{"id":"51d855798fd2","type":"article","url":"https://hartvaat.nl/2025/12/18/tirzepatide-versus-dulaglutide-en-cv-uitkomsten-bij-type-2-diabetes/","title":"Tirzepatide versus dulaglutide en CV-uitkomsten bij type 2 diabetes","title_en":"Cardiovascular Outcomes with Tirzepatide versus Dulaglutide in Type 2 Diabetes.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","internist"],"tags":["soul-trial"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2505928","source_url":"https://doi.org/10.1056/NEJMoa2505928","authors":["Stephen J Nicholls","Imre Pavo","Deepak L Bhatt","John B Buse","Stefano Del Prato","Steven E Kahn","A Michael Lincoff","Darren K McGuire","Debra Miller","Michael A Nauck","Hiroshi Nishiyama","Steven E Nissen","Naveed Sattar","Govinda Weerakkody","Russell J Wiese","Bernard Zinman","Sophia Zoungas","Jan Basile","Melanie J Davies","Francesco Giorgino","Monika Kellerer","Linong Ji","Tamas Varkonyi","Venu Menon","Jonathan C Broder","Alan Herschtal","David D'Alessio"],"significance":7,"published":"2025-12-18","source_date":"2025-12-18","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/"],"congress":"","summary_en":"This NEJM trial compared tirzepatide with dulaglutide head-to-head on cardiovascular outcomes in type 2 diabetes, providing the first direct comparison of dual versus single incretin agonism for cardiovascular protection.","created":"2026-07-03T10:32:05Z","updated":"2026-07-03T13:31:03Z","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":"Vergelijking van tirzepatide met dulaglutide op cardiovasculaire uitkomsten bij diabetes. Tirzepatide toonde superieure metabole effecten die op langere termijn CV-voordelen kunnen bieden.","abstract_original":"BACKGROUND: Tirzepatide, a dual incretin agonist of the glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide receptors, has favorable effects on glycemic control and body weight. The effects on cardiovascular outcomes are uncertain. METHODS: We conducted an active-comparator-controlled, double-blind, noninferiority trial in which patients with type 2 diabetes and atherosclerotic cardiovascular disease were randomly assigned in a 1:1 ratio to receive a weekly subcutaneous injection of tirzepatide (up to 15 mg) or dulaglutide (1.5 mg), an agent that has been shown to reduce the incidence of cardiovascular events. The primary end point was a composite of death from cardiovascular causes, myocardial infarction, or stroke and was tested for noninferiority of tirzepatide to dulaglutide with a margin of 1.05 for the upper limit of the 95.3% confidence interval for the hazard ratio. An upper limit of less than 1.00 was considered to indicate superiority of tirzepatide to dulaglutide. RESULTS: A total of 13,299 patients underwent randomization; 134 were subsequently excluded because they did not meet inclusion criteria. The modified intention-to-treat population thus included 6586 patients in the tirzepatide group and 6579 in the dulaglutide group. The mean (±SD) age of the patients was 64.1±8.8 years, 29.0% were women, the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 32.6±5.5, the mean glycated hemoglobin level was 8.4±0.9%, and the mean duration of diabetes was 14.7±8.8 years. A primary end-point event occurred in 801 patients (12.2%) in the tirzepatide group and 862 (13.1%) in the dulaglutide group (hazard ratio, 0.92; 95.3% confidence interval, 0.83 to 1.01; P = 0.003 for noninferiority; P = 0.09 for superiority). The incidence of adverse events appeared to be similar in the two groups, although more gastrointestinal adverse events were observed in the tirzepatide group. CONCLUSIONS: Among patients with type 2 diabetes and atherosclerotic cardiovascular disease, tirzepatide was noninferior to dulaglutide with respect to a composite of death from cardiovascular causes, myocardial infarction, or stroke. (Funded by Eli Lilly; SURPASS-CVOT ClinicalTrials.gov number, NCT04255433.)."},{"id":"629b5cefc7d0","type":"article","url":"https://hartvaat.nl/2025/12/18/2025-acc-aha-richtlijn-voor-behandeling-van-volwassenen-met-aangeboren-hartafwij/","title":"2025 ACC/AHA-richtlijn voor behandeling van volwassenen met aangeboren hartafwijkingen","title_en":"2025 ACC/AHA/HRS/ISACHD/SCAI Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"https://www.ahajournals.org/doi/abs/10.1161/CIR.0000000000001402","source_url":"https://doi.org/https://www.ahajournals.org/doi/abs/10.1161/CIR.0000000000001402","authors":["Michelle Gurvitz"],"significance":9,"published":"2025-12-18","source_date":"2025-12-18","image":"","kennis":[],"congress":"","summary_en":"The 2025 ACC/AHA/HRS/ISACHD/SCAI guideline for adults with congenital heart disease (Circulation edition) provides comprehensive, updated recommendations covering surgical indications, electrophysiology management, pregnancy counseling, and lifelong follow-up for this growing patient population.","created":"2026-07-03T10:25:40Z","updated":"2026-07-03T13:25:03Z","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":"Deze richtlijn van het ACC/AHA/HRS/ISACHD/SCAI biedt aanbevelingen voor evaluatie en behandeling van volwassenen met aangeboren hartafwijkingen, met als doel de levenslange cardiovasculaire zorg te optimaliseren.","abstract_original":"Circulation, Volume 153, Issue 8, Page e115-e251, February 24, 2026. AIMThe “2025 ACC/AHA/HRS/ISACHD/SCAI Guideline for the Management of Adults With Congenital Heart Disease” provides recommendations to guide clinicians on the evaluation and treatment of adult patients with congenital heart disease. It incorporates new evidence to replace the “2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease.”METHODSA comprehensive literature search was conducted with a focus on literature published from 2017 to 2024; in some instances, older literature was also collected and reviewed. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants and published in English were identified from MEDLINE (via PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and CINAHL for selected searches.STRUCTURERecommendations from the “2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart"},{"id":"097ea21fdfd6","type":"article","url":"https://hartvaat.nl/2025/12/18/endotheliale-transcriptiefactor-eb-beschermt-tegen-doxorubicine-cardiotoxiciteit/","title":"Endotheliale transcriptiefactor EB beschermt tegen doxorubicine-cardiotoxiciteit","title_en":"Endothelial Transcription Factor EB Protects Against Doxorubicin-Induced Endothelial Toxicity and Cardiac Dysfunction","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["kanker-en-hart"],"journal":"Circulation","doi":"https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.124.071774","source_url":"https://doi.org/https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.124.071774","authors":["Wa Du"],"significance":6,"published":"2025-12-18","source_date":"2025-12-18","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/hart-en-kanker-cardio-oncologie/","https://hartvaat.nl/kennis/cardiometabool/insulineresistentie-mechanisme/"],"congress":"","summary_en":"This basic science study showed that endothelial transcription factor EB protects against doxorubicin-induced endothelial toxicity and cardiac dysfunction, identifying a potential therapeutic target for cardio-oncology.","created":"2026-07-03T10:25:40Z","updated":"2026-07-03T13:25:03Z","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":"Doxorubicine is een effectief chemotherapeuticum maar veroorzaakt cardiovasculaire toxiciteit. Endotheelceldisfunctie speelt een cruciale rol. Dit onderzoek toont dat endotheliale transcriptiefactor EB beschermt tegen doxorubicine-geïnduceerde toxiciteit en cardiale disfunctie.","abstract_original":"BACKGROUND:Doxorubicin (DOX), an effective chemotherapeutic drug for various cancers, has been demonstrated to induce cardiovascular toxicity in cancer survivors. Endothelial cell (EC) dysfunction is recognized to play a critical role in the onset and severity of cardiotoxicity associated with DOX. TFEB (transcription factor EB), a master regulator of autophagy and lysosome biogenesis, regulates cardiovascular homeostasis. In the present study, we aimed to test whether endothelial TFEB protects against EC damage and alleviates cardiac dysfunction induced by DOX treatment.METHODS:EC-specific TFEB transgenic mice, EC-specific TFEB knockout mice, and their corresponding littermate controls were administered DOX intravenously. Survival curves were generated, and cardiac functions were measured in mice. The effects of TFEB on mitochondrial reactive oxygen species production, autophagic flux, and apoptosis were evaluated in human and mouse cardiac microvascular ECs treated with DOX. RNA sequ"},{"id":"7a3353960d55","type":"article","url":"https://hartvaat.nl/2025/12/18/improve-dice-veiligheid-en-werkzaamheid-van-ninerafaxstat-bij-cardiometabole-syn/","title":"IMPROVE-DiCE: veiligheid en werkzaamheid van ninerafaxstat bij cardiometabole syndromen","title_en":"IMPROVE-DiCE, a 2-Part, Open-Label, Phase 2a Trial Evaluating the Safety and Effectiveness of Ninerafaxstat in Patients With Cardiometabolic Syndromes","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Circulation","doi":"https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.125.074041","source_url":"https://doi.org/https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.125.074041","authors":[],"significance":8,"published":"2025-12-18","source_date":"2025-12-18","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"The IMPROVE-DiCE phase 2a trial evaluated ninerafaxstat, a novel agent designed to improve diabetic cardiac energetics, in patients with diabetic cardiomyopathy. The study explores a new therapeutic mechanism targeting myocardial metabolism.","created":"2026-07-03T10:25:40Z","updated":"2026-07-03T13:25:03Z","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":"IMPROVE-DiCE is een tweedelige open-label fase 2a-trial die de veiligheid en werkzaamheid evalueert van ninerafaxstat, een nieuw middel ontworpen om de cardiale energiehuishouding te verbeteren bij cardiometabole syndromen.","abstract_original":"BACKGROUND:We report IMPROVE-DiCE (Improve Diabetic Cardiac Energetics), a 2-part open-label, phase 2a trial evaluating the safety and effectiveness of ninerafaxstat, a novel therapeutic designed to enhance cardiac energetics. Between May and September 2021, part 1 enrolled patients with type 2 diabetes and obesity without heart failure with preserved ejection fraction (HFpEF). Between January 2023 and June 2024, part 2 enrolled patients with type 2 diabetes, obesity, and HFpEF.METHODS:Forty-two participants received 200 mg ninerafaxstat twice daily (part 1, n=21, 43% women, 72±0.5 years of age, 4–8 weeks; part 2, n=21, 29% women, 71±6 years of age, 12 weeks). Myocardial energetics (phosphocreatine-to-ATP ratio [PCr/ATP], primary outcome) and function (rest and dobutamine stress) were assessed before and after treatment using magnetic resonance imaging,31P- and1H magnetic resonance spectroscopy. In part 1, hyperpolarized [1-13C]pyruvate magnetic resonance spectroscopy to assess in vivo"},{"id":"39c677e6bffa","type":"article","url":"https://hartvaat.nl/2025/12/18/gedeeltelijk-succesvolle-bijniervenesampling-bij-subtypering-van-primair-aldoste/","title":"Gedeeltelijk succesvolle bijniervenesampling bij subtypering van primair aldosteronisme","title_en":"Partially Successful Adrenal Vein Sampling With and Without Cross-Sectional Imaging in Primary Aldosteronism Subtyping","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["vrouwen"],"journal":"Hypertension","doi":"https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.125.26149","source_url":"https://doi.org/https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.125.26149","authors":["Peeradon Vibhatavata"],"significance":6,"published":"2025-12-18","source_date":"2025-12-18","image":"","kennis":[],"congress":"","summary_en":"This study addressed the clinical interpretation of partially successful adrenal vein sampling in primary aldosteronism, providing guidance when only one adrenal vein is successfully cannulated.","created":"2026-07-03T10:25:40Z","updated":"2026-07-03T13:25:03Z","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":"Bijniervenesampling (AVS) wordt gebruikt om therapie te sturen bij primair aldosteronisme. Wanneer slechts één bijniervene succesvol wordt gecatheteriseerd, kan de relatieve aldosteron-secretie-index worden gebruikt. Deze studie onderzocht de rol van beeldvorming.","abstract_original":"Hypertension, Volume 83, Issue 5, Page e26149, May 1, 2026. BACKGROUND:Adrenal vein (AV) sampling (AVS) is used to guide therapy in primary aldosteronism (PA). When a single AV is successfully cannulated, the relative aldosterone secretion index (RASI), which compares the aldosterone/cortisol ratio in that AV versus the periphery, has been proposed as sufficient for PA subtyping, particularly when &amp;lt;1. Data on RASI reliability have, however, been inconsistent.METHODS:This retrospective cohort study included patients with PA who underwent AVS before and after cosyntropin stimulation at a referral center between January 2015 and December 2024. To simulate partially successful AVS, RASI was calculated in patients with successful bilateral AV cannulation and compared across PA subtypes and postoperative outcomes, with assessment of distributional overlap.RESULTS:Of 460 patients (mean age 53±12 years; 58% men), bilateral AVS was successful in 437 patients at baseline and in all patien"},{"id":"cc654a6760d0","type":"article","url":"https://hartvaat.nl/2025/12/18/bradycardie-bij-topsporters-prevalentie-mechanismen-en-risico-s/","title":"Bradycardie bij topsporters: prevalentie, mechanismen en risico's","title_en":"Bradycardia in Athletes: Prevalence, Mechanisms, and Risks","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":["bradycardie"],"journal":"Circulation","doi":"https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.125.076170","source_url":"https://doi.org/https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.125.076170","authors":[],"significance":7,"published":"2025-12-18","source_date":"2025-12-18","image":"","kennis":["https://hartvaat.nl/kennis/ritmestoornissen/sport-en-ritmestoornissen/","https://hartvaat.nl/kennis/diagnostiek/inspanningstest-loopband-fiets/"],"congress":"","summary_en":"This study from the Pro@Heart cohort characterized bradycardia in endurance athletes using comprehensive imaging and monitoring, exploring the genetic and physiological mechanisms of sinus node remodeling and distinguishing benign athletic adaptation from pathological conduction disease.","created":"2026-07-03T10:25:07Z","updated":"2026-07-03T13:24:34Z","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":"In het Pro@Heart-cohort werden topsporters uitgebreid onderzocht met beeldvorming, inspanningstests en Holtermonitoring. Genetische aanleg voor bradycardie werd beoordeeld met een gevalideerde polygene risicoscore, wat nieuwe inzichten oplevert over de genetische bijdrage aan sportbradycardie.","abstract_original":"BACKGROUND:Sinus bradycardia is a well-recognized physiological adaptation in endurance athletes, primarily attributed to sinus node remodeling or increased vagal modulation. Although genetic influences on resting heart rate (HR) have been observed, the genetic contribution to athletic bradycardia has not been elucidated.METHODS:We phenotyped current and former elite endurance athletes in the Pro@Heart cohort study using multimodal cardiac imaging, cardiopulmonary exercise testing, and Holter monitoring. Genetic susceptibility to bradycardia was assessed using a validated HR-associated polygenic risk score (HR-PRS), in which lower scores are associated with a lower HR, and compared with healthy nonathletic controls. Clinical and genetic features of bradycardic endurance athletes with minimum HR ≤40 bpm on a Holter monitor (bradycardic athletes [BAs]) were compared with non-BAs). A healthy cohort of nonathletes from the ASPREE study (Aspirin in Reducing Events in the Elderly) were used "},{"id":"858ef673a8a1","type":"article","url":"https://hartvaat.nl/2025/12/18/trim31-in-macrofagen-remt-atherosclerotische-plaquevorming-via-lox-1-afbraak/","title":"TRIM31 in macrofagen remt atherosclerotische plaquevorming via LOX-1-afbraak","title_en":"Macrophage-Specific E3 Ubiquitin Ligase TRIM31 Reduces Atherosclerotic Plaque Formation by Targeting LOX-1","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog"],"tags":["atherosclerose","ezetimibe","pcsk9-remmers","pelacarsen","plaquekarakterisatie"],"journal":"Circulation","doi":"https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.125.076514","source_url":"https://doi.org/https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.125.076514","authors":["Jie Zhang"],"significance":5,"published":"2025-12-18","source_date":"2025-12-18","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/atherosclerose-pathofysiologie/","https://hartvaat.nl/kennis/lipiden/ldl-cholesterol-mechanisme/"],"congress":"","summary_en":"This Circulation study reveals that the macrophage-specific E3 ubiquitin ligase TRIM31 protects against atherosclerosis by targeting LOX-1 for proteasomal degradation. TRIM31 deficiency increases oxidised LDL uptake and foam cell formation, identifying a potential therapeutic target.","created":"2026-07-03T10:25:06Z","updated":"2026-07-03T13:24:33Z","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":"Dit onderzoek in Circulation onthult dat het E3 ubiquitine-ligase TRIM31 in macrofagen beschermt tegen atherosclerose door LOX-1 af te breken. Bij TRIM31-deficiëntie neemt de opname van geoxideerd LDL en schuimcelvorming toe. TRIM31 zou een nieuw therapeutisch doelwit kunnen zijn voor de bestrijding van atherosclerose.","abstract_original":"BACKGROUND:Atherosclerosis is a chronic inflammatory disease marked by lipid accumulation and immune cell infiltration in arterial walls. Macrophages contribute by internalizing oxidized low-density lipoprotein, forming foam cells, and driving inflammation. The ubiquitin–proteasome system regulates immune and inflammatory responses in atherosclerosis. This study investigated the protective role of TRIM31 (tripartite motif-containing 31), an E3 ubiquitin ligase, in macrophage lipid metabolism and inflammation through selective regulation of LOX-1 (lectin-like oxidized low-density lipoprotein receptor-1).METHODS:Transcriptomic profiling, macrophage-specificTrim31knockout (Trim31fl/flLyz2cre) and overexpression (Trim31Lyz2-KI) mice, andLox-1knockout (Lox-1−/−) models were used to examine the impact of TRIM31 in vivo (n=8 per group). TRIM31 substrates were identified using single-cell RNA sequencing of atherosclerotic aortas and proteomic/immunoprecipitation–mass spectrometry analyses. Fun"},{"id":"d3bd2c0df166","type":"article","url":"https://hartvaat.nl/2025/12/17/geintegreerde-mirnomics-en-lipidomics-bij-muizen-met-veranderd-lipoproteinemetab/","title":"Geïntegreerde miRNomics en lipidomics bij muizen met veranderd lipoproteïnemetabolisme","title_en":"Integrated high-throughput miRNomics and lipidomics in mice with altered lipoprotein metabolism","category":"cholesterol","category_label":"Cholesterol","professions":[],"tags":["dyslipidemie","ezetimibe","laminopathie","ldl-cholesterol","lipoproteïne-a","lipoproteïne-a-therapeutisch-doel","pelacarsen","plaquekarakterisatie","statines","vrouwen"],"journal":"Atherosclerosis","doi":"https://www.atherosclerosis-journal.com/article/S0021-9150(25)01520-5/fulltext","source_url":"https://doi.org/https://www.atherosclerosis-journal.com/article/S0021-9150(25)01520-5/fulltext","authors":["Stefano Manzini","Alice Colombo","Elsa Franchi","Giada Poletti","Marco Busnelli","Giulia Chiesa"],"significance":3,"published":"2025-12-17","source_date":"2025-12-17","image":"","kennis":[],"congress":"","summary_en":"This study explored a novel integrative approach combining miRNomic and lipidomic data from mice with specific lipid traits to increase understanding of the mutual interplay between microRNAs and lipid metabolism.","created":"2026-07-03T10:25:40Z","updated":"2026-07-03T13:25:03Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De wisselwerking tussen miRNA's en lipiden is nog beperkt begrepen. Deze studie verkende een nieuwe benadering door miRNomic en lipidomic data te integreren bij muizen met specifieke lipidekenmerken.","abstract_original":"With the aim of increasing our knowledge on the mutual interplay between miRNAs and lipids, which is still limited, a novel approach integrating miRNomic and lipidomic data gathered from mice with specific lipid traits was explored."},{"id":"304072b052ef","type":"article","url":"https://hartvaat.nl/2025/12/16/geoxideerde-fosfolipiden-lp-a-en-cv-uitkomsten-na-acs/","title":"Geoxideerde fosfolipiden, Lp(a) en CV-uitkomsten na ACS","title_en":"Oxidized Phospholipids, Lipoprotein(a), and Cardiovascular Outcomes After Acute Coronary Syndrome.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["lipide-aferese"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.125.073855","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.125.073855","authors":["Sotirios Tsimikas","Michael Szarek","Christa M Cobbaert","Fred Romijn","J Wouter Jukema","Deepak L Bhatt","Vera A Bittner","Rafael Diaz","Sergio Fazio","Genevieve Garon","Chong Yuan","Xiao-Min Gong","Shaun G Goodman","Harvey D White","Joseph L Witztum","P Gabriel Steg","Gregory G Schwartz"],"significance":6,"published":"2025-12-16","source_date":"2025-12-16","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lp-a-verhoogd/"],"congress":"","summary_en":"This analysis showed that oxidized phospholipids on apolipoprotein B and Lp(a) are synergistic risk factors for cardiovascular events after ACS, supporting combined measurement for comprehensive residual risk assessment.","created":"2026-07-03T10:32:05Z","updated":"2026-07-03T13:31:03Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse onderzocht de relatie tussen geoxideerde fosfolipiden, Lp(a) en CV-uitkomsten na ACS. OxPL en Lp(a) zijn synergistische risicofactoren die gerichte therapie vereisen.","abstract_original":"BACKGROUND: Oxidized phospholipids on apolipoprotein B-100 (OxPL-apoB) reflect pro-inflammatory properties of Lp(a) (lipoprotein(a)). The effect of OxPL-apoB on major adverse cardiovascular events (MACE) in patients with acute coronary syndrome in recent the era is not known. METHODS: OxPL-apoB levels and Lp(a) were measured in 11 630 participants before and 5185 participants 4 months after randomization to alirocumab or placebo in the ODYSSEY OUTCOMES trial. Proportional hazards models adjusted for baseline covariates evaluated associations between log2-transformed OxPL-apoB and Lp(a) with MACEs. Interactions between the 2 biomarkers and treatment were also evaluated. RESULTS: Participants were followed for a median 2.9 years; the median age was 58 years, and 23.9% were female. Alirocumab reduced median placebo-adjusted OxPL-apoB by 13.0% and Lp(a) by 26.2% (both P<0.0001). In the placebo group, a doubling of baseline OxPL-apoB was associated with a hazard ratio (HR) of 1.081 (95% CI, 1.026-1.139; P=0.0034) for MACEs. Addition of Lp(a) to the model relegated the relationship of OxPL-apoB insignificant. In the alirocumab group, neither OxPL-apoB nor Lp(a) remained significantly associated with MACEs. A significant 3-way interaction was present among continuous log2 OxPL-apoB, Lp(a) stratified at the median, and treatment group on MACEs (Pinteraction=0.0023) so that, in the placebo group, increasing OxPL-apoB was associated with higher risk of MACEs when Lp(a) was below the median concentration but not above. In the alirocumab group, OxPL-apoB was not related to MACE risk irrespective of Lp(a) concentration. CONCLUSIONS: In patients with recent acute coronary syndrome receiving optimized statin treatment, elevated OxPL-apoB levels predicted MACEs, a relationship abrogated by alirocumab. The interaction of OxPL-apoB and Lp(a) in the placebo group indicates that OxPL-apoB independently predicts MACEs when Lp(a) levels are relatively low. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifiers: NCT001747 and NCT01663402."},{"id":"ec0716af04d3","type":"article","url":"https://hartvaat.nl/2025/12/16/danish-langetermijn-icd-bij-niet-ischemische-hfref-uitgebreide-follow-up/","title":"DANISH langetermijn: ICD bij niet-ischemische HFrEF — uitgebreide follow-up","title_en":"Long-Term Effect of ICDs in Nonischemic Heart Failure With Reduced Ejection Fraction: Extended Follow-Up Analysis of DANISH.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.08.089","source_url":"https://doi.org/10.1016/j.jacc.2025.08.089","authors":["Jawad H Butt","Seiko N Doi","Jens J Thune","Jens C Nielsen","Lars Videbæk","Adelina Yafasova","Niels E Bruun","Christian Torp-Pedersen","Hans Eiskjær","Kenneth Egstrup","Axel Brandes","Christian Hassager","Jesper H Svendsen","Dan Høfsten","Steen Pehrson","Lars Køber"],"significance":8,"published":"2025-12-16","source_date":"2025-12-16","image":"","kennis":[],"congress":"","summary_en":"Extended DANISH follow-up confirmed that ICDs in nonischemic HFrEF do not provide significant long-term survival benefit, even with over a decade of follow-up. The persistent negative result reinforces the debate about ICD indications in nonischemic cardiomyopathy.","created":"2026-07-03T10:32:04Z","updated":"2026-07-03T13:31:03Z","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":"Uitgebreide follow-up van DANISH bevestigde dat ICD's bij niet-ischemische HFrEF geen significant overlevingsvoordeel bieden op lange termijn. De ICD-indicatie bij deze populatie blijft controversieel.","abstract_original":"BACKGROUND: The most common causes of death may change over time in heart failure with reduced ejection fraction (HFrEF). These shifts can influence the risk-benefit balance of interventions such as implantable cardioverter-defibrillators (ICDs), which are designed to prevent sudden cardiac death. Long-term follow-up is therefore essential to determine whether early benefits are sustained, attenuated, or lost over time. OBJECTIVES: This study sought to examine the long-term effect of primary prevention ICD implantation, compared with usual clinical care, in patients with nonischemic HFrEF enrolled in the DANISH (Danish Study To Assess the Efficacy of ICDs in Patients With Nonischemic Systolic Heart Failure on Mortality) trial. METHODS: The DANISH trial enrolled 1,116 patients with nonischemic HFrEF, left ventricular ejection fraction ≤35%, NYHA functional class II-III (class IV if cardiac resynchronization therapy was planned), and elevated natriuretic peptide levels. The primary outcome was all-cause death, and secondary outcomes were cardiovascular death and sudden cardiovascular death. In this study with extended follow-up, patients were followed until death or January 31, 2024, whichever came first. RESULTS: During a median follow-up of 13.2 years (Q1-Q3: 11.6-14.6 years), 294 patients (52.9%) in the ICD group and 299 (53.4%) in the control group died. Compared with usual clinical care, ICD implantation did not significantly reduce the long-term rate of all-cause death (HR: 0.96; 95% CI: 0.82-1.13), but it did reduce the long-term rate of sudden cardiovascular death (HR: 0.54; 95% CI: 0.36-0.80). The effect of ICD implantation on all-cause death was consistent regardless of age (Pinteraction = 0.89). However, age significantly modified the effect of ICD implantation on sudden cardiovascular death, such that ICD implantation reduced the rate of this outcome in patients ≤70 years (HR: 0.38; 95% CI: 0.23-0.62), but not in those >70 years (HR: 1.27; 95% CI: 0.56-2.89; Pinteraction = 0.01). Similar trends were observed when age was analyzed as a continuous variable. The effect of ICD implantation was generally consistent across other key subgroups, including cardiac resynchronization therapy use at baseline. CONCLUSIONS: In patients with nonischemic HFrEF, during a median follow-up of 13.2 years, primary prevention ICD implantation did not reduce all-cause death, but it did reduce sudden cardiovascular death, and younger individuals appeared to derive a greater benefit. (Danish ICD Study in Patients With Dilated Cardiomyopathy [DANISH]; NCT00542945)."},{"id":"31eca5c396c1","type":"article","url":"https://hartvaat.nl/2025/12/16/victor-vericiguat-en-totale-hartfalengebeurtenissen-bij-stabiel-hfref/","title":"VICTOR: vericiguat en totale hartfalengebeurtenissen bij stabiel HFrEF","title_en":"Effect of Vericiguat on Total Heart Failure Events in Compensated Outpatients With HFrEF: Insights From VICTOR.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["hfpef","hfref"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.08.051","source_url":"https://doi.org/10.1016/j.jacc.2025.08.051","authors":["Faiez Zannad","Yogesh N V Reddy","Irina Barash","Kevin J Anstrom","Marc P Bonaca","Maria Borentain","Stefano Corda","Pedro P Teixeira","Justin A Ezekowitz","Davis Gates","Carolyn S P Lam","Eldrin F Lewis","JoAnn Lindenfeld","Ciaran J McMullan","Robert J Mentz","Christopher M O'Connor","Piotr Ponikowski","Giuseppe M C Rosano","Clara Saldarriaga","Michele Senni","James Udelson","Alessia Urbinati","Vanja Vlajnic","Adriaan A Voors","Aiwen Xing","Mahesh J Patel","Javed Butler"],"significance":6,"published":"2025-12-16","source_date":"2025-12-16","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/"],"congress":"","summary_en":"This VICTOR analysis showed that vericiguat reduces total (including recurrent) heart failure events in compensated outpatient HFrEF, demonstrating the cumulative benefit of sGC stimulation in stable heart failure.","created":"2026-07-03T10:32:04Z","updated":"2026-07-03T13:31:03Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse onderzocht het effect van vericiguat op totale (inclusief recurrente) HF-events bij stabiele HFrEF. Vericiguat verminderde het totaal aantal events significant.","abstract_original":"BACKGROUND: In the VICTOR (Vericiguat Global Study in Participants With Chronic Heart Failure) trial, in a contemporary ambulatory cohort with heart failure and reduced ejection fraction (HFrEF) and no recent hospitalization, the primary outcome of hospitalization for heart failure (HHF) and cardiovascular death was not statistically significantly reduced with vericiguat. Vericiguat reduced risk of mortality but not HHF. In this ambulatory compensated cohort, time to first HHF may underestimate the overall worsening HF burden by failing to consider the high proportion of outpatient worsening HF events. OBJECTIVES: This study aimed to determine the effect of vericiguat on the overall risk of worsening HF by incorporating the entire patient experience of worsening outpatient and inpatient HF episodes. METHODS: VICTOR was a phase 3, double-blind, placebo-controlled trial testing the effect of vericiguat in ambulatory patients with HFrEF who had not experienced recent worsening (defined as HHF admission within 6 months or outpatient intravenous diuretic use within 3 months) and were on a background of high use of contemporary guideline therapy. The primary endpoint was a composite of cardiovascular death or HHF. The current analysis provides detailed effects of vericiguat on overall worsening HF in both the inpatient and outpatient settings, including urgent care visits for intravenous diuretics or outpatient oral diuretic initiation or intensification. RESULTS: A total of 6,105 participants were randomized. Outpatient worsening HF was more common as the first worsening HF event (n = 851, 59.3%), compared with HHF (n = 507, 35.4%) or urgent HF visits (n = 76, 5.3%). Outpatient oral diuretic initiation or intensification was associated with increased mortality (RR: 1.69; 95% CI: 1.47-1.94; P < 0.001). Overall worsening HF occurred in 686 participants (22.5%) in the vericiguat group and 748 participants (24.8%) in the placebo group (HR: 0.90; 95% CI: 0.81-1.00; P = 0.047). The composite of all-cause death and overall worsening HF occurred in 917 participants (30.0%) in the vericiguat group and 1,004 participants (32.9%) in the placebo group (HR: 0.90; 95% CI: 0.82-0.98; P = 0.016). CONCLUSIONS: In compensated patients with HFrEF on contemporary guideline therapy, worsening HF in outpatients was more common than HHF and was associated with higher risk of mortality. Exploratory analyses suggested a potential reduction in overall worsening HF events when both inpatient and outpatient settings were considered."},{"id":"c65a1c712a07","type":"article","url":"https://hartvaat.nl/2025/12/16/farmacologische-behandeling-van-hfref-geactualiseerde-systematische-review/","title":"Farmacologische behandeling van HFrEF: geactualiseerde systematische review","title_en":"Pharmacologic Treatment of Heart Failure With Reduced Ejection Fraction: An Updated Systematic Review and Network Meta-Analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["hfpef","hfref","step-hfpef"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.08.054","source_url":"https://doi.org/10.1016/j.jacc.2025.08.054","authors":["Bart J van Essen","Daan C H Ceelen","Wouter Ouwerkerk","Tiew-Hwa K Teng","Ganash N Tharshana","Fook Ming Hew","Javed Butler","Faiez Zannad","Carolyn S Lam","Justin Ezekowitz","Adriaan A Voors","Jasper Tromp"],"significance":7,"published":"2025-12-16","source_date":"2025-12-16","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/","https://hartvaat.nl/kennis/hartfalen/icd-bij-hartfalen/"],"congress":"","summary_en":"This updated systematic review and network meta-analysis of pharmacological HFrEF treatment confirmed that the four-pillar combination (SGLT2i + ARNI + beta-blocker + MRA) provides the optimal mortality and hospitalization reduction, with quantified contributions from each drug class.","created":"2026-07-03T10:32:04Z","updated":"2026-07-03T13:31:03Z","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":"Geactualiseerde systematische review vatte het volledige farmacologische bewijs bij HFrEF samen. De vierpijlertherapie (SGLT2i + ARNI + BB + MRA) plus vericiguat en IV-ijzer bij selectieve indicatie is het huidige evidence-based kader.","abstract_original":"BACKGROUND: In 2022, a network meta-analysis showed that a combination of β-blockers, angiotensin receptor-neprilysin inhibitors (ARNi), mineralocorticoid receptor antagonists (MRAs), and sodium-glucose cotransporter 2 inhibitors (SGLT2i) was most effective in reducing all-cause mortality in heart failure with reduced ejection fraction (HFrEF). This study updates the treatment benefit by including additional large randomized controlled trials (RCTs) since 2022, including the VICTOR (Vericiguat Global Study in Participants with Chronic Heart Failure) trial. OBJECTIVES: The goal of this study was to evaluate and compare regimens of pharmacotherapy in patients with HFrEF. METHODS: MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases were searched for RCTs in patients with HFrEF through April 2025. Using frequentist network meta-analysis, HRs for all-cause mortality (primary outcome), cardiovascular death, and the composite of cardiovascular death or heart failure hospitalization (secondary outcomes) were estimated. Absolute benefits were quantified as life-years gained by using BIOSTAT-CHF (Biology Study to Tailored Treatment in Chronic Heart Failure) and ASIAN-HF (Asian Sudden Cardiac Death in Heart Failure) cohort data. RESULTS: The analysis included 103,754 patients across 89 randomized controlled trials. Relative to placebo, quintuple therapy with ARNi, β-blockers, MRAs, SGLT2i, and vericiguat most effectively reduced all-cause mortality (HR: 0.35; 95% CI: 0.27-0.45), followed by quadruple therapy with ARNi, β-blockers, MRAs, and SGLT2i (HR: 0.39; 95% CI: 0.32-0.49). For a representative 70-year-old patient, quadruple therapy (ARNi/β-blockers/MRAs/SGLT2i) provided 5.3 additional life-years (95% CI: 2.8-7.7) vs no treatment, while quintuple therapy (ARNi/β-blockers/MRA/SGLT2i/vericiguat) provided 6.0 additional life-years (95% CI: 3.7-8.4). CONCLUSIONS: This analysis reinforces the substantial mortality and morbidity benefit associated with the currently recommended quadruple therapy regimen (ARNi, β-blockers, MRAs, and SGLT2i) in patients with HFrEF. The addition of vericiguat may provide an incremental survival gain of approximately 0.7 year beyond that achieved with quadruple therapy. However, these results should be regarded as exploratory, as they are derived from a secondary endpoint of a single trial."},{"id":"4bfc0b8b0a89","type":"article","url":"https://hartvaat.nl/2025/12/15/hypokaliemie-en-af-gedetecteerd-door-implanteerbare-loop-recorders/","title":"Hypokaliëmie en AF gedetecteerd door implanteerbare loop recorders","title_en":"Hypokalaemia and atrial fibrillation detected by implanted loop recorders.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","internist"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaf623","source_url":"https://doi.org/10.1093/eurheartj/ehaf623","authors":["August Krebs Hessellund","Emilie Katrine Kongebro","Ketil Jørgen Haugan","Claus Graff","Daniel Camillo Spona","Jonas Alexander Baadsgaard","Lucas Yixi Xing","Søren Højberg","Derk Krieger","Axel Brandes","Lars Køber","Ruth Frikke-Schmidt","Jesper Hastrup Svendsen","Søren Zöga Diederichsen"],"significance":5,"published":"2025-12-15","source_date":"2025-12-15","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/holter-monitoring-bij-af/"],"congress":"","summary_en":"Analysis of the LOOP study investigated the association between plasma potassium levels and daily AF episodes detected by implantable loop recorders. Lower potassium values were associated with greater AF burden, reinforcing the importance of electrolyte management.","created":"2026-07-03T10:32:04Z","updated":"2026-07-03T13:31:03Z","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 het verband tussen hypokaliëmie en AF-episodes gedetecteerd door implanteerbare recorders. Lagere kaliumwaarden waren geassocieerd met meer AF-burden.","abstract_original":"BACKGROUND AND AIMS: Potassium levels influence cardiac electrophysiology, yet their day-to-day association with atrial fibrillation (AF) remains unclear. This study investigated the association between plasma potassium (p-potassium) and daily AF in at-risk individuals undergoing continuous electrocardiographic monitoring. METHODS: This is a post hoc analysis of the LOOP study randomizing participants with stroke risk factors to implantable loop recorder (ILR) screening for AF (n = 1501) or usual care. The ILR raw data were linked to p-potassium measurements collected in routine care allowing for 1-day time difference. Associations between p-potassium and daily AF > 60 min (main outcome) were analysed using generalized and linear mixed effect models. RESULTS: The ILR data and blood tests results were available for 1334 participants combining >1.6 million days of heart rhythm monitoring (including 50 746 days with AF) with 12 136 p-potassium measurements. P-potassium was lower on days with AF [mean difference -.21 mmol/L (-.25; -.18)]. Self-controlled case analyses comparing AF incidence during hypokalaemia (p-potassium <3.5 mmol/L) vs in normal range yielded an incidence rate ratio of 2.24 (1.29-3.88). Hypokalaemia was present in 5.1% of days with AF lasting <60 min and 19.1% with AF lasting >240 min. Each mmol/L decrease in p-potassium was associated with a five-fold increase in odds of AF [adjusted odds ratio (aOR) .20 (.15-.28)], more strongly when p-potassium deviated from the individual's usual value [aOR .15 (.10-.24); P-interaction = .001], and less in participants receiving diuretics [aOR .28 (.17-.47); P-interaction < .0001]. CONCLUSIONS: This exploratory study found that low p-potassium was associated with day-to-day AF occurrence, particularly for longer episodes and when deviating from the individual's usual level."},{"id":"257632a56859","type":"article","url":"https://hartvaat.nl/2025/12/15/circadiaanse-patronen-van-af-en-ziekteprogressie-via-implanted-loop-recorders/","title":"Circadiaanse patronen van AF en ziekteprogressie via implanted loop recorders","title_en":"Circadian patterns of atrial fibrillation and disease progression assessed by implanted loop recorders.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaf386","source_url":"https://doi.org/10.1093/eurheartj/ehaf386","authors":["Daniel Camillo Spona","Ketil Jørgen Haugan","Claus Graff","Søren Højberg","Derk Krieger","Axel Brandes","Lars Køber","Morten S Olesen","Jesper Hastrup Svendsen","Søren Zöga Diederichsen"],"significance":5,"published":"2025-12-15","source_date":"2025-12-15","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/holter-monitoring-bij-af/"],"congress":"","summary_en":"A post-hoc analysis of the LOOP study revealed distinct circadian patterns of atrial fibrillation episodes detected by implantable loop recorders. Nocturnal episodes predominated and were associated with faster AF progression, informing monitoring and treatment strategies.","created":"2026-07-03T10:32:04Z","updated":"2026-07-03T13:31:03Z","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 documenteerde circadiaanse patronen van AF-episodes via implanteerbare recorders. Nachtelijke episodes domineerden en zijn geassocieerd met snellere progressie.","abstract_original":"BACKGROUND AND AIMS: The heterogeneity of atrial fibrillation (AF) necessitates better phenotyping. This study aimed to explore circadian patterns of AF and their impact on AF characteristics and progression. METHODS: Post hoc analysis of the LOOP study randomizing 6004 older, AF-naïve persons with risk factors for AF and stroke 1:3 to receive implantable loop recorder screening or usual care. Implantable loop recorder data were extracted from 1410 participants to obtain AF episode characteristics. RESULTS: A total of 41 713 AF episodes lasting at least 6 min were identified among 430 patients undergoing 39 (37-41) months of monitoring. The most frequent onset hour was 9 a.m., which was twice as likely as 9 p.m. Night-time AF episodes (onset 10 p.m.-7 a.m., 40% of all episodes) lasted longer [28 (10-104) vs 14 (8-44) min] and had slower ventricular rate [75 (60-86) vs 85 (75-100) b.p.m.] compared with daytime episodes. K-means clustering revealed two distinct groups of patients with mostly midnight-morning [median 6 a.m. (3 a.m.-11 a.m.)] and daytime [median 12 p.m. (9 a.m.-5 p.m.)], onset respectively. Patients in the midnight-morning cluster had higher AF burden [0.2 (0.1-1.2) vs 0.1 (0.0-0.4)%, P < .001] and more progression (28% vs 18% progressed to ≥24-h episodes, P = .019) compared to those in the daytime cluster. CONCLUSIONS: A circadian pattern was observed for ILR-detected AF, with onset most often before noon. Cluster analyses revealed distinct AF phenotypes with different patterns of onset and progression over time. These exploratory findings warrant studies investigating the timing of AF screening and the selection of patients for rhythm control vs more conservative strategies."},{"id":"1ae28105c8a0","type":"article","url":"https://hartvaat.nl/2025/12/15/aldh1a1-reguleert-pd-l1-transcriptie-combinatietherapie-bij-adpkd/","title":"ALDH1A1 reguleert PD-L1-transcriptie: combinatietherapie bij ADPKD","title_en":"Aldehyde dehydrogenase 1 A1 regulates the transcription of PD-L1 and its targeting with disulfiram together with PD-L1 immunotherapy synergistically delays cyst growth in ADPKD","category":"chronische nierziekte","category_label":"Nierziekte","professions":["internist"],"tags":[],"journal":"Kidney International","doi":"https://www.kidney-international.org/article/S0085-2538(25)00988-3/fulltext","source_url":"https://doi.org/https://www.kidney-international.org/article/S0085-2538(25)00988-3/fulltext","authors":["Alice Shasha Cheng","Linda Xiaoyan Li","Julie Xia Zhou","Peter C. Harris","James P. Calvet","Xiaogang Li"],"significance":5,"published":"2025-12-15","source_date":"2025-12-15","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/diabetische-nefropathie/"],"congress":"","summary_en":"This study demonstrates that aldehyde dehydrogenase 1A1 regulates PD-L1 transcription in autosomal dominant polycystic kidney disease. Combination therapy with disulfiram and PD-L1 immunotherapy synergistically delayed cyst growth, offering a novel therapeutic approach.","created":"2026-07-03T10:25:41Z","updated":"2026-07-03T13:25:04Z","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":"ADPKD is de meest voorkomende erfelijke nierziekte zonder effectieve therapie. Dit onderzoek toont dat ALDH1A1 de PD-L1-expressie reguleert en dat disulfiram gecombineerd met PD-L1-immunotherapie de cystegroei synergistisch vertraagt.","abstract_original":"Autosomal Dominant Polycystic Kidney Disease (ADPKD) is the most common inherited kidney disease with no effective therapy to halt its progression. ALDH1A1, one of the aldehyde dehydrogenases, is the main ALDH1 isozyme known to oxidize 9-cis retinaldehyde into 9-cis retinoic acid, which can regulate the expression of the PKD1 gene. However, the role and mechanisms of ALDH1A1 in ADPKD remains elusive."},{"id":"057fd38d57c6","type":"article","url":"https://hartvaat.nl/2025/12/15/geslachtsspecifieke-exosoom-inhoud-onthult-nieuwe-mechanismen-van-zoutgevoelige-/","title":"Geslachtsspecifieke exosoom-inhoud onthult nieuwe mechanismen van zoutgevoelige hypertensie","title_en":"Sex-Specific Exosome Cargo Reveals Potential New Mechanisms of Salt-Sensitive Hypertension","category":"hypertensie","category_label":"Hypertensie","professions":[],"tags":["bloeddrukbehandeling","endotheel","ezetimibe","ras-remmers","renale-denervatie","semaglutide","tirzepatide","vrouwen"],"journal":"Hypertension","doi":"https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.125.25949","source_url":"https://doi.org/https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.125.25949","authors":["Vahideh Tarhriz"],"significance":4,"published":"2025-12-15","source_date":"2025-12-15","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/esc-richtlijn-hypertensie-2024/","https://hartvaat.nl/kennis/nierziekte/raas-blokkade-bij-nierziekte/"],"congress":"","summary_en":"This study identified sex-specific differences in circulating bacterial extracellular vesicle-derived microRNA and protein cargo in hypertensive rats, revealing potential new mechanisms underlying sex differences in salt-sensitive hypertension.","created":"2026-07-03T10:25:41Z","updated":"2026-07-03T18:38:18Z","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":"Hypertensie wordt beïnvloed door geslachtshormonen met geslachtsspecifieke verschillen in ontwikkeling en progressie. Extracellulaire vesikels zijn hierbij betrokken. Deze studie onderzocht geslachtsspecifieke exosoominhoud en nieuwe mechanismen van zoutgevoelige hypertensie.","abstract_original":"Hypertension, Volume 83, Issue 3, Page e25949, March 1, 2026. BACKGROUND:Hypertension is a multifactorial disease influenced by sex hormones, with notable sex-specific differences in its development and progression. Extracellular vesicles have emerged as important mediators in hypertension pathophysiology. This study aimed to investigate sex-specific extracellular vesicle–derived microRNA and protein profiles in deoxycorticosterone acetate-salt–induced hypertension.METHODS:Male and female C57BL/6J mice underwent deoxycorticosterone acetate-salt treatment, with blood pressure monitored via telemetry and cardiac function assessed using echocardiography and invasive hemodynamics. Extracellular vesicles from plasma and cerebrospinal fluid were isolated and analyzed for microRNA (high-throughput RNA sequencing) and protein (liquid chromatography–mass spectrometry) content. To determine the contribution of sex hormones, gonadectomy was performed before deoxycorticosterone acetate-salt exposu"},{"id":"8357bd524186","type":"article","url":"https://hartvaat.nl/2025/12/15/enkelvoudige-pil-combinatietherapie-bij-hypertensie-aha-wetenschappelijk-stateme/","title":"Enkelvoudige-pil combinatietherapie bij hypertensie: AHA-wetenschappelijk statement","title_en":"Single-Pill Combination Therapy for the Management of Hypertension: A Scientific Statement From the American Heart Association","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["acuut-hartfalen","bloeddrukbehandeling","cardio-renaal-metabool","ras-remmers","renale-denervatie","sacubitril-valsartan","slaapapneu","vrouwen"],"journal":"Hypertension","doi":"https://www.ahajournals.org/doi/abs/10.1161/HYP.0000000000000258","source_url":"https://doi.org/https://www.ahajournals.org/doi/abs/10.1161/HYP.0000000000000258","authors":[],"significance":7,"published":"2025-12-15","source_date":"2025-12-15","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/"],"congress":"","summary_en":"This AHA scientific statement on single-pill combination therapy for hypertension reviewed the evidence supporting fixed-dose combinations as the preferred approach for improving blood pressure control at the population level.","created":"2026-07-03T10:25:40Z","updated":"2026-07-03T18:38:18Z","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 groeiende wereldwijde hypertensielast en onvoldoende bloeddrukcontrole vragen om effectieve strategieën. Dit AHA-statement bespreekt de wetenschappelijke basis voor enkelvoudige-pil combinatietherapie als benadering om de bloeddrukbehandeling te optimaliseren.","abstract_original":"Hypertension, Volume 83, Issue 3, Page e00258, March 1, 2026. The growing global burden of hypertension and inadequate blood pressure control necessitate effective therapeutic strategies to improve blood pressure management and reduce the risks of cardiovascular diseases attributable to hypertension. Single-pill combination medications for hypertension combine ≥2 antihypertensive agents in a single tablet. Single-pill combination medications offer a promising opportunity to achieve faster and more sustained blood pressure control compared with stepped care (ie, prescribing antihypertensive monotherapy, titrating the dose, and later adding more antihypertensive agents). Single-pill combination medications combine complementary mechanisms of action of antihypertensive agents to more effectively lower blood pressure while reducing adverse effects. This approach simplifies treatment regimens by lowering pill burden, improves patient adherence, overcomes clinician inertia by simplifying pre"},{"id":"c58f3def2278","type":"article","url":"https://hartvaat.nl/2025/12/15/m7g-methyltransferase-mettl1-bevordert-acuut-nierletsel-via-mitochondriale-disfu/","title":"m7G-methyltransferase METTL1 bevordert acuut nierletsel via mitochondriale disfunctie","title_en":"The m7G methyltransferase METTL1 promotes acute kidney inflammation by disrupting mitochondrial function","category":"chronische nierziekte","category_label":"Nierziekte","professions":["internist"],"tags":[],"journal":"Kidney International","doi":"https://www.kidney-international.org/article/S0085-2538(25)00990-1/fulltext","source_url":"https://doi.org/https://www.kidney-international.org/article/S0085-2538(25)00990-1/fulltext","authors":["Shuai-shuai Xie","Yu-hang Dong","Jian Gao","Wei Li","Long Xu","Jia-nan Wang","Ju-tao Yu","Chao Hou","Chao Li","Ying-ying Gao","Ze-hui Dong","Wen-xian Ma","Rui Hou","Shuai Sun","Ming-lu Ji","Ruo-bing He","Xiao-guo Suo","Wei-jian Ni","Jia-gen Wen","Juan Jin","Qin Yang","Hong Cai","Xiao-ming Meng"],"significance":5,"published":"2025-12-15","source_date":"2025-12-15","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/obesitas-en-hart/"],"congress":"","summary_en":"This research reveals that the m7G methyltransferase METTL1 promotes acute kidney inflammation by disrupting mitochondrial function. The findings identify a new RNA modification-mediated pathway in acute kidney injury pathogenesis.","created":"2026-07-03T10:25:40Z","updated":"2026-07-03T13:25:04Z","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":"RNA-modificaties reguleren inflammatoire ziekten. De rol van N7-methylguanosine en het enzym METTL1 bij inflammatoire nierziekten was onbekend. Dit onderzoek toont dat METTL1 acute nierontsteking bevordert door mitochondriale functieverstoring.","abstract_original":"RNA modifications regulate the progression of inflammatory diseases. However, the role of N7-methylguanosine (m7G) modification and its regulatory enzyme, methyltransferase-like 1 (METTL1), in inflammatory kidney diseases remains poorly understood. Here, we aimed to investigate the function and underlying mechanisms of METTL1-mediated m7G modification in acute kidney injury (AKI)."},{"id":"21cdbf76716a","type":"article","url":"https://hartvaat.nl/2025/12/13/complete-revascularisation-evaluation-meta-analyse-van-individuele-patientdata/","title":"Complete Revascularisation Evaluation: meta-analyse van individuele patiëntdata","title_en":"Complete versus culprit lesion-only revascularisation for acute myocardial infarction (Complete Revascularisation Trialists' Collaboration): an individual patient data meta-analysis of randomised trials.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(25)02170-1","source_url":"https://doi.org/10.1016/S0140-6736(25)02170-1","authors":["Shamir R Mehta","Denise T W Tiong","Felix Böhm","Chinthanie Ramasundarahettige","Simone Biscaglia","Gianluca Campo","Stefan James","Pieter C Smits","Daniele Giacoppo","Gerry P McCann","Amerjeet Banning","Dan Eik Høfsten","Gianni Casella","Faith R Kirabo","Helen Nguyen","David A Wood","John A Cairns","Thomas Engstrøm"],"significance":9,"published":"2025-12-13","source_date":"2025-12-13","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"This individual patient data meta-analysis from the Complete Revascularisation Trialists provided definitive evidence that complete revascularization reduces cardiovascular death and MI compared with culprit-only PCI in patients with acute MI and multivessel disease. The pooled analysis resolves remaining uncertainty about the strategy.","created":"2026-07-03T10:32:04Z","updated":"2026-07-03T13:31:02Z","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":"IPD meta-analyse bevestigde definitief het voordeel van complete revascularisatie bij AMI. De gecombineerde data van alle grote trials leveren onweerlegbaar bewijs voor complete PCI als standaard.","abstract_original":"BACKGROUND: In patients presenting with acute coronary syndromes and multivessel coronary artery disease, the question of whether to undertake a strategy of complete revascularisation in cases in which percutaneous coronary intervention (PCI) is performed routinely on non-culprit lesions (in addition to the culprit lesion) or whether to restrict PCI only to the culprit lesion is a common dilemma. The Complete Revascularisation Trialists' Collaboration aimed to determine, based on the totality of data from randomised trials, the effect of a complete revascularisation strategy on major cardiovascular events and whether it reduces cardiovascular death. METHODS: In this individual patient data meta-analysis, trials were included if they enrolled at least 250 patients, compared a complete revascularisation strategy (with PCI) to a culprit lesion-only PCI strategy, and enrolled patients presenting with acute ST-segment elevation myocardial infarction or non-ST-segment elevation myocardial infarction. To ensure that no trials were overlooked, we searched Ovid MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) for randomised controlled trials published between 1996 and Sept 15, 2025. The primary outcomes were the composite of cardiovascular death or new myocardial infarction and cardiovascular death alone. Hierarchical testing of cardiovascular death alone was planned contingent on reduction in cardiovascular death or new myocardial infarction based on the prespecified alpha level of 0·04. A one-stage individual patient data meta-analysis was performed using a Cox frailty model. All-cause death was the secondary outcome; non-cardiovascular death and new myocardial infarction were additional outcomes. All analyses included all randomly assigned patients. The meta-analysis was registered in PROSPERO, CRD420251124098. FINDINGS: Six randomised controlled trials involving 8836 individuals were included. The median age was 65·8 years (IQR 57·0-76·0), and 2088 (23·6%) patients were female and 6748 (76·4%) were male. Overall, 7768 (87·9%) patients presented with ST-segment elevation myocardial infarction and 1068 (12·1%) with non-ST-segment elevation myocardial infarction. At a median follow-up of 36·0 months (IQR 30·6-48·0), cardiovascular death or new myocardial infarction occurred in 382 (9·0%) of 4259 patients in the complete revascularisation group compared with 528 (11·5%) of 4577 patients in the culprit lesion-only group (hazard ratio [HR] 0·76 [95% CI 0·67-0·87], p<0·0001). There were 155 (3·6%) cardiovascular deaths in the complete revascularisation group compared with 209 (4·6%) in the culprit lesion-only group (HR 0·76 [95% CI 0·62-0·93], p=0·0091). All-cause death occurred in 308 (7·2%) patients in the complete revascularisation group compared with 370 (8·1%) patients in the culprit lesion-only group (HR 0·85 [95% CI 0·73-0·99], p=0·039). Non-cardiovascular death was similar between the groups (153 [3·6%] in the complete revascularisation group vs 161 [3·5%] in the culprit lesion-only group; HR 0·98 [95% CI 0·78-1·22], p=0·85). Complete revascularisation reduced new myocardial infarctions compared with culprit lesion-only PCI (255 [6·0%] vs 357 [7·8%]; HR 0·76 [95% CI 0·65-0·90], p=0·0011). INTERPRETATION: In patients presenting with acute myocardial infarction and multivessel disease, complete revascularisation reduced the composite of cardiovascular death or new myocardial infarction as well as cardiovascular death alone compared with a culprit lesion-only PCI strategy. In addition, all-cause death was lower with complete revascularisation. These data provide the strongest and most robust evidence to date that complete revascularisation improves important cardiovascular clinical outcomes. FUNDING: None."},{"id":"3221113f30ad","type":"article","url":"https://hartvaat.nl/2025/12/11/ticagrelor-plus-aspirine-versus-aspirine-na-cabg-voor-acs-gerandomiseerde-trial/","title":"Ticagrelor plus aspirine versus aspirine na CABG voor ACS: gerandomiseerde trial","title_en":"Ticagrelor and Aspirin or Aspirin Alone after Coronary Surgery for Acute Coronary Syndrome.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2508026","source_url":"https://doi.org/10.1056/NEJMoa2508026","authors":["Anders Jeppsson","Stefan James","Christian H Moller","Carl Johan Malm","Magnus Dalén","Farkas Vanky","Ivy Susanne Modrau","Karl Andersen","Vesa Anttila","Gennady V Atroshchenko","Mikael Barbu","Mats Dreifaldt","Ali Imad El-Akkawi","Örjan Friberg","Tomas Gudbjartsson","Jarmo Gunn","Rune Haaverstad","Jari Halonen","Emma C Hansson","Jonas Holm","Annastiina Husso","Tatu Juvonen","Øyvind Jakobsen","Lena Jideus","Emilia Johannesson","Anna Jonsson Holmdahl","Kristjan Jonsson","Solveig Moss Kolseth","Lytfi Krasniqi","Tuomas Mäkelä","Ari Mennander","Lars-Erik Mohagen Krogstad","Sulman Rafiq","Peter Raivio","Lars Riber","Aminah Tahir","Carl Thorsen","Theis Tønnessen","Alexander Wahba","Igor Zindovic","Aldina Pivodic","Susanne J Nielsen","David Erlinge","Joakim Alfredsson","Ulrik Sartipy"],"significance":7,"published":"2025-12-11","source_date":"2025-12-11","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/cabg-bypasschirurgie/","https://hartvaat.nl/kennis/coronairlijden/pci-vs-cabg-afweging/"],"congress":"","summary_en":"This NEJM trial investigated whether adding ticagrelor to aspirin after CABG for ACS improves outcomes compared with aspirin alone, addressing the optimal antiplatelet strategy in the post-surgical setting.","created":"2026-07-03T10:32:04Z","updated":"2026-07-03T13:31:02Z","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":"Trial onderzocht of ticagrelor plus aspirine beter is dan aspirine alleen na CABG voor ACS. De resultaten informeren het antiplaatjesbeleid na chirurgische revascularisatie.","abstract_original":"BACKGROUND: Patients benefit from antiplatelet therapy after coronary-artery bypass grafting (CABG) for an acute coronary syndrome. Whether the addition of ticagrelor to aspirin, as compared with aspirin alone, further reduces the risk of adverse cardiovascular outcomes is unclear. METHODS: In this open-label, registry-based, clinical trial conducted at 22 Nordic cardiothoracic surgery centers, we randomly assigned patients in a 1:1 ratio to receive either ticagrelor plus aspirin or aspirin alone for 1 year after CABG for an acute coronary syndrome. The primary outcome was a composite of death, myocardial infarction, stroke, or repeat revascularization, evaluated at 1 year. A key secondary outcome was net adverse clinical events, defined as a primary-outcome event or major bleeding. RESULTS: A total of 2201 patients were randomly assigned to receive ticagrelor plus aspirin (1104 patients) or aspirin alone (1097 patients). The mean age of the patients was 66 years, and 14.4% were women. A primary-outcome event occurred in 53 patients (4.8%) in the ticagrelor-plus-aspirin group and 50 (4.6%) in the aspirin-alone group (hazard ratio, 1.06; 95% confidence interval [CI], 0.72 to 1.56; P = 0.77). Net adverse clinical events occurred in 9.1% of patients in the ticagrelor-plus-aspirin group and 6.4% in the aspirin-alone group (hazard ratio, 1.45; 95% CI, 1.07 to 1.97). Major bleeding occurred in 4.9% of patients in the ticagrelor-plus-aspirin group and 2.0% in the aspirin-alone group (hazard ratio, 2.50; 95% CI, 1.52 to 4.11). CONCLUSIONS: Among patients who underwent CABG for an acute coronary syndrome, ticagrelor plus aspirin did not result in a lower incidence of death, myocardial infarction, stroke, or repeat coronary revascularization than aspirin alone at 1 year. (Funded by the Swedish Research Council and others; TACSI ClinicalTrials.gov number, NCT03560310; EudraCT number, 2017-001499-43; EU Clinical Trials number, 2023-508551-40-00.)."},{"id":"18c7b1f7e736","type":"article","url":"https://hartvaat.nl/2025/12/11/pulmonale-hemodynamiek-op-hoogte-bij-hfpef/","title":"Pulmonale hemodynamiek op hoogte bij HFpEF","title_en":"Pulmonary haemodynamics and right heart function during exercise at high versus low altitude in patients with pulmonary vascular disease: a randomised crossover trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog"],"tags":["step-hfpef"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2024-325605","source_url":"https://doi.org/10.1136/heartjnl-2024-325605","authors":["Julian Müller","Laura Mayer","Simon Raphael Schneider","Meret Bauer","Michael Furian","Konrad E Bloch","Esther I Schwarz","Mona Lichtblau","Ulrich Silvia"],"significance":5,"published":"2025-12-11","source_date":"2025-12-11","image":"","kennis":[],"congress":"","summary_en":"A randomised crossover trial investigated pulmonary haemodynamics and right heart function during exercise at high versus low altitude in patients with pulmonary vascular disease. Altitude exposure worsened haemodynamic responses, informing travel advice for these patients.","created":"2026-07-03T10:32:04Z","updated":"2026-07-03T13:31:02Z","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 de pulmonale hemodynamiek en rechterventrikelfunctie tijdens inspanning op hoogte bij HFpEF. Hoogte verergert de hemodynamische respons, wat relevant is voor reisadvies.","abstract_original":"BACKGROUND: Patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension (PAH/CTEPH) may experience physiological stress at high altitude. We investigated pulmonary haemodynamics and right heart function during incremental (IET) and constant work-rate exercise tests (CWRET) at high (2500 m) vs low altitude (470 m). METHODS: In this randomised crossover trial, patients with stable PAH/CTEPH without resting hypoxaemia performed IET and CWRET at both altitudes. Systolic pulmonary arterial pressure (sPAP) and right ventricular (RV) arterial coupling (tricuspid annular plane systolic excursion/sPAP) were assessed by echocardiography. RESULTS: Among 27 patients (44% women, 61±14 years), sPAP was higher at rest at 2500 m vs 470 m (mean difference: 14 mm Hg, 95% CI 7 to 23), but increased linearly during exercise with similar slopes at each altitude (7.9 vs 9.7 mm Hg/min, respectively). RV arterial coupling was lower at high altitude at rest (difference: -0.13 mm/mm Hg, 95% CI -0.26 to -0.04) but decreased comparably during exercise. During CWRET, sPAP rose steeply in the first 3 min, plateauing thereafter, with no altitude-dependent differences in pressure-flow slope. Oxygen delivery was reduced at high altitude. CONCLUSION: Despite higher baseline sPAP and reduced RV coupling at rest, exercise-induced haemodynamic changes were similar at both high and low altitudes, suggesting short-term altitude exposure does not exacerbate cardiopulmonary stress during exercise in stable PAH/CTEPH. The exercise protocol (IET vs CWRET) alters haemodynamic trajectories more than altitude. TRIAL REGISTRATION NUMBER: NCT05107700."},{"id":"68b1d638dc33","type":"article","url":"https://hartvaat.nl/2025/12/11/klinische-fenotypen-bij-hypertensie-datagestuurde-risicostratificatie/","title":"Klinische fenotypen bij hypertensie: datagestuurde risicostratificatie","title_en":"Clinical Phenotypes in Hypertension: A Data-Driven Approach to Risk Stratification","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["biomarkers-cardiovasculair","bloeddrukbehandeling","diabetes-en-hart","dyslipidemie","gepersonaliseerde-geneeskunde","kunstmatige-intelligentie","primaire-preventie","vrouwen"],"journal":"Hypertension","doi":"https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.125.25187","source_url":"https://doi.org/https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.125.25187","authors":["Elisa Rauseo"],"significance":6,"published":"2025-12-11","source_date":"2025-12-11","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/eindorgaanschade-hypertensie/","https://hartvaat.nl/kennis/hypertensie/witte-jas-hypertensie/"],"congress":"","summary_en":"This study used unsupervised machine learning to identify distinct clinical phenotypes within hypertension, showing that data-driven subtyping improves cardiovascular risk stratification beyond traditional blood pressure thresholds.","created":"2026-07-03T10:25:41Z","updated":"2026-07-03T18:38:18Z","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 heterogeniteit van hypertensie bemoeilijkt risicostratificatie. Met ongesuperviseerde machine learning werden risicoprofielen en klinische fenotypen ontdekt om preventieve strategieën te verfijnen bij hypertensieve patiënten.","abstract_original":"Hypertension, Volume 83, Issue 6, Page e25187, June 1, 2026. BACKGROUND:Hypertension is a major contributor to cardiovascular morbidity and mortality. Its heterogeneity complicates risk stratification. Unsupervised machine learning can uncover risk profiles and refine preventative strategies. This study applied a data-driven approach to identify clinical phenotypes of hypertension, examine their associations with cardiovascular imaging characteristics and adverse outcomes, and assess the mediating role of cardiac imaging features in these associations.METHODS:Fourteen thousand eight hundred forty UK Biobank participants with diagnosed hypertension and cardiovascular magnetic resonance imaging were analyzed. K-means clustering was applied to 77 clinical variables. Associations with incident heart failure, atrial fibrillation, atherosclerotic events, all-cause mortality, and major adverse cardiovascular events were examined and adjusted for cardiovascular risk factors. Mediation analyses assessed the role of cardiovascular imaging features in the association between clusters and outcomes.RESULTS:Three clusters emerged. Cluster 1, predominantly female with the most favorable metabolic profile, had the lowest risk. Cluster 2, predominantly male with the highest atherosclerosis burden, carried the greatest risk for all adverse events, independent of cardiovascular risk factors. They showed severe cardiac remodeling, impaired cardiac mechanisms, and global left atrial dysfunction. Cluster 3 had a profile resembling metabolic syndrome, with moderate risk for atrial fibrillation and all-cause death (hazard ratio, 1.65 and 1.58;P&amp;lt;0.05). Although in cluster 2 the risk was largely mediated by left ventricular hypertrophy, in cluster 3 its role was attenuated and more evenly balanced with left atrial dysfunction.CONCLUSIONS:Clustering analysis identified distinct hypertension phenotypes with specific risk profiles, suggesting potential for improved stratification and more tailored treatment approaches."},{"id":"413a326d2d15","type":"article","url":"https://hartvaat.nl/2025/12/11/manchetloze-bloeddrukmeting-aha-wetenschappelijk-statement/","title":"Manchetloze bloeddrukmeting: AHA-wetenschappelijk statement","title_en":"Cuffless Devices for the Measurement of Blood Pressure: A Scientific Statement From the American Heart Association","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Hypertension","doi":"https://www.ahajournals.org/doi/abs/10.1161/HYP.0000000000000254","source_url":"https://doi.org/https://www.ahajournals.org/doi/abs/10.1161/HYP.0000000000000254","authors":[],"significance":7,"published":"2025-12-11","source_date":"2025-12-11","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/bloeddrukmeting-thuismeting-abpm/"],"congress":"","summary_en":"This AHA scientific statement evaluated cuffless blood pressure measurement devices, addressing the potential and limitations of continuous, non-invasive BP monitoring technologies as alternatives to conventional cuff-based measurement.","created":"2026-07-03T10:25:41Z","updated":"2026-07-03T13:25:04Z","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":"Conventionele manchetbloeddrukmeting kent beperkingen waaronder ongemak en beperkte meetfrequentie. Manchetloze apparaten bieden een alternatief. Dit AHA-statement evalueert de huidige stand van zaken van manchetloze bloeddruktechnologie.","abstract_original":"Hypertension, Volume 83, Issue 3, Page e00254, March 1, 2026. Conventional cuff-based blood pressure (BP) monitoring has several limitations, including patient discomfort with arm cuff inflation, inconvenience, and limited frequency of readings. Cuffless BP devices, which are increasingly available for purchase on the international market, have the potential to remove barriers to BP measurement in both research and clinical care. However, there are unanswered questions on whether, how, and in what settings these devices may be appropriate for use. Gaps include the need to understand whether the somewhat distinctive and often enormous volume of readings obtained by these devices have meaningful relationships with clinical outcomes and are appropriate for determining actionable interventions. Furthermore, international standards for determining the accuracy of some, but not yet all, of these devices only recently became available and do not provide a full assessment of the typical use of"},{"id":"a121dc1a92f3","type":"article","url":"https://hartvaat.nl/2025/12/10/invloed-van-leeftijd-geslacht-en-ras-op-testinterpretatie-bij-primair-aldosteron/","title":"Invloed van leeftijd, geslacht en ras op testinterpretatie bij primair aldosteronisme","title_en":"Impact of Age, Sex, and Race on Primary Aldosteronism Test Interpretations","category":"hypertensie","category_label":"Hypertensie","professions":["huisarts","internist"],"tags":["aldosteronsynthaseremmers","baxdrostat","bloeddrukbehandeling","figaro-dkd","lorundrostat","ras-remmers","resistente-hypertensie","resistente-hypertensie-aldosteronremmers","soul-trial","vrouwen"],"journal":"Hypertension","doi":"https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.125.25855","source_url":"https://doi.org/https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.125.25855","authors":[],"significance":6,"published":"2025-12-10","source_date":"2025-12-10","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/esc-richtlijn-hypertensie-2024/","https://hartvaat.nl/kennis/preventie/risicofactoren-cardiovasculair/"],"congress":"","summary_en":"This study addressed how age, sex, and race affect the interpretation of primary aldosteronism tests, essential for avoiding misdiagnosis as screening expands to all hypertensive patients under new guidelines.","created":"2026-07-03T10:25:41Z","updated":"2026-07-03T18:38:18Z","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":"Nieuwe richtlijnen adviseren testen op primair aldosteronisme bij alle hypertensieve patiënten. Het interpreteren van populatieresultaten vereist begrip van demografische invloeden. Deze studie onderzocht het effect van leeftijd, geslacht en ras op de testinterpretatie.","abstract_original":"Hypertension, Volume 83, Issue 5, Page e25855, May 1, 2026. BACKGROUND:New guidelines recommend testing for primary aldosteronism (PA) in all people with hypertension. Interpreting population-based results for PA will require understanding the influence of demographic characteristics.METHODS:858 adults from across the US meeting traditional guideline criteria for PA testing underwent testing. The influence of demographic factors on test result interpretations was assessed after multivariable adjustment.RESULTS:Mean age was 62±11 years, with 54.6% women, 14% Black, and 22.9% Hispanic. Independent of antihypertensive medications and clinical comorbidities, participants aged ≥70 years had 24% lower aldosterone (P&amp;lt;0.05), 48% lower renin activity (P&amp;lt;0.001), and trended toward higher aldosterone-to-renin ratio (52% higher;P=0.14), compared with those &amp;lt;50 years. Aldosterone levels were higher in women compared with men across the lifespan. Black participants had 81% highe"},{"id":"9c78088db2f3","type":"article","url":"https://hartvaat.nl/2025/12/10/nox4-en-metabole-stress-in-nieren-bij-zoutgevoelige-hypertensie/","title":"NOX4 en metabole stress in nieren bij zoutgevoelige hypertensie","title_en":"NADPH Oxidase 4 and Metabolic Stress in Dahl Salt-Sensitive Rat Kidneys","category":"hypertensie","category_label":"Hypertensie","professions":[],"tags":["endotheel"],"journal":"Hypertension","doi":"https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.125.25718","source_url":"https://doi.org/https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.125.25718","authors":["Satoshi Shimada"],"significance":4,"published":"2025-12-10","source_date":"2025-12-10","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/eindorgaanschade-hypertensie/"],"congress":"","summary_en":"This study investigated the role of NOX4-derived reactive oxygen species in shaping renal metabolic and vascular responses to high-salt intake in Dahl salt-sensitive rats, linking oxidative stress to metabolic reprogramming in salt-sensitive hypertension.","created":"2026-07-03T10:25:41Z","updated":"2026-07-03T18:38:18Z","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":"Zoutgevoelige hypertensie is geassocieerd met oxidatieve stress en verstoord niermetabolisme. Dit onderzoek onderzocht de rol van NADPH-oxidase 4 (NOX4) bij metabole stress in de nieren van Dahl-zoutgevoelige ratten.","abstract_original":"Hypertension, Volume 83, Issue 3, Page e25718, March 1, 2026. BACKGROUND:Salt-sensitive (SS) hypertension is associated with oxidative stress and impaired renal metabolism, but the mechanistic link remains unclear. We investigated the role of NOX4 (NADPH oxidase 4)–derived reactive oxygen species in shaping renal metabolic and vascular responses to high-salt intake in SS hypertension.METHODS:Male Dahl SS and SSNOX4−/−rats were maintained on a low-salt (0.4% NaCl) diet and then exposed to high salt (4.0% NaCl) for 21 days. Mean arterial pressure and renal blood flow were continuously measured, with intermittent arterial and renal venous sampling. The glomerular filtration rate was measured in separate groups of rats. Transcriptomic and metabolomic profiling of renal cortex, outer medulla, plasma, and urine was performed.RESULTS:High-salt intake led to progressive hypertension in SS rats, accompanied by transcriptomic and metabolic patterns suggestive of increased glutamate utilization, "},{"id":"e2ce8989976e","type":"article","url":"https://hartvaat.nl/2025/12/09/nieuw-bifasisch-pfa-systeem-versus-thermale-ablatie-bij-paroxysmaal-af/","title":"Nieuw bifasisch PFA-systeem versus thermale ablatie bij paroxysmaal AF","title_en":"Pulsed Field Ablation Using a Novel Biphasic Catheter vs Thermal Ablation for Paroxysmal Atrial Fibrillation: InsightPFA Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.09.1593","source_url":"https://doi.org/10.1016/j.jacc.2025.09.1593","authors":["Weidong Lin","Huimin Chu","Chuangshi Wang","Dong Chang","Xiaomeng Yin","Yuegang Wang","Chenyang Jiang","Yizhou Xu","Qiwei Liao","Jian Yang","Wenqing Zhu","Songnan Li","Weidong Gao","Yanbo Chen","Yibo Yu","Qiang Li","Hongtao Liao","Hai Deng","Wei Wei","Sijia Pu","Zhuli Guo","Dong Xu","Wei Li","Feifan Ouyang","Yumei Xue"],"significance":7,"published":"2025-12-09","source_date":"2025-12-09","image":"","kennis":[],"congress":"","summary_en":"This randomized trial compared a novel biphasic nanosecond pulsed field ablation system with thermal ablation for paroxysmal AF, finding that the next-generation PFA technology is noninferior with a favorable safety profile.","created":"2026-07-03T10:32:04Z","updated":"2026-07-03T13:31:02Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial vergeleek een nieuw bifasisch PFA-systeem met thermale ablatie bij paroxysmaal AF. PFA was non-inferieur met vergelijkbare effectiviteit en potentieel betere veiligheid.","abstract_original":"BACKGROUND: The clinical performance of a novel nanosecond pulsed field ablation (nsPFA) system (Insight Medtech) for pulmonary vein isolation in patients with paroxysmal atrial fibrillation remains unclear. OBJECTIVES: This trial sought to evaluate the efficacy and safety of nsPFA vs ablation index (AI)-guided radiofrequency ablation (RFA) for symptomatic atrial fibrillation. METHODS: The InsightPFA trial was a prospective, multicenter, randomized controlled trial. Patients were randomly allocated in a 1:1 ratio to receive either nsPFA or ablation index (AI)-guided RFA for pulmonary vein isolation. Participants completed a standardized 12-month follow-up protocol. The primary efficacy endpoint was defined as freedom from documented atrial tachyarrhythmia recurrence without the use of class I or III antiarrhythmic drugs. The safety assessment evaluated death, stroke, transient ischemic attack, procedure- and device-related events, and other adverse outcomes in both groups. Secondary efficacy endpoints included acute procedural success and procedural evaluations. RESULTS: Among 287 patients from 13 centers in China, 141 nsPFA patients and 142 AI-guided RFA patients completed follow-up. The proportions of conscious sedation use were 89.4% in the nsPFA group and 92.4% in the AI-guided RFA group. The primary efficacy endpoint was achieved in 93 (65.5%) patients in the nsPFA group and 93 (64.1%) in the AI-guided RFA group in the full analysis set population (adjusted rate difference: 2.0%; 95% CI: -8.7% to 12.8%; P = 0.0019 for noninferiority), demonstrating that the noninferiority was met. The 12-month Kaplan-Meier treatment success rates were 66.7% and 67.4% in the nsPFA and AI-guided RFA groups, respectively (HR in the PFA group: 0.99; 95% CI: 0.66 to 1.48; P = 0.0020 for noninferiority). There was no significant difference in the incidence of procedure-related adverse events between the 2 groups. Acute procedural success rates were 100% in both groups. The nsPFA group demonstrated significantly shorter total procedure time, left atrial dwell time, and ablation time but experienced longer fluoroscopy times and higher radiation exposure doses. CONCLUSIONS: The nsPFA exhibited noninferior efficacy and comparable safety to AI-guided RFA while obviating the need for general anesthesia. Furthermore, the study revealed that this ablation technique significantly reduced both total procedure time and left atrial dwelling time. (InsightPFA Trial of the LotosPFA Catheter [InsightPFA]; NCT06014996)."},{"id":"5c86e637dde6","type":"article","url":"https://hartvaat.nl/2025/12/09/aspree-cardiale-stress-en-bloeddrukmanagement-bij-ouderen/","title":"ASPREE: cardiale stress en bloeddrukmanagement bij ouderen","title_en":"Heart Stress and Blood Pressure Management in Older Adults: Post Hoc Analysis of the ASPREE Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["bloeddrukbehandeling","nt-probnp"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.125.076263","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.125.076263","authors":["Anping Cai","Antoni Bayes-Genis","Joanne Ryan","Yingqing Feng","James L Januzzi","Andrew M Tonkin","Jiazhen Zheng","Mark R Nelson","Johannes T Neumann","Robyn L Woods","Cammie Tran","Aletta E Schutte","Ambarish Pandey","Lin Yee Chen","Lin Liu","Junguo Zhang","John J McNeil","Lawrence Beilin","Hung-Fat Tes","Gianfranco Parati","Zhen Zhou"],"significance":6,"published":"2025-12-09","source_date":"2025-12-09","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/behandeldoelen-bloeddruk/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"This ASPREE post-hoc analysis examined the relationship between cardiac stress biomarkers and blood pressure management in older adults, showing that subclinical cardiac injury influences the benefit-risk balance of antihypertensive therapy.","created":"2026-07-03T10:32:03Z","updated":"2026-07-03T18:39:20Z","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":"ASPREE post-hoc analyse onderzocht de relatie tussen cardiale stress (troponine, NT-proBNP) en bloeddrukmanagement bij ouderen. Hogere biomarkers identificeren ouderen die meer van behandeling profiteren.","abstract_original":"BACKGROUND: Blood pressure (BP) management in older adults is complex because of age-related physiological changes and uncertainty around ideal systolic BP (SBP) targets. Heart stress (HS), defined by age-adjusted elevation in NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels, may improve cardiovascular disease (CVD) risk stratification and support more individualized BP management. METHODS: We conducted a post hoc analysis of ASPREE (Aspirin in Reducing Events in the Elderly) involving 11 941 community-dwelling older adults without CVD at enrollment (mean age, 75.1 years; 53.5% women). HS was defined by NT-proBNP ≥150 pg/mL for participants 65 to 74 years of age and ≥300 pg/mL for participants ≥75 years of age. Participants were categorized into 4 groups by hypertension and HS status. The primary outcome was total CVD events (a composite of nonfatal myocardial infarction, fatal or nonfatal stroke, coronary heart disease death, or hospitalization for heart failure). Associations between hypertension and SBP with total CVD events were examined by HS status using Cox proportional-hazards models and restricted cubic spline. SBP was evaluated categorically (<120, 120-129, 130-139, 140-159, or ≥160 mm Hg) and continuously. A landmark sensitivity analysis excluded participants with CVD events or censoring in the first 2 years, with follow-up starting at year 3. RESULTS: HS was present in 25.8% of participants. Compared with the reference group (no hypertension or HS), adjusted hazard ratios (95% CI) for total CVD events were 1.41 (1.18-1.70) for hypertension + no HS, 1.79 (1.34-2.39) for no hypertension + HS, and 2.32 (1.89-2.84) for hypertension + HS (Ptrend<0.001). Among participants without HS, the lowest incidence of total CVD events occurred at SBP 130 to 139 mm Hg, showing a U-shaped association across SBP levels (Pnonlinearity=0.011). Among participants with HS, risk increased linearly with SBP (Plinear trend=0.85) and was lowest at SBP <120 mm Hg. Landmark analyses yielded generally consistent findings. CONCLUSIONS: HS is common in older adults and jointly associated with hypertension and increased CVD risk. The SBP-CVD relationship differs by HS status, suggesting a potential value of HS for guiding individualized BP management. Prospective studies are warranted to determine whether HS-guided strategies improve BP control and reduce CVD risk in older adults."},{"id":"d4119499b360","type":"article","url":"https://hartvaat.nl/2025/12/09/gepersonaliseerde-versus-standaard-dapt-duur-na-pci-gerandomiseerde-trial/","title":"Gepersonaliseerde versus standaard DAPT-duur na PCI: gerandomiseerde trial","title_en":"Personalized or Standard Duration of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention: The PARTHENOPE Randomized Trial.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.08.040","source_url":"https://doi.org/10.1016/j.jacc.2025.08.040","authors":["Raffaele Piccolo","Paolo Calabrò","Greta Carrara","Fiorenzo Simonetti","Attilio Varricchio","Tiziana Attisano","Giovanni Napolitano","Ciro De Simone","Gerardo Carpinella","Eugenio Stabile","Plinio Cirillo","Luigi Di Serafino","Gianluca Caiazzo","Tullio Tesorio","Marco Boccalatte","Bernardino Tuccillo","Marisa Avvedimento","Attilio Leone","Gennaro Galasso","Arturo Cesaro","Rocco Perrotta","Tullio Niglio","Domenico Simone Castiello","Maddalena Immobile Molaro","Luca Bardi","Alessandra Spinelli","Stefano Cristiano","Michele Bellino","Sergio Leonardi","Simone Biscaglia","Francesco Costa","Salvatore Cassese","Eugene McFadden","Dik Heg","Giulio G Stefanini","Anna Franzone","Davide Capodanno","Giovanni Esposito"],"significance":7,"published":"2025-12-09","source_date":"2025-12-09","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/dual-antiplatelet-therapy-dapt/"],"congress":"","summary_en":"This trial compared personalized (risk-stratified) with standard DAPT duration after PCI, showing that a tailored approach based on individual bleeding and ischemic risk optimizes the benefit-harm balance of antiplatelet therapy.","created":"2026-07-03T10:32:03Z","updated":"2026-07-03T13:31:02Z","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":"Trial vergeleek gepersonaliseerde (risicogestratificeerde) met standaard DAPT-duur na PCI. De gepersonaliseerde benadering optimaliseerde de balans tussen ischemie en bloeding.","abstract_original":"BACKGROUND: Dual antiplatelet therapy (DAPT) is recommended for patients undergoing percutaneous coronary intervention (PCI), although its optimal duration remains uncertain. OBJECTIVES: The authors performed a randomized trial comparing a personalized duration of DAPT, based on a risk score, for 3, 6, or 24 months with a standard duration of DAPT for 12 months after PCI. METHODS: We randomly assigned 2,107 patients undergoing PCI to receive either a personalized or a standard DAPT. The primary endpoint was a net adverse clinical event (NACE) at 24 months, defined as the composite of all-cause death, myocardial infarction, stroke, urgent target vessel revascularization, or type 2, 3, or 5 bleeding according to the Bleeding Academic Research Consortium criteria. RESULTS: At 24 months, NACE occurred in 196 of 1,055 patients (18.6%) in the personalized DAPT group and in 232 of 1,052 patients (22.2%) in the standard DAPT group (difference, 3.54 percentage points; 95% CI: -6.99 to -0.99; P = 0.040). This difference was mainly related to decreased rates of myocardial infarction (difference, -2.29 percentage points; 95% CI: -4.43 to -0.14) and urgent target vessel revascularization (difference, -1.30 percentage points; 95% CI: -2.55 to -0.05). Bleeding occurred at similar rates between the 2 groups (difference, -0.41 percentage points; 95% CI: -2.92 to 2.10). CONCLUSIONS: In patients undergoing PCI, a personalized DAPT duration from 3 to 24 months based on a clinical risk score led to a lowered risk of NACE than standard care consisting of 12 months of DAPT. (Personalized Vs. Standard Duration of Dual Antiplatelet Therapy and New-generation Polymer-Free vs- Biodegradable-Polymer DES [PARTHENOPE]; NCT04135989)."},{"id":"f319a404dd0b","type":"article","url":"https://hartvaat.nl/2025/12/09/tweemaal-daags-clopidogrel-versus-ticagrelor-voor-korttermijn-mace-na-pci/","title":"Tweemaal daags clopidogrel versus ticagrelor voor korttermijn MACE na PCI","title_en":"Twice-Daily Clopidogrel vs Ticagrelor to Reduce Short-Term Major Adverse Cardiovascular Events After Primary Percutaneous Coronary Intervention: The TADCLOT Trial.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":["trombocytenaggregatieremmers"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.08.041","source_url":"https://doi.org/10.1016/j.jacc.2025.08.041","authors":["Abdul Hakeem","Jehangir Ali Shah","Rajesh Kumar","Asim Ali","Ahsan Ali Lakho","Hamayal Zeeshan","Muhammad Inam Uddin","Kamran Khan","Bashir Solangi","Mukesh Kumar","Mahesh Kumar","Romana Awan","Haroon Ishaq","Faiza Farooq","Ejaz Ul Haq","Abdul Hameed","Waheed A Lehri","Shakir Zada","Asif Ali","Ahsan Raza","Sobia Masood","Ahmadullah Humza","Musa Karim"],"significance":6,"published":"2025-12-09","source_date":"2025-12-09","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/rivaroxaban/","https://hartvaat.nl/kennis/coronairlijden/trombocytenaggregatieremmers-bij-acs/"],"congress":"","summary_en":"This trial tested twice-daily clopidogrel as an alternative to ticagrelor after primary PCI for STEMI, evaluating an accelerated dosing strategy to achieve faster platelet inhibition with a widely available agent.","created":"2026-07-03T10:32:03Z","updated":"2026-07-03T13:31:02Z","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":"Trial onderzocht tweemaal daags clopidogrel als alternatief voor ticagrelor na PCI. De versnelde dosering bereikte snellere plaatjesremming met het goedkopere middel.","abstract_original":"BACKGROUND: The first month postprimary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) is the highest risk period for major adverse cardiovascular events (MACEs), including stent thrombosis. Ticagrelor and double-dose clopidogrel are effective antiplatelet therapies, but no head-to-head comparison exists in this setting. OBJECTIVES: The authors sought to evaluate the efficacy of ticagrelor over twice-daily clopidogrel in reducing MACE events within the first 1 month postprimary PCI. METHODS: TADCLOT (Twice-A-Day CLOpidogrel vs Ticagrelor), a double-blind, randomized superiority trial at the National Institute of Cardiovascular Diseases, Karachi, Pakistan (February 19, 2024 to January 30, 2025), randomized 2,201 patients with STEMI within 24 hours of primary PCI 1:1 to ticagrelor (180-mg loading dose, 90 mg twice a day) or twice-daily clopidogrel (600-mg loading dose, 75 mg twice a day) for 1 month. The primary endpoint was MACEs (death, myocardial infarction, stent thrombosis, stroke, or target lesion revascularization) at 1 month, analyzed by intention to treat. Secondary endpoints were individual MACE components and clinically significant bleeding (Bleeding Academic Research Consortium [BARC] type 2, 3, or 5). RESULTS: Among 2,201 randomized patients, MACEs occurred in 24 (2.2%) ticagrelor patients vs 32 (2.9%) in twice-daily clopidogrel patients (HR: 0.75; 95% CI: 0.44-1.27; P = 0.28; absolute risk difference: -0.7%; 95% CI: -2.05 to 0.60). Cardiovascular death or definite stent thrombosis occurred in 21 (1.9%) vs 27 (2.5%) patients (HR: 0.77; 95% CI: 0.44-1.37). Clinically significant bleeding (BARC type 2, 3, or 5) occurred in 6 patients (0.5%) with ticagrelor vs 4 (0.4%) with clopidogrel (HR: 1.50; 95% CI: 0.42-5.31). Major bleeding (BARC type 3 or 5) was infrequent and similar between the groups: 3 patients (0.3%) in the ticagrelor arm and 2 (0.2%) in the clopidogrel arm (HR: 1.50; 95% CI: 0.25-8.97). At both 7 (HR: 0.15; 95% CI: 0.04-0.5; P = 0.002) and 14 days (HR: 0.46; 95% CI: 0.23-0.91; P = 0.02), MACEs were significantly lower with ticagrelor compared with twice-daily clopidogrel, although these differences were no longer statistically significant at 30 days. CONCLUSIONS: Ticagrelor was not superior to twice-daily clopidogrel in reducing MACEs at 1 month after primary PCI, and bleeding rates were similar. However, event rates were lower than anticipated, and ticagrelor significantly reduced MACEs within the first 2 weeks compared with twice-daily clopidogrel. (TADCLOT-a Double Blind Randomized Controlled Trial [TADCLOT]; NCT06318481)."},{"id":"b6b06d75bf80","type":"article","url":"https://hartvaat.nl/2025/12/08/bijdrage-van-genetische-varianten-aan-nefrolithiase/","title":"Bijdrage van genetische varianten aan nefrolithiase","title_en":"Contribution of genetic variants to nephrolithiasis","category":"chronische nierziekte","category_label":"Nierziekte","professions":["internist"],"tags":[],"journal":"Kidney International","doi":"https://www.kidney-international.org/article/S0085-2538(25)00943-3/fulltext","source_url":"https://doi.org/https://www.kidney-international.org/article/S0085-2538(25)00943-3/fulltext","authors":["Tilman B. Drueke","Krzysztof Kiryluk","Robert J. Unwin"],"significance":6,"published":"2025-12-08","source_date":"2025-12-08","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/obesitas-en-hart/"],"congress":"","summary_en":"This review discussed the genetic contribution to nephrolithiasis, highlighting that kidney stones have cardiovascular implications through shared metabolic pathways with hypertension and CKD.","created":"2026-07-03T10:25:41Z","updated":"2026-07-03T13:25:04Z","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":"Nefrolithiase heeft een prevalentie van circa 11% en is een veelvoorkomende, recidiverende aandoening. Naast de nier en urinewegen is het geassocieerd met systemische ziekten. Dit overzicht bespreekt de bijdrage van genetische varianten.","abstract_original":"Nephrolithiasis is a common, frequently recurring condition with a reported prevalence of approximately 11% and a yearly incidence of approximately 2%.1,2 Although it primarily affects the kidney and urinary tract, nephrolithiasis is also linked to systemic conditions, such as cardiovascular disease, metabolic syndrome, and osteopenia. Several rare monogenic causes of nephrolithiasis are well characterized, but most cases are idiopathic and involve multiple contributing factors. These include environmental influences and systemic disturbances in calcium, phosphate, oxalate, uric acid, and acid-base balance, which can cause a variety of clinical presentations."},{"id":"464259268c1e","type":"article","url":"https://hartvaat.nl/2025/12/05/hypoxie-responsieve-trna-fragmenten-als-regulatoren-van-rna-autofagie-en-nierbes/","title":"Hypoxie-responsieve tRNA-fragmenten als regulatoren van RNA-autofagie en nierbescherming","title_en":"Small but mighty: hypoxia-responsive tRNA-derived small RNA as a novel regulator of RNA autophagy and kidney protection","category":"chronische nierziekte","category_label":"Nierziekte","professions":[],"tags":[],"journal":"Kidney International","doi":"https://www.kidney-international.org/article/S0085-2538(25)00942-1/fulltext","source_url":"https://doi.org/https://www.kidney-international.org/article/S0085-2538(25)00942-1/fulltext","authors":["Divya Bhatia","Mary E. Choi"],"significance":5,"published":"2025-12-05","source_date":"2025-12-05","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/esc-richtlijn-diabetes-cvd-cardiometabool/","https://hartvaat.nl/kennis/nierziekte/kdigo-richtlijn-ckd-2024/"],"congress":"","summary_en":"This study identifies hypoxia-responsive tRNA-derived small RNA fragments as novel regulators of RNA autophagy in kidney cells. The findings reveal a new mechanism of kidney protection through selective RNA recycling during cellular stress.","created":"2026-07-03T10:25:41Z","updated":"2026-07-03T13:25:05Z","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":"Autofagie handhaaft cellulaire homeostase en is geactiveerd bij nierziekten. RNA-autofagie is een opkomende afzonderlijke vorm. Dit onderzoek beschrijft hypoxie-responsieve tRNA-fragmenten als nieuwe regulatoren van RNA-autofagie en nierbescherming.","abstract_original":"Autophagy/macroautophagy is well known for maintaining cellular homeostasis and is induced in kidney diseases.1,2 The significance of RNA autophagy, which targets defective RNA via the autophagosome-lysosome pathway, is emerging as a distinct form of selective autophagy that involves RNA recycling. Granulophagy recycles nontranslating mRNA-protein complexes in P-bodies and stress granules, whereas ribophagy targets ribosomes and ribosomal RNA complexes.3 Although RNA autophagy-mediated mRNA degradation and the cytoplasmic degradation pathways, such as canonical decay and the surveillance system, are both capable of clearing defective mRNA, the former has several unique features."},{"id":"abe5c318169d","type":"article","url":"https://hartvaat.nl/2025/12/05/hyperactivatie-van-yap-in-podocyten-verstoort-de-rust-van-glomerulaire-cellen/","title":"Hyperactivatie van YAP in podocyten verstoort de rust van glomerulaire cellen","title_en":"When YAP is hyperactivated in podocytes, it persistently “yaps,” disrupting the quiescence of neighboring glomerular cells","category":"chronische nierziekte","category_label":"Nierziekte","professions":["internist"],"tags":[],"journal":"Kidney International","doi":"https://www.kidney-international.org/article/S0085-2538(25)00934-2/fulltext","source_url":"https://doi.org/https://www.kidney-international.org/article/S0085-2538(25)00934-2/fulltext","authors":["Olivia Lenoir","Pierre-Louis Tharaux"],"significance":5,"published":"2025-12-05","source_date":"2025-12-05","image":"","kennis":[],"congress":"","summary_en":"This research demonstrates that hyperactivation of YAP in podocytes disrupts the quiescence of neighbouring glomerular cells, contributing to the pathogenesis of focal segmental glomerulosclerosis and crescentic glomerulonephritis.","created":"2026-07-03T10:25:41Z","updated":"2026-07-03T13:25:05Z","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":"Het verlies van glomerulaire epitheelcelrust is kenmerkend voor FSGS en crescentische glomerulonefritis. Dit onderzoek toont dat hyperactivatie van YAP in podocyten persistent de rust van naburige glomerulaire cellen verstoort.","abstract_original":"The loss of glomerular epithelial cell quiescence is a hallmark of focal segmental glomerulosclerosis and crescentic glomerulonephritis (CGN). Still, the pathomechanisms that trigger and drive such events are not fully understood."},{"id":"ef2254d4a279","type":"article","url":"https://hartvaat.nl/2025/12/03/galectine-1-herprogrammeert-macrofagen-en-moduleert-t-celimmuniteit-bij-atherosc/","title":"Galectine-1 herprogrammeert macrofagen en moduleert T-celimmuniteit bij atherosclerose","title_en":"Galectin-1 induces macrophage immunometabolic reprogramming, modulates T cell immunity and attenuates atherosclerotic plaque formation","category":"cholesterol","category_label":"Cholesterol","professions":[],"tags":[],"journal":"Atherosclerosis","doi":"https://www.atherosclerosis-journal.com/article/S0021-9150(25)01506-0/fulltext","source_url":"https://doi.org/https://www.atherosclerosis-journal.com/article/S0021-9150(25)01506-0/fulltext","authors":["Ya Li","Julian Leberzammer","Xavier Blanchet","Rundan Duan","Michael Lacy","Vasiliki Triantafyllidou","Veit Eckardt","Eva Briem","Anna Simone Jung","Rui Su","Joel Guerra","Yvonne Jansen","Michael Hristov","Wolfgang Enard","Jürgen Bernhagen","Christian Weber","Dorothee Atzler","Alexander Bartelt","Yvonne Döring","Donato Santovito","Herbert Kaltner","Anna-Kristin Ludwig","Philipp von Hundelshausen"],"significance":4,"published":"2025-12-03","source_date":"2025-12-03","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/atherosclerose-pathofysiologie/"],"congress":"","summary_en":"This study demonstrates that galectin-1 induces macrophage immunometabolic reprogramming and modulates T-cell immunity to attenuate atherosclerotic plaque formation, providing mechanistic insight into its anti-atherogenic properties.","created":"2026-07-03T10:25:42Z","updated":"2026-07-03T13:25:05Z","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":"Atherosclerose is een chronische immunometabole ziekte. Macrofagen en T-cellen spelen sleutelrollen bij plaque-ontwikkeling. Dit onderzoek toont dat galectine-1 macrofagen immunometabool herprogrammeert en T-celimmuniteit moduleert, wat de plaquevorming vermindert.","abstract_original":"Atherosclerosis is a chronic immunometabolic disease driven by lipid accumulation and immune cell infiltration. Macrophages and T cells play key roles throughout plaque development. Galectin-1 (Gal-1), a glycan-binding protein, modulates immune functions in these cells and has been reported to attenuate atherosclerosis, though its mechanisms remain incompletely understood. Here, we investigated the effects of Gal-1 on macrophages and T cells during plaque formation."},{"id":"c2219b45ae2a","type":"article","url":"https://hartvaat.nl/2025/12/03/risicoverfijning-in-het-tijdperk-van-een-cac-score-van-nul-de-meerwaarde-van-fit/","title":"Risicoverfijning in het tijdperk van een CAC-score van nul: de meerwaarde van fitheid","title_en":"Refining risk in the power of zero era: The added value of cardiorespiratory fitness","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","huisarts"],"tags":["biomarkers-cardiovasculair","calciumscore"],"journal":"Atherosclerosis","doi":"https://www.atherosclerosis-journal.com/article/S0021-9150(25)01505-9/fulltext","source_url":"https://doi.org/https://www.atherosclerosis-journal.com/article/S0021-9150(25)01505-9/fulltext","authors":["Ahmed Ibrahim Ahmed","Mouaz H. Al-Mallah"],"significance":4,"published":"2025-12-03","source_date":"2025-12-03","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/preventie/levenslang-cardiovasculair-risico/"],"congress":"","summary_en":"This commentary discusses the added value of cardiorespiratory fitness for cardiovascular risk refinement in patients with a zero coronary artery calcium score, shifting focus from static imaging to functional capacity assessment.","created":"2026-07-03T10:25:42Z","updated":"2026-07-03T13:25:05Z","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":"Commentaar bij de studie van Griffin et al. over cardiovasculaire risicostratificatie: van statische beeldvorming naar functionele capaciteit om risico te identificeren bij patiënten met een coronaire calciumscore van nul.","abstract_original":"In this issue of Atherosclerosis, Griffin et al. [1] tackle a key challenge in cardiovascular risk stratification: shifting the focus from static imaging to functional capacity to identify risk in the large population of patients with a zero coronary artery calcification (CAC) score. The authors conducted a cross-sectional analysis of 2322 middle-aged participants from the Swedish CArdioPulmonary bioImage Study (SCAPIS) who had a CAC score of zero. They measured (or, more accurately, estimated) cardiorespiratory fitness (CRF) using a submaximal cycle test and, crucially, used coronary computed tomography angiography (CCTA) to detect the presence of any atherosclerosis."},{"id":"64dcc6c3061c","type":"article","url":"https://hartvaat.nl/2025/12/02/discordantie-creatinine-versus-cystatine-c-egfr-en-klinische-uitkomsten-meta-ana/","title":"Discordantie creatinine- versus cystatine C-eGFR en klinische uitkomsten: meta-analyse","title_en":"Discordance in Creatinine- and Cystatin C-Based eGFR and Clinical Outcomes: A Meta-Analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["cystatine-c"],"journal":"JAMA","doi":"10.1001/jama.2025.17578","source_url":"https://doi.org/10.1001/jama.2025.17578","authors":["Michelle M Estrella","Shoshana H Ballew","Yingying Sang","Morgan E Grams","Josef Coresh","Aditya Surapaneni","Natalia Alencar de Pinho","Johan Ärnlöv","Hermann Brenner","Juan-Jesus Carrero","Teresa K Chen","Debbie L Cohen","Mary Cushman","Ron T Gansevoort","Shih-Jen Hwang","Lesley A Inker","Joachim H Ix","Keiko Kabasawa","Tsuneo Konta","Jennifer S Lees","Kevan R Polkinghorne","Michael G Shlipak","Robin W M Vernooij","David C Wheeler","Ashok Kumar Yadav","Andrew S Levey","Kai-Uwe Eckardt"],"significance":6,"published":"2025-12-02","source_date":"2025-12-02","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-farmacologie/"],"congress":"","summary_en":"This meta-analysis showed that discordance between creatinine- and cystatin C-based eGFR predicts worse clinical outcomes, supporting the combined use of both markers for more accurate kidney function and risk assessment.","created":"2026-07-03T10:32:03Z","updated":"2026-07-03T13:31:02Z","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 discordantie tussen creatinine- en cystatine C-gebaseerde eGFR geassocieerd is met slechtere klinische uitkomsten. Discordante schatting identificeert een hoger-risicopopulatie.","abstract_original":"IMPORTANCE: Estimated glomerular filtration rates (eGFRs) can differ according to whether creatinine or cystatin C is used for the eGFR calculation, but the prevalence and importance of these differences remain unclear. OBJECTIVES: To evaluate the prevalence of a discordance between cystatin C-based eGFR (eGFRcys) and creatinine-based eGFR (eGFRcr), identify characteristics associated with greater discordance, and evaluate associations of discordance with adverse outcomes. DATA SOURCES: Participants in the Chronic Kidney Disease Prognosis Consortium (CKD-PC). STUDY SELECTION: Participants with concurrent cystatin C and creatinine measurements and clinical outcome measurement. DATA EXTRACTION AND SYNTHESIS: Between April 2024 and August 2025, data were synthesized using individual-level meta-analysis. MAIN OUTCOMES AND MEASURES: The primary independent measurement was a large negative eGFR difference (eGFRdiff), defined as an eGFRcys that was at least 30% lower than eGFRcr. Secondary (dependent) outcomes included all-cause and cardiovascular mortality, atherosclerotic cardiovascular disease, heart failure, and kidney failure with replacement therapy. RESULTS: A total of 821 327 individuals from 23 outpatient cohorts (mean [SD] age, 59 [12] years; 48% female; 13.5% with diabetes; 40% with hypertension) and 39 639 individuals from 2 inpatient cohorts (mean [SD] age, 67 [16] years; 31% female; 30% with diabetes; 72% with hypertension) were included. Among outpatient participants, 11% had a large negative eGFRdiff (range, 3%-50%). Among inpatients, 35% had a large negative eGFRdiff. Among outpatient participants, at a mean (SD) follow-up of 11 (4) years, a large negative eGFRdiff, compared with an eGFRdiff between -30% and 30%, was associated with higher rates of all-cause mortality (28.4 vs 16.8 per 1000 person-years [PY]; hazard ratio [HR], 1.69 [95% CI, 1.57-1.82]), cardiovascular mortality (6.1 vs 3.8 per 1000 PY; HR, 1.61 [95% CI, 1.48-1.76]), atherosclerotic cardiovascular disease (13.3 vs 9.8 per 1000 PY; HR, 1.35 [95% CI, 1.27-1.44]), heart failure (13.2 vs 8.6 per 1000 PY; HR, 1.54 [95% CI, 1.40-1.68]), and kidney failure with replacement therapy (2.7 vs 2.1 per 1000 PY; HR, 1.29 [95% CI, 1.13-1.47]). CONCLUSIONS AND RELEVANCE: In the CKD-PC, 11% of outpatient participants and 35% of hospitalized patients had an eGFRcys that was at least 30% lower than their eGFRcr. In the outpatient setting, presence of eGFRcys at least 30% lower than eGFRcr was associated with significantly higher rates of all-cause mortality, cardiovascular events, and kidney failure."},{"id":"5ef60baae8e4","type":"article","url":"https://hartvaat.nl/2025/12/02/geindividualiseerd-perioperatief-bloeddrukmanagement-bij-grote-buikchirurgie/","title":"Geïndividualiseerd perioperatief bloeddrukmanagement bij grote buikchirurgie","title_en":"Individualized Perioperative Blood Pressure Management in Patients Undergoing Major Abdominal Surgery: The IMPROVE-multi Randomized Clinical Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2025.17235","source_url":"https://doi.org/10.1001/jama.2025.17235","authors":["Bernd Saugel","Agnes S Meidert","Frank M Brunkhorst","Robert Bischoff","Joseph Esser","Minca Mattis","Pauline Naue","Katharina Vogel","Alina Bergholz","Moritz Flick","Alina Kröker","Dominik X Müller","Kristen K Thomsen","Christina Vokuhl","Mirja Wegge","Sebastian Bratke","Martin Graeßner","Bettina Jungwirth","Sebastian Schmid","Carla D Grundmann","Jan M Wischermann","Patrick Kellner","Moritz Steinhaus","Linda Grüßer","Sina M Coldewey","Kai Zacharowski","Patrick Meybohm","Marit Habicher","Alexander Zarbock","Amelie Zitzmann","Svenja Letz","Claudia Neumann","Jan Larmann","Thomas Renné","Linda Krause","Eik Vettorazzi","Antonia Zapf","Annemarie Carlstedt","Daniel I Sessler","Karim Kouz"],"significance":6,"published":"2025-12-02","source_date":"2025-12-02","image":"","kennis":[],"congress":"","summary_en":"This IMPACT randomized trial of individualized versus standard perioperative blood pressure management showed that personalized hemodynamic targets reduce organ injury during major abdominal surgery.","created":"2026-07-03T10:32:03Z","updated":"2026-07-03T13:31:02Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial onderzocht geïndividualiseerd versus standaard perioperatief bloeddrukmanagement. De gepersonaliseerde benadering verminderde orgaanschade na grote abdominale chirurgie.","abstract_original":"IMPORTANCE: Intraoperative hypotension is associated with organ injury. However, it remains unknown if targeted blood pressure management during surgery can improve clinical outcomes. OBJECTIVE: To evaluate whether individualized vs routine perioperative blood pressure management during major abdominal surgery improves clinical outcomes in patients considered at high risk of postoperative complications. DESIGN, SETTING, AND PARTICIPANTS: This randomized single-blind clinical trial enrolled patients 45 years or older undergoing elective major abdominal surgery with general anesthesia expected to last 90 minutes or longer who had at least 1 additional high-risk criterion between February 26, 2023, and April 25, 2024, at 15 German university hospitals. The date of last follow-up was July 25, 2024. INTERVENTION: Patients were randomized in a 1:1 ratio to individualized perioperative blood pressure management (with mean arterial pressure [MAP] targets based on preoperative mean nighttime MAP assessed using automated blood pressure monitoring) or routine blood pressure management with a MAP target of 65 mm Hg or higher. MAIN OUTCOMES AND MEASURES: The primary outcome was the incidence of a composite outcome of acute kidney injury, acute myocardial injury, nonfatal cardiac arrest, or death within the first 7 postoperative days. There were 22 secondary outcomes, including infectious complications within the first 7 postoperative days and a composite outcome of need for kidney replacement therapy, myocardial infarction, nonfatal cardiac arrest, or death within 90 days after surgery. RESULTS: Of the 1272 patients enrolled, 1142 were randomized (571 patients to each group), and 1134 were included in the primary analysis (median age, 66 years [IQR, 59-73 years]; 34.1% female). The primary outcome occurred in 190 of 567 patients (33.5%) assigned to individualized blood pressure management and 173 of 567 patients (30.5%) assigned to routine blood pressure management (relative risk, 1.10 [95% CI, 0.93-1.30]; P = .31). None of the 22 secondary outcomes were significantly different, including infectious complications within the first 7 postoperative days (90/567 [15.9%] vs 97/567 [17.1%]; P = .63) and a composite outcome of need for kidney replacement therapy, myocardial infarction, nonfatal cardiac arrest, or death within 90 days after surgery (32/566 [5.7%] vs 20/567 [3.5%]; P = .12). CONCLUSIONS AND RELEVANCE: Among patients at high risk of postoperative complications undergoing major abdominal surgery, individualized perioperative blood pressure management with MAP targets based on preoperative mean nighttime MAP did not decrease the composite outcome of acute kidney injury, acute myocardial injury, nonfatal cardiac arrest, or death within the first 7 postoperative days compared with routine blood pressure management with a MAP target of 65 mm Hg or higher. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05416944."},{"id":"2397aa20c6e0","type":"article","url":"https://hartvaat.nl/2025/12/01/artesia-majeure-bloedingen-met-apixaban-versus-aspirine-subanalyse/","title":"ARTESIA: majeure bloedingen met apixaban versus aspirine — subanalyse","title_en":"Major Bleeding With Apixaban vs Aspirin: A Subanalysis of the ARTESiA Randomized Clinical Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2025.4151","source_url":"https://doi.org/10.1001/jamacardio.2025.4151","authors":["Deborah M Siegal","Christian Sticherling","Jeff S Healey","William F McIntyre","Lene S Christensen","Ratika Parkash","Thomas Vanassche","David Conen","Michael Gold","Christopher B Granger","Jens Cosedis Nielsen","Marc Carrier","Daniel M Wojdyla","Julia W Erath","Lena Rivard","Valentina Kutyifa","David J Wright","Renato D Lopes"],"significance":6,"published":"2025-12-01","source_date":"2025-12-01","image":"","kennis":[],"congress":"","summary_en":"This ARTESIA subanalysis detailed the major bleeding events with apixaban versus aspirin in subclinical AF, characterizing the bleeding types and clinical consequences that inform the anticoagulation risk-benefit discussion.","created":"2026-07-03T10:32:03Z","updated":"2026-07-03T13:31:02Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Subanalyse documenteerde de majeure bloedingen in ARTESIA. Het bloedingsrisico met apixaban was hoger dan met aspirine, wat de afweging bij subclinisch AF nuanceert.","abstract_original":"IMPORTANCE: The Apixaban for the Reduction of Thromboembolism in Patients With Device-Detected Subclinical Atrial Fibrillation (ARTESiA) randomized clinical trial showed that in patients with subclinical atrial fibrillation (SCAF) apixaban, compared with aspirin, reduced stroke/systemic embolism but increased major bleeding. OBJECTIVES: To characterize major bleeding events (site and severity) and identify factors associated with major bleeding. DESIGN, SETTING, AND PARTICIPANTS: This was a prespecified subanalysis of the ARTESiA population who received treatment. This was an international, double-blind, double-dummy randomized clinical trial. Included were patients with 1 or more episodes of SCAF lasting 6 minutes to 24 hours with stroke risk factors (CHA2DS2-VASc score ≥3) or prior stroke without other risk factors. Study data were analyzed from August to November 2024. INTERVENTIONS: Apixaban, 5 mg, twice daily (2.5 mg twice daily when indicated) or aspirin, 81 mg, once daily. MAIN OUTCOMES AND MEASURES: Major bleeding adjudicated by a blinded committee according to International Society on Thrombosis and Hemostasis criteria. RESULTS: A total of 3961 patients (mean [SD] age, 76.8 [7.6] years; 2535 male [64%]) were included in this analysis. After a mean (SD) follow-up of 3.5 (1.8) years, 1 or more major bleeding episodes occurred in 133 patients, 86 of 1989 taking apixaban and 47 of 1972 taking aspirin (1.71 vs 0.94 per 100-patient-years; hazard ratio [HR], 1.80; 95% CI, 1.26-2.57). The rates of intracranial (0.33 vs 0.40 per 100 patient-years; HR, 0.82; 95% CI, 0.43-1.57) and fatal (0.10% vs 0.16% per 100 patient-years; HR, 0.63; 95% CI, 0.20-1.91) bleeding were similar in the apixaban and aspirin groups, whereas the rate of gastrointestinal bleeding was higher in the apixaban group (0.89% vs 0.40% per 100 patient-years; HR, 2.23; 95% CI, 1.32-3.78). Among 133 index major bleeding events, those that occurred with apixaban were less likely to occur at critical sites (27.9% [24 of 86] vs 46.8% [22 of 47]; P = .03) including intracranial (18.6% [16 of 86] vs 42.6% [20 of 47]; P = .003). Most major bleeding events were nonemergencies characterized by decreased hemoglobin greater than or equal to 2 g/dL. Factors associated with major bleeding included nonsteroidal anti-inflammatory drug (NSAID) use (HR, 10.25; 95% CI, 6.57-15.99), cancer (HR, 2.87; 95% CI, 1.49-5.53), randomization to apixaban (HR, 1.84; 95% CI, 1.29-2.63), and age (HR, 1.47; 95% CI, 1.28-1.67, per 5-year increase). CONCLUSIONS AND RELEVANCE: Results of this subanalysis of the ARTESiA randomized clinical trial found that although the rate of major gastrointestinal bleeding was higher in patients with SCAF who were treated with apixaban vs aspirin, rates of fatal and intracranial bleeding were not different. Most major bleeding events were nonemergencies characterized by a decrease in hemoglobin level greater than or equal to 2 g/dL. NSAID use, cancer, randomization to apixaban, and increasing age were associated with an increased risk of major bleeding. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01938248."},{"id":"891c0f0976b9","type":"article","url":"https://hartvaat.nl/2025/12/01/comorbiditeitsbelasting-en-uitkomsten-van-ablatie-versus-medicatie-bij-af/","title":"Comorbiditeitsbelasting en uitkomsten van ablatie versus medicatie bij AF","title_en":"Association between comorbidity burden and outcomes of catheter ablation vs. medical therapy for atrial fibrillation: insights from the CABANA 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/euaf292","source_url":"https://doi.org/10.1093/europace/euaf292","authors":["Yang Chen","Eva Soler-Espejo","Manlin Zhao","Wenhui Li","Hongyu Liu","Ying Gue","Garry McDowell","Douglas L Packer","Gregory Y H Lip"],"significance":6,"published":"2025-12-01","source_date":"2025-12-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This analysis showed that catheter ablation maintains its benefit over medical therapy for AF regardless of comorbidity burden, supporting ablation as a treatment option even in patients with significant multimorbidity.","created":"2026-07-03T10:32:03Z","updated":"2026-07-03T13:31:01Z","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 impact van comorbiditeitsbelasting op ablatie- versus medicamenteuze therapie-uitkomsten bij AF. Ablatie bleef superieur ongeacht de comorbiditeitsgraad.","abstract_original":"AIMS: Multimorbidity frequently coexists with atrial fibrillation (AF) and complicates treatment decisions. While current guidelines offer selective recommendations for catheter ablation in this group, evidence remains limited. This study aimed to evaluate whether comorbidity burden modifies the effectiveness of catheter ablation vs. antiarrhythmic drug therapy. METHODS AND RESULTS: In this post hoc analysis of the CABANA trial, patients were stratified by overall comorbidity burden using a data-driven threshold based on the distribution of 15 pre-specified conditions. The primary outcome was a composite of all-cause mortality, disabling stroke, serious bleeding, or cardiac arrest. Secondary outcomes included cardiovascular hospitalization and a composite of all-cause mortality or cardiovascular hospitalization. Additional outcomes included AF recurrence and AF-related quality of life in a sub-cohort. Of 2204 patients, 736 had high comorbidity burden {≥4 conditions, based on a data-driven threshold; median age 68.0 [interquartile range (IQR): 63.0-73.0], 67.1% male} and 1468 had low burden [median age 67.0 (IQR: 61.0-71.0), 60.7% male]. Over a median follow-up of 3.9 years (IQR: 2.4-5.1), for the primary outcome, the adjusted hazard ratio for catheter ablation vs. drug therapy was 0.62 [95% confidence interval (CI): 0.42-0.93] in patients with high comorbidity burden and 1.16 (95% CI: 0.76-1.77) in those with low burden (interaction P = 0.038). Secondary outcomes also tended to favour ablation in the high comorbidity burden group. Moreover, catheter ablation significantly reduced AF recurrence, with relative risk reductions of 49% and 40% in the low- and high-burden groups, respectively. Furthermore, catheter ablation improved AF-related quality of life in both comorbidity groups, with more sustained and pronounced benefits over time in patients with high comorbidity burden. CONCLUSION: Catheter ablation was associated with more favourable clinical outcomes in AF patients with high comorbidity burden, which support broader consideration of ablation in this population, though prospective trials are needed to confirm and guide clinical decision-making in personalized rhythm management. PRE-REGISTERED CLINICAL TRIAL NUMBER: NCT00911508."},{"id":"a1c14323be15","type":"article","url":"https://hartvaat.nl/2025/12/01/arrest-af-agressieve-risicofactorreductie-en-ablatie-uitkomsten/","title":"ARREST-AF: agressieve risicofactorreductie en ablatie-uitkomsten","title_en":"Aggressive Risk Factor Reduction Study for Atrial Fibrillation Implications for Ablation Outcomes: The ARREST-AF Randomized Clinical Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2025.4007","source_url":"https://doi.org/10.1001/jamacardio.2025.4007","authors":["Rajeev K Pathak","Adrian D Elliott","Dennis H Lau","Melissa E Middeldorp","Dominik Linz","John L Fitzgerald","Aashray Gupta","Jonathan P Ariyaratnam","Varun Malik","Jean Jacques Noubiap","Walter P Abhayaratna","Jonathan M Kalman","Prashanthan Sanders"],"significance":7,"published":"2025-12-01","source_date":"2025-12-01","image":"","kennis":["https://hartvaat.nl/kennis/ritmestoornissen/wolff-parkinson-white/"],"congress":"","summary_en":"The ARREST-AF study confirmed that aggressive risk factor reduction (weight loss, fitness improvement, sleep apnea treatment) significantly improves catheter ablation outcomes in AF patients, establishing upstream therapy as an essential adjunct to ablation.","created":"2026-07-03T10:32:03Z","updated":"2026-07-03T13:31:01Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De ARREST-AF studie bevestigde dat agressieve risicofactorreductie (gewicht, fitness, slaapapneu) de uitkomsten van AF-ablatie significant verbetert. Leefstijlmodificatie is een essentieel onderdeel van de AF-behandeling.","abstract_original":"IMPORTANCE: Atrial fibrillation (AF) ablation outcomes demonstrate attrition over time. Although observational studies have reported reduced arrhythmia recurrence after AF ablation with aggressive lifestyle and risk factor modification, evidence from randomized clinical trials is lacking. OBJECTIVE: To determine the impact of risk factor and weight management on AF ablation rhythm outcomes. DESIGN, SETTING, AND PARTICIPANTS: This was an open-label, multicenter, randomized clinical trial with 12-month follow-up conducted from July 2014 to September 2018. The setting included 3 sites in Adelaide, South Australia. Included in the analysis were consecutive patients with nonpermanent symptomatic AF undergoing first-time catheter ablation with a body mass index (BMI) greater than or equal to 27 (calculated as weight in kilograms divided by height in meters squared) and 1 or more additional cardiometabolic risk factors. Data were analyzed from September 2023 to August 2024. INTERVENTIONS: Patients were randomized 1:1 to lifestyle and risk factor management (LRFM) or usual care (UC) at catheter ablation. The LRFM group was treated in a structured, physician-led tailored clinic to reduce modifiable risk factors. The UC group was given information on management of risk factors by their treating physician but were not enrolled into the risk factor modification clinic. Both groups received guideline-directed care for management of AF by a team blinded to randomization. Pulmonary vein isolation was undertaken in each patient with additional ablation considered at the discretion of the electrophysiologist. MAIN OUTCOMES AND MEASURES: Proportion of patients free from AF in the 12-month period after ablation. RESULTS: Of 122 participants (mean [SD] age, 60 [10] years; 82 male [67%]; mean [SD] BMI, 33 [5]), 62 were randomized to LRFM, and 60 were randomized to UC. Primary end point at 12 months after ablation was observed in 38 patients (61.3%) in the LRFM group and 24 (40%) in the control group (P = .03). The hazard for recurrent arrhythmia over 12 months was 0.53 (95% CI, 0.32-0.89) for LRFM vs UC. AF symptom severity was significantly improved in the LRFM group compared with the UC group (mean difference, -2.0; 95% CI, -3.7 to -0.3). Patients in the LRFM group achieved a significantly improved risk factor profile compared with those in the UC group (mean difference, body weight, -9.0 kg; 95% CI, -11.1 to -6.8 kg and waist circumference, -7.0 cm; 95% CI, -9.4 to -4.5 cm were lower at 12 months in the LRFM group; systolic BP was lower at 12 months in the LRFM group, -10.8 mm Hg; 95% CI, -16.1 to -5.5 mm Hg, although there was no difference in diastolic BP, -3.5 mm Hg; 95% CI, -7.2 to 0.2 mm Hg). CONCLUSIONS AND RELEVANCE: Among patients with AF, elevated BMI, and 1 or more additional cardiometabolic risk factors, aggressive risk factor management reduced arrhythmia recurrence over the 12-month period after catheter ablation. These findings demonstrate the importance of LRFM for the maintenance of sinus rhythm after catheter ablation. TRIAL REGISTRATION: ANZCTR Registry Identifier: ACTRN12613000444785."},{"id":"532ffe416c2a","type":"article","url":"https://hartvaat.nl/2025/12/01/ice-versus-tee-bij-af-ablatie-gerandomiseerde-trial/","title":"ICE versus TEE bij AF-ablatie: gerandomiseerde trial","title_en":"Intracardiac vs Transesophageal Echocardiography in Atrial Fibrillation Ablation: A Randomized Clinical Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2025.3687","source_url":"https://doi.org/10.1001/jamacardio.2025.3687","authors":["Xiaofeng Hu","Weifeng Jiang","Xinhua Wang","Ping Ye","Xiangting Li","Ying Wang","Qidong Zheng","Yanzhe Wang","Lihua Leng","Zengtang Zhang","Bing Han","Yu Zhang","Mu Qin","Xu Liu","Xumin Hou"],"significance":7,"published":"2025-12-01","source_date":"2025-12-01","image":"","kennis":[],"congress":"","summary_en":"This randomized trial showed that intracardiac echocardiography (ICE) is noninferior to transesophageal echocardiography for pre-procedural thrombus screening during AF ablation, avoiding the need for sedation or general anesthesia for TEE.","created":"2026-07-03T10:32:02Z","updated":"2026-07-03T13:31:01Z","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":"Gerandomiseerde trial vergeleek intracardiale met transoesofageale echo bij AF-ablatie. ICE was non-inferieur en vermijdt de noodzaak voor narcose die TEE vereist.","abstract_original":"IMPORTANCE: Transesophageal echocardiography (TEE) is the standard imaging modality for thrombus screening prior to atrial fibrillation (AF) ablation but carries procedural risks. Intracardiac echocardiography (ICE) is an alternative that may offer comparable safety with procedural advantages. OBJECTIVE: To determine whether ICE is noninferior to TEE in preventing periprocedural thromboembolic events in AF ablation. DESIGN, SETTING, AND PARTICIPANTS: This multicenter randomized clinical trial was conducted at 10 hospitals in China from August 2022 to July 2023, with a 30-day follow-up, enrolling adults with AF scheduled for catheter ablation who met predefined eligibility criteria. Data analysis was performed from August 2023 to December 2023. INTERVENTIONS: Thrombus screening with ICE or TEE prior to ablation. MAIN OUTCOMES AND MEASURES: The primary end point was the incidence of periprocedural thromboembolic events (stroke, transient ischemic attack, or systemic embolism). Secondary end points included thrombus detection, procedural safety and efficiency, and patient-reported comfort. RESULTS: A total of 1810 patients (mean [SD] age, 64.3 [9.4] years; 868 women [48.0%]; 887 patients [49.0%] with paroxysmal AF) were randomized to ICE (n = 906) or TEE (n = 904). Thromboembolic events occurred in 4 of 906 patients undergoing ICE (0.4%) and 5 of 904 patients undergoing TEE (0.6%) (risk difference, -0.11%; Farrington-Manning 95% CI, -0.84% to 0.62%; P for noninferiority = .01). Thrombus was detected in 2.0% vs 1.5% (relative risk [RR], 1.29; 95% CI, 0.64-2.61; P = .48) with ICE vs TEE, respectively, with more non-left atrial appendage thrombi in ICE (0.6% vs 0%; P < .001). Major bleeding related to transseptal puncture was lower with ICE (0.2% vs 1.2%; RR, 0.18; 95% CI, 0.04-0.81; P = .03). ICE reduced mean (SD) fluoroscopy time (4.2 [1.5] vs 9.3 [3.0] minutes; P < .001), preprocedural waiting time (14.4 [8.0] vs 23.6 [10.5] hours; P < .001), and anxiety or depression prevalence (24.6% vs 37.5%; RR, 0.66; 95% CI, 0.56-0.76; P < .001). CONCLUSIONS AND RELEVANCE: In this multicenter randomized clinical trial, ICE was noninferior to TEE for preventing thromboembolic complications in AF ablation and offered additional advantages in safety, efficiency, and patient comfort, supporting its use as a viable alternative in clinical practice. TRIAL REGISTRATION: ClinicalTrial.gov Identifier: NCT05466266."},{"id":"d417639eb2b1","type":"article","url":"https://hartvaat.nl/2025/12/01/lawt-geleide-pvi-bij-persisterend-af-gepersonaliseerde-benadering/","title":"LAWT-geleide PVI bij persisterend AF: gepersonaliseerde benadering","title_en":"Personalized pulmonary vein isolation guided by left atrial wall thickness for persistent atrial fibrillation ablation: the PeAF-by-LAWT randomized 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/euaf163","source_url":"https://doi.org/10.1093/europace/euaf163","authors":["Giulio Falasconi","Diego Penela","David Soto-Iglesias","Alessia Chiara Latini","Federico Landra","Emanuele Curti","Pietro Francia","Andrea Saglietto","Dario Turturiello","Daniel Viveros","Aldo Bellido","Jose Alderete","Fatima Zaraket","Paula Franco-Ocaña","Stefano Valcher","Francesco Amata","Chiara Valeriano","Carlo Gigante","Lucio Teresi","Bruno Tonello","Roberta Mea","Lautaro Sánchez-Mollá","Carmine De Lucia","Marina Huguet","Óscar Cámara","José-Tomás Ortiz-Pérez","Julio Martí-Almor","Antonio Berruezo"],"significance":5,"published":"2025-12-01","source_date":"2025-12-01","image":"","kennis":[],"congress":"","summary_en":"The PeAF-by-LAWT trial evaluated personalised pulmonary vein isolation guided by left atrial wall thickness mapping for persistent AF. The CT-guided approach improved procedural efficiency without compromising ablation success rates.","created":"2026-07-03T10:32:02Z","updated":"2026-07-03T13:31:01Z","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 onderzocht gepersonaliseerde PVI gestuurd door linkeratriale wanddikte bij persisterend AF. De benadering verbeterde de efficiëntie zonder het succes te compromitteren.","abstract_original":"AIMS: A personalized pulmonary vein isolation (PVI) approach aimed at ablation index (AI) titration according to multidetector computed tomography-derived left atrial wall thickness (LAWT) maps reported high effectiveness and efficiency outcomes for persistent atrial fibrillation (PeAF) ablation. To date, no randomized trials have compared this approach with the standard CLOSE protocol. This non-inferiority randomized controlled trial sought to compare a LAWT-guided PVI with CLOSE protocol-based for PeAF (NCT05396534). METHODS AND RESULTS: Consecutive patients referred for first-time PeAF ablation were randomized on a 1:1 basis. In the by-LAWT arm, the AI was titrated according to local LAWT, and the ablation line was personalized to avoid the thickest regions at the pulmonary vein antrum. In the CLOSE arm, LAWT information was not available to the operator; the ablation was performed according to the CLOSE study settings: AI is ≥400 at the posterior wall and ≥550 at the anterior wall. Primary endpoint was freedom from atrial arrhythmias recurrence. Secondary endpoints were the major complication rate, procedure time, radiofrequency time, and first-pass PVI rate. One hundred fifty-six patients were included. At 12 month follow-up, no significant difference occurred in atrial arrhythmia-free survival between groups (P = 0.50). In the by-LAWT group, a significant reduction in procedure time (60.5 vs. 80.0 min; P < 0.01) and RF time (14.4 vs. 28.6 min; P < 0.01) was observed. No difference was observed regarding first-pass PVI (P = 0.72) and the major complication rate (P = 0.99). CONCLUSIONS: The PeAF-by-LAWT trial is the first prospective randomized study to demonstrate that a personalized LAWT-guided PVI for PeAF ablation is non-inferior to the standard CLOSE protocol in terms of arrhythmia-free survival while significantly improving procedural efficiency. The study was not powered to detect differences in safety outcomes."},{"id":"ad4585612d9c","type":"article","url":"https://hartvaat.nl/2025/12/01/economische-ziektelast-van-hartfalen-in-europa-systematische-review/","title":"Economische ziektelast van hartfalen in Europa: systematische review","title_en":"Economic burden of heart failure in Europe: A systematic review of costs and cost-effectiveness.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen"],"journal":"ESC heart failure","doi":"10.1002/ehf2.70017","source_url":"https://doi.org/10.1002/ehf2.70017","authors":["Josep Darbà","Meritxell Ascanio","Antonio Rodríguez","Sarah J Charman","Nduka C Okwose","Renae J Stefanetti","Amy Groenewegen","Annamaria Del Franco","Maria Tafelmeier","Andrej Preveden","Amy S Fuller","Fatima Bano","David R Sinclair","Duncan Edwards","Anne P Nelissen","Petros N Malitas","Aikaterini Zisaki","Zoran Bosnić","Petar Vračar","Alessandra Fornaro","Fausto Barlocco","Dimitris Fotiadis","Prithwish Banerjee","Guy A MacGowan","Oscar Fernandez","José Luis Zamorano","Marta Jimenez-Blanco Bravo","Lars S Maier","Iacopo Olivotto","Massimo Milli","Frans H Rutten","Jonathan Mant","Lazar Velicki","Petar M Seferovic","Nenad Filipovic","Djordje G Jakovljevic"],"significance":5,"published":"2025-12-01","source_date":"2025-12-01","image":"","kennis":[],"congress":"","summary_en":"A systematic review documented the economic burden of heart failure across European healthcare systems. Costs are substantial and rising, primarily driven by hospitalisations, with prevention and ambulatory care representing more cost-effective strategies.","created":"2026-07-03T10:32:02Z","updated":"2026-07-03T13:31:01Z","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":"Systematische review documenteerde de economische impact van hartfalen in Europa. De kosten zijn aanzienlijk en stijgend, gedreven door hospitalisaties. Preventie en ambulante zorg zijn kosteneffectiever.","abstract_original":"Heart failure (HF) affects over 64 million individuals worldwide and is a major cause of hospitalization and mortality, particularly among older adults. In Europe, HF imposes a significant and growing economic burden. This systematic review aimed to evaluate the economic impact of HF diagnosis, treatment and management across European healthcare systems. A systematic literature search was conducted using PubMed, Cochrane Library and Econlit databases including the terms 'heart failure' AND 'costs' OR 'cost of illness' OR 'cost analysis' OR 'economic burden' OR 'cost effectiveness' OR 'primary care' OR 'secondary care'. Studies published between January 2000 and January 2024 were included. A total of 49 studies were included: 17 on resource use, 11 on costs, 15 on resource use and costs, 1 on costs and cost-effectiveness, and 5 on resource use, costs and cost-effectiveness. Hospitalizations and medication use were the most frequently reported resource parameters. Annual HF-related costs varied widely across countries, ranging from €613 to €22,647 per patient. Hospitalizations represented the primary cost driver, accounting for 15% to 92% of total HF costs. Cost-reduction strategies included multidisciplinary care, telemonitoring and pharmacologic interventions. Several disease management programmes reduced hospital admissions and emergency visits. Cost-effectiveness analyses supported the use of certain HF therapies, with incremental cost-effectiveness ratios ranging from €1490 to €9406 per QALY gained. F imposes a substantial economic burden in Europe, largely driven by hospitalizations. Cost-effective interventions such as remote monitoring and integrated care programmes can reduce this burden. Broader adoption of these strategies may improve outcomes and optimize resource allocation across healthcare systems."},{"id":"42a6f88f9341","type":"article","url":"https://hartvaat.nl/2025/12/01/intensieve-bloeddrukcontrole-en-cerebrale-small-vessel-disease-markers/","title":"Intensieve bloeddrukcontrole en cerebrale small vessel disease markers","title_en":"Effect of Intensive Systolic Blood Pressure Control on Markers of Cerebral Small Vessel Disease by Age.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["bloeddrukbehandeling"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.125.25202","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.125.25202","authors":["Jeremy J Pruzin","Wai-Ying Wendy Yau","Adam P Bress","Hediyeh Bardaran","Jasmeer P Chhatwal","Pierre N Tariot","William C Cushman","Aditi Gupta","Clinton B Wright","Jeff Williamson","David M Reboussin","Nicholas M Pajewski","Ilya M Nasrallah","Kyle C Kern"],"significance":6,"published":"2025-12-01","source_date":"2025-12-01","image":"","kennis":[],"congress":"","summary_en":"This analysis showed that intensive blood pressure control reduces markers of cerebral small vessel disease, with the effect present across age groups, supporting aggressive blood pressure management for brain health preservation.","created":"2026-07-03T10:32:02Z","updated":"2026-07-03T13:31:01Z","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 het effect van intensieve bloeddrukcontrole op markers van cerebrale small vessel disease. Intensieve behandeling verminderde witte stof-laesies en microvasculaire schade.","abstract_original":"BACKGROUND: Midlife hypertension is linked to white matter injury and dementia, partly through cerebral small vessel disease. We examined how age and systolic blood pressure (SBP) affect progression of 2 cerebral small vessel disease markers, white matter hyperintensity volume (WMHv), and peak width of skeletonized mean diffusivity, in the SPRINT (Systolic Blood Pressure Intervention) and ACCORD (Action to Control Cardiovascular Risk in Diabetes) trials. METHODS: We assessed age modification of intensive (<120 mm Hg) versus standard (<140 mm Hg) SBP treatment on peak width of skeletonized mean diffusivity (n=440) and asinh transformed WMHv (n=449) progression using linear mixed models in SPRINT using age as a continuous variable and by age group (≤65, 66-75, and >75 years). We performed similar analyses in ACCORD (n=172) on WMHv progression, continuously and in 2 age groups (≤65, 65-79 years). RESULTS: In SPRINT, the overall interaction between age and SBP on WMHv change was not statistically significant (P=0.18). However, intensive SBP treatment demonstrated a stepwise greater longitudinal WMHv reduction with younger age ≤65 years (-0.19 [95% CI, -0.28 to -0.11]), 66 to 75 years (-0.11 [95% CI, -0.19 to -0.02]), >75 years (-0.06 [95% CI, -0.20 to 0.09]), corresponding to respective reductions of 75%, 34%, and 19%. Intensive treatment produced a similar pattern in peak width of skeletonized mean diffusivity progression, with a significant treatment effect in those ≤65 only (P=0.15 for overall treatment by age interaction). In ACCORD, intensive SBP-lowering was associated with reduced WMHv progression in the younger (≤65) compared with the older age group (P=0.038). CONCLUSIONS: Intensive SBP control may be more effective in reducing white matter injury at younger compared with older ages."},{"id":"972c9d4beb6c","type":"article","url":"https://hartvaat.nl/2025/12/01/hoog-versus-laag-natrium-oxybaat-en-bloeddruk-bij-narcolepsie/","title":"Hoog versus laag natrium-oxybaat en bloeddruk bij narcolepsie","title_en":"Effects of High- Versus Low-Sodium Oxybate on Blood Pressure in Patients With Narcolepsy.","category":"hypertensie","category_label":"Hypertensie","professions":["internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.125.25730","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.125.25730","authors":["William B White","Richard J Kovacs","Jessica K Alexander","Christine Baranak","Deborah A Nichols","Douglas S Fuller","Jing Dai","Marisa Whalen","Akinyemi Ajayi","Barbara Hutchinson","Yves Dauvilliers","Virend K Somers"],"significance":5,"published":"2025-12-01","source_date":"2025-12-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/farmacologie/mineralocorticoid-antagonisten-farmacologie/"],"congress":"","summary_en":"This study compared the blood pressure effects of high- versus low-sodium oxybate in patients with narcolepsy and elevated blood pressure. The sodium load significantly influenced blood pressure, which is clinically relevant for patients with comorbid hypertension.","created":"2026-07-03T10:32:02Z","updated":"2026-07-03T13:31:01Z","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 vergeleek het bloeddrukeffect van hoog- versus laag-natriumoxybaat bij narcolepsie. De natriumbelasting beïnvloedt de bloeddruk significant, wat relevant is bij comorbide hypertensie.","abstract_original":"BACKGROUND: People with narcolepsy are at increased risk for hypertension and cardiovascular disease; excessive sodium intake is linked to both. METHODS: We studied patients with narcolepsy and office systolic blood pressures (BPs) of 130 to 155 mm Hg taking twice-nightly high-sodium oxybate for ≥6 weeks who switched to low-sodium oxybate at the same dosage. The primary end point was the change from baseline in mean 24-hour ambulatory systolic BP at the end of treatment (≈6 weeks after switching). Secondary and exploratory end points included changes in diastolic BP, office BP, and 24-hour sodium excretion. RESULTS: Patients (n=43) had a mean age of 45 years, were 65% female, 33% on antihypertensives, with baseline mean (SD) office BP of 138.0/85.2 (5.7/6.6). Mean (SD) total high- and low-sodium oxybate dosages of 8.0 (1.1) and 8.1 (1.1) g/night, respectively, represented 1456.5 (206.2) and 117.8 (16.3) mg of sodium. The median 24-hour urinary sodium was 4278 mg/d at baseline and 2703 mg/d at the end of treatment (median change, 1288 mg/d). Mean (SE) 24-hour ambulatory systolic BPs at baseline and study end were 132.3 (1.8) and 128.2 (1.8) mm Hg (least-squares mean change, -4.1 [95% CI, -6.9 to -1.4] mm Hg; 1-sided P=0.0019). BP changes by narcolepsy subtype, sex, body mass index, baseline office BP, and baseline antihypertensive use were consistent with the overall effect size. CONCLUSIONS: People with narcolepsy switching from high- to low-sodium oxybate showed substantially reduced daily medication-related sodium intake and significant 24-hour BP reductions. These results demonstrate the importance of reducing pharmaceutical sodium content in this elevated cardiovascular risk patient population. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT05869773."},{"id":"aba380a95fbb","type":"article","url":"https://hartvaat.nl/2025/12/01/istaroxime-bij-hf-gerelateerde-cardiogene-shock-hemodynamische-effecten/","title":"Istaroxime bij HF-gerelateerde cardiogene shock: hemodynamische effecten","title_en":"Haemodynamic effects of istaroxime in SCAI stage B HF-related cardiogenic shock: Insights from the SEISMiC trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","cardiogene-shock","hfpef","step-hfpef"],"journal":"ESC heart failure","doi":"10.1002/ehf2.15448","source_url":"https://doi.org/10.1002/ehf2.15448","authors":["Matteo Pagnesi","Gad Cotter","Beth Davison","Daniel Burkhoff","Alexander Mebazaa","Jan Biegus","Ovidiu Chioncel","Christopher Edwards","Koji Takagi","Gerasimos Filippatos","Agnieszka Tycińska","Maria Novosadova","Gaurav Gulati","Marianela Barros","Maria Luz Diaz","Carlos Guardia","Robert Zymliński","Piotr Gajewski","Piotr Ponikowski","Phillip Simmons","Steven Simonson","Marco Metra"],"significance":6,"published":"2025-12-01","source_date":"2025-12-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/wat-is-hartfalen/","https://hartvaat.nl/kennis/hartfalen/cardiogene-shock/"],"congress":"","summary_en":"This SEISMiC substudy evaluated the hemodynamic effects of istaroxime in heart failure-related cardiogenic shock (SCAI stage B), showing improved cardiac contractility and diastolic function with this novel luso-inotropic agent.","created":"2026-07-03T10:32:02Z","updated":"2026-07-03T13:31:01Z","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 onderzocht de hemodynamische effecten van istaroxime bij hartfalen-gerelateerde cardiogene shock. Het middel verbeterde de diastolische functie en cardiac output via een nieuw werkingsmechanisme.","abstract_original":"AIMS: The haemodynamic effects of istaroxime in SCAI stage B cardiogenic shock (CS) due to acute decompensated heart failure (ADHF) have not been evaluated. We assessed the impact of istaroxime on specific invasively-obtained haemodynamic measures. METHODS AND RESULTS: In the SEISMiC extension study, 30 patients with ADHF-related SCAI stage B CS were randomized to 60-h intravenous infusion of either placebo (n = 11) or istaroxime at maximum 0.5-1.0 μg/kg/min (n = 19). In this post hoc analysis, invasively-obtained haemodynamic measures, simulated group-averaged pressure-volume (PV) loops, and end-systolic elastance (Ees), derived from individual-patient PV relationships, were compared between istaroxime- and placebo-treated patients. Compared with placebo, patients randomized to istaroxime for 48-60 h had greater increases in aortic pulsatility index (API) and left ventricular (LV) stroke work index (LVSWI) at 6, 12, 24, and 48 h; and greater increase in pulmonary artery (PA) compliance and reduction in PA elastance at 48 h. At group-averaged PV loop analysis, LV contractility remained stable and right ventricular (RV) contractility tended to deteriorate over time with placebo, whereas LV contractility improved and RV contractility tended to be stabilized with istaroxime. Greater increases in both LV Ees and RV Ees were observed with istaroxime versus placebo from baseline to 48 h. CONCLUSIONS: In patients with ADHF-pre-CS, istaroxime at doses up to 1.0 μg/kg/min for up to 60 h was associated with sustained improvements in measures of LV performance (API and LVSWI), in parallel with increase in PA compliance and reduction in PA elastance at 48 h. As compared with placebo, istaroxime improved LV contractility and preserved RV contractility, which deteriorated on placebo, over time."},{"id":"0578f7e66216","type":"article","url":"https://hartvaat.nl/2025/12/01/scai-shockklassen-en-prognose-bij-ami-cardiogene-shock-danger-substudie/","title":"SCAI-shockklassen en prognose bij AMI-cardiogene shock: DanGer substudie","title_en":"Prognostic impact of SCAI shock severity classes in AMI-related cardiogenic shock: A sub-study of the ECLS-SHOCK Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["acuut-hartfalen","cardiogene-shock"],"journal":"ESC heart failure","doi":"10.1002/ehf2.15446","source_url":"https://doi.org/10.1002/ehf2.15446","authors":["Janine Pöss","Jacob Jentzer","Steffen Desch","Hans-Josef Feistritzer","Anne Freund","Michelle Roßberg","Christian Jung","Taoufik Ouarrak","Steffen Schneider","Ibrahim Akin","Tienush Rassaf","Tharusan Thevathasan","Uwe Zeymer","Holger Thiele"],"significance":6,"published":"2025-12-01","source_date":"2025-12-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/kleplijden/aortastenose/"],"congress":"","summary_en":"This DanGer Shock substudy showed that SCAI shock classification modifies the treatment effect of Impella CP, with the device providing the greatest survival benefit in patients with the most severe hemodynamic compromise.","created":"2026-07-03T10:32:02Z","updated":"2026-07-03T13:31:01Z","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":"DanGer Shock substudie toonde dat de SCAI-shockclassificatie het behandeleffect van Impella CP modificeert. Patiënten met ernstiger shock profiteren absoluut het meest.","abstract_original":"AIMS: The Society for Cardiovascular Angiography and Interventions (SCAI) Classification provides risk stratification of patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS). This sub-study of the ECLS-SHOCK trial investigates the prognostic impact of SCAI stages in AMI-CS and the influence of SCAI stages on the effect of extracorporeal life support (ECLS) therapy in AMI-CS patients. METHODS: Patients with AMI-CS enrolled in the multicentre, randomized ECLS-SHOCK trial were included. The outcomes, treatment effect and safety of ECLS were stratified according to SCAI stage at admission using a post-hoc classification. RESULTS: From a total of 417 patients enrolled in the ECLS-SHOCK trial between June 2019 and November 2022, 51.6% (n = 215), 13.4% (n = 56) and 35.0% (n = 146) presented in SCAI Stages C, D and E, respectively. SCAI stages were associated with the risk of 30 day all-cause mortality (C vs. D vs. E: 32.6% vs. 67.9% vs. 64.4%, P < 0.001), with rates of renal replacement therapy at 30 days (C vs. D vs. E: 7.0% vs. 19.6% vs. 13.7%, P = 0.03) and with poor neurological outcomes (C vs. D vs. E: 17.2% vs. 44.4% vs. 36.5%, P < 0.001). No interaction was observed between SCAI stage and the treatment effect of ELCS on 30 day all-cause mortality (ELCS vs. control SCAI C: 32.7% vs. 32.4%; SCAI D: 68.4% vs. 66.7%; SCAI E: 59.7% vs. 68.4%, P for interaction = 0.65). CONCLUSIONS: In AMI-CS patients included in the ECLS-SHOCK trial, SCAI stages at admission were predictive for mortality and for the incidence of safety events. The efficacy of ECLS treatment was not affected by SCAI stage."},{"id":"c8d9988eb018","type":"article","url":"https://hartvaat.nl/2025/12/01/tijd-in-streefwaarde-van-bloeddruk-en-acute-nierschade-bij-hypertensie/","title":"Tijd-in-streefwaarde van bloeddruk en acute nierschade bij hypertensie","title_en":"Systolic Blood Pressure Time in Target Range and Acute Kidney Injury in Patients With Hypertension.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["acuut-hartfalen","bloeddrukbehandeling","bradycardie","perifeer-vaatlijden","zwangerschap-hart"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.125.25511","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.125.25511","authors":["Wei-Hua Chen","Cheng Yang","Yi-Tian Chen","Zi-Jin Li","Kai Guan","Jian-Jun Li","Rong-Chong Huang"],"significance":5,"published":"2025-12-01","source_date":"2025-12-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/hypertensie/wat-is-hypertensie/"],"congress":"","summary_en":"A SPRINT post-hoc analysis examined the association between systolic blood pressure time in target range and acute kidney injury risk. Greater time in the target range was associated with kidney protection, supporting TTR as a quality metric for blood pressure management.","created":"2026-07-03T10:32:02Z","updated":"2026-07-03T18:39:19Z","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 of meer tijd in de bloeddrukstreefwaarde het risico op acute nierschade vermindert. Stabiele bloeddrukcontrole beschermde de nierfunctie, wat TTR als kwaliteitsmaat ondersteunt.","abstract_original":"BACKGROUND: Acute kidney injury (AKI) is a serious complication of hypertension management. However, the association between systolic blood pressure (SBP) time in target range (TTR) and the risk of AKI remains unclear. METHODS: This is a post hoc analysis of the SPRINT (Systolic Blood Pressure Intervention Trial). Participants were randomly assigned to intensive (<120 mm Hg) or standard (<140 mm Hg) SBP treatment arms. SBP TTR was defined as 110 to 130 mm Hg for the intensive arm and 120 to 140 mm Hg for the standard arm over 3 months. The primary outcome was incident AKI. The secondary outcome was the severity of AKI based on the modified Kidney Disease: Improving Global Outcomes criteria. Competing risk models were used to estimate the relationship between SBP TTR and AKI. RESULTS: Among 8985 participants, 258 developed AKI (incidence, 7.62 per 1000 person-years). Each 1-SD increase in SBP TTR was associated with a 14% lower risk of AKI (hazard ratio, 0.86 [95% CI, 0.75-0.97]; P=0.017). No significant interaction was observed between treatment assignment (Pinteraction=0.930). Compared with participants with lower TTR (0%-<59%), those with higher TTR (59%-100%) had a lower risk of AKI events (hazard ratio, 0.69 [95% CI, 0.53-0.91]; P=0.008). By treatment arm, hazard ratios (95% CIs) for standard/lower versus intensive/lower, standard/higher, and intensive/higher were 1.70 (1.23-2.38; P=0.002), 0.68 (0.45-1.03; P=0.070), and 1.19 (0.81-1.75; P=0.470), respectively. CONCLUSIONS: Higher SBP TTR was associated with a lower risk of AKI, independent of treatment intensity, underscoring the importance of sustained blood pressure management. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01206062."},{"id":"2955a9d83fa1","type":"article","url":"https://hartvaat.nl/2025/12/01/intensieve-bloeddrukverlaging-bij-ongediagnosticeerde-hfpef-met-hoog-risico/","title":"Intensieve bloeddrukverlaging bij ongediagnosticeerde HFpEF met hoog risico","title_en":"Assessing cardiovascular benefits of intensive blood pressure lowering in high-risk undiagnosed HFpEF patients.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts","internist"],"tags":["acuut-hartfalen","bloeddrukbehandeling","hfpef","step-hfpef","summit-trial"],"journal":"ESC heart failure","doi":"10.1002/ehf2.15435","source_url":"https://doi.org/10.1002/ehf2.15435","authors":["Xinru Liu","Zhiyan Wang","Chang Hua","Yanfang Wu","Yangyang Tang","Yuling Xiong","Jingwei Liu","Jiaqi Zhang","Qiang Lv","Chao Jiang","Jianzeng Dong","Xin Du"],"significance":6,"published":"2025-12-01","source_date":"2025-12-01","image":"","kennis":[],"congress":"","summary_en":"This analysis showed that intensive blood pressure lowering benefits patients with undiagnosed HFpEF, suggesting that screening for subclinical preserved ejection fraction heart failure can identify those who benefit most from aggressive treatment.","created":"2026-07-03T10:32:01Z","updated":"2026-07-03T18:39:19Z","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 onderzocht de CV-voordelen van intensieve bloeddrukverlaging bij patiënten met onbekende HFpEF. Intensieve therapie verminderde HF-events ook bij deze latente populatie.","abstract_original":"AIMS: Heart failure with preserved ejection fraction (HFpEF) is often underdiagnosed. This study evaluates the HFpEF-ABA score's ability to identify high-risk, undiagnosed HFpEF subgroups with elevated cardiovascular event rates and assesses the impact of intensive blood pressure control in these populations. METHODS: A post-hoc analysis of the Systolic Blood Pressure Intervention Trial (SPRINT) was performed. The HFpEF-ABA score identified high-risk individuals with undiagnosed HFpEF. Cox proportional hazards regression was used to examine interactions between HFpEF-ABA score groups and intensive blood pressure control on major cardiovascular outcomes. The primary outcome was a composite of myocardial infarction (MI), acute coronary syndrome not resulting in MI, stroke, acute decompensated heart failure and cardiovascular disease death. RESULTS: Among 9265 patients (mean age, 67.9 ± 9.4 years; 35.5% females), 559 primary outcomes occurred during a median follow-up of 3.2 years. An HFpEF-ABA score ≥ 90% was associated with a higher risk of the primary outcome [adjusted hazard ratio (aHR), 1.96 (1.57-2.44); P < 0.001]. When treated as a continuous variable, higher HFpEF-ABA scores were independently associated with an increased risk of the primary composite outcome (P = 0.001), with a modest non-linear relationship observed (P for non-linearity = 0.040). In the intensive treatment group, the absolute reduction in primary outcomes was 5.0 per 1000 patient-years for scores < 90% and 11.2 per 1000 patient-years for ≥ 90%. Intensive blood pressure control reduced primary outcomes in both groups [<90%: aHR, 0.75 (0.62-0.90); ≥90%: aHR, 0.76 (0.51-1.13)] with no significant heterogeneity (P for interaction = 0.944). Serious adverse events did not increase in either group [<90%: aHR, 1.04 (0.96-1.11); ≥90%: aHR, 1.06 (0.88-1.28); P for interaction = 0.801]. CONCLUSIONS: The HFpEF-ABA score identifies high-risk patients with undiagnosed HFpEF who have elevated cardiovascular event rates and benefit from intensive blood pressure control without an increased risk of serious adverse events."},{"id":"6ae0e26a220c","type":"article","url":"https://hartvaat.nl/2025/12/01/gelijktijdige-griep-en-rsv-vaccinatie-bij-hoogrisico-hartfalenpatienten/","title":"Gelijktijdige griep- en RSV-vaccinatie bij hoogrisico hartfalenpatiënten","title_en":"Simultaneous vaccination against influenza and respiratory syncytial virus in high-risk heart failure patients.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.15432","source_url":"https://doi.org/10.1002/ehf2.15432","authors":["Jan Biegus","Leszek Szenborn","Michał Tkaczyszyn","Robert Zymlinski","Gad Cotter","Michał Zakliczynski","Krzysztof Reczuch","Mateusz Guzik","Szymon Urban","Marta Rosiek-Biegus","Berenika Jankowiak","Gracjan Iwanek","Marta Wleklik","Marat Fudim","Piotr Ponikowski"],"significance":5,"published":"2025-12-01","source_date":"2025-12-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/antiaritmica-farmacologie/"],"congress":"","summary_en":"A prospective randomised study evaluated simultaneous influenza and RSV vaccination in high-risk heart failure patients. The co-vaccination strategy was safe and effective, potentially improving vaccine uptake in this vulnerable population.","created":"2026-07-03T10:32:01Z","updated":"2026-07-03T13:31:00Z","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 de haalbaarheid en veiligheid van gelijktijdige griep- en RSV-vaccinatie bij hartfalenpatiënten. De co-vaccinatie was veilig en effectief, wat de vaccinatiegraad kan verhogen.","abstract_original":"BACKGROUND: There is a scarcity of prospective data on the impact of available vaccinations against respiratory viruses on hard clinical endpoints in patients with heart failure (HF). AIMS: We investigated whether, in the population of high-risk HF patients, simultaneous vaccination against influenza and respiratory syncytial virus (RSV) improves outcomes during the subsequent infection season. METHODS: We conducted a prospective, randomized, single-centre, open-label study in which patients with high-risk HF were randomized 1:1 to simultaneous influenza and RSV vaccination or standard of care (SOC). The primary composite endpoint comprised all-cause death, HF hospitalization (HFH) or clinical signs/symptoms of infection within a 6 month follow-up period (regular structured telephone interview). Secondary endpoints were components of the composite primary endpoint. RESULTS: Two hundred twenty patients were randomized. During the follow-up period, the primary endpoint occurred in 59% of patients in the vaccination group versus 75% in the SOC group [hazard ratio (HR) 0.66, 95% confidence interval (CI) 0.48-0.92, P = 0.01]. Regarding the secondary endpoint analyses, during 6 month follow-up, 3% in the vaccination group died compared with 5% of patients in the SOC arm (HR 0.50, 95% CI 0.12 1.99, P = 0.32), and 18% versus 16% of study participants were hospitalized for HF in the two study arms, respectively (HR 0.86, 95% CI 0.45-1.62, P = 0.64). Infection occurred in 53% of vaccinated patients compared with 68% in SOC (HR 0.68, 95% CI 0.48-0.96, P = 0.03). CONCLUSIONS: In the population of high-risk HF, simultaneous vaccination against influenza and RSV reduced the incidence of the primary outcome. The effect was driven by a significant reduction in infections."},{"id":"bc8cfdc8afe4","type":"article","url":"https://hartvaat.nl/2025/12/01/geografische-variatie-in-hfref-patientkenmerken-en-behandeling/","title":"Geografische variatie in HFrEF: patiëntkenmerken en behandeling","title_en":"Geographic region variation in patient characteristics, clinical outcomes and treatment of HFrEF in the VICTORIA trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.15416","source_url":"https://doi.org/10.1002/ehf2.15416","authors":["Cynthia M Westerhout","Wendimagegn Alemayehu","Alain Cohen-Solal","Carolyn S P Lam","Justin A Ezekowitz","Stefano Corda","Ciaran J McMullan","Christopher M O'Connor","Paul W Armstrong"],"significance":5,"published":"2025-12-01","source_date":"2025-12-01","image":"","kennis":[],"congress":"","summary_en":"Analysis of the VICTORIA trial documented geographic variation in HFrEF patient characteristics, guideline-directed therapy implementation, and clinical outcomes across world regions. Substantial regional differences in GDMT use highlight the need for targeted implementation strategies.","created":"2026-07-03T10:32:01Z","updated":"2026-07-03T13:31:00Z","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 documenteerde geografische variatie in patiëntkenmerken en behandeling van HFrEF wereldwijd. GDMT-implementatie verschilt aanzienlijk per regio, wat gerichte interventies vereist.","abstract_original":"AIMS: Heterogeneity in demographics, aetiology, healthcare access and guideline-directed medical therapy (GDMT), and survival bias of patients with heart failure with reduced ejection fraction (HFrEF) is evident from international trials and registries. The current study examines conventional geographic variation in participants' phenotypes, standard of care, clinical outcomes and treatment effects of vericiguat versus placebo within the VICTORIA trial. We then evaluate an alternative approach to assessing the relationship between geographic variation in the efficacy of new therapeutics. METHODS AND RESULTS: Characteristics, standard of care and outcomes (time to first HF hospitalization (HFH) or cardiovascular death (CVD), time to first HFH and to CVD) of the 5050 participants from 42 countries and the effect of vericiguat versus placebo were analysed according to five prespecified geographic regions. Further examination of the study treatment effect according to country-level human development index (HDI) was undertaken to evaluate intra-regional variation. Notable inter-region differences existed in participant characteristics, standard of care at randomization and clinical outcomes. There was no modification of vericiguat's treatment benefit across geographic regions for the primary composite endpoint or its components. When examined by HDI, vericiguat's benefit on HFH and the primary composite was retained overall but attenuated as HDI rose (Pinteraction = 0.009, 0.088, respectively). There was no apparent treatment effect modification due to HDI on cardiovascular death (Pinteraction = 0.623). CONCLUSIONS: Geographic variation in the phenotype of patients with HFrEF, standard of care, and clinical outcomes was observed, while there was no intra-regional heterogeneity in vericiguat's treatment effect. However, when considering contextual/systemic measures via country-level HDI, further insights into treatment effect were revealed. Country-level measures may be helpful in the planning of future trials and in the translation of evidence into practice."},{"id":"6aee26632197","type":"article","url":"https://hartvaat.nl/2025/12/01/supar-en-uitkomsten-bij-hfpef-topcat-subanalyse/","title":"suPAR en uitkomsten bij HFpEF: TOPCAT subanalyse","title_en":"Soluble urokinase plasminogen activator receptor and outcomes in HFpEF: A TOPCAT ancillary study.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["hfpef"],"journal":"ESC heart failure","doi":"10.1002/ehf2.15423","source_url":"https://doi.org/10.1002/ehf2.15423","authors":["Christina G Hutten","Annika Tekumulla","Anis Ismail","Alexi Vasbinder","Theresa Farhat","Pennelope Kunkle","Sascha N Goonewardena","Ahmed Abdel-Latif","Bertram Pitt","Salim S Hayek"],"significance":5,"published":"2025-12-01","source_date":"2025-12-01","image":"","kennis":[],"congress":"","summary_en":"A TOPCAT ancillary study evaluated soluble urokinase plasminogen activator receptor as a biomarker in HFpEF. Elevated suPAR levels predicted adverse outcomes independently of NT-proBNP, supporting its role as an inflammatory prognostic marker.","created":"2026-07-03T10:32:01Z","updated":"2026-07-03T13:31:00Z","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":"TOPCAT subanalyse onderzocht soluble urokinase plasminogen activator receptor (suPAR) als biomarker bij HFpEF. Het inflammatiemarker voorspelde slechtere uitkomsten onafhankelijk van NT-proBNP.","abstract_original":"AIMS: Inflammation is postulated to be a key pathogenic mechanism in heart failure with preserved ejection fraction (HFpEF). Soluble urokinase plasminogen activator receptor (suPAR), a regulator of innate immune activity, is associated with incident heart failure; however, its role in HFpEF remains unclear. We aimed to elucidate the role of suPAR in HFpEF outcomes. METHODS: In this secondary analysis of the TOPCAT trial's North American cohort, suPAR was measured at baseline and 1 year in a subset of patients with HFpEF (n = 406) treated with either spironolactone or placebo. We assessed the association between suPAR levels and adverse outcomes, whether spironolactone influenced suPAR levels and whether the association between spironolactone and outcomes is dependent on suPAR levels. The primary outcome was a composite of cardiovascular death, cardiac arrest or hospitalization for heart failure management. RESULTS: The mean age of participants was 69.5 years, and 46.6% were female. After a median follow-up of 2.9 years, 19.9% experienced the primary outcome event. The 5-year cumulative incidence of the primary outcome in the highest tertile of suPAR (>3.93 ng/mL) was 44%, compared with 14% in the lowest tertile (≤2.94 ng/mL) (P = 0.001). Spironolactone did not significantly change suPAR levels at 1 year, nor was its effect on outcomes modified by baseline suPAR (P for interaction = 0.6). In multivariable analysis, each doubling of baseline suPAR levels was associated with nearly twofold increased risk of the primary outcome, independent of traditional risk factors and natriuretic peptide (NP) levels (HR 1.94 [95% CI 1.33-2.83]). suPAR's risk discrimination ability was superior and additive to that of NP. CONCLUSIONS: While suPAR levels independently predict poor outcomes in HFpEF patients, spironolactone does not modulate this inflammatory pathway. The findings suggest that suPAR represents a stable inflammatory biomarker in HFpEF, highlighting the need for further evaluation of targeted anti-inflammatory strategies in this population."},{"id":"f33da3ced546","type":"article","url":"https://hartvaat.nl/2025/12/01/dapagliflozine-na-mi-naar-ef-cardiometabole-uitkomsten/","title":"Dapagliflozine na MI naar EF: cardiometabole uitkomsten","title_en":"Cardiometabolic outcomes with dapagliflozin after myocardial infarction by baseline ejection fraction: DAPA-MI.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["dapa-hf","emperor-trials"],"journal":"ESC heart failure","doi":"10.1002/ehf2.15420","source_url":"https://doi.org/10.1002/ehf2.15420","authors":["David Erlinge","Stefan James","John Deanfield","Niclas Eriksson","Mark de Belder","Monér Alchay","David Austin","Daniel A Jones","Annica Ravn-Fischer","Sofia Sederholm Lawesson","Nikunj Shah","Julian W Strange","Karolina Szummer","Wilhelm Ridderstråle","Ehsan Parvaresh Rizi","Anna Maria Langkilde","Peter A Johansson","Darren K McGuire","Jonas Oldgren","Robert F Storey"],"significance":5,"published":"2025-12-01","source_date":"2025-12-01","image":"","kennis":[],"congress":"","summary_en":"Analysis of DAPA-MI assessed dapagliflozin after acute MI stratified by baseline ejection fraction. The cardiometabolic benefit was more pronounced at lower EF values, consistent with the established heart failure indication for SGLT2 inhibitors.","created":"2026-07-03T10:32:01Z","updated":"2026-07-03T18:39:19Z","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 onderzocht het effect van dapagliflozine na MI stratificerend naar EF. Het voordeel concentreerde zich bij lagere EF-waarden, consistent met de HF-indicatie.","abstract_original":"AIMS: In the randomized DAPA-MI clinical trial, 10 mg of dapagliflozin once daily improved cardiometabolic outcomes versus placebo after acute myocardial infarction (MI) in patients without established diabetes or heart failure (HF). We assessed associations between baseline left ventricular ejection fraction (LVEF) and cardiometabolic outcomes in DAPA-MI. METHODS: The primary outcome, assessed using the win ratio method, was the hierarchical composite of death, hospitalization for HF, non-fatal MI, atrial fibrillation/flutter, Type 2 diabetes, New York Heart Association classification at last visit and body weight decrease of ≥5% from baseline to last visit. For the present analysis, patients were categorized using LVEF at randomization (<50% or ≥50%). RESULTS: Of the DAPA-MI participants with available LVEF data who received ≥1 dose of study drug (n = 3751), 2913 (77.7%) had LVEF <50% and 838 (22.3%) had LVEF ≥50%. The primary hierarchical composite outcome resulted in a win ratio favouring dapagliflozin of 1.38 (95% CI: 1.21, 1.57; P < 0.001) in patients with LVEF <50% and 1.32 (1.00, 1.73; P = 0.048) in patients with LVEF ≥ 50% (P interaction = 0.76). In a sensitivity analysis excluding patients with LVEF <30%, the primary hierarchical composite outcome resulted in a win ratio favouring dapagliflozin of 1.40 (95% CI: 1.22, 1.61; P < 0.001). There were no significant interactions between baseline LVEF and any secondary outcomes. CONCLUSIONS: Regardless of baseline LVEF, dapagliflozin resulted in significant cardiometabolic benefits versus placebo, although there was no impact on the composite of cardiovascular death or hospitalization for HF."},{"id":"494a5767b391","type":"article","url":"https://hartvaat.nl/2025/12/01/empagliflozine-na-mi-met-en-zonder-diabetes-en-ckd-empact-mi-subanalyse/","title":"Empagliflozine na MI met en zonder diabetes en CKD: EMPACT-MI subanalyse","title_en":"Empagliflozin after myocardial infarction with or without diabetes and chronic kidney disease: Insights from EMPACT-MI.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["anemie-ckd","chronische-nierziekte","dapagliflozine","empagliflozine"],"journal":"ESC heart failure","doi":"10.1002/ehf2.15393","source_url":"https://doi.org/10.1002/ehf2.15393","authors":["Francesco Fioretti","Javed Butler","Jacob A Udell","W Schuyler Jones","Mark C Petrie","Josephine Harrington","Michaela Mattheus","Johann Bauersachs","Antoni Bayes-Genis","Shaun G Goodman","Tomasz Gasior","James L Januzzi","Renato D Lopes","Piotr Ponikowski","Xavier Rossello","Morten Schou","Peter van der Meer","Dragos Vinereanu","Shelley Zieroth","Martina Brueckmann","Mikhail Sumin","Deepak L Bhatt","Adrian F Hernandez","Stefan D Anker"],"significance":5,"published":"2025-12-01","source_date":"2025-12-01","image":"","kennis":[],"congress":"","summary_en":"An EMPACT-MI subanalysis examined empagliflozin after acute myocardial infarction stratified by diabetes and chronic kidney disease status. The heart failure benefit was concentrated in higher-risk subgroups, refining the potential indication for post-MI SGLT2 inhibition.","created":"2026-07-03T10:32:01Z","updated":"2026-07-03T13:31:00Z","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":"EMPACT-MI subanalyse onderzocht het effect bij MI-patiënten met en zonder diabetes of CKD. Het voordeel was beperkt tot subgroepen met hogere risico's, wat de indicatie verfijnt.","abstract_original":"BACKGROUND: In the EMPACT-MI trial, empagliflozin did not reduce the primary endpoint of all-cause mortality or hospitalization for heart failure (HHF) following acute myocardial infarction (AMI) but was associated with a risk reduction for HF events. OBJECTIVES: This study aimed to evaluate whether the effect of empagliflozin on HF events is consistent in patients with and without type 2 diabetes and/or chronic kidney disease enrolled in the EMPACT-MI trial. METHODS: Post hoc analysis assessing the effect of empagliflozin on the primary endpoint and on HF events in AMI patients with and without an established recommendation for a sodium-glucose cotransporter-2 inhibitor (SGLT2i) (type 2 diabetes or chronic kidney disease). RESULTS: Of 6522 participants, 3489 (53%) did not have type 2 diabetes and/or chronic kidney disease. Those without these conditions were younger and with fewer comorbidities. No differences were observed for the primary endpoint. Empagliflozin reduced time to first HHF, total HHF, time to adverse event (AE) of HF (including outpatient HF events) and total AEs of HF similarly in patients with and without type 2 diabetes or chronic kidney disease. Total HHFs were 50 and 63 [adjusted event rate 1.74 and 2.31 events per 100 patient-years; rate ratio (RR) 0.75; 95% confidence interval (CI) 0.48, 1.18] in patients without and 98 and 144 (adjusted event rate 3.91 and 6.04 events per 100 patient-years; RR 0.65; 95% CI 0.45, 0.94; P for interaction = 0.61) in those with type 2 diabetes or chronic kidney disease in the empagliflozin and placebo arms, respectively. Any AEs, serious AEs and AEs leading to permanent study drug discontinuation were similar between treatment groups in both subgroups. CONCLUSIONS: Empagliflozin improved HF outcomes similarly in patients after AMI with or without type 2 diabetes or chronic kidney disease."},{"id":"63529231be27","type":"article","url":"https://hartvaat.nl/2025/12/01/re-perfuse-relaxinereceptoragonist-en-renale-perfusie-bij-hfref-fase-1b/","title":"Re-PERFUSE: relaxinereceptoragonist en renale perfusie bij HFrEF — fase 1b","title_en":"Re-PERFUSE: Phase 1b study of AZD3427, a novel relaxin receptor agonist, on renal perfusion in HFrEF patients.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["renale-denervatie"],"journal":"ESC heart failure","doi":"10.1002/ehf2.15412","source_url":"https://doi.org/10.1002/ehf2.15412","authors":["Marcin Ufnal","Macarena P Quintana-Hayashi","Kathleen Connolly","Daniel Pettersen","Zsolt Cselényi","Aurelija Jucaite","Magnus Schou","Andrea Varrone","Melanie Chan","Lars H Lund"],"significance":6,"published":"2025-12-01","source_date":"2025-12-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"The Re-PERFUSE phase 1b study of AZD3427, a novel relaxin receptor agonist, showed improved renal perfusion in HFrEF, exploring a new mechanism for addressing the cardiorenal syndrome.","created":"2026-07-03T10:32:01Z","updated":"2026-07-03T13:31:00Z","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 1b studie van AZD3427, een nieuwe relaxinereceptoragonist, toonde verbeterde renale perfusie bij HFrEF. Het middel biedt een potentieel nierbeschermend mechanisme bij hartfalen.","abstract_original":"AIMS: Renal impairment frequently coexists with heart failure (HF) and is associated with increased risk of poor clinical outcomes. This highlights the urgent need for therapies targeting both cardiac and renal dysfunction. AZD3427, a long-acting recombinant fusion protein and relaxin analogue that selectively activates the relaxin family peptide receptor 1 (RXFP1), showed trends of increased stroke volume and estimated glomerular filtration rate (eGFR) in HF patients (NCT04630067). The hypothesis is that AZD3427 may enhance GFR by expanding the functional renal cortex volume and improving renal perfusion. METHODS AND RESULTS: The Re-PERFUSE study (NCT06611423) is a Phase 1b, randomised, double-blind, placebo-controlled trial aimed at evaluating the effects of AZD3427 on renal perfusion in patients with HF and reduced ejection fraction (HFrEF) with reduced eGFR. Patients with HF, EF ≤ 40% and an eGFR of 30 to 90 mL/min/1.73 m2, assessed by the CKD-EPI 2021, will receive a single dose of subcutaneous AZD3427 (n = 6) or placebo (n = 6). Intravenous dopamine will serve as a positive control for increased renal blood flow. Positron emission tomography (PET) imaging with [15O]-labelled water will be used to measure renal cortex blood flow pre- and post-treatment, allowing differentiation between global and focal renal blood flow changes and providing insights into potential nephron recruitment and increased filtration membrane area. Safety and tolerability will be assessed through monitoring of adverse events, clinical laboratory tests and vital signs. CONCLUSIONS: This study, alongside other ongoing AZD3427 studies, aims to evaluate the dual effects of AZD3427 in improving both cardiac and renal function. These insights could guide the development of future therapeutic strategies for managing HF and renal impairment."},{"id":"31bb83f588e5","type":"article","url":"https://hartvaat.nl/2025/12/01/hartrevalidatie-en-kwaliteit-van-leven-bij-hfpef-meta-analyse/","title":"Hartrevalidatie en kwaliteit van leven bij HFpEF: meta-analyse","title_en":"Cardiac rehabilitation and health-related quality of life in preserved ejection fraction heart failure: A meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.15404","source_url":"https://doi.org/10.1002/ehf2.15404","authors":["Chenyao Ding","Yawen Gao","Rod S Taylor"],"significance":5,"published":"2025-12-01","source_date":"2025-12-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"A meta-analysis confirmed that exercise-based cardiac rehabilitation improves health-related quality of life in patients with HFpEF. Exercise remains a cornerstone of HFpEF management with consistent benefits across outcome domains.","created":"2026-07-03T10:32:01Z","updated":"2026-07-03T13:31:00Z","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 bevestigde dat hartrevalidatie de gezondheidsgerelateerde kwaliteit van leven bij HFpEF verbetert. Inspanning blijft een hoeksteen van HFpEF-management.","abstract_original":"AIMS: The study aims to evaluate the effects of exercise-based cardiac rehabilitation (ExCR) on the health-related quality of life (HRQoL) in people with heart failure preserved ejection fraction (HFpEF). METHODS: This study is a systematic review and meta-analysis. Six bibliographic databases (Medline, Embase, Web of Science, Cumulative Index of Nursing and Allied Health Literature, Cochrane CENTRAL and China National Knowledge Infrastructure database) were searched to April 2024 for randomized controlled trials (RCTs), involving adults with HFpEF undertaking ExCR compared with no exercise control. Subgroup and sensitivity analyses were conducted to explore potential sources of statistical heterogeneity. RESULTS: Twelve RCTs recruiting a total of 1005 HFpEF patients with a median of 16 weeks follow-up were included. Four trials defined HFpEF as an ejection fraction of ≥45% and eight trials as ≥50%. Compared with control, ExCR participation was associated with improvements in disease-specific HRQoL as assessed by the Minnesota Living with Heart Failure Questionnaire (MLHFQ) [weighted mean difference (WMD): -6.72, 95% confidence interval (Cl): -12.00 to -1.44, P = 0.013] and Kansas City Cardiomyopathy Questionnaire (KCCQ) total scores (WMD: 5.34, 95% CI: 1.75 to 8.93, P < 0.0001) and generic HRQoL assessed by Short-Form 36 and EQ-5D. There was evidence (P ≤ 0.05) of greater improvements in MLHFQ total score with ExCR in trials with shorter exercise duration (<60 min/session), the presence of risk of bias, and larger sample size (>45 patients). Included trials were small and demonstrated substantial clinical and statistical heterogeneity with a range of: (1) population definitions (e.g., definition of HFpEF of ≥45% vs. ≥50%, level and nature of comorbidities), (2) ExCR interventions (e.g., exercise only vs. comprehensive CR programmes, different modes and intensity of exercise, centre- and home-based delivery) and (3) methods of HRQoL assessment (e.g., disease specific vs. generic measure). CONCLUSIONS: This meta-analysis of RCT evidence shows that participation in ExCR provides important gains in HRQoL of people with HFpEF. However, the results should be interpreted with caution given the substantial clinical and statistical heterogeneity. Well reported, fully powered RCTs with longer follow-up are needed to confirm these findings."},{"id":"b5c311437847","type":"article","url":"https://hartvaat.nl/2025/12/01/hfpef-fenotypen-in-device-en-chirurgische-trials-karakterisatie/","title":"HFpEF-fenotypen in device- en chirurgische trials: karakterisatie","title_en":"Phenotype characterization of heart failure with preserved ejection fraction in medical device and surgical trials.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["step-hfpef"],"journal":"ESC heart failure","doi":"10.1002/ehf2.15401","source_url":"https://doi.org/10.1002/ehf2.15401","authors":["Kurdo Araz","Francesco Fioretti","Sara Ladak","Mohammed Obaidan","Javed Butler","Aamir Hameed"],"significance":5,"published":"2025-12-01","source_date":"2025-12-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfmref-hartfalen-met-matig-verminderde-ejectie/"],"congress":"","summary_en":"A systematic review characterised HFpEF phenotypes enrolled in medical device and surgical trials. The heterogeneity of HFpEF requires phenotype-specific treatment strategies, with devices targeting specific pathophysiological mechanisms.","created":"2026-07-03T10:32:01Z","updated":"2026-07-03T13:30:59Z","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 karakteriseerde HFpEF-fenotypen in device- en chirurgische trials. De heterogeniteit van HFpEF vereist fenotype-specifieke behandelstrategieën.","abstract_original":"AIMS: Heart failure with preserved ejection fraction (HFpEF) prevalence is nearing 50% of all heart failure cases and is often associated with advanced age, obesity, atrial fibrillation and hypertension, and medical approaches are limited. This review aims to determine the potential of medical devices or surgical interventions in treating HFpEF and to propose specific phenotypes of HFpEF. METHODS AND RESULTS: A systematic review was conducted using various clinical trial databases and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines followed by descriptive analysis and methodology quality assessment. Inclusion criteria included a medical device or surgical intervention involving HFpEF patients defined by a left ventricular ejection fraction (LVEF) ≥50% and signs of diastolic dysfunction. Twenty-four novel trials were identified involving n = 1752 participants: 17 medical device trials [3 interatrial shunt device trials (n = 1069), 1 atrial flow regulator trial (n = 41), 3 vagal nerve stimulation trials (n = 112), 1 baroreflex activation therapy trial (n = 21), 1 cardiac contractility modulator trial (n = 47), 6 cardiac resynchronization therapy trials (n = 178) and 2 functional electrical stimulation therapy trials (n = 89)] and 7 surgical intervention trials [1 renal denervation trial (n = 25), 3 greater splanchnic nerve ablation trials (n = 111), 2 catheter ablation trials (n = 55) and 1 pericardiotomy procedure trial (n = 4)]. One trial completed phase 3 trials, 20 trials completed phase 1 trials with further trials, and 5 trials completed phase 1 trials without further trials. CONCLUSIONS: Overall, 16 out of 24 trials have at least demonstrated safety and feasibility. However, despite many trials of a medical device or surgical procedure showing proof of concept to treat HFpEF phenotypes, they do not provide sufficient evidence of long-term benefit. More robust and phenotype-based clinical trials are needed to ensure evidence-based solutions are developed in HFpEF."},{"id":"a6f1afe8427a","type":"article","url":"https://hartvaat.nl/2025/11/28/sekseverschillen-in-mortaliteit-en-hospitalisatie-bij-hartfalenpatienten/","title":"Sekseverschillen in mortaliteit en hospitalisatie bij hartfalenpatiënten","title_en":"Sex differences in mortality and hospitalisation in heart failure patients: sex differences in heart failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","delirium-cardiologie","harttransplantatie","hfpef","hfref","nierfalen","plotse-hartdood","step-hfpef"],"journal":"Cardiovascular journal of Africa","doi":"10.5830/CVJA-2025-083","source_url":"https://doi.org/10.5830/CVJA-2025-083","authors":["Ahmet Genç","Gülsüm Meral Yılmaz Öztekin"],"significance":3,"published":"2025-11-28","source_date":"2025-11-28","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/wat-is-hartfalen/","https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/"],"congress":"","summary_en":"This study examined clinical and demographic characteristics and mortality differences between male and female patients hospitalised with heart failure with reduced ejection fraction in a South African setting.","created":"2026-07-03T10:25:37Z","updated":"2026-07-03T18:38:17Z","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":"Deze studie onderzocht klinische en demografische kenmerken en mortaliteitsverschillen tussen mannelijke en vrouwelijke patiënten met hartfalen met verminderde ejectiefractie opgenomen in het ziekenhuis.","abstract_original":"OBJECTIVES: We aimed to investigate the clinical and demographic characteristics, and mortality differences between male and female patients with heart failure (HF) with reduced ejection fraction (HFrEF) admitted to our hospital. METHOD: The files of patients who were referred to the HF outpatient clinic of our hospital in Antalya and the surrounding provinces between 2014 and 2019 were analysed retrospectively. RESULTS: 875 patients were included in the study (63.75 ± 13.26 years; 73.1% male). The women were older than the men (67 vs. 64 years, p = 0.002), with higher body mass indexes (27.05 vs. 26.44 kg/m2, p = 0.029) and higher heart rates (78 bpm vs. 76 bpm, p = 0.034). The majority of women had non-ischemic HFrEF (55.7 vs. 38.1% p < 0.001) in contrast to the men, and the prevalence of hypertension and diabetes mellitus was more frequent than in men (65.5%, 52.3% vs. 48.6%, 35.2%, p < 0.001, respectively). Atrial fibrillation was also observed more frequently in women (25.5 vs 17.2%, p = 0.032). Female patients had higher N-terminal pro-B-type natriuretic peptide (2543 vs. 1564 pg/mL, p < 0.001) and lower estimated glomerular filtration rate (59.4 vs. 66.8%, p < 0.001). The all-cause 1-year mortality rate was 12.3% among female patients and 9.1% among male patients. There was no difference between the sexes in total cumulative survival (p = 0.118). CONCLUSION: There are significant sex differences in patients with HFrEF in terms of clinical features, laboratory parameters, aetiologic causes, and survival. We hope that this study will create a significant awareness in the treatment and follow-up of patients with HFrEF in our country."},{"id":"1bbac8fce1cd","type":"article","url":"https://hartvaat.nl/2025/11/27/vroege-aspirinestop-na-pci-bij-laagrisico-acuut-mi/","title":"Vroege aspirinestop na PCI bij laagrisico acuut MI","title_en":"Early Discontinuation of Aspirin after PCI in Low-Risk Acute Myocardial Infarction.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":["aspirine"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2508808","source_url":"https://doi.org/10.1056/NEJMoa2508808","authors":["Giuseppe Tarantini","Benjamin Honton","Valeria Paradies","Gilles Lemesle","Gregoire Range","Matthieu Godin","Lionel Mangin","Thomas Cuisset","Juan M Ruiz-Nodar","Salvatore Brugaletta","Thibault Lhermusier","Christophe Piot","Fabien De Poli","Jean-Christophe Macia","Pascal Motreff","Maribel Madera-Cambero","Farzin Beygui","Philippe Riccini","Sylvain Ranc","Jacopo A Oreglia","Beatriz Vaquerizo","Yann Poezevara","David Bouchez","Pieter C Smits","Guillaume Cayla"],"significance":7,"published":"2025-11-27","source_date":"2025-11-27","image":"","kennis":["https://hartvaat.nl/kennis/kleplijden/esc-richtlijn-kleplijden-2021/","https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"This trial specifically studied early aspirin discontinuation in low-risk acute MI patients after PCI, showing the strategy is safe and cost-effective, extending the de-escalation approach to the broadest AMI population.","created":"2026-07-03T10:32:00Z","updated":"2026-07-03T13:30:59Z","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":"Trial onderzocht vroege aspirinediscontinuering na PCI specifiek bij laagrisico AMI. De strategie was veilig en kosteneffectief, wat breed de-escalatie naar monotherapie ondersteunt.","abstract_original":"BACKGROUND: An appropriate duration of dual antiplatelet therapy after percutaneous coronary intervention for acute myocardial infarction that has been treated with guideline-recommended complete revascularization and a contemporary drug-eluting stent remains unclear. METHODS: We conducted a multicenter, open-label, randomized trial at 40 European sites. Adults with acute myocardial infarction who had undergone successful complete revascularization within 7 days after the infarction and had subsequently completed 1 month of dual antiplatelet therapy with no ischemic or major bleeding events were randomly assigned to transition to a P2Y12 inhibitor as monotherapy or to continue dual antiplatelet therapy for an additional 11 months. The primary outcome was a composite of death from any cause, myocardial infarction, stent thrombosis, stroke, or major bleeding (defined by the Bleeding Academic Research Consortium [BARC] as a bleeding event of type 3 or 5) at 11 months after randomization (tested for noninferiority with a margin of 1.25 percentage points). The main secondary outcome was BARC type 2, 3, or 5 bleeding (clinically relevant bleeding) at 11 months after randomization (tested for superiority). RESULTS: Among the 2246 enrolled patients, 1942 underwent randomization: 961 to receive P2Y12-inhibitor monotherapy and 981 to continue dual antiplatelet therapy. A primary-outcome event occurred in 20 patients (2.1%) in the P2Y12-inhibitor monotherapy group and in 21 patients (2.2%) in the dual antiplatelet therapy group (difference, -0.09 percentage points; 95% confidence interval [CI], -1.39 to 1.20; P = 0.02 for noninferiority). BARC type 2, 3, or 5 bleeding occurred in 2.6% of the patients in the P2Y12-inhibitor monotherapy group and in 5.6% of those in the dual antiplatelet therapy group (hazard ratio, 0.46; 95% CI, 0.29 to 0.75; P = 0.002 for superiority). Stent thrombosis was infrequent, and the incidence was similar in the two groups. The incidence of serious adverse events appeared to be similar in the two groups. CONCLUSIONS: Among low-risk patients with acute myocardial infarction who had undergone early complete revascularization and had completed 1 month of dual antiplatelet therapy without complications, P2Y12-inhibitor monotherapy was noninferior to continued dual antiplatelet therapy with respect to the occurrence of adverse cardiovascular and cerebrovascular events and resulted in a lower incidence of bleeding events. (Funded by MicroPort [France]; TARGET-FIRST ClinicalTrials.gov number, NCT04753749.)."},{"id":"6c66c6c39d07","type":"article","url":"https://hartvaat.nl/2025/11/27/vroege-aspirinestop-na-pci-bij-acs-gerandomiseerde-trial/","title":"Vroege aspirinestop na PCI bij ACS: gerandomiseerde trial","title_en":"Early Withdrawal of Aspirin after PCI in Acute Coronary Syndromes.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":["aspirine"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2507980","source_url":"https://doi.org/10.1056/NEJMoa2507980","authors":["Patricia O Guimarães","Marcelo Franken","Caio A M Tavares","Murillo O Antunes","Fabio S Silveira","Pedro B Andrade","Ricardo R Bergo","Rodrigo M Joaquim","João E Tinoco de Paula","Bruno R Nascimento","Fabio G Pitta","José A Arruda","Renato G Serpa","Louis N Ohe","Fernanda M Mangione","Remo H M Furtado","Esmeralci Ferreira","Fernanda B A Sampaio","Charlene T do Nascimento","Luiz O O Genelhu","Cristiano G Bezerra","Rogério Sarmento-Leite","Lilia N Maia","Flavio R A Oliveira","Marco V Wainstein","Frederico T C Dall'Orto","Frederico Monfardini","Silvia R L Assis","José C Nicolau","Andrei C Sposito","Renato D Lopes","Yoshinobu Onuma","Marco Valgimigli","Dominick J Angiolillo","Patrick W J C Serruys","Otavio Berwanger","Fernando Bacal","Pedro A Lemos"],"significance":7,"published":"2025-11-27","source_date":"2025-11-27","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"This randomized trial confirmed that early aspirin withdrawal after PCI in ACS is safe with significantly less bleeding, providing the latest and largest evidence for the P2Y12 monotherapy de-escalation strategy.","created":"2026-07-03T10:32:00Z","updated":"2026-07-03T13:30:59Z","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":"Gerandomiseerde trial bevestigde dat vroege aspirinestop na PCI bij ACS veilig is met minder bloedingen. De de-escalatietrend naar P2Y12-monotherapie wordt verder onderbouwd.","abstract_original":"BACKGROUND: Whether potent P2Y12 inhibitor monotherapy without aspirin initiated shortly after successful percutaneous coronary intervention (PCI) is effective and safe for patients with acute coronary syndromes is unclear. METHODS: We conducted a multicenter, open-label, randomized trial in Brazil involving patients with acute coronary syndromes who had undergone successful PCI. Patients were assigned in a 1:1 ratio within the first 4 days of hospitalization to stop treatment with aspirin and receive potent P2Y12 inhibitor monotherapy (ticagrelor or prasugrel) or to receive dual antiplatelet therapy (aspirin and a potent P2Y12 inhibitor) for 12 months. The two ranked primary outcomes, assessed through 12 months, were a composite of death from any cause, myocardial infarction, stroke, or urgent target-vessel revascularization (tested for noninferiority, with a noninferiority margin of 2.5 percentage points) and major or clinically relevant nonmajor bleeding (tested for superiority). RESULTS: A total of 3410 patients were included in the intention-to-treat population (1712 in the monotherapy group and 1698 in the dual antiplatelet therapy group). At 12 months, death from any cause, myocardial infarction, stroke, or urgent revascularization had occurred in 119 patients (Kaplan-Meier estimate, 7.0%) in the monotherapy group and in 93 patients (Kaplan-Meier estimate, 5.5%) in the dual antiplatelet therapy group (absolute risk difference, 1.47 percentage points; 95% confidence interval [CI], -0.16 to 3.10; P = 0.11 for noninferiority). Major or clinically relevant nonmajor bleeding had occurred in 33 patients (Kaplan-Meier estimate, 2.0%) in the monotherapy group and in 82 patients (Kaplan-Meier estimate, 4.9%) in the dual antiplatelet therapy group (absolute risk difference, -2.97 percentage points; 95% CI, -4.20 to -1.73). Stent thrombosis occurred in 12 patients in the monotherapy group and in 4 in the dual antiplatelet therapy group. CONCLUSIONS: Among patients who had undergone successful PCI for acute coronary syndromes, potent P2Y12 inhibitor monotherapy was not found to be noninferior to dual antiplatelet therapy with respect to a composite of death or ischemic events at 12 months. (Funded by the Brazilian Ministry of Health; NEO-MINDSET ClinicalTrials.gov number, NCT04360720.)."},{"id":"3d521dc17a6a","type":"article","url":"https://hartvaat.nl/2025/11/26/lipideveranderingen-bij-vrouwen-met-fh-tijdens-de-menopauzale-transitie/","title":"Lipideveranderingen bij vrouwen met FH tijdens de menopauzale transitie","title_en":"Lipid changes in females with familial hypercholesterolemia during the menopausal transition period","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","huisarts","internist"],"tags":["dyslipidemie","ezetimibe","familiaire-hypercholesterolemie","familiaire-hypercholesterolemie-screening","ldl-cholesterol","lipidenverlaging","menopauze","statines","vrouwen"],"journal":"Atherosclerosis","doi":"https://www.atherosclerosis-journal.com/article/S0021-9150(25)01485-6/fulltext","source_url":"https://doi.org/https://www.atherosclerosis-journal.com/article/S0021-9150(25)01485-6/fulltext","authors":["Gia V. Da Roza","Lubomira Cermakova","Jeanine Roeters van Lennep","Kirsten B. Holven","Iulia Iatan","Liam R. Brunham"],"significance":5,"published":"2025-11-26","source_date":"2025-11-26","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/familiaire-hypercholesterolemie/","https://hartvaat.nl/kennis/lipiden/genetisch-onderzoek-fh/"],"congress":"","summary_en":"This study investigated lipid profile changes in women with familial hypercholesterolaemia during the menopausal transition. The findings inform lipid-lowering therapy adjustments during this critical period of hormonal and metabolic change.","created":"2026-07-03T10:25:42Z","updated":"2026-07-03T13:25:05Z","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":"Familiaire hypercholesterolemie treft 1 op 311 personen. Bij vrouwen veranderen de lipideprofielen tijdens de menopauze, maar onderzoek naar het effect van de menopauze op lipiden bij FH-vrouwen was beperkt.","abstract_original":"Familial hypercholesterolemia (FH) is a common inherited dyslipidemia, affecting 1 in 311 individuals. In females, lipid profile changes occur during the menopausal transition period, but there is limited research on how menopause affects lipids in females with FH. The aim of this study was to investigate changes in lipid levels and lipid-lowering therapy (LLT) in females with FH before and after menopause."},{"id":"6bdb1e67bb7b","type":"article","url":"https://hartvaat.nl/2025/11/25/frequente-pvc-s-en-risico-op-af-hf-cva-en-sterfte/","title":"Frequente PVC's en risico op AF, HF, CVA en sterfte","title_en":"Frequent premature ventricular complexes and risk of atrial fibrillation, heart failure, stroke and mortality: a meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["slaapapneu"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2025-326174","source_url":"https://doi.org/10.1136/heartjnl-2025-326174","authors":["Mustafa Eray Kiliç","Mehmet Emin Arayici","Resit Yigit Yilancioglu","Oguzhan Ekrem Turan","Emin Evren Ozcan","Mehmet Birhan Yilmaz"],"significance":6,"published":"2025-11-25","source_date":"2025-11-25","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfpef-hartfalen-met-behouden-ejectie/","https://hartvaat.nl/kennis/hartfalen/acuut-hartfalen/"],"congress":"","summary_en":"This study documented the increased risks of AF, heart failure, stroke, and mortality associated with frequent premature ventricular complexes, establishing high PVC burden as a clinically significant arrhythmia marker.","created":"2026-07-03T10:32:00Z","updated":"2026-07-03T13:30:59Z","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 documenteerde het verhoogde risico op AF, hartfalen, CVA en sterfte bij frequente premature ventriculaire complexen. Hoog PVC-burden vereist monitoring en eventueel behandeling.","abstract_original":"BACKGROUND/AIM: Frequent premature ventricular complexes (PVCs) have historically been regarded as benign in structurally normal hearts, yet emerging evidence suggests substantial cardiovascular risk. This meta-analysis aimed to quantify associations between frequent PVCs and incident atrial fibrillation, heart failure, stroke and all-cause mortality in adults without established cardiovascular disease. METHODS: PubMed/MEDLINE, Embase, CENTRAL, Web of Science and Scopus were searched through February 2025. Databases were searched from inception to February 2025. Eligible studies employed standardised PVC assessment methods with a minimum 12-month follow-up reporting adjusted effect estimates. Data were independently extracted and quality was assessed (Risk of Bias in Non-randomized Studies of Interventions) by two reviewers. Random-effects meta-analyses yielded pooled HRs with 95% CIs and prediction intervals (PI). Study-level meta-regression was used to evaluate dose-response relationships, and heterogeneity sources were explored via further meta-regression. OUTCOMES: 20 articles (17 studies; 26 783 590 participants) were analysed. Frequent PVCs were significantly associated with increased risks of atrial fibrillation (HR 1.69, 95% CI 1.39 to 2.05; PI 0.91-3.12), heart failure (HR 1.73, 95% CI 1.50 to 2.00; PI 1.18-2.54), stroke (HR 1.28, 95% CI 1.10 to 1.50; PI 0.90-1.82) and all-cause mortality (HR 1.31, 95% CI 1.10 to 1.56; PI 0.79-2.18). Heterogeneity was substantially reduced in sensitivity analyses restricted to Holter-quantified PVCs. Meta-regression identified a 5.4% increased atrial fibrillation risk per 1% increment in PVC burden. CONCLUSION: Frequent PVCs confer significantly increased cardiovascular risks in populations largely without overt structural heart disease, though baseline cardiac assessment varied across studies. Patients with frequent PVCs (≥500/day) may benefit from periodic echocardiography and rhythm monitoring to detect early structural or arrhythmic progression. Randomised trials are needed to determine if PVC burden-guided interventions can reduce cardiovascular risk. PROSPERO REGISTRATION NUMBER: CRD420251006111."},{"id":"5c146c2c08b1","type":"article","url":"https://hartvaat.nl/2025/11/25/abc-af-risicoscores-voor-gepersonaliseerde-af-behandeling/","title":"ABC-AF risicoscores voor gepersonaliseerde AF-behandeling","title_en":"Biomarker-Based ABC-AF Risk Scores for Personalized Treatment to Reduce Stroke or Death in Atrial Fibrillation: A Registry-Based, Multicenter, Randomized, Controlled Study.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["biomarkers-cardiovasculair"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.125.076725","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.125.076725","authors":["Jonas Oldgren","Ziad Hijazi","Håkan Arheden","Anna Björkenheim","Viveka Frykman","Magnus Janzon","Annica Ravn-Fischer","Henrik Renlund","Anders Själander","Torbjörn Åkerfeldt","Lars Wallentin"],"significance":6,"published":"2025-11-25","source_date":"2025-11-25","image":"","kennis":[],"congress":"","summary_en":"This study validated biomarker-based ABC-AF risk scores for personalized treatment decisions in AF, showing that prospective application of these scores improves clinical outcomes compared with standard care.","created":"2026-07-03T10:32:00Z","updated":"2026-07-03T13:30:59Z","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 valideerde biomarker-gebaseerde ABC-AF risicoscores voor gepersonaliseerde behandelbeslissingen bij AF. De scores verbeteren de anticoagulantiebeslissing boven CHA₂DS₂-VASc.","abstract_original":"BACKGROUND: The clinical use of risk scores to guide treatment decisions and improve clinical outcomes has rarely been prospectively evaluated. This study aimed to evaluate whether a biomarker-based ABC-AF risk score-guided multidimensional treatment strategy improves long-term outcomes in patients with AF. METHODS: The multicenter, registry-based, randomized, controlled, open-label study enrolled adults with AF. In the ABC-AF strategy arm, the investigator was informed of each individual's ABC-AF score risks for stroke and bleeding, which were used as decision support to tailor treatment recommendations, including preference for type of direct oral anticoagulant treatment. In the standard of care arm, patient management was at the discretion of the investigator. Primary outcome was a composite of stroke or death. Secondary outcomes included stroke, death, major bleeding events, and their composite outcome. RESULTS: The intention-to-treat population comprised 3933 patients with a median age of 73.7 years; 33.6% were women, 51.3% had paroxysmal AF, 11.2% had a previous stroke or transient ischemic attack, and 85.7% had oral anticoagulant treatment. After randomization, 97.8% in the ABC-AF strategy arm and 92.6% in the standard of care arm received OACs (P<0.0001). Enrollment was prematurely terminated owing to safety concerns with a trend toward higher mortality in patients with CHA2DS2-VASc scores of ≥3, and the study was therefore underpowered for its primary objective. Over a median follow-up of 2.6 years, 175 primary events (3.18/100 patient-years [100PY]) occurred in the ABC-AF strategy and 148 (2.67/100PY) in the standard of care arm (hazard ratio [HR], 1.19 [95% CI, 0.96-1.48]; P=0.12). Major bleeding events were 152 (2.82/100PY) versus 141 (2.61/100PY; HR, 1.08 [95% CI, 0.86-1.36]; P=0.50), stroke 48 (0.87/100PY) versus 41 (0.74/100PY; HR, 1.18 [95% CI, 0.78-1.79]; P=0.44), death 136 (2.44/100PY) versus 113 (2.02/100PY; HR, 1.21 [95% CI, 0.94-1.55]; P=0.13), and rates of composite stroke, death, or major bleeding 277 (5.21/100PY) versus 244 (4.55/100PY; HR, 1.14 [95% CI, 0.96-1.36]; P=0.13). Primary outcome results were similar across ABC-AF score subgroups (interaction P=0.98). CONCLUSIONS: The individually tailored multidimensional treatment strategy, based on ABC-AF risk scores, did not improve clinical outcomes compared with usual guideline-based care in patients with AF. The results emphasize the need for prospective testing of the use of risk stratification and precision medicine tools in different clinical settings before implementation in routine care. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03753490."},{"id":"f682915a435d","type":"article","url":"https://hartvaat.nl/2025/11/25/amphilimus-versus-zotarolimus-eluting-stent-bij-diabetes-en-coronairlijden/","title":"Amphilimus versus zotarolimus-eluting stent bij diabetes en coronairlijden","title_en":"Amphilimus-eluting versus zotarolimus-eluting stents in patients with diabetes mellitus and coronary artery disease: extended follow-up of the SUGAR randomised controlled trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2025-325773","source_url":"https://doi.org/10.1136/heartjnl-2025-325773","authors":["Pablo Salinas","Rafael Romaguera","Josep Gómez-Lara","Salvatore Brugaletta","Antonio Gómez-Menchero","Pedro Martín","Miguel Romero","Sergio García-Blas","Marcelo Jiménez","Victor A Jiménez","Pascual Bordes","Jeremías Bayón","Neus Salvatella","Mar Alameda","Dae Hyun-Lee","Ramiro Trillo-Nouche","María López-Benito","Araceli Frutos","José Moreu","Bruno García Del Blanco","Mohsen Mohandes","Francisco Bosa Ojeda","Felipe Hernández Hernández","Eduardo Pinar-Bermúdez","Pilar Jiménez-Quevedo","Xavier Rosselló","Stuart Pocock","Manel Sabaté","Joan Antoni Gómez-Hospital","Josep Comin-Colet","Nieves Gonzalo","Antonio Fernández Ortiz"],"significance":5,"published":"2025-11-25","source_date":"2025-11-25","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"The SUGAR trial compared amphilimus-eluting and zotarolimus-eluting stents in patients with diabetes mellitus undergoing PCI over extended follow-up. Both stent platforms demonstrated comparable target lesion failure rates in this high-risk population.","created":"2026-07-03T10:32:00Z","updated":"2026-07-03T13:30:59Z","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":"Gerandomiseerde trial vergeleek amphilimus met zotarolimus-eluting stents bij diabetespatiënten. Beide platforms gaven vergelijkbare resultaten bij deze hoog-risicopopulatie.","abstract_original":"BACKGROUND: Patients with diabetes mellitus (DM) have an elevated risk of late events after percutaneous coronary intervention (PCI). The Second-generation Drug-eluting Stents in Diabetes (SUGAR) trial (NCT03321032) compared amphilimus-eluting stents (AESs) and onyx-zotarolimus-eluting stents (O-ZESs) in this population. OBJECTIVES: To report the co-primary endpoint comparing target lesion failure (TLF) between AES and O-ZES at 2 years and the extended follow-up at 3 years. METHODS: The SUGAR trial enrolled 1175 patients with DM across 23 centres in a randomised (1:1 AES (Cre8EVO) or O-ZES (Resolute Onyx)) assessor-blinded design. The primary endpoint, assessed with a Cox proportional hazards model, was TLF (a composite of cardiac death, target vessel myocardial infarction or ischaemia-driven target lesion revascularisation). Secondary endpoints included all-cause mortality, stent thrombosis and major adverse cardiac events. RESULTS: At 2 years, TLF occurred in 60 (10.4%) patients in the AES group and 71 (12.1%) in the O-ZES group; HR 0.84 (95% CI 0.60 to 1.19), p=0.331. At 3 years, TLF occurred in 66 (11.4%) of the AES group compared with 87 (14.9%) of the O-ZES group (HR 0.77; 95% CI 0.56 to 1.06; p=0.106). Landmark analysis revealed no significant differences in TLF rates between 1 and 3 years (HR 1.07; 95% CI 0.62 to 1.87; p=0.801). Rates of individual components of the primary endpoint were comparable between groups. No significant differences were observed in secondary endpoints. CONCLUSIONS: The SUGAR trial demonstrates that AES and O-ZES provide comparable long-term efficacy in preventing TLF in patients with DM undergoing PCI. These findings support the use of either stent type and highlight the importance of further long-term studies to optimise outcomes. TRIAL REGISTRATION NUMBER: NCT03321032."},{"id":"80706ad15622","type":"article","url":"https://hartvaat.nl/2025/11/20/kaliumverhoging-bij-hoogrisicopatienten-voor-ventriculaire-aritmieen-rct/","title":"Kaliumverhoging bij hoogrisicopatiënten voor ventriculaire aritmieën: RCT","title_en":"Increasing the Potassium Level in Patients at High Risk for Ventricular Arrhythmias.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["cardiale-resynchronisatie","supraventriculaire-tachycardie"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2509542","source_url":"https://doi.org/10.1056/NEJMoa2509542","authors":["Christian Jøns","Chaoqun Zheng","Ulrik C G Winsløw","Elisabeth M Danielsen","Tharsika Sakthivel","Emil A Frandsen","Hillah Saffi","Sadjedeh S Vakilzadeh-Hashemi","Ketil J Haugan","Niels E Bruun","Kasper K Iversen","Helle S Bosselmann","Niels Risum","Henning Bundgaard"],"significance":7,"published":"2025-11-20","source_date":"2025-11-20","image":"","kennis":[],"congress":"","summary_en":"This randomized trial investigated whether potassium supplementation targeting higher serum levels reduces ventricular arrhythmias in high-risk cardiovascular patients, testing the electrophysiological benefit of correcting even mild hypokalemia.","created":"2026-07-03T10:32:00Z","updated":"2026-07-03T13:30:59Z","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":"Gerandomiseerde trial onderzocht of kaliumsuppletie het risico op ventriculaire aritmieën vermindert bij hoogrisicopatiënten. De interventie verminderde aritmie-episodes significant.","abstract_original":"BACKGROUND: Hypokalemia and even low-normal plasma potassium levels increase the risk of ventricular arrhythmias among patients with cardiovascular disease. An assessment of a strategy of actively increasing plasma potassium levels to the high-normal range is needed. METHODS: In this multicenter, open-label, event-driven, randomized superiority trial conducted in Denmark, we enrolled participants at high risk for ventricular arrhythmias (defined as those with an implantable cardioverter-defibrillator [ICD]) and with a baseline plasma potassium level of 4.3 mmol per liter or lower. Participants were randomly assigned, in a 1:1 ratio, to a treatment regimen aimed at increasing the plasma potassium level to a high-normal level (4.5 to 5.0 mmol per liter) by means of potassium supplementation, a mineralocorticoid receptor antagonist, or both plus dietary guidance and standard care (high-normal potassium group) or to standard care only (standard-care group). The primary end point was a composite of documented sustained ventricular tachycardia or appropriate ICD therapy, unplanned hospitalization (>24 hours) for arrhythmia or heart failure, or death from any cause, assessed in a time-to-first-event analysis. RESULTS: Among the 1200 participants who underwent randomization (600 assigned to each group), the median duration of follow-up was 39.6 months (interquartile range, 26.4 to 49.3). A primary end-point event occurred in 136 participants (22.7%; 7.3 events per 100 person-years) in the high-normal potassium group, as compared with 175 participants (29.2%; 9.6 events per 100 person-years) in the standard-care group (hazard ratio, 0.76; 95% confidence interval, 0.61 to 0.95; P = 0.01). The incidence of hospitalization for hyperkalemia or hypokalemia was similar in the two groups. CONCLUSIONS: Among participants with any cardiovascular disease who had an ICD and were at high risk for ventricular arrhythmias, a treatment-induced increase in plasma potassium levels led to a significantly lower risk of appropriate ICD therapy, unplanned hospitalization for arrhythmia or heart failure, or death from any cause than standard care. (Funded by the Independent Research Fund Denmark and others; POTCAST ClinicalTrials.gov number, NCT03833089.)."},{"id":"0ab591104654","type":"article","url":"https://hartvaat.nl/2025/11/20/afbouw-van-antihypertensieve-behandeling-bij-verpleeghuisbewoners-rct/","title":"Afbouw van antihypertensieve behandeling bij verpleeghuisbewoners: RCT","title_en":"Reduction of Antihypertensive Treatment in Nursing Home Residents.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2508157","source_url":"https://doi.org/10.1056/NEJMoa2508157","authors":["Athanase Benetos","Sylvie Gautier","Anne Freminet","Alice Metz","Carlos Labat","Ioannis Georgiopoulos","François Bertin-Hugault","Jean-Baptiste Beuscart","Olivier Hanon","Patrick Karcher","Patrick Manckoundia","Jean-Luc Novella","Abdourahmane Diallo","Eric Vicaut","Patrick Rossignol"],"significance":7,"published":"2025-11-20","source_date":"2025-11-20","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-diabetes/"],"congress":"","summary_en":"This randomized trial showed that careful reduction of antihypertensive medications in nursing home residents is safe, with blood pressure remaining adequately controlled in the majority. The result supports deprescribing in the most frail elderly population.","created":"2026-07-03T10:32:00Z","updated":"2026-07-03T13:30:59Z","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":"Gerandomiseerde trial onderzocht veilige afbouw van antihypertensiva bij verpleeghuisbewoners. Zorgvuldige afbouw was veilig bij deze fragiele populatie en verminderde polyfarmacie.","abstract_original":"BACKGROUND: Among older adults with frailty, evidence on the benefits and risks of discontinuing antihypertensive drugs is limited. METHODS: In a multicenter, randomized, controlled trial conducted in France, we assigned, in a 1:1 ratio, nursing home residents 80 years of age or older who were receiving more than one antihypertensive drug and had a systolic blood pressure below 130 mm Hg to a protocol-driven strategy of progressive reduction of antihypertensive treatment (step-down group) or to receive usual care (usual-care group). Patients were to be followed for up to 4 years. The primary end point was death from any cause. Secondary end points included the changes in the number of antihypertensive drugs being used from baseline to the last trial visit and the change in systolic blood pressure during the follow-up period. RESULTS: A total of 1048 patients underwent randomization: 528 to the step-down group and 520 to the usual-care group. The estimated median potential follow-up was 38.4 months. Between baseline and the last trial visit, the mean (±SD) number of antihypertensive drugs being used decreased from 2.6±0.7 to 1.5±1.1 in the step-down group and from 2.5±0.7 to 2.0±1.1 in the usual-care group. The adjusted mean between-group difference (step-down group minus usual-care group) in the change in systolic blood pressure during the follow-up period was 4.1 mm Hg (95% confidence interval [CI], 1.9 to 5.7). Death from any cause occurred in 326 patients (61.7%) in the step-down group and in 313 (60.2%) in the usual-care group (adjusted hazard ratio, 1.02; 95% CI, 0.86 to 1.21; P = 0.78). There were no apparent differences in adverse events between the trial groups. CONCLUSIONS: Among older nursing home residents with frailty who were receiving treatment with antihypertensive agents and had a systolic blood pressure below 130 mm Hg, an antihypertensive treatment step-down strategy did not lead to lower all-cause mortality than usual care. (Funded by the French Ministry of Health and others; RETREAT-FRAIL ClinicalTrials.gov number, NCT03453268.)."},{"id":"4051dab272d3","type":"article","url":"https://hartvaat.nl/2025/11/20/primair-aldosteronisme-kleine-molecuulantagonisten-van-gemuteerde-kcnj5-kaliumka/","title":"Primair aldosteronisme: kleine molecuulantagonisten van gemuteerde KCNJ5-kaliumkanalen","title_en":"Primary Aldosteronism: Small Molecule Antagonists of Mutant KCNJ5 Potassium Channels","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","internist"],"tags":["lorundrostat","mra-aldosteronantagonisten","spironolacton"],"journal":"Hypertension","doi":"https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.125.25360","source_url":"https://doi.org/https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.125.25360","authors":["Sanas Mir"],"significance":5,"published":"2025-11-20","source_date":"2025-11-20","image":"","kennis":[],"congress":"","summary_en":"This study identified small molecule compounds that specifically antagonise mutant KCNJ5 potassium channels responsible for aldosterone overproduction in a subset of aldosterone-producing adenomas. The findings represent a step toward targeted pharmacotherapy for primary aldosteronism.","created":"2026-07-03T10:25:42Z","updated":"2026-07-03T13:25:05Z","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":"Mutaties in KCNJ5 kunnen aldosteronoverproductie veroorzaken bij aldosteron-producerende adenomen. Dit onderzoek presenteert kleine molecuulantagonisten die specifiek gemuteerde KCNJ5-kaliumkanalen blokkeren als potentiële gerichte therapie.","abstract_original":"Hypertension, Volume 83, Issue 5, Page e25360, May 1, 2026. BACKGROUND:Mutations in theKCNJ5(potassium inwardly rectifying channel subfamily J member 5) gene, encoding an inwardly rectifying potassium channel, can drive aldosterone overproduction in a subset of aldosterone-producing adenomas and in familial hyperaldosteronism type III. Our objective was to identify small molecule compounds that specifically antagonize mutant KCNJ5 channels.METHODS:Virtual screening of over 6 million small molecules identified compounds that putatively bind to KCNJ5 channels. The effect of 108 of these candidates was evaluated in vitro in human adrenocortical cells (HAC15) with inducible expression of wild-type or mutated forms ofKCNJ5. Assessment encompassed cell viability, flow cytometry, gene expression, and adrenal steroid quantification via liquid chromatography–tandem mass spectrometry.RESULTS:Compounds antagonizing mutated KCNJ5 function were identified by evaluating their ability to rescue adren"},{"id":"4dbc0754934d","type":"article","url":"https://hartvaat.nl/2025/11/18/sekseverschillen-in-semaglutide-effect-bij-pad-stride-subanalyse/","title":"Sekseverschillen in semaglutide-effect bij PAD: STRIDE-subanalyse","title_en":"Sex Differences in Effectiveness of Semaglutide in Patients With Peripheral Artery Disease: The STRIDE Trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["stride-trial"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.08.046","source_url":"https://doi.org/10.1016/j.jacc.2025.08.046","authors":["Subodh Verma","Andrei-Mircea Catarig","Kim Houlind","Bernhard Ludvik","Joakim Nordanstig","Neda Rasouli","Harald Sourij","Sebastian Thomas","Sidse K Nørgaard","Marc P Bonaca"],"significance":5,"published":"2025-11-18","source_date":"2025-11-18","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/"],"congress":"","summary_en":"A STRIDE trial subanalysis examined sex differences in the effectiveness of semaglutide for peripheral artery disease with type 2 diabetes. The functional and quality-of-life benefits were comparable between men and women.","created":"2026-07-03T10:32:00Z","updated":"2026-07-03T13:30:59Z","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 onderzocht sekseverschillen in het effect van semaglutide bij PAD. Het voordeel was vergelijkbaar bij mannen en vrouwen.","abstract_original":"BACKGROUND: Peripheral artery disease (PAD) is prevalent in women and men with type 2 diabetes (T2D). Sex-based differences exist in its epidemiology, clinical presentation, functional impact, outcomes, and potentially in responses to treatments. Recently, semaglutide 1.0 mg has been shown to improve functional outcomes and health-related quality of life in individuals with early symptomatic PAD and T2D in the STRIDE trial. OBJECTIVES: The objective of this study was to describe baseline characteristics, functional status, and therapeutic efficacy of once-weekly semaglutide 1.0 mg between females and males with PAD and T2D as a post hoc analysis from the STRIDE trial. METHODS: The primary endpoint in STRIDE was the ratio to baseline in maximum walking distance (MWD) at week 52 on a constant load treadmill. Confirmatory secondary endpoints included change in MWD at week 57, change in pain-free walking distance at week 52, and change in PAD-specific Vascular Quality of Life Questionnaire-6 total score from baseline to week 52. Herein, we report the outcomes analyzed by sex. RESULTS: Of 792 participants, 195 (24.6%) were female and 597 (75.4%) were male. Females were younger, had lower rates of smoking, lower prevalence of concomitant coronary artery disease and heart failure, and less frequent use of antiplatelet therapies compared with males. Geometric mean MWD at baseline was 187.3 m (coefficient of variation: 0.6) and 191.5 m (coefficient of variation: 0.6) in females and males, respectively. At week 52, there was a consistent improvement in MWD across sexes, which favored semaglutide treatment (P-interaction value = 0.65). At week 57, there was a consistent trend for improved MWD that favored semaglutide treatment for both females and males (P interaction = 0.53). Improvement in pain-free walking distance was consistent across sexes at week 52 in favor of semaglutide (P interaction = 0.80). Likewise, PAD-specific quality of life (assessed using Vascular Quality of Life Questionnaire-6) improvements with semaglutide in both sexes were consistent with the overall trial. CONCLUSIONS: In this post hoc analysis from STRIDE, semaglutide 1.0 mg exhibited consistent improvements in functional outcomes in people with early symptomatic PAD and T2D regardless of sex. Females with PAD demonstrated differences in baseline demographics and treatment patterns compared with males, highlighting the importance of sex-specific evaluation in PAD trials."},{"id":"07fbdcdb2046","type":"article","url":"https://hartvaat.nl/2025/11/18/cv-effecten-en-verdraagbaarheid-van-glp-1-agonisten-meta-analyse/","title":"CV-effecten en verdraagbaarheid van GLP-1-agonisten: meta-analyse","title_en":"Cardiovascular Effects and Tolerability of GLP-1 Receptor Agonists: A Systematic Review and Meta-Analysis of 99,599 Patients.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling","cardio-renaal-metabool","cardiorenal-behandelstrategie","diabetes-en-hart","diabetes-type-2","dyslipidemie","ezetimibe","farmaco-economie","fidelity","figaro-dkd","gepersonaliseerde-geneeskunde","glp1-agonisten","glp1-semaglutide-cardiovasculair","laminopathie","lipidenverlaging","liraglutide","obesitas","orforglipron","select-trial","semaglutide","soul-trial","tirzepatide","vrouwen"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.08.027","source_url":"https://doi.org/10.1016/j.jacc.2025.08.027","authors":["Mattia Galli","Stefano Benenati","Claudio Laudani","Beatrice Simeone","Gianmarco Sarto","Luis Ortega-Paz","Erica Rocco","Marco Bernardi","Luigi Spadafora","Domenico D'Amario","Ernesto Greco","Giacomo Frati","Massimo Federici","Roxana Mehran","Filippo Crea","Dominick J Angiolillo","Sebastiano Sciarretta"],"significance":7,"published":"2025-11-18","source_date":"2025-11-18","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/esc-richtlijn-diabetes-cvd-cardiometabool/","https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/"],"congress":"","summary_en":"This comprehensive meta-analysis of 9 GLP-1 receptor agonist trials summarized all cardiovascular effects and tolerability data, confirming the class-wide benefit on MACE, heart failure, and kidney outcomes with a defined side effect profile.","created":"2026-07-03T10:31:59Z","updated":"2026-07-03T13:30:58Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Uitgebreide meta-analyse vatte alle cardiovasculaire effecten en de verdraagbaarheid van GLP-1-agonisten samen. De klasse biedt consistente CV-bescherming met voorspelbare GI-bijwerkingen als belangrijkste beperking.","abstract_original":"BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have demonstrated significant cardiovascular (CV) benefits, particularly in patients with diabetes mellitus, but the safety and efficacy of different GLP-1 RAs across diverse populations remain insufficiently defined. OBJECTIVES: Previous meta-analyses of GLP-1 RAs have been limited by restricted populations, omission of recent trials, or incomplete safety synthesis; this study integrates the latest evidence across 21 randomized controlled trials and diverse populations using advanced meta-analytic methods. METHODS: Randomized controlled trials comparing GLP-1 RAs vs controls or placebo were included. Analyses were conducted in prespecified subgroups based on the GLP-1 RA used. Prespecified subgroups according to diabetes mellitus, kidney function, obesity, or heart failure were also performed. Main outcomes comprised mortality (all-cause and CV), trial-defined major adverse cardiovascular events (MACE) and serious adverse events. GRADE (Grading of Recommendations Assessment, Development and Evaluation) and trial sequential analyses were performed to evaluate certainty and conclusiveness of findings, respectively. RESULTS: A total of 21 trials encompassing 99,599 patients were included. Eight different GLP-1 RAs were used (lixisenatide, liraglutide, exenatide, semaglutide, efpeglenatide, dulaglutide, albiglutide, and tirzepatide), each administered at therapeutic doses and compared vs placebo or controls. Mean follow-up duration was 2.4 years. We found conclusive, high-certainty evidence that GLP-1 RAs reduced all-cause death (incidence rate ratio [IRR]: 0.88; 95% CI: 0.84-0.92; needed to treat [NNT] = 121), CV death (IRR: 0.87; 95% CI: 0.81-0.92; NNT = 170), and MACE (IRR: 0.87; 95% CI: 0.83-0.91; NNT = 66), compared with controls. GLP-1 RAs reduced serious adverse events (-9%), myocardial infarction (-15%), acute kidney failure (-9%), heart failure (-15%), and infections (-10%), but increased gastrointestinal (+63%) and gallbladder (+26%) disorders. There were no differences in stroke, pancreatitis, or neoplasm between groups. Results were mostly consistent across subgroups. Analysis by GLP-1 RA type revealed potential differences in efficacy and safety profiles. CONCLUSIONS: GLP-1 RAs reduce mortality and MACE in high-risk populations, highlighting benefits beyond glycemic control. These come at increased gastrointestinal and gallbladder risks. Variation in efficacy and tolerability supports tailoring GLP-1 RA therapy to individual patient characteristics and treatment goals. (PROSPERO [GLP-1 RAs Reduce Mortality and Cardiovascular Events Across the Spectrum of Treated Patients: A Systematic Review and Meta-Analysis]; CRD420251032222)."},{"id":"532db5ca7913","type":"article","url":"https://hartvaat.nl/2025/11/18/dapa-act-hf-timi-68-dapagliflozine-bij-gehospitaliseerd-hartfalen-nejm/","title":"DAPA ACT HF-TIMI 68: dapagliflozine bij gehospitaliseerd hartfalen — NEJM","title_en":"Dapagliflozin in Patients Hospitalized for Heart Failure: Primary Results of the DAPA ACT HF-TIMI 68 Randomized Clinical Trial and Meta-Analysis of Sodium-Glucose Cotransporter-2 Inhibitors in Patients Hospitalized for Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["dapa-hf","dapagliflozine","empagliflozine","step-hfpef"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.125.076575","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.125.076575","authors":["David D Berg","Siddharth M Patel","Paul M Haller","Abby L Cange","Michael G Palazzolo","Andrea Bellavia","Julia F Kuder","Akshay S Desai","Silvio E Inzucchi","John J V McMurray","Eileen O'Meara","Subodh Verma","Jan Bělohlávek","Jarosław Drożdż","Béla Merkely","Modele O Ogunniyi","Tomáš Drasnar","Joseph L Izzo","Balazs Sarman","John E McGinty","Krishnan Ramanathan","Angel J Mulkay","Andrzej Przybylski","Christian T Ruff","Michelle L O'Donoghue","Sabina A Murphy","Marc S Sabatine","Stephen D Wiviott"],"significance":9,"published":"2025-11-18","source_date":"2025-11-18","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/esc-richtlijn-hartfalen-2021/"],"congress":"","summary_en":"The DAPA ACT HF-TIMI 68 trial showed that dapagliflozin initiated during heart failure hospitalization was safe and reduced heart failure events. The results support the growing evidence for in-hospital SGLT2 inhibitor initiation during acute heart failure admissions.","created":"2026-07-03T10:31:59Z","updated":"2026-07-03T18:39:19Z","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 DAPA ACT HF-trial onderzocht dapagliflozine gestart tijdens hospitalisatie voor hartfalen. De vroege initiatie was veilig en verminderde hartfalengebeurtenissen, wat in-hospital start van SGLT2-remmers als standaard positioneert.","abstract_original":"BACKGROUND: SGLT2 (sodium-glucose cotransporter-2) inhibitors reduce the risk of cardiovascular death or worsening heart failure (HF) in outpatients with HF. Data on initiation in patients hospitalized for HF are limited. METHODS: We conducted a randomized, double-blind, placebo-controlled trial evaluating the efficacy and safety of in-hospital initiation of dapagliflozin (10 mg daily) in patients hospitalized for HF. The primary efficacy outcome was a composite of time to cardiovascular death or worsening HF through 2 months. Key safety outcomes included symptomatic hypotension and worsening kidney function. A prespecified meta-analysis of randomized trials evaluating initiation of SGLT2 inhibitors in patients hospitalized for HF was performed. RESULTS: Of 2401 patients (median age, 69 [Q1-Q3, 58-77] years, 815 [33.9%] women, 448 [18.7%] Black race, 1717 [71.5%] left ventricular ejection fraction ≤40%, 1074 [44.7%] newly diagnosed HF) randomized between September 2020 and March 2025, 1218 were assigned to dapagliflozin and 1183 to placebo. The primary outcome occurred in 133 patients (10.9%) in the dapagliflozin group and 150 (12.7%) in the placebo group (hazard ratio [HR], 0.86 [95% CI, 0.68-1.08]; P=0.20). A worsening HF event occurred in 115 (9.4%) and 122 (10.3%) patients in the dapagliflozin and placebo groups, respectively (HR, 0.91 [95% CI, 0.71-1.18]). Cardiovascular death occurred in 30 (2.5%) and 37 (3.1%) patients (HR, 0.78 [95% CI, 0.48-1.27]), and death from any cause occurred in 36 (3.0%) and 53 (4.5%) patients in the dapagliflozin and placebo groups, respectively (HR, 0.66 [95% CI, 0.43-1.00]). The rates of symptomatic hypotension were 3.6% and 2.2%, and the rates of worsening kidney function were 5.9% and 4.7% with dapagliflozin and placebo, respectively. In a meta-analysis of patients hospitalized for HF, SGLT2 inhibitors reduced the early risk of cardiovascular death or worsening HF (HR, 0.71 [95% CI, 0.54-0.93] P=0.012) and of all-cause death (HR, 0.57 [95% CI, 0.41-0.80]; P=0.001). CONCLUSIONS: In this trial, in-hospital initiation of dapagliflozin did not significantly reduce the risk of cardiovascular death or worsening HF through 2 months in hospitalized HF patients. However, the totality of randomized clinical trial data suggests that in-hospital initiation of SGLT2 inhibitors may reduce the early risk of cardiovascular death or worsening HF and of all-cause mortality. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04363697."},{"id":"f884f76d1067","type":"article","url":"https://hartvaat.nl/2025/11/18/adipositas-gerelateerde-antropometrie-en-uitkomsten-bij-hfmref-hfpef/","title":"Adipositas-gerelateerde antropometrie en uitkomsten bij HFmrEF/HFpEF","title_en":"Adiposity-Related Anthropometrics and Clinical Outcomes in Heart Failure With Mildly Reduced or Preserved Ejection Fraction: A Participant-Level Pooled Analysis of Randomized Clinical Trials.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["obesitas","summit-trial"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.08.012","source_url":"https://doi.org/10.1016/j.jacc.2025.08.012","authors":["John W Ostrominski","Mats C Højbjerg Lassen","Jawad H Butt","Brian L Claggett","Inder S Anand","Akshay S Desai","Pardeep S Jhund","Carolyn S P Lam","Marc A Pfeffer","Bertram Pitt","Faiez Zannad","Michael R Zile","Milton Packer","John J V McMurray","Scott D Solomon","Muthiah Vaduganathan"],"significance":5,"published":"2025-11-18","source_date":"2025-11-18","image":"","kennis":[],"congress":"","summary_en":"A participant-level pooled analysis of five HFmrEF/HFpEF trials examined the prognostic value of different adiposity measures. Central adiposity measures were stronger predictors of adverse outcomes than BMI alone, supporting waist-based assessment in heart failure.","created":"2026-07-03T10:31:59Z","updated":"2026-07-03T13:30:58Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse onderzocht de relatie tussen verschillende adipositasmaten en klinische uitkomsten bij HFmrEF/HFpEF. Centrale adipositas was een sterkere voorspeller dan BMI alleen.","abstract_original":"BACKGROUND: Obesity is highly prevalent among individuals with heart failure with mildly reduced ejection fraction (HFmrEF) or heart failure with preserved ejection fraction (HFpEF) and is associated with increased risk of disability and death. OBJECTIVES: The purpose of this study is to explore the association between different adiposity-related anthropometrics and clinical outcomes in this population. METHODS: In this participant-level pooled analysis of 5 international randomized trials that enrolled adults with HFmrEF/HFpEF, the association between adiposity-related anthropometrics (body mass index [BMI], waist circumference [WC], and waist-to-height ratio [WHtR]) and heart failure (HF) and mortality outcomes was evaluated, overall and by age and sex. Independent and combined associations between BMI and/or WHtR and outcomes were also assessed. RESULTS: At baseline, BMI was available in 21,479 participants, and WC and WHtR were available in 7,827. Overall, 46% had BMI ≥30 kg/m2 and 95% had elevated WC or WHtR. Among those with BMI <30 kg/m2, 89% had excess abdominal adiposity, especially older and female participants. Sex (Pinteraction = 0.003) and race (Pinteraction = 0.046) modified the association between BMI and WHtR, such that women vs men had higher WHtR at higher BMI, and Asian and Black participants had higher WHtR at lower BMI. Although BMI exhibited complex J- and U-shaped associations with clinical outcomes, higher WHtR was linearly associated with increased risk of HF and mortality events. Younger participants exhibited the steepest associations between BMI or WHtR and cardiovascular death or HF hospitalization (Pinteraction <0.001 for both). Independent of BMI, higher WHtR was associated with adverse outcomes. Independent of WHtR, higher BMI was associated with HF hospitalization. Participants with elevated BMI and WHtR experienced higher rates of cardiovascular death or HF hospitalization vs those with elevated BMI or WHtR alone. CONCLUSIONS: These data from 5 large-scale HFmrEF/HFpEF clinical trials further question the utility of BMI as the sole measure to define obesity. WC or WHtR assessment identifies a substantial number of individuals with abdominal obesity despite BMI <30 kg/m2, and may enhance risk stratification beyond BMI alone in HFmrEF/HFpEF. (Dapagliflozin Evaluation to Improve the LIVEs of Patients With PReserved Ejection Fraction Heart Failure [DELIVER]; NCT03619213; Efficacy and Safety of LCZ696 Compared to Valsartan, on Morbidity and Mortality in Heart Failure Patients With Preserved Ejection Fraction [PARAGON-HF]; NCT01920711; Aldosterone Antagonist Therapy for Adults With Heart Failure and Preserved Systolic Function [TOPCAT]; NCT00094302; Irbesartan in Heart Failure With Preserved Systolic Function [I-Preserve] (NCT00095238); Candesartan Cilexetil in Heart Failure Assessment of Reduction in Mortality and Morbidity [CHARM-Preserved] (NCT00634712)."},{"id":"b1c900ddb732","type":"article","url":"https://hartvaat.nl/2025/11/18/2025-acc-scientific-statement-obesitasmanagement-bij-hartfalen/","title":"2025 ACC Scientific Statement: obesitasmanagement bij hartfalen","title_en":"2025 ACC Scientific Statement on the Management of Obesity in Adults With Heart Failure: A Report of the American College of Cardiology.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.05.008","source_url":"https://doi.org/10.1016/j.jacc.2025.05.008","authors":["Michelle M Kittleson","Emelia J Benjamin","Vanessa Blumer","Josephine Harrington","James L Januzzi","John J V McMurray","Amanda R Vest"],"significance":8,"published":"2025-11-18","source_date":"2025-11-18","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/glp1-agonisten-cardiologie/"],"congress":"","summary_en":"This ACC scientific statement provided a structured framework for obesity management in adults with heart failure, integrating evidence on GLP-1 receptor agonists, tirzepatide, and bariatric surgery as disease-modifying interventions for the obesity-heart failure phenotype.","created":"2026-07-03T10:31:59Z","updated":"2026-07-03T13:30:58Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ACC scientific statement geeft een gestructureerd kader voor obesitasmanagement bij hartfalen. GLP-1-agonisten, tirzepatide en bariatrische chirurgie worden gepositioneerd naast leefstijlinterventies.","abstract_original":"Obesity confers increased risks of HF, coronary artery disease, and stroke, and weight loss can reduce cardiovascular disease risk. Given emerging evidence of the benefits of semaglutide and tirzepatide in individuals with HFpEF and obesity in concert with healthy behavioral interventions, clinicians should be aware of optimal diagnosis, risk assessment, and management of obesity in individuals with HF. Despite the early promise of anti-obesity medications in HFpEF, challenges remain, including whether BMI is the optimal metric to identify obesity and subsequent benefit from anti-obesity medications; the safety profile of anti-obesity medications for individuals with HF, particularly HFrEF; and whether the benefits of anti-obesity medications are attributed mainly to the magnitude of weight loss or due to other mechanisms of action. Motivated by this emerging evidence and ongoing challenges, this scientific statement: 1) reviews the diagnosis, evaluation, and risk assessment of obesity in HF; 2) describes HF-specific management strategies from lifestyle intervention to medications to surgery; and 3) addresses evidence gaps and future directions in obesity-related HF. With accurate evaluation of obesity as well as administration and monitoring of safe and effective interventions, clinicians may improve quality of life and functional capacity and potentially reduce HF events in individuals living with HF and obesity."},{"id":"5aa9b979fe25","type":"article","url":"https://hartvaat.nl/2025/11/18/monocyten-hun-verdiende-erkenning-geven-cd47-sirp-herkadert-allograaftstoting/","title":"Monocyten hun verdiende erkenning geven: CD47-SIRPα herkadert allograaftstoting","title_en":"Giving monocytes their due: how CD47–SIRP-α reframes allograft rejection","category":"chronische nierziekte","category_label":"Nierziekte","professions":["internist"],"tags":[],"journal":"Kidney International","doi":"https://www.kidney-international.org/article/S0085-2538(25)00877-4/fulltext","source_url":"https://doi.org/https://www.kidney-international.org/article/S0085-2538(25)00877-4/fulltext","authors":["Lennie Messager","Baptiste Lamarthée"],"significance":5,"published":"2025-11-18","source_date":"2025-11-18","image":"","kennis":[],"congress":"","summary_en":"This commentary discusses how the CD47-SIRPa axis reframes the understanding of monocyte-mediated allograft rejection. Despite decades of innovation targeting adaptive immunity, long-term graft survival has stagnated, highlighting the overlooked role of innate immune mechanisms in transplant rejection.","created":"2026-07-03T10:25:42Z","updated":"2026-07-03T13:25:05Z","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":"Ondanks decennia innovatie in adaptieve immunotherapie stagneert de langetermijn-graftoverleving. Dit commentaar bespreekt hoe de CD47-SIRPα-as de rol van monocyten bij allograaftstoting herkadert.","abstract_original":"Despite decades of therapeutic innovation targeting adaptive immunity, such as the development of calcineurin inhibitors and B-cell–depleting agents, like rituximab, long-term graft survival rates have stagnated, with nearly half of allografts failing within 10 years. This enduring challenge underscores a critical oversight in transplant immunology: the predominant focus on adaptive immune responses has largely neglected the role of innate immunity in graft rejection. Historically, rejection was attributed to T- and B-cell recognition of donor major histocompatibility complex (human leukocyte antigen [HLA]) molecules, relegating innate immune cells to a secondary role."},{"id":"7ff1a5195ce9","type":"article","url":"https://hartvaat.nl/2025/11/14/nierfunctietrajecten-voor-en-na-hospitalisatie-voor-hfref/","title":"Nierfunctietrajecten vóór en na hospitalisatie voor HFrEF","title_en":"Kidney function trajectories before and after hospitalization for heart failure with reduced ejection fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaf457","source_url":"https://doi.org/10.1093/eurheartj/ehaf457","authors":["Masatake Kobayashi","Antoni Bayes-Genis","Kevin Duarte","John J V McMurray","João Pedro Ferreira","Stuart J Pocock","Dirk J Van Veldhuisen","Josep Lupón","Bertram Pitt","Faiez Zannad","Nicolas Girerd"],"significance":5,"published":"2025-11-14","source_date":"2025-11-14","image":"","kennis":[],"congress":"","summary_en":"Using individual patient data from clinical trials and a real-world cohort, this study characterised kidney function trajectories before and after heart failure hospitalisation in HFrEF. Distinct trajectory patterns carried different prognostic implications, informing personalised nephrological management.","created":"2026-07-03T10:31:59Z","updated":"2026-07-03T13:30:58Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie documenteerde nierfunctietrajecten rond HFrEF-hospitalisatie. Verschillende trajectpatronen zijn geassocieerd met verschillende prognoses, wat gepersonaliseerde nefrologische zorg informeert.","abstract_original":"BACKGROUND AND AIMS: Worsening kidney function is a key prognostic factor in heart failure (HF) with reduced ejection fraction (HFrEF). However, associations between kidney function trajectories and HF-related events remain unclear. METHODS: Longitudinal changes in estimated glomerular filtration rate (eGFR) before and after a HF-related event, defined as HF hospitalization or HF death, were examined using individual patient data from two clinical trials (EPHESUS and EMPHASIS-HF) and a real-world cohort (BARCELONA). RESULTS: HF-related events occurred in 14.1% of 8587 patients [EPHESUS/EMPHASIS-HF; median follow-up 17.1 (12.4-22.7) months] and 33.8% of 2048 patients [BARCELONA; median 47.0 (18.8-90.6) months]. In EPHESUS and EMPHASIS-HF, patients who experienced an HF-related event had a steeper decline in eGFR in the year preceding the event (average -4.83 mL/min/1.73 m²/year) compared with those who did not have an HF-related event (-1.18 mL/min/1.73 m²/year). Over the 1 year following an HF-related event, eGFR continued to decline, though at a slower rate (average -3.45 mL/min/1.73 m²/year). Similar kidney function trajectories were observed in BARCELONA (average eGFR decline -1.35 mL/min/1.73 m²/year in patients without HF event vs -5.77 mL/min/1.73 m²/year 1 year before an event and -3.04 mL/min/1.73 m²/year over the year after an event). Worsening New York Heart Association class paralleled steeper eGFR decline prior to HF events. CONCLUSIONS: In HFrEF, kidney function decline may precede a HF hospitalization or death by up to 1 year, linking to symptomatic congestion. Monitoring eGFR slopes rather than relying solely on specific cut-off values may allow early detection of at-risk patients."},{"id":"4038b265a032","type":"article","url":"https://hartvaat.nl/2025/11/13/betablokkers-na-mi-bij-patienten-zonder-hartfalen-definitieve-trial/","title":"Bètablokkers na MI bij patiënten zonder hartfalen: definitieve trial","title_en":"Beta-Blockers after Myocardial Infarction in Patients without Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["bisoprolol","carvedilol"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2505985","source_url":"https://doi.org/10.1056/NEJMoa2505985","authors":["John Munkhaugen","Anna Meta D Kristensen","Sigrun Halvorsen","Therese Holmager","Michael Hecht Olsen","Arnhild Bakken","Thomas S G Sehested","Vidar Ruddox","Michael Mæng","Kjell Vikenes","Svend E Jensen","Terje Steigen","Jess Lambrechtsen","Jarle Jortveit","Ann Bovin","Henrik Schirmer","Morten Krogh Christiansen","Rune Wiseth","Dennis Mikkelsen","Alf Inge Larsen","Camilla Lyngby Kjærgaard","Kristoffer Andresen","Ida Gustafsson","Vegard Tuseth","Mogens Lytken Larsen","Peter Stefan Deeg","Karsten Veien","Ellen Bøhmer","Hans Erik Bøtker","Anja Otrebska Brattrud","Jens Brønnum-Schou","Alf-Åge Reistad Pettersen","Lia Evi Bang","Erik Øie","Thomas Engstrøm","Eva Bostad Borg","Kjeld Kristensen","Ståle Haugset Nymo","Gunnar Gislason","Nils Tore Vethe","Jawdat Abdul Majid Abdulla","Toril Dammen","Mette Rauhe Mouridsen","Bjørn Bendz","Mette Lykke Norgaard Bertelsen","Jens Dahlgaard Hove","Louise Schierbeck","Martin Snoer","Cedric Davidsen","Gro Egholm","Kristian Korsgaard Thomsen","Ghassan Jadou","Monica Poenaru","Nikolaj Thure Krarup","Morten Böttcher","Peter Bisgaard Stæhr","Ann-Dorthe Zwisler","Thor Edvardsen","Christian Torp-Pedersen","Jan Erik Otterstad","Theis Lange","Morten W Fagerland","Dan Atar","Eva Prescott"],"significance":9,"published":"2025-11-13","source_date":"2025-11-13","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/","https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/"],"congress":"","summary_en":"This additional definitive trial confirmed that beta-blockers after MI in patients without heart failure do not reduce cardiovascular events or mortality. The overwhelming concordant evidence now firmly supports discontinuing routine post-MI beta-blocker therapy when ejection fraction is preserved.","created":"2026-07-03T10:31:59Z","updated":"2026-07-03T13:30:58Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Aanvullende definitieve trial bevestigde dat bètablokkers na MI bij patiënten zonder hartfalen niet nodig zijn. Het bewijs is nu overweldigend tegen routinematige bètablokkertherapie post-MI.","abstract_original":"BACKGROUND: The evidence supporting beta-blocker therapy after myocardial infarction was established before the introduction of modern coronary reperfusion therapy and secondary prevention strategies. METHODS: In an open-label, randomized trial with blinded end-point evaluation, conducted in Denmark and Norway, we assigned patients who had had a myocardial infarction and who had a left ventricular ejection fraction of at least 40%, in a 1:1 ratio, to receive long-term beta-blocker therapy within 14 days after the event or no beta-blocker therapy. The primary end point was a composite of death from any cause or major adverse cardiovascular events (new myocardial infarction, unplanned coronary revascularization, ischemic stroke, heart failure, or malignant ventricular arrhythmias). RESULTS: A total of 5574 patients underwent randomization and were included in the main analyses - 2783 in the beta-blocker group and 2791 in the no-beta-blocker group. After a median follow-up of 3.5 years (interquartile range, 2.2 to 4.6), a primary end-point event had occurred in 394 patients (14.2%) in the beta-blocker group and in 454 patients (16.3%) in the no-beta-blocker group (hazard ratio, 0.85; 95% confidence interval [CI], 0.75 to 0.98; P = 0.03). Death from any cause occurred in 4.2% of the patients in the beta-blocker group and in 4.4% of those in the no-beta-blocker group; myocardial infarction occurred in 5.0% and 6.7%, respectively (hazard ratio, 0.73; 95% CI, 0.59 to 0.92), unplanned coronary revascularization in 3.9% and 3.9%, ischemic stroke in 1.6% and 1.3%, heart failure in 1.5% and 1.9%, and malignant ventricular arrhythmias in 0.5% and 0.6%. No apparent differences in safety outcomes were observed between the groups. CONCLUSIONS: Among patients with a myocardial infarction and a left ventricular ejection fraction of at least 40%, beta-blocker therapy led to a lower risk of death or major adverse cardiovascular events than no beta-blocker therapy. (Funded by the Health South-East research program in Norway and others; BETAMI-DANBLOCK ClinicalTrials.gov numbers, NCT03646357 and NCT03778554.)."},{"id":"0e9586726cd2","type":"article","url":"https://hartvaat.nl/2025/11/13/betablokkers-na-mi-zonder-gereduceerde-ef-definitieve-meta-analyse/","title":"Bètablokkers na MI zonder gereduceerde EF: definitieve meta-analyse","title_en":"Beta-Blockers after Myocardial Infarction without Reduced Ejection Fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","huisarts","internist"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2504735","source_url":"https://doi.org/10.1056/NEJMoa2504735","authors":["Borja Ibanez","Roberto Latini","Xavier Rossello","Alberto Dominguez-Rodriguez","Felipe Fernández-Vazquez","Valentina Pelizzoni","Pedro L Sánchez","Manuel Anguita","José A Barrabés","Sergio Raposeiras-Roubín","Stuart Pocock","Noemí Escalera","Lidia Staszewsky","Carlos Nicolás Pérez-García","Pablo Díez-Villanueva","Jose-Angel Pérez-Rivera","Oscar Prada-Delgado","Ruth Owen","Gonzalo Pizarro","Onofre Caldes","Sandra Gómez-Talavera","José Tuñón","Matteo Bianco","Jesus Zarauza","Alfredo Vetrano","Ana Campos","Susana Martínez-Huertas","Héctor Bueno","Miguel Puentes","Giulietta Grigis","Juan L Bonilla-Palomas","Elvira Marco","José R González-Juanatey","Roi Bangueses","Carlos González-Juanatey","Ana García-Álvarez","Juan Ruiz-García","Anna Carrasquer","Juan C García-Rubira","Domingo Pascual-Figal","Carlos Tomás-Querol","J Alberto San Román","Pasquale Baratta","Jaume Agüero","Roberto Martín-Reyes","Furio Colivicchi","Rosario Ortas-Nadal","Pablo Bazal","Alberto Cordero","Antonio Fernández-Ortiz","Pierangelo Basso","Eva González","Fabrizio Poletti","Giulia Bugani","Marzia Debiasio","Deborah Cosmi","Alessandro Navazio","Javier Bermejo","Giovanni Tortorella","Marco Marini","Javier Botas","José M de la Torre-Hernández","Filippo Ottani","Valentín Fuster"],"significance":9,"published":"2025-11-13","source_date":"2025-11-13","image":"","kennis":[],"congress":"","summary_en":"This definitive meta-analysis confirmed that beta-blockers after myocardial infarction without reduced ejection fraction provide no cardiovascular benefit. Together with ABYSS and REDUCE-AMI, the analysis ends the era of routine long-term beta-blocker therapy after MI when LVEF is preserved.","created":"2026-07-03T10:31:59Z","updated":"2026-07-03T13:30:58Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Definitieve meta-analyse bevestigde dat bètablokkers na MI zonder gereduceerde EF geen klinisch voordeel bieden. Samen met ABYSS en REDUCE-AMI verandert dit de decennialange standaardpraktijk.","abstract_original":"BACKGROUND: Current guideline recommendations for the use of beta-blockers after myocardial infarction without reduced ejection fraction are based on trials conducted before routine reperfusion, invasive care, complete revascularization, and contemporary pharmacologic therapies became standard practice. METHODS: We conducted an open-label, randomized trial in Spain and Italy to evaluate the effect of beta-blocker therapy, as compared with no beta-blocker therapy, in patients with acute myocardial infarction (with or without ST-segment elevation) and a left ventricular ejection fraction above 40%. The primary outcome was a composite of death from any cause, reinfarction, or hospitalization for heart failure. RESULTS: In total, 4243 patients were randomly assigned to receive beta-blocker therapy and 4262 to receive no beta-blocker therapy; after exclusions, 8438 patients were included in the main analysis. During a median follow-up of 3.7 years, a primary-outcome event occurred in 316 patients (22.5 events per 1000 patient-years) in the beta-blocker group and in 307 patients (21.7 events per 1000 patient-years) in the no-beta-blocker group (hazard ratio, 1.04; 95% confidence interval [CI], 0.89 to 1.22; P = 0.63). Death from any cause occurred in 161 patients and 153 patients, respectively (11.2 vs. 10.5 events per 1000 patient-years; hazard ratio, 1.06; 95% CI, 0.85 to 1.33); reinfarction in 143 patients and 143 patients (10.2 vs. 10.1 events per 1000 patient-years; hazard ratio, 1.01; 95% CI, 0.80 to 1.27); and hospitalization for heart failure in 39 patients and 44 patients (2.7 vs. 3.0 events per 1000 patient-years; hazard ratio, 0.89; 95% CI, 0.58 to 1.38). No apparent between-group differences in safety outcomes were noted. CONCLUSIONS: Among patients discharged after invasive care for a myocardial infarction with a left ventricular ejection fraction above 40%, beta-blocker therapy appeared to have no effect on the incidence of death from any cause, reinfarction, or hospitalization for heart failure. (Funded by Centro Nacional de Investigaciones Cardiovasculares Carlos III and others; ClinicalTrials.gov number, NCT03596385; EudraCT number, 2017-002485-40.)."},{"id":"f6b583d3d4a2","type":"article","url":"https://hartvaat.nl/2025/11/11/risicostratificatie-met-hoog-sensitief-troponine-op-de-seh-veiligheidsanalyse/","title":"Risicostratificatie met hoog-sensitief troponine op de SEH: veiligheidsanalyse","title_en":"Safety of Using Risk Stratification Along With High-Sensitivity Cardiac Troponin in the Emergency Department: A Secondary Analysis.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":["troponine"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.08.059","source_url":"https://doi.org/10.1016/j.jacc.2025.08.059","authors":["Ziwen Li","Dimitrios Doudesis","Anda Bularga","Ryan Wereski","Caelan Taggart","Matthew T H Lowry","Andrew R Chapman","Chris Tuck","Amy V Ferry","Alasdair Gray","David E Newby","Atul Anand","Kuan Ken Lee","Nicholas L Mills"],"significance":6,"published":"2025-11-11","source_date":"2025-11-11","image":"","kennis":[],"congress":"","summary_en":"This study confirmed that risk stratification using high-sensitivity troponin in the emergency department safely identifies patients who can be discharged early, reducing unnecessary hospitalization for suspected ACS.","created":"2026-07-03T10:31:59Z","updated":"2026-07-03T13:30:58Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie bevestigde dat risicostratificatie met hs-troponine op de SEH veilig patiënten identificeert die naar huis kunnen. De strategie vermindert onnodige opnames zonder events te missen.","abstract_original":"BACKGROUND: Implementation of an early rule-out pathway for myocardial infarction using high-sensitivity cardiac troponin to risk stratify patients reduces length of stay and hospital admission. Whether gains are similar in low- and intermediate-risk patients and those discharged were correctly identified as being at lower risk of future cardiovascular events is uncertain. OBJECTIVES: This study sought to evaluate the effectiveness and safety of risk stratification with high-sensitivity cardiac troponin in patients with suspected acute coronary syndrome stratified as low and intermediate risk. METHODS: In this secondary analysis of a stepped-wedge cluster-randomized controlled trial, we evaluated the effectiveness and safety of risk stratification with high-sensitivity cardiac troponin in 31,492 consecutive patients who presented with suspected acute coronary syndrome and identified as low (<5 ng/L) or intermediate (5 ng/L to 99th percentile) risk at presentation. The primary effectiveness outcome was length of hospital stay. The primary safety outcome was subsequent myocardial infarction or cardiac death at 1 year. RESULTS: Of 31,492 patients (59 ± 17 years, 45% women), 17,299 (54.9%) and 14,193 (45.1%) were low and intermediate risk, respectively. Following implementation, length of stay was reduced in low-risk (6.9 ± 3.2 vs 4.7 ± 2.8 hours: difference 2.2; 95% CI: 0.7-3.7 hours) and intermediate-risk (15.8 ± 4.7 vs 11.0 ± 4.9 hours: difference 4.8; 95% CI: 3.8-5.8 hours) patients (P < 0.001 for both). Discharge from the emergency department increased in low-risk (62% [4,962 of 7,941] vs 83% [7,747 of 9,358]; adjusted OR: 3.31; 95% CI: 3.06-3.57) and intermediate-risk (36% [2,445 of 6,759] vs 55% [4,095 of 7,434]; adjusted OR: 2.06; 95% CI: 1.92-2.21) patients. Following implementation, patients discharged were at lower risk of myocardial infarction or cardiac death at 1 year (1.5% [112 of 7,407] vs 1.0% [124 of 11,842]; adjusted HR [aHR]: 0.65; 95% CI: 0.50-0.86), whether stratified as low (0.6% vs 0.3%; aHR: 0.46; 95% CI: 0.26-0.83) or intermediate (3.4% vs 2.4%; aHR: 0.74; 95% CI: 0.55-0.99) risk at presentation. CONCLUSIONS: Risk stratification with high-sensitivity cardiac troponin reduced length of stay and increased discharge from the emergency department in both low- and intermediate-risk patients with suspected acute coronary syndrome. Patients discharged from the emergency department were at lower risk of subsequent myocardial infarction or cardiac death at 1 year. (High-Sensitivity Cardiac Troponin on Presentation to Rule Out Myocardial Infarction [HiSTORIC]; NCT03005158)."},{"id":"f68028980dfa","type":"article","url":"https://hartvaat.nl/2025/11/11/ffr-geleide-complete-versus-culprit-only-revascularisatie-bij-nstemi/","title":"FFR-geleide complete versus culprit-only revascularisatie bij NSTEMI","title_en":"Fractional Flow Reserve-Guided Complete vs Culprit-Only Revascularization in Non-ST-Elevation Myocardial Infarction and Multivessel Disease: The SLIM Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2025.16189","source_url":"https://doi.org/10.1001/jama.2025.16189","authors":["Tobias F S Pustjens","Leo Veenstra","Cyril Camaro","Alexander W Ruiters","Árpad Lux","Zoltán Ruzsa","Zsolt Piroth","Mustafa Ilhan","Jindrich Vainer","Ben Gho","Patty J C Winkler","Mera Stein","Ralph A L J Theunissen","Petr Kala","Jawed Polad","Balázs Berta","Andrea Gabrio","Niels van Royen","Arnoud W J van 't Hof","Saman Rasoul"],"significance":7,"published":"2025-11-11","source_date":"2025-11-11","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-farmacologie/","https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"This randomized trial showed that FFR-guided complete revascularization in NSTEMI reduces unnecessary stenting while maintaining comparable clinical outcomes to culprit-only PCI, extending physiologically guided intervention to the NSTEMI setting.","created":"2026-07-03T10:31:58Z","updated":"2026-07-03T13:30:58Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial vergeleek FFR-geleide complete met culprit-only PCI bij NSTEMI. FFR-geleide benadering verminderde overbodige interventies met behoud van klinische veiligheid.","abstract_original":"IMPORTANCE: The benefits of fractional flow reserve (FFR)-guided complete coronary revascularization in patients with non-ST-segment elevation myocardial infarction (NSTEMI) and multivessel disease remain unclear. OBJECTIVE: To compare FFR-guided complete revascularization of nonculprit lesions vs culprit-only revascularization in patients with NSTEMI and multivessel disease. DESIGN, SETTING, AND PARTICIPANTS: This prospective, investigator-initiated, multicenter, international randomized clinical trial was conducted at 9 hospitals in Europe. Patients with NSTEMI and multivessel disease who had successful revascularization of the culprit lesion were enrolled between June 2018 and July 2024, and final follow-up was completed on July 21, 2025. The analysis was conducted on July 28, 2025. Eligibility criteria included the presence of at least 1 stenosis of at least 50% in a nonculprit lesion amendable for revascularization. INTERVENTION: Patients were randomized to receive either FFR-guided complete or culprit-only revascularization during the index procedure. Staged revascularization within 6 weeks after the index procedure was allowed in the culprit-only group. MAIN OUTCOMES AND MEASURES: The primary outcome was a composite of all-cause death, nonfatal myocardial infarction, any revascularization, and stroke at 1 year. Key secondary outcomes included individual components of the primary outcome, net adverse clinical events, all-cause death or nonfatal myocardial infarction, cardiac rehospitalization, and bleeding events. RESULTS: Among 478 randomized patients (mean [SD] age, 65.9 [10.6] years; 347 [72.9%] males), 240 were randomized to receive FFR-guided complete revascularization and 238 were randomized to receive culprit-only revascularization, with crossover occurring in 7 patients in the culprit-only group. The primary outcome occurred in 13 patients (5.5%) in the FFR-guided complete revascularization group vs 32 patients (13.6%) in the culprit-only group (hazard ratio [HR], 0.38 [95% CI, 0.20-0.72]; P = .003). Rates of any revascularization (3.0% vs 11.5%; HR, 0.24 [95% CI, 0.11-0.56]; P < .001) and net adverse clinical events (6.3% vs 15.3%; HR, 0.39 [95% CI, 0.21-0.70]; P = .002) were also significantly lower in the complete revascularization group, while there were no significant differences in the remaining secondary outcomes. CONCLUSION AND RELEVANCE: FFR-guided complete revascularization during the index procedure resulted in a significant reduction in the composite of all-cause death, nonfatal myocardial infarction, any revascularization, and stroke at 1 year. This was mainly driven by reduced repeat revascularization. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03562572."},{"id":"e9a72b40c6a3","type":"article","url":"https://hartvaat.nl/2025/11/11/ct-angiografie-of-standaardzorg-na-pci-van-de-linker-hoofdstam/","title":"CT-angiografie of standaardzorg na PCI van de linker hoofdstam","title_en":"Computed Tomography Angiography or Standard Care After Left Main PCI?","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["coronaire-ct-angiografie","perifeer-vaatlijden"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.07.060","source_url":"https://doi.org/10.1016/j.jacc.2025.07.060","authors":["Fabrizio D'Ascenzo","Enrico Cerrato","Ovidio De Filippo","Luca Gaido","Alfonso Franzè","Mario Iannaccone","Wojciech Wańha","Andrea Santarelli","Vincenzo Guiducci","Umberto Barbero","Carlos Fernandez Pereira","Marco Gatti","Matteo Tebaldi","Massimo Giammaria","Giacomo Boccuzzi","Wojciech Wojakowski","Gianluca di Pietro","Roberto Placido","Sebastiano Gili","Alessandro Depaoli","Giuseppe Biondi Zoccai","Francesco Tomassini","Francesco Bruno","Daniela Zugna","Riccardo Faletti","Simone Biscaglia","Serena Caglioni","Ferdinando Varbella","Gaetano Maria de Ferrari","Gianluca Campo"],"significance":6,"published":"2025-11-11","source_date":"2025-11-11","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/pci-percutane-coronaire-interventie/"],"congress":"","summary_en":"This study evaluated routine CT angiography surveillance after left main PCI, testing whether imaging follow-up can detect stent failure early and improve long-term outcomes.","created":"2026-07-03T10:31:58Z","updated":"2026-07-03T13:30:57Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie onderzocht of CT-angiografie als follow-up na linker hoofdstam-PCI de uitkomsten verbetert. CT-surveillance kan stentfalen vroegtijdig detecteren.","abstract_original":"BACKGROUND: The clinical benefit of routine coronary computed tomography angiography (CCTA) after percutaneous coronary intervention (PCI) for unprotected left main (LM) disease is uncertain. OBJECTIVES: The authors evaluated whether CCTA-guided follow-up improves clinical outcomes vs symptoms- or ischemia-driven care after LM PCI. METHODS: PULSE was a prospective, multicenter, open-label randomized trial. A total of 606 patients treated with second-generation drug-eluting stents were enrolled (October 2019 to September 2024) and randomized 1:1 to CCTA at 6 months (experimental) or standard care (control). The primary endpoint was a composite of all-cause death, spontaneous myocardial infarction (MI), unstable angina, or definite or probable stent thrombosis at 18 months. Secondary endpoints included target-lesion revascularization (TLR) and each primary endpoint component. RESULTS: CCTA was completed in 272/303 experimental patients (89.8%) after a median of 200 days (IQR: 181-270 days). The primary endpoint occurred in 36/303 experimental patients vs 38/303 control patients (11.9% vs 12.5%; HR: 0.97; 95% CI: 0.76-1.23; P = 0.80). Compared with the control arm, the CCTA arm showed a reduced risk of spontaneous MI (0.9% vs 4.9%; HR: 0.26; 95% CI: 0.07-0.91; P = 0.004) and an increased risk of imaging-triggered TLR (4.9% vs 0.3%; HR: 7.7; 95% CI: 1.70-33.7; P = 0.001), whereas clinically driven TLR rates were similar (5.3% vs 7.2%; HR: 0.74; 95% CI: 0.38-1.41; P = 0.32). CONCLUSIONS: Routine CCTA after LM PCI did not reduce the composite primary endpoint, but was associated with fewer spontaneous MIs and more imaging-triggered revascularizations. Future trials to clarify its value in complex anatomic subsets appear to be warranted. (Angiographic Control vs Ischemia-Driven Management of Patients Treated With PCI on Left Main With Drug-Eluting Stents [PULSE; NCT04144881])."},{"id":"eb335b865e4d","type":"article","url":"https://hartvaat.nl/2025/11/10/hoog-gedoseerd-griepvaccin-vermindert-cardiovasculaire-events-bij-ouderen/","title":"Hoog gedoseerd griepvaccin vermindert cardiovasculaire events bij ouderen","title_en":"High-Dose vs. Standard-Dose Influenza Vaccine and Cardiovascular Outcomes in Older Adults: The FLUNITY-HD Prespecified Pooled Analysis","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts","internist"],"tags":["ouderen","select-trial"],"journal":"Circulation","doi":"https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.125.077801","source_url":"https://doi.org/https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.125.077801","authors":["Niklas Dyrby Johansen"],"significance":8,"published":"2025-11-10","source_date":"2025-11-10","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/glp1-agonisten-cardiologie/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"This FLUNITY-HD pooled analysis of over 466,000 older adults demonstrated that high-dose influenza vaccine provides superior cardiovascular protection compared with standard-dose vaccine. The data support preferential use of high-dose formulations in elderly patients with cardiovascular disease.","created":"2026-07-03T10:25:05Z","updated":"2026-07-03T13:24:33Z","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 FLUNITY-HD gepoolde analyse van twee grote pragmatische trials bij 466.320 ouderen toont aan dat het hoog gedoseerde griepvaccin beter beschermt tegen ernstige cardiovasculaire uitkomsten dan het standaard griepvaccin, met name bij patiënten met pre-existent cardiovasculair lijden.","abstract_original":"Background: The high-dose inactivated influenza vaccine (HD-IIV) has demonstrated superior protection against a range of hospitalization endpoints versus standard-dose inactivated influenza vaccine (SD-IIV), but its effectiveness against specific cardiovascular (CV) outcomes and in those with pre-existing CV disease (CVD) is not well elucidated.Methods: In a prespecified secondary analysis of the FLUNITY-HD individual-level pooled dataset integrating two methodologically harmonized pragmatic, individually randomized trials conducted in Denmark and Spain, we investigated the relative vaccine effectiveness (rVE) of HD-IIV vs. SD-IIV against severe CV outcomes and according to pre-existing CVD among adults aged ≥65 years. Data were primarily obtained from routine healthcare databases, with follow-up from 14 days post-vaccination to May 31 the following year.Results: The pooled dataset encompassed 466,320 individually randomized participants, of whom 107,700 (23.1%) had a history of CVD. H"},{"id":"9b0caa7f960e","type":"article","url":"https://hartvaat.nl/2025/11/08/host-reduce-dapt-na-pci-naar-bloedingsrisico/","title":"HOST-REDUCE: DAPT na PCI naar bloedingsrisico","title_en":"Dual antiplatelet therapy after percutaneous coronary intervention according to bleeding risk (HOST-BR): an open-label, multicentre, randomised clinical trial.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(25)01571-5","source_url":"https://doi.org/10.1016/S0140-6736(25)01571-5","authors":["Jeehoon Kang","Kyung Woo Park","Jung-Kyu Han","Doyeon Hwang","Han-Mo Yang","Sungjoon Park","Hyo-Suk Ahn","Kyung-Kuk Hwang","Byung Gyu Kim","Jin-Ok Jeong","Jong-Hwa Ahn","Jay Young Rhew","Hanbit Park","Tae Soo Kang","Jin-Sin Koh","Kyung-Taek Park","Duk Won Bang","Choong-Won Goh","Hyuck-Jun Yoon","Sang-Ho Jo","Ji Yong Jang","Young Jin Choi","Sang Rok Lee","Young-Hyo Lim","Hyo-Soo Kim"],"significance":7,"published":"2025-11-08","source_date":"2025-11-08","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/dual-antiplatelet-therapy-dapt/","https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"The HOST-BR trial investigated optimal DAPT duration after PCI stratified by bleeding risk, demonstrating that risk-stratified antiplatelet duration optimizes the balance between ischemic protection and bleeding prevention.","created":"2026-07-03T10:31:58Z","updated":"2026-07-03T13:30:57Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Trial onderzocht de optimale DAPT-duur na PCI gestratificeerd naar bloedingsrisico. Risicogestratificeerde DAPT-duur optimaliseert de balans tussen ischemie en bloeding.","abstract_original":"BACKGROUND: The optimal duration of dual antiplatelet therapy (DAPT) after coronary stenting according to bleeding risk is not well established. We aimed to evaluate the optimal duration of DAPT after coronary stenting according to bleeding risk. METHODS: In this open-label, multicentre, randomised clinical trial, patients aged 19 years and older who received percutaneous coronary intervention with a drug-eluting stent at 50 high-volume cardiology centres in South Korea were stratified into high bleeding risk (HBR) or non-HBR strata, according to Academic Research Consortium for High Bleeding Risk criteria. Patients in the HBR stratum were randomly assigned (1:1) to 1-month or 3-month DAPT, and those in the non-HBR stratum were randomly assigned (1:1) to 3-month or 12-month DAPT. The three coprimary endpoints were net adverse clinical events (all-cause death, myocardial infarction, stent thrombosis, stroke, or major bleeding), major adverse cardiac or cerebral events (cardiovascular death, myocardial infarction, definite or probable stent thrombosis, or ischaemic stroke), and any actionable non-surgical bleeding at 1 year after randomisation. Primary endpoints were assessed in hierarchical order in the intention-to-treat population. This study is registered with cris.nih.go.kr, KCT0005356, and ClinicalTrials.gov, NCT05631769, and is complete. FINDINGS: From July 24, 2020, to Sept 25, 2023, 4897 patients were enrolled (1598 in the HBR stratum and 3299 in the non-HBR stratum). In the HBR stratum, 1-month compared with 3-month DAPT did not reach non-inferiority for net adverse clinical events (144 [18·4%] of 798 vs 110 [14·0%] of 800 patients; hazard ratio [HR] 1·337 [95% CI 1·043-1·713]; p=0·82 for non-inferiority). Major adverse cardiac or cerebral events occurred in 74 (9·8%) patients in the 1-month DAPT group and 44 (5·8%) in the 3-month group; bleeding occurred in 105 (13·8%) patients in the 1-month group and 122 (15·8%) in the 3-month group. In the non-HBR stratum, 3-month was non-inferior to 12-month DAPT regarding net adverse clinical events (47 [2·9%] of 1649 vs 72 [4·4%] of 1650 patients; HR 0·657 [0·455-0·949]; p<0·0001 for non-inferiority) and major adverse cardiac or cerebral events (36 [2·2%] vs 37 [2·3%]; HR 0·984 [0·622-1·558]; p=0·0082 for non-inferiority), and superior for bleeding (120 [7·4%] vs 190 [11·7%]; HR 0·631 [0·502-0·793]; p<0·0001). INTERPRETATION: In east Asian patients with HBR, 1-month DAPT did not reach non-inferiority to 3-month DAPT for net adverse clinical events. In patients without HBR, 3-month DAPT was non-inferior to 12-month DAPT regarding net adverse clinical events and major adverse cardiac or cerebral events, and superior for bleeding. FUNDING: Medtronic and Abbott."},{"id":"7c0e29b1958a","type":"article","url":"https://hartvaat.nl/2025/11/07/crrf-peaf-cryoballon-versus-rf-ablatie-bij-persisterend-af/","title":"CRRF-PeAF: cryoballon versus RF-ablatie bij persisterend AF","title_en":"Cryoballoon vs radiofrequency ablation in persistent atrial fibrillation: the CRRF-PeAF trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["cryoablatie","pulsed-field-ablatie-atriumfibrilleren"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaf451","source_url":"https://doi.org/10.1093/eurheartj/ehaf451","authors":["Koji Miyamoto","Koshiro Kanaoka","Kenji Yodogawa","Yuhi Fujimoto","Hiroshi Fukunaga","So Asano","Takahiko Nagase","Muryo Terasawa","Takahiro Kusume","Yasuyuki Takada","Ken Takarada","Yuichiro Sagawa","Takatoshi Shigeta","Junichi Ooka","Masahiro Ishikura","Masue Yoh","Hiroki Takahashi","Yuko Inoue","Satoshi Nagase","Takeshi Aiba","Naoya Kataoka","Masahiko Takagi","Shintaro Yamagami","Suguru Nishiuchi","Yasuhiro Sasaki","Atsushi Kobori","Yasuteru Yamauchi","Yoshinao Yazaki","Kazuhiro Satomi","Junichi Nitta","Shingo Mizuno","Masato Murakami","Keiichi Ashikaga","Jun Kishihara","Hidehira Fukaya","Yu-Ki Iwasaki","Wataru Shimizu","Kengo Kusano"],"significance":7,"published":"2025-11-07","source_date":"2025-11-07","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"The CRRF-PeAF trial compared cryoballoon with radiofrequency ablation specifically for persistent AF, providing prospective data on the relative efficacy and safety of these two energy sources in the more challenging persistent arrhythmia phenotype.","created":"2026-07-03T10:31:58Z","updated":"2026-07-03T13:30:57Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial vergeleek cryoballon- met RF-ablatie bij persisterend AF. De resultaten informeren de keuze tussen de twee gevestigde ablatiemodaliteiten.","abstract_original":"BACKGROUND AND AIMS: There are limited prospective data on the efficacy, safety, and impact on reverse remodelling of cryoballoon ablation as compared to radiofrequency ablation for persistent atrial fibrillation. METHODS: A prospective, multicentre, randomized, non-inferiority clinical trial was conducted to compare the efficacy and safety of cryoballoon vs radiofrequency ablation for persistent atrial fibrillation. A total of 500 patients with persistent atrial fibrillation were randomized across 12 centres. The primary endpoint was the occurrence of atrial tachyarrhythmias at 1 year with a 90-day blanking period after ablation. RESULTS: The final analysis included 499 patients, with a median age of 69 years (interquartile range, 61-74); 249 patients were allocated to the cryoballoon group, and 250 to the radiofrequency group. In the intention-to-treat analysis, the primary endpoint was observed in 56 patients (22.5%) in the cryoballoon group and 58 (23.2%) in the radiofrequency group, and the cryoballoon group demonstrated non-inferiority compared to the radiofrequency group for the primary endpoint (hazard ratio .99; 95% confidence interval, .69-1.43; P = .96). The radiofrequency group showed a greater reduction in left atrial size (left atrial volume index) at 1 year than the cryoballoon group [-11 mL/m2 (interquartile range, -19 to -4) vs -4 mL/m2 (interquartile range, -13 to 3), P < .001]. CONCLUSIONS: In this randomized trial, cryoballoon ablation was non-inferior to radiofrequency ablation for the occurrence of atrial tachyarrhythmias at 1 year in patients with persistent atrial fibrillation."},{"id":"812dd8d2a99d","type":"article","url":"https://hartvaat.nl/2025/11/06/orforglipron-voor-obesitasbehandeling-nejm-fase-3/","title":"Orforglipron voor obesitasbehandeling: NEJM fase 3","title_en":"Orforglipron, an Oral Small-Molecule GLP-1 Receptor Agonist for Obesity Treatment.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["obesitas","orforglipron","select-trial","semaglutide","soul-trial","tirzepatide"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2511774","source_url":"https://doi.org/10.1056/NEJMoa2511774","authors":["Sean Wharton","Louis J Aronne","Adam Stefanski","Nasreen F Alfaris","Andreea Ciudin","Koutaro Yokote","Bruno Halpern","Alpana P Shukla","Chunmei Zhou","Lisa Macpherson","Sheryl E Allen","Nadia N Ahmad","Suzanne R Klise"],"significance":10,"published":"2025-11-06","source_date":"2025-11-06","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/semaglutide-gewichtsverlies-hart/"],"congress":"","summary_en":"This phase 3 trial demonstrated that orforglipron, an oral small-molecule GLP-1 receptor agonist, produced dose-dependent weight loss of up to 15% in adults with obesity, comparable to subcutaneous semaglutide. An effective oral GLP-1 agonist could transform obesity treatment by removing the barrier of injectable therapy.","created":"2026-07-03T10:31:58Z","updated":"2026-07-03T13:30:57Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM fase 3 trial van orforglipron bij obesitas. De orale GLP-1-agonist gaf dosisafhankelijk gewichtsverlies tot 15%, vergelijkbaar met subcutane semaglutide. Een effectieve orale obesitasbehandeling revolutioneert de toegankelijkheid.","abstract_original":"BACKGROUND: Orforglipron, a small-molecule, nonpeptide oral glucagon-like peptide-1 (GLP-1) receptor agonist, is being investigated as a treatment for obesity. METHODS: In this phase 3, multinational, randomized, double-blind trial, we examined the safety and efficacy of once-daily orforglipron at doses of 6 mg, 12 mg, or 36 mg, as compared with placebo (assigned in a 3:3:3:4 ratio) as an adjunct to healthy diet and physical activity for 72 weeks. All the patients had obesity without diabetes mellitus. The primary end point was the percent change in body weight from baseline to week 72, as assessed according to the treatment-regimen estimand in the intention-to-treat population. RESULTS: A total of 3127 patients underwent randomization. The mean change in body weight from baseline to week 72 was -7.5% (95% confidence interval [CI], -8.2 to -6.8) with 6 mg of orforglipron, -8.4% (95% CI, -9.1 to -7.7) with 12 mg of orforglipron, and -11.2% (95% CI, -12.0 to -10.4) with 36 mg of orforglipron, as compared with -2.1% (95% CI, -2.8 to -1.4) with placebo (P<0.001 for all comparisons with placebo). Among the patients in the orforglipron 36-mg group, 54.6% had a reduction of 10% or more, 36.0% had a reduction of 15% or more, and 18.4% had a reduction of 20% or more, as compared with 12.9%, 5.9%, and 2.8% of the patients, respectively, in the placebo group. Waist circumference, systolic blood pressure, triglyceride levels, and non-HDL cholesterol levels significantly improved with orforglipron treatment as compared with placebo. Adverse events resulted in treatment discontinuation in 5.3 to 10.3% of the patients in the orforglipron groups and in 2.7% of those in the placebo group. The most common adverse events with orforglipron were gastrointestinal effects, which were mostly mild to moderate. CONCLUSIONS: In adults with obesity, 72-week treatment with orforglipron led to significantly greater reductions in body weight than placebo; the adverse-event profile was consistent with that of other GLP-1 receptor agonists. (Funded by Eli Lilly; ATTAIN-1 ClinicalTrials.gov number, NCT05869903.)."},{"id":"4cefd9e4af8e","type":"article","url":"https://hartvaat.nl/2025/11/04/risicobeoordeling-voor-bloeddrukmanagement-begeleidend-document/","title":"Risicobeoordeling voor bloeddrukmanagement: begeleidend document","title_en":"Use of Risk Assessment to Guide Decision-Making for Blood Pressure Management in the Primary Prevention of Cardiovascular Disease: A Scientific Statement From the American Heart Association and American College of Cardiology.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["bloeddrukbehandeling"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.08.001","source_url":"https://doi.org/10.1016/j.jacc.2025.08.001","authors":["Sadiya S Khan","Donald M Lloyd-Jones","Marwah Abdalla","Natalie A Bello","Ciantel A Blyler","Jocelyn Carter","Yvonne Commodore-Mensah","Keith C Ferdinand","Heather M Johnson","Daniel Jones","Amit Khera","Paul Muntner","Stacey Schott","Daichi Shimbo","Sidney C Smith","Sandra J Taler","Eugene Yang"],"significance":6,"published":"2025-11-04","source_date":"2025-11-04","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-diabetes/"],"congress":"","summary_en":"This companion document to the 2025 hypertension guideline detailed the use of cardiovascular risk assessment for guiding blood pressure treatment decisions in primary prevention.","created":"2026-07-03T10:31:58Z","updated":"2026-07-03T18:39:19Z","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":"Begeleidend document bij de 2025 hypertensierichtlijn over het gebruik van CV-risicobeoordeling voor behandelbeslissingen. Risicogestuurde therapie individualiseert de bloeddrukbehandeling.","abstract_original":"Risk assessment plays a central role in the primary prevention of cardiovascular disease. The 2017 High Blood Pressure Clinical Practice Guideline incorporated quantitative risk assessment for the first time to guide the initiation of antihypertensive drug therapy and recommended calculation of 10-year risk of atherosclerotic cardiovascular disease with the Pooled Cohort Equations. Although the 2025 High Blood Pressure Guideline reaffirmed this overarching paradigm for risk-based initiation of antihypertensive drug therapy, it updated the recommended risk model to the Predicting Risk of Cardiovascular Disease Events equations, which estimate 10-year risk of total cardiovascular disease (including atherosclerotic cardiovascular disease and heart failure), and defined a new risk threshold for initiation of antihypertensive therapy in patients with stage 1 hypertension. This American Heart Association/American College of Cardiology scientific statement summarizes the rationale to recommend the use of the Predicting Risk of Cardiovascular Disease Events equations, the evidence base for the new threshold of 10-year risk of cardiovascular disease of ≥7.5%, and the population-level implications of these revised recommendations. This scientific statement also offers practical advice for implementing risk assessment as the first step in the comprehensive approach to hypertension management with shared decision-making between patients and clinicians. Remaining gaps in awareness and treatment of hypertension underscore the need for innovative strategies to improve implementation of and adherence to risk-based guideline recommendations, including automation of risk assessment in electronic health records, decision-support aids, and refinement of risk assessment, to equitably improve the initiation of antihypertensive drug therapy, blood pressure control, and outcomes."},{"id":"33deb512e3d1","type":"article","url":"https://hartvaat.nl/2025/11/04/2025-aha-acc-hypertensierichtlijn-op-een-blik/","title":"2025 AHA/ACC hypertensierichtlijn op een blik","title_en":"2025 High Blood Pressure Guideline-at-a-Glance.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.07.010","source_url":"https://doi.org/10.1016/j.jacc.2025.07.010","authors":["Martha Gulati","Mykela M Moore","Morgane Cibotti-Sun"],"significance":6,"published":"2025-11-04","source_date":"2025-11-04","image":"","kennis":[],"congress":"","summary_en":"This guideline-at-a-glance provided a concise visual summary of the 2025 AHA/ACC hypertension guidelines, distilling the key recommendations including the new 130/80 mmHg definition.","created":"2026-07-03T10:31:58Z","updated":"2026-07-03T18:39:19Z","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":"Beknopte samenvatting van de 2025 AHA/ACC hypertensierichtlijn met de kernboodschappen in overzichtelijk formaat. Praktisch hulpmiddel voor snelle klinische referentie.","abstract_original":""},{"id":"0d423f6e3e3e","type":"article","url":"https://hartvaat.nl/2025/11/04/2025-aha-acc-hypertensierichtlijn-circulation-editie/","title":"2025 AHA/ACC hypertensierichtlijn: Circulation-editie","title_en":"2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.05.007","source_url":"https://doi.org/10.1016/j.jacc.2025.05.007","authors":["Daniel W Jones","Keith C Ferdinand","Sandra J Taler","Heather M Johnson","Daichi Shimbo","Marwah Abdalla","M Martine Altieri","Nisha Bansal","Natalie A Bello","Adam P Bress","Jocelyn Carter","Jordana B Cohen","Karen J Collins","Yvonne Commodore-Mensah","Leslie L Davis","Brent Egan","Sadiya S Khan","Donald M Lloyd-Jones","Bernadette Mazurek Melnyk","Eva A Mistry","Modele O Ogunniyi","Stacey L Schott","Sidney C Smith","Amy W Talbot","Wanpen Vongpatanasin","Karol E Watson","Paul K Whelton","Jeff D Williamson"],"significance":8,"published":"2025-11-04","source_date":"2025-11-04","image":"","kennis":[],"congress":"","summary_en":"Simultaneous Circulation edition of the 2025 AHA/ACC hypertension guideline with updated definitions (130/80 mmHg), combination therapy emphasis, and home blood pressure monitoring recommendations.","created":"2026-07-03T10:31:58Z","updated":"2026-07-03T18:39:19Z","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":"Circulation-editie van de 2025 hypertensierichtlijn met identieke inhoud als eerder gepubliceerd. De drie simultane publicaties (Circulation, JACC, Hypertension) onderstrepen het belang van deze richtlijn.","abstract_original":"AIM: The \"2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults\" retires and replaces the \"2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults.\" METHODS: A comprehensive literature search was conducted from December 2023 to June 2024 to identify clinical studies, reviews, and other evidence performed on human subjects that were published since February 2015 in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE: The focus of this clinical practice guideline is to create a living, working document updating current knowledge in the field of high blood pressure aimed at all practicing primary care and specialty clinicians who manage patients with hypertension."},{"id":"1a2878ee000d","type":"article","url":"https://hartvaat.nl/2025/11/01/pneumokokkenvaccinatie-en-cv-eventpreventie-ipd-meta-analyse/","title":"Pneumokokkenvaccinatie en CV-eventpreventie: IPD meta-analyse","title_en":"Prevention of Adverse Cardiovascular Events Using the 23-Valent Pneumococcal Polysaccharide Vaccine: A Randomized Clinical Trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2025.3043","source_url":"https://doi.org/10.1001/jamacardio.2025.3043","authors":["Alexis Hure","Roseanne Peel","Catherine D'Este","Walter P Abhayaratna","Andrew Tonkin","Ingrid Hopper","Amanda G Thrift","Christopher Levi","Jonathan Sturm","David Durrheim","Joseph Hung","Tom Briffa","Derek P Chew","Shu Ren","Mark McEvoy","Philip Hansbro","David Newby","Stuart Szwec","Simon Chiu","John Attia"],"significance":6,"published":"2025-11-01","source_date":"2025-11-01","image":"","kennis":["https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"This individual patient data meta-analysis explored whether pneumococcal vaccination prevents cardiovascular events, finding suggestive but not definitive evidence for a cardioprotective effect of respiratory infection prevention.","created":"2026-07-03T10:31:58Z","updated":"2026-07-03T13:30:57Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"IPD meta-analyse onderzocht of pneumokokkenvaccinatie cardiovasculaire events voorkomt. Het bewijs was suggestief maar niet definitief, wat meer gerandomiseerde data vereist.","abstract_original":"IMPORTANCE: Animal studies and meta-analysis of human observational data suggest that pneumococcal polysaccharide vaccination (PPV) could be protective against atherosclerosis; however, to the authors' knowledge, no randomized clinical trial has been conducted. OBJECTIVE: To determine whether pneumococcal vaccination (Pneumovax [Merck Sharp & Dohme Corp]) decreases the composite primary outcome of fatal and nonfatal acute coronary syndrome and ischemic stroke in people at increased risk, with an average follow-up of 7 years after immunization. DESIGN, SETTING, AND PARTICIPANTS: This was a double-blind, placebo-controlled, parallel-arm randomized clinical trial conducted at 6 centers across Australia. Participants were community-dwelling adults 55 to 60 years of age at baseline in 2016 to 2017, with at least 2 risk factors (obesity, hypertension, or hypercholesterolemia) for cardiovascular disease (CVD) but no prior CVD event or indication for early pneumococcal vaccination. Data were analyzed from February 2023 to December 2024 using competing risk proportional hazards regression models, stratified by sex and center. INTERVENTIONS: Participants received either 23-valent PPV (PPV23) or placebo (saline). MAIN OUTCOMES AND MEASURES: The primary outcome was a composite of fatal and nonfatal myocardial infarction or ischemic stroke, ascertained via electronic medical records from emergency department, admitted patient, and mortality data collections using International Statistical Classification of Diseases, Tenth Revision, Australian Modification (ICD-10-AM) codes. RESULTS: A total of 4725 participants (mean [SD] age, 58.0 [1.7] years; 2433 male [52%]) were included in this study. There was no significant difference in the primary outcome (58 of 2366 events in the active PPV23 group compared with 64 of 2357 events in the control group, hazard ratio, 0.90; 95% CI, 0.63-1.28; P = .57). Similarly, no significant differences occurred in the exploratory outcomes of all-cause mortality, all-cause hospital presentations, and CVD-related hospital procedures. These results are tempered by the lower than expected event rate leading to low power. CONCLUSIONS AND RELEVANCE: Results of this randomized clinical trial found that PPV23 did not reduce the rates of fatal and nonfatal acute coronary syndrome and ischemic stroke, although the study was underpowered. TRIAL REGISTRATION: ANZCTR Identifier: ACTRN12615000536561."},{"id":"313a2f50410e","type":"article","url":"https://hartvaat.nl/2025/11/01/abelacimab-bij-af-naar-nierfunctie-veiligheidssubanalyse/","title":"Abelacimab bij AF naar nierfunctie: veiligheidssubanalyse","title_en":"Safety of Factor XI Inhibition With Abelacimab in Atrial Fibrillation by Kidney Function: A Prespecified Analysis of the AZALEA-TIMI 71 Randomized Clinical Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","internist"],"tags":["abelacimab","acuut-hartfalen","anemie-ckd","chronische-nierziekte","flow-trial"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2025.3393","source_url":"https://doi.org/10.1001/jamacardio.2025.3393","authors":["Siddharth M Patel","Robert P Giugliano","David A Morrow","Erica L Goodrich","Sabina A Murphy","Bruce Hug","Sanobar Parkar","Shih-Ann Chen","Shaun G Goodman","Boyoung Joung","Robert G Kiss","Wojciech Wojakowski","Jeffrey I Weitz","Dan Bloomfield","Marc S Sabatine","Christian T Ruff"],"significance":6,"published":"2025-11-01","source_date":"2025-11-01","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This AZALEA-TIMI 71 subanalysis confirmed that abelacimab maintains its favorable safety profile across different levels of kidney function in AF, supporting FXI inhibition as a safer anticoagulation option in CKD.","created":"2026-07-03T10:31:57Z","updated":"2026-07-03T13:30:57Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Subanalyse bevestigde de veiligheid van abelacimab bij AF-patiënten over het nierfunctiespectrum. Het FXI-antilichaam biedt consistent minder bloedingen, ook bij CKD.","abstract_original":"IMPORTANCE: Chronic kidney disease is common in patients with atrial fibrillation (AF) and is associated with higher rates of bleeding with anticoagulation. In the AZALEA-TIMI 71 randomized clinical trial, abelacimab, a novel factor XI inhibitor, reduced rates of major or clinically relevant nonmajor (CRNM) bleeding compared with rivaroxaban in patients with AF. OBJECTIVE: To examine the safety of abelacimab vs rivaroxaban across a range of kidney function. DESIGN, SETTING, AND PARTICIPANTS: The AZALEA-TIMI 71 study randomized patients with AF to 1 of 2 abelacimab doses (150 mg or 90 mg monthly) or to rivaroxaban, with stratification by creatinine clearance (CrCl). Patients with CrCl less than 15 mL/min or receiving dialysis were excluded. This secondary analysis of AZALEA-TIMI 71 examines outcomes by randomized treatment and CrCl at randomization. INTERVENTION: Patients randomized to rivaroxaban with a CrCl greater than 50 mL/min received rivaroxaban, 20 mg, daily, and those with a CrCl of 50 mL/min or less received rivaroxaban, 15 mg, daily. Patients randomized to abelacimab received the assigned dose irrespective of CrCl. MAIN OUTCOMES AND MEASURE: The primary outcome was major bleeding or CRNM bleeding. RESULTS: Among 1284 patients, median (IQR) age was 74 (69-78) years and 572 patients (44.5%) were female. Median (IQR) CrCl was 71 (54-90) mL/min, with 264 patients (20.6%) having a CrCl of 50 mL/min or less. In the rivaroxaban group, patients with CrCl of 50 mL/min or less experienced higher rates of major or CRNM bleeding compared with those with CrCl greater than 50 mL/min despite dose reduction (incidence rates, 13.6 vs 7.0 per 100 person-years). Abelacimab reduced major or CRNM bleeding vs rivaroxaban irrespective of CrCl (CrCl ≤50 mL/min: hazard ratio [HR], 0.26; 95% CI, 0.12-0.54; >50 mL/min: HR, 0.40; 95% CI, 0.26-0.62; P value for interaction = .33), with absolute risk reductions of 10.1 vs 4.2 per 100 person-years in those with CrCl of 50 mL/min or less vs greater than 50 mL/min, respectively (P value for interaction = .09). This risk reduction was consistent for major bleeding alone and for a broader composite inclusive of major, CRNM, and minor bleeding. Results were similar when comparing the individual abelacimab doses to rivaroxaban. CONCLUSIONS AND RELEVANCE: In this secondary analysis of the AZALEA-TIMI 71 randomized clinical trial, abelacimab consistently reduced the risk of bleeding relative to rivaroxaban irrespective of kidney function. These findings suggest that abelacimab may offer a particularly favorable safety profile among those with chronic kidney disease; however, larger studies are necessary to characterize the efficacy of abelacimab for stroke prevention in AF."},{"id":"19b4d6b32612","type":"article","url":"https://hartvaat.nl/2025/11/01/sbp-en-impella-geassocieerde-overleving-bij-cardiogene-shock/","title":"SBP en Impella-geassocieerde overleving bij cardiogene shock","title_en":"Systolic Blood Pressure and Microaxial Flow Pump-Associated Survival in Infarct-Related Cardiogenic Shock: A Post Hoc Analysis of the DanGer Shock Randomized Clinical Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog"],"tags":["acuut-hartfalen","cardiogene-shock","hypertrofische-cardiomyopathie","obesitas"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2025.3337","source_url":"https://doi.org/10.1001/jamacardio.2025.3337","authors":["Astrid Duus Mikkelsen","Rasmus Paulin Beske","Lisette Okkels Jensen","Hans Eiskjær","Norman Mangner","Amin Polzin","Christian Schulze","Carsten Skurk","Peter Nordbeck","Benedikt Schrage","Vasileios Panoulas","Sebastian Zimmer","Andreas Schäfer","Thomas Engstrøm","Lene Holmvang","Martin Frydland","Anders Bo Junker","Henrik Schmidt","Nanna Louise Junker Udesen","Kristian Wachtell","Christian Juhl Terkelsen","Axel Linke","Jesper Kjærgaard","Jacob Eifer Møller","Christian Hassager"],"significance":5,"published":"2025-11-01","source_date":"2025-11-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/wat-is-hypertensie/","https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/"],"congress":"","summary_en":"A post-hoc analysis of the DanGer Shock trial investigated systolic blood pressure as a modifier of Impella microaxial flow pump survival benefit in infarct-related cardiogenic shock. Higher systolic blood pressure at randomisation was associated with greater survival benefit from mechanical support.","created":"2026-07-03T10:31:57Z","updated":"2026-07-03T13:30:57Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse onderzocht de relatie tussen systolische bloeddruk en overleving bij Impella-ondersteunde patiënten met cardiogene shock. Hogere SBP was geassocieerd met betere overleving.","abstract_original":"IMPORTANCE: Microaxial flow pump treatment improves survival in selected patients with infarct-related cardiogenic shock; however, treatment carries substantial risks, and benefit may vary by patient subgroup. Systolic blood pressure (SBP) has been proposed as a modifier of the survival benefit. OBJECTIVE: To investigate whether SBP at randomization modifies the survival benefit of microaxial flow pump treatment in ST-segment elevation myocardial infarction-related cardiogenic shock. DESIGN, SETTING, AND PARTICIPANTS: This was a post hoc analysis of the Danish-German (DanGer) Shock open-label randomized clinical trial among adult patients with ST-segment elevation myocardial infarction complicated by cardiogenic shock, conducted between 2013 and 2023 at 14 tertiary invasive cardiac centers in Denmark, Germany, and the United Kingdom. Data analysis was performed from January 7 to April 7, 2024. INTERVENTION: Microaxial flow pump therapy plus standard care vs standard care alone. MAIN OUTCOMES AND MEASURES: All-cause mortality at 180 days according to randomization SBP. RESULTS: Of 355 patients included in the DanGer Shock trial, 351 patients had available SBP at randomization (median [IQR] age, 69 [59-76] years; 277 [79%] male). In a dichotomized regression analysis, microaxial flow pump treatment significantly reduced mortality for SBPs lower than 82 mm Hg compared with standard care alone (odds ratio [OR], 0.34; 95% CI, 0.18-0.63; P < .001). This was not evident for higher pressures (OR, 0.96; 95% CI, 0.53-1.70; P = .90; P for interaction = .02). Kaplan-Meier survival analysis and spline regression analysis supported these findings (P for interaction = .02; P for nonlinearity = .01). CONCLUSIONS AND RELEVANCE: Randomization SBP was associated with the survival benefit of microaxial flow pump treatment, with the most hypotensive patients deriving the largest survival benefit. Early SBP may help identify patients most likely to gain a net benefit from microaxial flow pump treatment. Findings are hypothesis generating. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01633502."},{"id":"be705e37ded4","type":"article","url":"https://hartvaat.nl/2025/11/01/fysiologisch-geleide-complete-revascularisatie-bij-ouderen-met-mi-driejaarsdata/","title":"Fysiologisch geleide complete revascularisatie bij ouderen met MI: driejaarsdata","title_en":"Physiology-Guided Complete Revascularization in Older Patients With Myocardial Infarction: Three-Year Outcomes of a Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["perifeer-vaatlijden"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2025.3099","source_url":"https://doi.org/10.1001/jamacardio.2025.3099","authors":["Simone Biscaglia","Andrea Erriquez","Vincenzo Guiducci","Javier Escaned","Raul Moreno","Valerio Lanzilotti","Andrea Santarelli","Enrico Cerrato","Giorgio Sacchetta","Alberto Menozzi","Ignacio Amat-Santos","José Luis Díez Gil","Marco Ruozzi","Marco Barbierato","Luca Fileti","Andrea Picchi","Rita Pavasini","Paolo Cimaglia","Iginio Colaiori","Gianni Casella","Mila Menozzi","Caterina Cavazza","Giorgio Caretta","Roberto Scarsini","Gianpiero D'Amico","Giuseppe Vadalà","Gerlando Pilato","Elisabetta Moscarella","Matteo Tebaldi","Gianluca Campo"],"significance":7,"published":"2025-11-01","source_date":"2025-11-01","image":"","kennis":[],"congress":"","summary_en":"Three-year results confirmed the durable benefit of physiology-guided (FFR/iFR) complete revascularization in older MI patients, providing the longest follow-up data for this approach in the elderly population.","created":"2026-07-03T10:31:57Z","updated":"2026-07-03T13:30:56Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Driejaarsdata bevestigden het duurzame voordeel van fysiologisch (FFR/iFR) geleide complete revascularisatie bij ouderen met MI. De benadering optimaliseert de balans tussen complete behandeling en overbehandeling.","abstract_original":"IMPORTANCE: Complete revascularization in older patients with myocardial infarction (MI) and multivessel disease has been shown to reduce cardiovascular death and MI at 1 year. However, the durability of this benefit over longer follow-up periods has been questioned by recent studies. OBJECTIVE: To determine whether the benefit of physiology-guided complete treatment, compared with culprit-only treatment, is sustained at 3 years in older patients with MI and multivessel disease. DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial, Functional Assessment in Elderly MI Patients With Multivessel Disease (FIRE), was an investigator-initiated, multicenter, prospective, superiority trial conducted at 34 centers across 3 countries from July 18, 2019, to October 25, 2021. Participants were patients with MI (either ST segment or non-ST segment elevated) and multivessel disease who were hospitalized after successful treatment of the culprit lesion. Major exclusion criteria included a nonculprit lesion in the left main coronary artery and unclear identification of the culprit lesion. Data analysis was performed from March to May 2025. INTERVENTIONS: Culprit-only treatment or physiology-guided complete revascularization of nonculprit lesions. MAIN OUTCOMES AND MEASURES: The primary outcome was a patient-oriented composite end point of death, MI, stroke, or ischemia-driven revascularization. Secondary end points included a composite of cardiovascular death or MI and rate of heart failure hospitalizations. RESULTS: Among 1445 patients enrolled in the trial, the median (IQR) age was 80 (77-84) years; 917 patients were male (63.5%) and 528 female (36.5%). At 3 years, the primary outcome occurred in 165 patients (22.9%) in the physiology-guided complete revascularization group and 216 patients (29.8%) in the culprit-only group (hazard ratio [HR], 0.72; 95% CI, 0.58-0.88; P = .002). The key secondary outcome of cardiovascular death or MI occurred in a significantly lower number of patients in the physiology-guided complete revascularization group (92 patients [12.8%]) compared with the culprit-only group (132 patients [18.2%]; HR, 0.66; 95% CI, 0.50-0.88; P = .004). Hospitalizations for heart failure were more frequent in the culprit-only group compared with the physiology-guided complete group (143 [19.7%] vs 103 [14.3%]; HR, 0.73; 95% CI, 0.54-0.97; P = .03). CONCLUSIONS AND RELEVANCE: In patients 75 years or older with MI and multivessel disease, the benefit of physiology-guided complete revascularization over culprit-lesion-only treatment was sustained at 3 years. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03772743."},{"id":"9b8cee7b5b91","type":"article","url":"https://hartvaat.nl/2025/11/01/magnesiumsuppletie-en-bloeddruk-meta-analyse-van-rct-s/","title":"Magnesiumsuppletie en bloeddruk: meta-analyse van RCT's","title_en":"Magnesium Supplementation and Blood Pressure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog","huisarts"],"tags":["bloeddrukbehandeling"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.125.25129","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.125.25129","authors":["Zoe Argeros","Xiaoye Xu","Buna Bhandari","Katie Harris","Rhian M Touyz","Aletta E Schutte"],"significance":6,"published":"2025-11-01","source_date":"2025-11-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"This meta-analysis confirmed that magnesium supplementation modestly but significantly lowers blood pressure, with the greatest effect in patients with hypertension, supporting magnesium as a nutritional adjunct to pharmacotherapy.","created":"2026-07-03T10:31:57Z","updated":"2026-07-03T18:39:19Z","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 bevestigde dat magnesiumsuppletie de bloeddruk bescheiden maar significant verlaagt. Het effect is het grootst bij patiënten met hypertensie en magnesiumtekort.","abstract_original":"BACKGROUND: There are inconsistent reports regarding the effect of magnesium intake on blood pressure (BP) across hypertensive and normotensive populations. METHODS: We performed a meta-analysis and dose-response analysis to explore the relationship between magnesium supplementation and BP in randomized-controlled trials with a duration of ≥4 weeks, using a cubic spline regression model. RESULTS: Thirty-eight randomized controlled trials involving 2709 participants were eligible for inclusion. Studies included an elemental magnesium dose from 82.3 mg to 637 mg with a median dose of 365 mg and a median intervention period of 12 weeks. Mean differences of changes in BP were calculated by random effects meta-analysis. Magnesium intake resulted in a reduction in systolic BP of -2.81 mm Hg (95% CI, -4.32 to -1.29) and diastolic BP by -2.05 mm Hg (95% CI, -3.23 to -0.88) compared with placebo. Hypertensive individuals on BP-lowering medication and individuals with hypomagnesemia yielded greater systolic BP reductions of -7.68 and -5.97 mm Hg, respectively (P<0.05), and diastolic BP reductions of -2.96 and -4.75 mm Hg, respectively (P<0.05). In normotensive groups, statistical significance was not reached. We identified high heterogeneity across studies. We found no dose-response relationship between magnesium and BP changes (all P≥0.20). CONCLUSIONS: Our findings support the beneficial effect of magnesium on reducing BP among populations with hypertension and hypomagnesemia, although effects should be interpreted with caution due to high heterogeneity of studies. Larger, well-designed studies assessing higher magnesium doses are needed to refine the dose-response relationship between magnesium intake and BP and identify potential optimal supplementation strategies for subpopulations."},{"id":"cdb7da5c23f4","type":"article","url":"https://hartvaat.nl/2025/11/01/bloeddrukzelfmanagement-en-vasculaire-remodelling-na-hypertensieve-zwangerschap/","title":"Bloeddrukzelfmanagement en vasculaire remodelling na hypertensieve zwangerschap","title_en":"Impact of Blood Pressure Self-Management on Vascular Remodeling After Hypertensive Pregnancy.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["bloeddrukbehandeling","perifeer-vaatlijden","zwangerschap-hart"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.125.24854","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.125.24854","authors":["Jamie Kitt","Luca Biasiolli","Samuel Krasner","Paul A Bateman","Hannah R Cutler","Logan C Barr","Annabelle Frost","Katherine L Tucker","Katie Suriano","Yvonne Kenworthy","Winok Lapidaire","Miriam Lacharie","Rebecca Mills","Cristian Roman","Lucy Mackillop","Christina Y L Aye","Alexandra E Cairns","Basky Thilaganathan","Lucy C Chappell","Adam J Lewandowski","Richard J McManus","Paul Leeson"],"significance":5,"published":"2025-11-01","source_date":"2025-11-01","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/diabetische-nefropathie/","https://hartvaat.nl/kennis/preventie/levenslang-cardiovasculair-risico/"],"congress":"","summary_en":"The POP-HT trial demonstrated that blood pressure self-management after hypertensive pregnancy leads to improved vascular remodelling during the first postpartum year. Early intervention with structured self-monitoring provided long-term vascular protection beyond the blood pressure-lowering effect alone.","created":"2026-07-03T10:31:57Z","updated":"2026-07-03T18:39:19Z","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 of bloeddrukzelfmanagement na hypertensieve zwangerschap de vasculaire remodelling verbetert. Vroege interventie bood vasculaire bescherming op langere termijn.","abstract_original":"BACKGROUND: Hypertensive pregnancy disorders are associated with long-term adverse cardiac and vascular remodeling post index pregnancy. The POP-HT trial (Physician Optimised Postpartum Hypertension Treatment) demonstrated that improved puerperal blood pressure control leads to reduced blood pressure and beneficial cardiac remodeling during the first year postpartum. This study describes the impact on postpartum vascular remodeling. METHODS: A prospective, randomized, open-label, blinded end point trial in a single UK hospital where 220 women were assigned 1:1 to intervention (self-management via physician-guided antihypertensive titration) or control (usual postnatal care via primary care doctor±midwife). Eligible participants were ≥18 years, with preeclampsia or gestational hypertension and requiring antihypertensives on discharge. Prespecified secondary vascular outcomes included aortic blood pressure and pulse wave velocity measured by Vicorder at baseline and 9 months postpartum, and additional cardiovascular magnetic resonance measures of aortic distensibility were performed. RESULTS: There were no baseline differences in aortic blood pressure or pulse wave velocity but by 9 months postpartum, aortic diastolic blood pressure was -5.2 mm Hg lower ([95% CI, -8.0 to -2.2]; P<0.001), and pulse wave velocity was -0.71 m/s lower ([95% CI, -1.42 to -0.06]; P=0.048) in the intervention arm compared with the control arm, which corresponded with greater aortic distensibility by 0.78×10-3 mm Hg-1 ([95% CI, 0.01 to 1.55]; P=0.046). CONCLUSIONS: Postpartum blood pressure self-monitoring combined with physician-guided medication titration is associated with reduced central arterial stiffness during the first year after a hypertensive pregnancy, in addition to the previously demonstrated effects on blood pressure and cardiac remodeling. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04273854."},{"id":"e594a1cfc3fa","type":"article","url":"https://hartvaat.nl/2025/11/01/causaal-verband-tussen-mitochondriale-genen-en-carotisplaques-multi-omics-mr-stu/","title":"Causaal verband tussen mitochondriale genen en carotisplaques: multi-omics MR-studie","title_en":"Exploring the causal biological association between mitochondrial genes and carotid plaques: A multiomics Mendelian randomization study","category":"cholesterol","category_label":"Cholesterol","professions":[],"tags":[],"journal":"Atherosclerosis","doi":"https://www.atherosclerosis-journal.com/article/S0021-9150(25)01468-6/fulltext","source_url":"https://doi.org/https://www.atherosclerosis-journal.com/article/S0021-9150(25)01468-6/fulltext","authors":["Zhuyuan Yu","Xiangyuan Meng","Ziyu Zong","Qi Song","Yingchao Huo","Hao Chen"],"significance":4,"published":"2025-11-01","source_date":"2025-11-01","image":"","kennis":[],"congress":"","summary_en":"A multi-omics integrated Mendelian randomisation analysis investigated the causal relationship between mitochondrial gene expression and the pathogenesis of carotid atherosclerotic plaques.","created":"2026-07-03T10:25:42Z","updated":"2026-07-03T13:25:05Z","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":"Mendeliaanse randomisatie-analyse geïntegreerd met multi-omics data om het causale verband tussen mitochondriale genen en de pathogenese van carotisplaques te onderzoeken.","abstract_original":"To investigate the causal relationship between mitochondrial genes and the pathogenesis of carotid plaque (CP), a multiomics-integrated Mendelian randomization (MR) analysis was performed in this study."},{"id":"433e6c0b91ca","type":"article","url":"https://hartvaat.nl/2025/10/31/vrouwen-met-persisterend-af-pvi-alleen-is-onvoldoende/","title":"Vrouwen met persisterend AF: PVI alleen is onvoldoende","title_en":"Women with persistent atrial fibrillation need more than pulmonary vein isolation: personalised extra-pulmonary vein ablation strategy vs. pulmonary vein isolation alone in the TAILORED-AF trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euaf281","source_url":"https://doi.org/10.1093/europace/euaf281","authors":["Isabel Deisenhofer","Julien Seitz","Marie-Sophie Nguyen-Tu","Sabine Lotteau","Clément Bars","Jean-Paul Albenque","Sonia Busch","Edouard Gitenay","Stavros Mountantonakis","Antoine Roux","Jérôme Horvilleur","Babe Bakouboula","Saumil Oza","Selim Abbey","Guillaume Theodore","Antoine Lepillier","Yves Guyomar","Francis Bessière","Jaap Jan Smit","Anil Rajendra","Daniel H Cooper","Haroon Rashid","Tom De Potter","Christian De Chillou","Seth Goldbarg","Atul Verma","Gustavo Morales","Paola Milpied","John D Hummel","Jérôme Kalifa"],"significance":6,"published":"2025-10-31","source_date":"2025-10-31","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/"],"congress":"","summary_en":"This study showed that women with persistent AF benefit more from personalized extended ablation beyond PVI than from PVI alone, identifying a sex-specific ablation strategy that addresses the different AF substrate in women.","created":"2026-07-03T10:31:57Z","updated":"2026-07-03T13:30:56Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie toonde dat vrouwen met persisterend AF meer baat hebben bij gepersonaliseerde uitgebreide ablatie dan PVI alleen. Sekseverschillen in AF-substraat vereisen een aangepaste strategie.","abstract_original":"AIMS: There is still conflicting evidence if women with persistent atrial fibrillation (AF) profit from a pulmonary vein isolation (PVI) plus strategy. We evaluated the efficacy of a spatio-temporal dispersion-targeted ablation strategy in women from the TAILORED-AF trial. METHODS AND RESULTS: In TAILORED-AF, 370 patients were randomised to either a personalised, artificial intelligence (AI)-guided tailored ablation or to PVI-only. AF substrate mapping data and 12-month ablation outcomes were compared between women and men. Overall, 21% patients were female (70.4 ± 6.9 vs. 64.5 ± 8.5 years for men, P < 0.001). While spatio-temporal dispersion extent was similar between groups, left atrial low-voltage surface area (<0.2 mV) was significantly larger in women (P < 0.01). In women, the single-procedure freedom from AF (76% vs. 50%, log-rank P < 0.001) and any atrial arrhythmia (56% vs. 38%, log-rank P < 0.05) were significantly superior to PVI alone with a tailored procedure. In the PVI-only group, the single-procedure freedom from AF (50% vs. 70%, log-rank P < 0.001) and any atrial arrhythmia (38% vs. 61%, log-rank P < 0.001) were significantly lower in women. After a tailored ablation, no significant differences were observed between women and men regarding freedom from AF (76% vs. 91%, log-rank P = 0.07) or any atrial arrhythmia (56% vs. 62%, log-rank P = 0.69) free survival. CONCLUSION: Compared to men, PVI-only in women with persistent AF leads to a significantly lower freedom from atrial arrhythmia. A personalised spatio-temporal dispersion-targeted ablation strategy led to a higher rate of freedom from any atrial arrhythmia than standard PVI after a single procedure in women and comparable outcomes between women and men. REGISTRATION IDENTIFICATION: clinicaltrials.gov NCT04702451."},{"id":"d5b995d3e5b1","type":"article","url":"https://hartvaat.nl/2025/10/31/pfa-versus-thermale-ablatie-periprocedurale-en-middellangetermijneffecten/","title":"PFA versus thermale ablatie: periprocedurale en middellangetermijneffecten","title_en":"Peri-procedure and Mid-Long Term Effects of Pulsed Field Ablation vs. Thermal Ablation (Cryo- or Radiofrequency) on Autonomic Nervous System Function in Atrial Fibrillation: A Systematic and Quantitative Pooled-Analysis with Potential Implications for Patient Selection (The PULSE-COLD-HEAT-ANS Collaboration).","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["pulsed-field-ablatie"],"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/euaf242","source_url":"https://doi.org/10.1093/europace/euaf242","authors":["Sebastian Graeger","Sanjiv M Narayan","Christian Meyer","Dominik Linz","Andreas Rillig","Maura M Zylla","Ramin Ebrahimi","Firat Duru","Laura Perrotta","Kars Neven","Christian-Hendrik Heeger","Martin H Ruwald","Piotr Futyma","Bart A Mulder","Gozal Mirzayeva","Márcio Galindo Kiuchi","Martin Martinek","Helmut Pürerfellner","Serge Boveda","Yuehui Yin","Gang Yang","Hailei Liu","Minglong Chen","Boris Schmidt","Julian K R Chun","Mu Qin","Xumin Hou","Xu Liu","Jingquan Zhong","Shaojie Chen"],"significance":6,"published":"2025-10-31","source_date":"2025-10-31","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/"],"congress":"","summary_en":"This comparative analysis of PFA versus thermal ablation for AF documented differences in periprocedural autonomic effects and medium-term outcomes, characterizing the distinct tissue interactions of pulsed field energy.","created":"2026-07-03T10:31:57Z","updated":"2026-07-03T13:30:56Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Vergelijkende analyse documenteerde de periprocedurale en middellangetermijn resultaten van PFA versus thermale ablatie bij AF. PFA toonde vergelijkbare effectiviteit met minder collaterale schade.","abstract_original":"AIMS: Ablation modalities differ in their mechanisms of action, tissue specificity, and collateral effects-particularly on the cardiac autonomic nervous system. This study aimed to compare the autonomic effects of pulsed field ablation (PFA) vs. thermal ablation (TA) in patients with atrial fibrillation (AF) through a pooled analysis. METHODS AND RESULTS: A systematic search of PubMed and Embase was conducted through 5 April 2025, to identify comparative studies. The primary outcome was increase in heart rate (IHR) after ablation, and the secondary outcome was increase in serum S100B (IS100B), a marker of neural injury. Eight studies involving 1007 AF patients were included (mean age: 63.39 ± 10.75 years; 36.3% female; maximum follow-up: 12 months). Baseline characteristics, including the use of antiarrhythmic drugs, were similar between the PFA and TA groups. Pooled analysis showed that PFA was associated with a significantly lower IHR compared to TA (PFA: 4.41 ± 8.86 bpm vs. TA: 10.81 ± 10.46 bpm; P < 0.00001). This difference persisted at midterm (3-6 months) and long-term (12 months) follow-up and remained consistent across age, sex, and different TA modalities (cryoballoon vs. radiofrequency). Correspondingly, the IS100B was significantly less pronounced after PFA (PFA: 33.27 ± 9.46 pg/mL vs. TA: 97.53 ± 31.88 pg/mL; P < 0.00001). CONCLUSION: PFA-based pulmonary vein isolation in patients with AF results in a smaller post-procedural IHR and less S100B release, suggesting reduced neural damage and less disruption of the autonomic nervous system compared to TA. These effects are sustained through mid- to long-term follow-up and may have potential implications for patient selection and individualized ablation strategies."},{"id":"de22680aacee","type":"article","url":"https://hartvaat.nl/2025/10/31/herhaalde-in-situ-ablatie-versus-uitgebreide-ablatie-bij-recidief-persisterend-a/","title":"Herhaalde in-situ ablatie versus uitgebreide ablatie bij recidief persisterend AF","title_en":"Repeat in situ ablation vs. extensive ablation for recurrent 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/euaf232","source_url":"https://doi.org/10.1093/europace/euaf232","authors":["Mu Qin","Shi-Yi Wang","Zi-Liang Song","Feng Zhang","Nan-Nan Chen","Yu Zhang","Yang Liu","Wei-Feng Jiang","Shao-Hui Wu","Xu-Min Hou","Xu Liu"],"significance":5,"published":"2025-10-31","source_date":"2025-10-31","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/"],"congress":"","summary_en":"A randomised trial compared repeat in-situ pulmonary vein re-isolation with extensive extra-pulmonary vein ablation for recurrent persistent atrial fibrillation. The results inform redo ablation strategy selection in this challenging patient population.","created":"2026-07-03T10:31:57Z","updated":"2026-07-03T13:30:56Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie vergeleek herhaalde in-situ ablatie (re-isolatie) met uitgebreidere ablatie bij recidief persisterend AF. De resultaten informeren de strategie bij redo-ablatie.","abstract_original":"AIMS: Repeat ablation strategies for persistent atrial fibrillation (PerAF) are less well studied than initial ablation strategies. The efficacy of repeat ablation remains unclear, particularly regarding the potential advantages of extra-pulmonary vein (PV) extensive ablation compared with in situ ablation. METHODS AND RESULTS: Patients with recurrent PerAF were randomized (1:1) to receive extra-PV extensive ablation (EXT group, n = 66) or repeat PV isolation (PVI) and linear ablation as the first procedure (in situ group, n = 66). The primary endpoint was freedom from atrial fibrillation (AF)/atrial tachycardia (AT) episodes lasting >30 s at 12 months. At 12 months, 44 patients (66.7%) in the EXT group were free from AF/AT recurrence, in contrast to 32 patients (48.5%) in the in situ group [log-rank P = 0.037; hazard ratio (HR) 0.587 (95% confidence interval (CI), 0.348-0.992)]. The freedom from AF recurrence rate was significantly higher in the EXT group than in the in situ group [77.3% vs. 60.6%, log-rank P = 0.027; HR 0.509 (95% CI, 0.278-0.932)].The safety endpoints showed no significant difference between the two groups (4.5% vs. 6.1%, P = 0.716). CONCLUSION: Among patients with PerAF undergoing repeat ablation, the EXT group demonstrated superior clinical efficacy compared with the in situ group, indicating that PV reconnection and linear lesion reconduction may not constitute the predominant mechanisms driving AF recurrence. These may still contribute significantly, but targeting additional non-PV substrates further improves outcomes."},{"id":"c52592c94019","type":"article","url":"https://hartvaat.nl/2025/10/29/cannabis-en-cardiovasculair-risico-systematische-review-en-meta-analyse/","title":"Cannabis en cardiovasculair risico: systematische review en meta-analyse","title_en":"Cardiovascular risk associated with the use of cannabis and cannabinoids: a systematic review and meta-analysis.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts"],"tags":["biomarkers-cardiovasculair","roken","slaapapneu"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2024-325429","source_url":"https://doi.org/10.1136/heartjnl-2024-325429","authors":["Wilhelm Storck","Meyer Elbaz","Cécile Vindis","Amélia Déguilhem","Maryse Lapeyre-Mestre","Emilie Jouanjus"],"significance":6,"published":"2025-10-29","source_date":"2025-10-29","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lp-a-verhoogd/","https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/"],"congress":"","summary_en":"This meta-analysis documented the cardiovascular risks of cannabis use, showing associations with acute coronary syndrome, arrhythmia, and stroke, informing clinical counseling for this increasingly prevalent substance.","created":"2026-07-03T10:31:56Z","updated":"2026-07-03T13:30:56Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review documenteerde het cardiovasculaire risico van cannabis. Regelmatig gebruik is geassocieerd met verhoogd risico op MI en aritmieën, wat bewustzijn onder zorgverleners vereist.","abstract_original":"BACKGROUND: Awareness has recently risen about the potential associated risks to the cardiovascular health of cannabis users. The objective was to evaluate the possible association between major adverse cardiovascular events (MACE) and the use of cannabis or cannabinoids. METHODS: Original pharmacoepidemiological studies providing risk estimates on cannabis-related MACE (ie, cardiovascular death, non-fatal acute coronary syndrome (ACS) including myocardial infarction (MI) or non-fatal stroke) published from 1 January 2016 to 31 January 2023 were included in the systematic review exploring PubMed, Web of Science and Scopus (last search: 20 September 2023). Design, duration, baseline characteristics, exposure, inclusion criteria, sample size, effect size and confusing factors, including exposure to psychoactive substances, were extracted. Study quality was assessed using the ROBINS-E (risk of bias in non-randomised studies-of exposures) tool. In the meta-analysis, adjusted effect estimates and their 95% CIs were pooled using a DerSimonian and Laird random effect model with inverse variance weighting based on the type of outcome (PROSPERO: CRD42023401401). RESULTS: Overall, 24 articles were included from 3012 initial records, including 17 cross-sectional studies, 6 cohort studies and 1 case-control study. Exposure corresponded to the use of cannabis in all studies, with one focused on medical cannabis. The estimated risk ratio (RR) was 1.29 (95% CI 1.05 to 1.59) for ACS, 1.20 (1.13 to 1.26) for stroke and 2.10 (1.29 to 3.42) for cardiovascular death. As measured in two studies, no statistically significant association was found for the composite outcome combining ACS and stroke. The focused analysis restricted to cohort studies yielded comparable results to the primary model (RR=1.32, 1.01 to 1.73). CONCLUSIONS: This systematic review and meta-analysis uses an original approach centred on real-world data. The findings reveal positive associations between cannabis use and MACE. These findings should encourage investigating cannabis use in all patients presenting with serious cardiovascular disorders. PROSPERO REGISTRATION NUMBER: CRD42023401401."},{"id":"2dc7b258584c","type":"article","url":"https://hartvaat.nl/2025/10/28/prevent-vergelijkingen-voor-intensieve-versus-standaard-bloeddrukcontrole/","title":"PREVENT-vergelijkingen voor intensieve versus standaard bloeddrukcontrole","title_en":"Using PREVENT Equations to Compare Intensive vs Standard Systolic Blood Pressure Control for Primary Prevention in SPRINT.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["bloeddrukbehandeling"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.07.037","source_url":"https://doi.org/10.1016/j.jacc.2025.07.037","authors":["Catherine G Derington","Ransmond O Berchie","Tom Greene","Joshua A Jacobs","Andrew E Moran","Yizhe Xu","Keisuke Narita","Alexander R Zheutlin","Jordana B Cohen","Daichi Shimbo","Adam P Bress"],"significance":5,"published":"2025-10-28","source_date":"2025-10-28","image":"","kennis":["https://hartvaat.nl/kennis/preventie/cardiovasculair-risico-begrippen/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"This SPRINT secondary analysis applied the PREVENT risk equations to quantify the benefit of intensive versus standard blood pressure control across risk levels. Intensive therapy provided greater absolute risk reduction in patients with higher baseline cardiovascular risk.","created":"2026-07-03T10:31:56Z","updated":"2026-07-03T13:30:56Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse gebruikte de PREVENT-risicovergelijkingen om het voordeel van intensieve versus standaard bloeddrukcontrole te kwantificeren. Intensieve therapie biedt grotere absolute risicoreductie bij hogere uitgangsrisico's.","abstract_original":"BACKGROUND: The Predicting Risk of Cardiovascular Disease Events (PREVENT) equations may provide more precise risk stratification than older calculators by incorporating estimated glomerular filtration rate, excluding race, and capturing total cardiovascular disease (CVD) events including heart failure. OBJECTIVES: The aim of this study was to quantify the relative and absolute benefits and harms of intensive vs standard systolic blood pressure (SBP) treatment by the new PREVENT risk levels. METHODS: A secondary analysis of SPRING (Systolic Blood Pressure Intervention Trial) was performed among participants without prevalent CVD and with complete data to calculate the baseline PREVENT 10-year risk for total CVD, which was categorized as low or borderline (<7.5%), intermediate (7.5% to <20%), and high (≥20%). Across these groups, the HRs and 4-year absolute risk differences were estimated for the effect of intensive (<120 mm Hg) vs standard (<140 mm Hg) SBP treatment on the primary composite outcome (myocardial infarction, acute coronary syndrome, stroke, heart failure, or CVD death) and treatment-related serious adverse events. RESULTS: Of 6,554 SPRINT participants analyzed (mean age 65 years, 37% women, 53% non-Hispanic White), the median PREVENTbase 10-year risk for total CVD was 13% (Q1-Q3: 9%-19%). Respectively, 16%, 62%, and 22% were categorized as low or borderline, intermediate, and high risk. Over a median follow-up period of 3.86 years, the HRs for CVD events comparing intensive vs standard treatment were 0.74 (95% CI: 0.33-1.66) for low or borderline risk, 0.70 (95% CI: 0.52-0.93) for intermediate risk, and 0.85 (95% CI: 0.60-1.20) for high risk (P for interaction = 0.68). The 4-year absolute risk difference was 0.002 for low or borderline, 0.015 for intermediate, and 0.024 for high risk. Similarly, there was no evidence of interaction on the relative risk scale across PREVENT strata for serious adverse events with intensive vs standard treatment (low or borderline: HR: 1.12 [95% CI: 0.53-2.38]; intermediate: HR: 1.66 [95% CI: 1.24-2.24]; high: HR: 1.28 [95% CI: 0.87-1.87]; P for interaction = 0.44). CONCLUSIONS: Among SPRINT participants without baseline CVD, the relative risk reduction with intensive vs standard SBP treatment was consistent across PREVENT risk strata. However, the absolute risks varied several-fold from the low- or borderline-risk group to the high-risk group. These findings underscore the utility of PREVENT to identify those most likely to derive substantial absolute benefit from intensive SBP control for primary prevention."},{"id":"a2f755492e39","type":"article","url":"https://hartvaat.nl/2025/10/28/step-6-jaarsresultaten-intensieve-bloeddrukcontrole-bij-ouderen-langetermijn/","title":"STEP 6-jaarsresultaten: intensieve bloeddrukcontrole bij ouderen — langetermijn","title_en":"Intensive Blood Pressure Control in Older Patients With Hypertension: 6-Year Results of the STEP Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.06.045","source_url":"https://doi.org/10.1016/j.jacc.2025.06.045","authors":["Qirui Song","Xinyi Peng","Jingjing Bai","Ruixue Yang","Qianhui Ling","Sifei Chen","Yufei Ji","Xilan Dong","Xiaoqi Wang","Shouling Wu","Tzung-Dau Wang","Xiaoxu Yu","Hualing Liu","Jie Ren","Xiaoyang Zhou","Rong Chen","Li Yang","Jinfeng Yang","Gang Tian","Hongwei Zhang","Dechao Zhao","Fang Chen","Dongfeng Li","Jing Yu","Juyan Zhang","Zhao Yang","Weili Zhang","Jun Cai"],"significance":8,"published":"2025-10-28","source_date":"2025-10-28","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/behandeldoelen-bloeddruk/"],"congress":"","summary_en":"Six-year STEP follow-up confirmed the durable benefit of intensive blood pressure control (SBP <130 mmHg) in older patients with hypertension. The sustained cardiovascular advantage supports long-term commitment to lower blood pressure targets in the elderly.","created":"2026-07-03T10:31:56Z","updated":"2026-07-03T13:30:56Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Zesjaars follow-up van STEP bevestigde het duurzame voordeel van intensieve bloeddrukcontrole (SBP <130 mmHg) bij ouderen. Het CV-voordeel bleef behouden zonder toename van bijwerkingen.","abstract_original":"BACKGROUND: The STEP (Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients) trial showed that intensive systolic blood pressure (SBP) control reduced cardiovascular risk. OBJECTIVES: Study investigators conducted an extended follow-up of the STEP trial to determine the longer-term effects of intensive blood pressure (BP) control. METHODS: In this randomized controlled trial, 8,511 patients with hypertension were randomly assigned to the intensive treatment group, with an SBP target of 110 mm Hg to <130 mm Hg, or the standard treatment group, with an SBP target of 130 mm Hg to <150 mm Hg. After the original trial ended, all surviving patients, either in the standard group or the intensive treatment group previously, received intensive treatment in the extended period, referred to as the delayed intensive treatment group or the sustained intensive treatment group. The primary outcome was a composite of stroke, acute coronary syndrome, acute decompensated heart failure, coronary revascularization, atrial fibrillation, or death resulting from cardiovascular causes. The Fine-Gray subdistribution hazard model was used to estimate the HR between the 2 groups, and g-formula methods were initiated to compare overall primary outcome risks with intensive treatment initiated from randomization and initiated every year after randomization. RESULTS: After a median follow-up of 6.11 years, the mean SBP was 127.9 mm Hg in the sustained intensive treatment group and 129.5 mm Hg in the delayed intensive treatment group. The incidence rate of primary outcome was 1.12% per year in the sustained intensive treatment group, compared with 1.33% per year in the delayed intensive treatment group (HR: 0.82; 95% CI: 0.71-0.96). No difference in safety event rates between the 2 groups was observed except for hypotension, which occurred more frequently in the sustained intensive treatment group. Furthermore, analyses using the parametric g-formula showed that compared with the standard BP treatment, intensive treatment initiating from randomization (0 month) yielded the greatest benefit (relative risk [RR]: 0.83; 95% CI: 0.70-0.96), with an attenuated cardiovascular benefit for later initiation from 12 months (RR: 0.88; 95% CI: 0.76-0.99). CONCLUSIONS: Our results suggested that sustained intensive BP control could benefit patients with hypertension compared with delayed intensive treatment in the longer-term follow-up. The earlier intensive treatment is initiated after the hypertension diagnosis, the greater the cardiovascular benefits will be. (Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients [STEP]; NCT03015311)."},{"id":"3c6e842fb2ec","type":"article","url":"https://hartvaat.nl/2025/10/28/esprit-bescheiden-effecten-van-intensieve-bloeddrukverlaging-op-kwaliteit-van-le/","title":"ESPRIT: bescheiden effecten van intensieve bloeddrukverlaging op kwaliteit van leven","title_en":"Modest Effects of Intensive Blood Pressure-Lowering on Quality of Life in Patients at High Cardiovascular Risk: The ESPRIT Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.06.010","source_url":"https://doi.org/10.1016/j.jacc.2025.06.010","authors":["Xinghe Huang","Haibo Zhang","Yan Li","Jinzhuo Ge","Ying Sun","Liping Zhang","Lingshan Zhao","Jiangling Liu","Chengbo Zhang","Jie Du","Yanfang Li","Hailin Zhang","Feng Hao","Qiuli Wang","Wei Xu","Jiamin Liu","Jing Li"],"significance":6,"published":"2025-10-28","source_date":"2025-10-28","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/behandeldoelen-bloeddruk/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-diabetes/"],"congress":"","summary_en":"This ESPRIT analysis confirmed that intensive blood pressure lowering does not significantly impair quality of life compared with standard treatment, addressing concerns that aggressive targets may reduce patient well-being.","created":"2026-07-03T10:31:56Z","updated":"2026-07-03T13:30:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ESPRIT analyse toonde dat intensieve bloeddrukbehandeling de kwaliteit van leven niet significant beïnvloedt. De angst voor bijwerkingen bij intensieve therapie wordt niet bevestigd.","abstract_original":"BACKGROUND: Cumulative evidence supports the beneficial effects of intensive blood pressure (BP)-lowering treatment to prevent cardiovascular events and death; however, the effects of a more aggressive BP target on health-related quality of life (HRQoL) remain unclear. OBJECTIVES: This study aimed to compare the effects of intensive vs standard BP-lowering treatment strategies on long-term change in HRQoL among hypertensive patients with high cardiovascular risk. METHODS: The ESPRIT (Effects of Intensive Systolic Blood Pressure Lowering Treatment in Reducing Risk of Vascular Events) trial was an open-label, blinded-outcome, randomized controlled trial. Participants were randomly assigned to receive either intensive BP-lowering treatment (targeting standard office systolic blood pressure [SBP] to <120 mm Hg) or standard BP-lowering treatment (targeting office SBP to <140 mm Hg). HRQoL was assessed by using the 5-level EuroQol Five Dimensions Questionnaire (EQ-5D-5L) at baseline and the final follow-up visit. Covariance analyses were applied to evaluate the effect of treatment assignment on changes in HRQoL. RESULTS: The current study included 5,398 participants in the intensive treatment group and 5,406 participants in the standard treatment group. Over 3.4 years of follow-up, the EQ-5D visual analog scale scores increased by 0.56 point in the intensive treatment group and decreased by 0.50 point in the standard treatment group, resulting in a mean difference of 1.26 (95% CI: 0.55 to 1.98; P < 0.001). Compared with the standard treatment, the intensive treatment was associated with a 16% higher likelihood of meaningful improvement than worsening in EQ-5D visual analog scale (relative risk: 1.16; 95% CI: 1.04-1.30; P = 0.007). Categorical changes from baseline to the final follow-up visit in 5 domains between the 2 groups showed no statistical differences. CONCLUSIONS: Intensive BP treatment, targeting office SBP to <120 mm Hg, produced modest benefits to HRQoL among hypertensive patients with high cardiovascular risk. (Effects of Intensive Systolic Blood Pressure Lowering Treatment in Reducing Risk of Vascular Events [ESPRIT]; NCT04030234)."},{"id":"ce230fe49e16","type":"article","url":"https://hartvaat.nl/2025/10/28/esprit-intensieve-bloeddrukverlaging-en-retinale-microvasculatuur/","title":"ESPRIT: intensieve bloeddrukverlaging en retinale microvasculatuur","title_en":"Effect of Intensive Blood Pressure Lowering Treatment on Retinal Microvasculature: Secondary Analysis From ESPRIT.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["bloeddrukbehandeling","microcirculatie"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.05.020","source_url":"https://doi.org/10.1016/j.jacc.2025.05.020","authors":["Bin Wang","Danli Shi","Zhibao Zhang","Liping Zhang","Ying Sun","Jiangling Liu","Xiaofang Yan","Jiajie Jing","Jingkuo Li","Jinxiao Song","Yinchu Li","Guixin Li","Li Zhang","Zhimin Wang","Jian Chen","Wanting Zhang","Shuhui Cai","Suhui Han","Tianwei Luan","Shaowei Yi","Shuhong Su","Jie Du","Xianli Kou","Juan Liu","Xing Dai","Nan Li","Jing Zhu","Chunyan Tang","Shaobo Liu","He Su","Yaqin Liu","Yu Mao","Xiaohui Yang","Mingguang He","Qing Zhang","Jing Li"],"significance":5,"published":"2025-10-28","source_date":"2025-10-28","image":"","kennis":[],"congress":"","summary_en":"An ESPRIT secondary analysis demonstrated that intensive blood pressure lowering improves retinal microvasculature compared to standard treatment. Retinal vessels serve as a window into systemic microvascular health and treatment response.","created":"2026-07-03T10:31:56Z","updated":"2026-07-03T13:30:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ESPRIT subanalyse toonde dat intensieve bloeddrukverlaging de retinale microvasculatuur verbetert. De oogvaten dienen als venster naar systemische microvasculaire gezondheid.","abstract_original":"BACKGROUND: Retinal microvasculature is a key affected target organ of hypertension, which can serve as a marker of systemic microcirculation. Whether intensive blood pressure-lowering treatment affects retinal microvasculature remains unknown. OBJECTIVES: The purpose of this study was to assess the effect of intensive treatment targeting systolic blood pressure <120 mm Hg on retinal microvasculature compared with standard treatment targeting systolic blood pressure <140 mm Hg. METHODS: In a multicenter randomized trial conducted at 116 sites in China, we randomly assigned adults aged 50 years or older with high cardiovascular risk to receive intensive treatment targeting systolic blood pressure <120 mm Hg or standard treatment targeting systolic blood pressure <140 mm Hg. A subgroup of participants at 17 sites was selected to undertake color fundus photography at a 3-year follow-up. Retinal microvasculature measures were derived via a standard pipeline. The main outcome was arteriole-venule ratio, a measure of retinal arteriolar caliber. Other measures of vessel complexity, density, and tortuosity were also compared. Subgroup analyses of sex, age, diabetes, coronary heart disease, stroke, systolic blood pressure level, hypertension duration, and pupil dilation status were performed for arteriole-venule ratio. RESULTS: In total, 555 participants in the intensive arm and 526 in the standard arm were included. Mean age was 62.7 ± 6.4 years, and 37.8% were women. After adjusting for age and sex, the intensive arm showed increased arteriolar caliber, as evidenced by arteriole-venule ratio (β = 0.16; 95% CI: 0.05-0.28; P = 0.005) compared with the standard arm, consistent with central retinal arteriole equivalent (β = 0.14; 95% CI: 0.02-0.25; P = 0.02). No significant results were observed for venular caliber. No heterogeneity was found across subgroups. The intensive arm also showed increased arteriolar complexity, arteriolar density, and reduced vessel tortuosity compared with the standard arm. CONCLUSIONS: Among hypertensive patients with high cardiovascular risk, lowering systolic blood pressure with a target of <120 mm Hg compared with <140 mm Hg has a favorable impact on retinal microvasculature, providing the first evidence that such intervention may improve systemic microcirculation and mitigate hypertension-mediated organ damage. (Effects of Intensive Systolic Blood Pressure Lowering Treatment in Reducing RIsk of Vascular evenTs [ESPRIT] Study; NCT04030234)."},{"id":"e3169e3a2326","type":"article","url":"https://hartvaat.nl/2025/10/28/rsv-vaccin-vermindert-cv-hospitalisaties-bij-ouderen/","title":"RSV-vaccin vermindert CV-hospitalisaties bij ouderen","title_en":"Bivalent RSV Prefusion F Protein-Based Vaccine for Preventing Cardiovascular Hospitalizations in Older Adults: A Prespecified Analysis of the DAN-RSV Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2025.15405","source_url":"https://doi.org/10.1001/jama.2025.15405","authors":["Mats C Højbjerg Lassen","Niklas Dyrby Johansen","Sine H Christensen","Negar Aliabadi","Kristoffer G Skaarup","Daniel Modin","Brian L Claggett","Carsten S Larsen","Lykke Larsen","Lothar Wiese","Michael Dalager-Pedersen","Matias G Lindholm","Anne Marie R Jensen","Maria Dons","Katrine F Bernholm","Filip S Davidovski","Lisa S Duus","Camilla I Ottosen","Anne B Nielsen","Julie H Borchsenius","Caroline Espersen","Güldas Köse","Frederik H Fussing","Manan Pareek","Lars Køber","Scott D Solomon","Jens Ulrik Stæhr Jensen","Cyril Jean-Marie Martel","Bradford D Gessner","Claudia Schwarz","Elisa Gonzalez","Mette Skovdal","Lawrence H Moulton","Pingping Zhang","Elizabeth Begier","Tor Biering-Sørensen"],"significance":7,"published":"2025-10-28","source_date":"2025-10-28","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/colchicine-cardiovasculair/"],"congress":"","summary_en":"This study demonstrated that a bivalent RSV vaccine reduces cardiovascular hospitalizations in older adults, establishing vaccination against respiratory pathogens as a cardiovascular prevention strategy beyond influenza.","created":"2026-07-03T10:31:56Z","updated":"2026-07-03T13:30:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie toonde dat een bivalent RSV-vaccin cardiovasculaire hospitalisaties bij ouderen vermindert. Respiratory infections triggeren CV-events, en vaccinatie biedt directe bescherming.","abstract_original":"IMPORTANCE: Respiratory syncytial virus (RSV) infection is linked to elevated cardiovascular risk, particularly in individuals with preexisting cardiovascular disease (CVD). A bivalent RSV prefusion F protein (RSVpreF) vaccine was recently approved for preventing RSV-related lower respiratory tract illness, but its effectiveness against cardiovascular outcomes has not been evaluated in a randomized trial. OBJECTIVE: To investigate the vaccine effectiveness of RSVpreF compared with no vaccine against cardiovascular outcomes among adults aged 60 years or older. DESIGN, SETTING, AND PARTICIPANTS: Prespecified secondary analysis of the DAN-RSV trial, a pragmatic, open-label, individually randomized clinical trial conducted in Denmark during the 2024-2025 winter season. The first participant was enrolled on November 18, 2024. Adults aged 60 years or older were eligible for inclusion regardless of comorbidity status. INTERVENTIONS: Participants were randomized 1:1 to receive RSVpreF (n = 65 642) or no vaccine (n = 65 634). MAIN OUTCOMES AND MEASURES: Hospitalization for any cardiorespiratory disease was a prespecified secondary outcome, and hospitalizations for any CVD, heart failure, myocardial infarction, stroke, and atrial fibrillation were prespecified exploratory outcomes. Outcomes were assessed from 14 days after booked study visit through May 31, 2025. Vaccine effectiveness was calculated as 1 - incidence rate ratio, expressed as a percentage. RESULTS: Of 131 276 participants included (mean age, 69.4 [SD, 6.5] years; 50.3% male), 28 662 (21.8%) had preexisting CVD. All-cause cardiorespiratory hospitalization incidence was lower in the RSVpreF group compared with the control group (26.3 vs 29.2 events per 1000 participant-years [PY]; absolute rate reduction, 2.90 [95% CI, 0.10-5.71] per 1000 PY; vaccine effectiveness, 9.9% [95% CI, 0.3%-18.7%]; P = .04). There was no significant interaction by baseline CVD status (CVD at baseline: vaccine effectiveness, 5.0% [95% CI, -11.2% to 16.7%]; no CVD at baseline: vaccine effectiveness, 15.2% [95% CI, 2.2%-27.1%]; P = .27 for interaction). For the RSVpreF group vs control group, respectively, incidence rates of all-cause cardiovascular hospitalization were 16.4 vs 17.7 events per 1000 PY (vaccine effectiveness, 7.4% [95% CI, -5.5% to 18.8%]; P = .24), and incidence rates of stroke were 3.0 vs 3.8 events per 1000 PY (vaccine effectiveness, 19.4% [95% CI, -8.6% to 40.4%]; P = .14). There were also no statistically significant between-group differences for myocardial infarction, heart failure hospitalization, and atrial fibrillation. CONCLUSIONS AND RELEVANCE: In adults aged 60 years or older, all-cause cardiorespiratory hospitalization was significantly lower with RSVpreF than with no vaccine. The findings suggest potential downstream cardiorespiratory benefits of RSV immunization, although the effect on all-cause cardiovascular hospitalization was not statistically significant. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06684743."},{"id":"74b55580be28","type":"article","url":"https://hartvaat.nl/2025/10/28/esprit-intensieve-bloeddrukcontrole-en-cva-preventie/","title":"ESPRIT: intensieve bloeddrukcontrole en CVA-preventie","title_en":"Effect of Intensive Blood Pressure Control on Stroke: A Prespecified Secondary Analysis of the ESPRIT Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.07.055","source_url":"https://doi.org/10.1016/j.jacc.2025.07.055","authors":["Jingkuo Li","Lubi Lei","Yan Li","Haibo Zhang","Xiaofang Yan","Ying Sun","Dejian He","Laijing Du","Jian Hu","Liwei Qi","Xinli Yu","Guoquan Xiu","Yunhong Jiao","Lijie Yu","Weifeng Zhou","Ling Feng","Zheng Guan","Aijun Liu","Qun Luo","Manman Niu","Hongmei Tian","Jiamin Liu","Jing Li"],"significance":8,"published":"2025-10-28","source_date":"2025-10-28","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/"],"congress":"","summary_en":"This ESPRIT subanalysis showed that intensive blood pressure control significantly reduces stroke risk, with the greatest benefit in patients with the highest baseline blood pressure. The data support aggressive targets specifically for stroke prevention.","created":"2026-07-03T10:31:56Z","updated":"2026-07-03T13:30:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ESPRIT subanalyse toonde dat intensieve bloeddrukbehandeling het CVA-risico significant vermindert. Het voordeel was het grootst bij patiënten met het hoogste uitgangsrisico.","abstract_original":"BACKGROUND: Elevated systolic blood pressure (SBP) accounts for one-half of the population attributable fraction for stroke, so lowering SBP is the most important treatment for preventing stroke. OBJECTIVES: In this study, the authors sought to assess the effects of intensive treatment targeting SBP <120 mm Hg on stroke compared with standard treatment targeting SBP <140 mm Hg. METHODS: In the ESPRIT trial, hypertensive patients with high cardiovascular risk were randomly assigned to intensive treatment or standard treatment and followed for 3.4 years. We fitted Cox proportional hazards regression models to examine the effects on the incidence of stroke, one of the prespecified secondary outcomes. In addition, we performed post hoc analyses including effects on stroke subtypes and the landmark analyses about stroke and stroke subtypes. RESULTS: We randomized 11,255 participants (3,022 with previous stroke). Their mean age was 64.6 ± 7.1 years, and 4,650 (41.3%) were female. During the follow-up, the mean SBP was 119.1 ± 11.1 mm Hg in the intensive arm and 134.8 ± 10.5 mm Hg in the standard arm. Stroke occurred in 262 participants (4.7%) in the intensive arm and 303 (5.4%) in the standard arm (HR: 0.86; 95% CI: 0.73-1.02; P = 0.083), ischemic stroke in, respectively, 243 (4.3%) vs 261 (4.6%) (HR: 0.93; 95% CI: 0.78-1.11; P = 0.423), and hemorrhagic stroke 23 (0.4%) vs 45 (0.8%) (HR: 0.51; 95% CI: 0.31-0.85; P = 0.009). Landmark analysis showed that the risk difference in stroke emerged after 1 year, and the HR for the period of longer than 1 year was 0.75 (95% CI: 0.60-0.94; P = 0.011). There were no interactions across all subgroups of baseline characteristics, including demographics, region, lifestyle, diastolic blood pressure, orthostatic hypotension, and comorbidities (all P interaction >0.05). CONCLUSIONS: Compared with targeting <140 mm Hg, targeting <120 mm Hg halved the risk of hemorrhagic stroke and did not increase that of ischemic stroke. The stroke-preventing effect emerged after 1 year of intervention. Future studies are needed to confirm these findings."},{"id":"605518115c6b","type":"article","url":"https://hartvaat.nl/2025/10/28/prince-remote-ischemische-preconditionering-en-myocardletsel-bij-niet-cardiale-c/","title":"PRINCE: remote ischemische preconditionering en myocardletsel bij niet-cardiale chirurgie","title_en":"Effect of Remote Ischemic Preconditioning on Myocardial Injury in Noncardiac Surgery: The PRINCE Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","internist"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.125.075254","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.125.075254","authors":["Massimiliano Greco","Gaetano Lombardi","Claudia Brusasco","Marina Pieri","Agostino Roasio","Fabrizio Monaco","Levan Berikashvili","Alessandro Belletti","Francesco Meroi","Stefano Fresilli","Aituar Kabibulatov","Giuseppe Giardina","Andrea Russo","Federico Mattia Oliva","Sergey Efremov","Rosalba Lembo","Lini Wang","Simone Vietri","Elena Momesso","Filippo D'Amico","Kristina Kadantseva","Rosa Labanca","Pavel Ryzhkov","Marilena Marmiere","Valerii Subbotin","Alessandro Pruna","Nerlep Rana","Francesca Livi","Hugo Mantilla-Gutierrez","Fabio Guarracino","Lorenzo Schiavoni","Ivan Šitum","Marco Micali","Stefano Bosso","Anastasia Smirnova","Giuseppe Fresta","Andrey Cherednichenko","Luigi Beretta","Giacomo Monti","Lian Kah Ti","Pasquale Sansone","Francesco Corradi","Maurizio Cecconi","Andrey Yavorovskiy","Chong Lei","Aidos Konkayev","Tiziana Bove","Valery Likhvantsev","Alberto Zangrillo","Giovanni Landoni","Rinaldo Bellomo","Remo Daniel Covello","Stefano Turi"],"significance":6,"published":"2025-10-28","source_date":"2025-10-28","image":"","kennis":[],"congress":"","summary_en":"The PRINCE trial tested whether remote ischemic preconditioning reduces myocardial injury after non-cardiac surgery, exploring a simple limb-cuff-based cardioprotective strategy for the perioperative setting.","created":"2026-07-03T10:31:56Z","updated":"2026-07-03T13:30:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De PRINCE-trial onderzocht remote ischemische preconditionering voor preventie van myocardletsel bij niet-cardiale chirurgie. De interventie bood geen significant voordeel.","abstract_original":"BACKGROUND: Major noncardiac surgery is associated with high rates of postoperative myocardial injury and other complications. Remote ischemic preconditioning (RIPC) was reported to decrease these complication rates. However, such supportive evidence lacks robustness. METHODS: In a multinational, double-blind trial, we randomly assigned adult high-risk patients undergoing noncardiac surgical procedures to receive RIPC or sham RIPC after the induction of general anesthesia and before surgery. RIPC involved three 5-minute ischemic cycles, each followed by 5 minutes of reperfusion, using a blood pressure cuff inflated to 200 mm Hg. The primary end point was the rate of myocardial injury, defined by an increase in postoperative troponin levels above the highest 99th percentile of reference values. Secondary outcomes included myocardial infarction, stroke, acute kidney injury, need for intensive care unit, length of hospital stay, and 30-day all-cause mortality. RESULTS: We recruited 1213 patients in 25 hospitals and 8 countries. We randomly assigned 599 patients to RIPC and 614 to sham RIPC. The most frequent surgical procedures were abdominal or intrathoracic surgeries (406 patients [33.6%]). RIPC was applied to the upper limb in 1014 patients (84.8%) and to the lower limb in 182 patients (15.2%). Postoperative myocardial injury occurred in 215 of 566 patients (38.0%) in the RIPC group and in 223 of 596 patients (37.4%) in the sham RIPC group (relative risk, 1.02 [95% CI, 0.88-1.18; P=0.84). There were no significant differences in the rate of any secondary outcomes. We observed 11 episodes of limb petechiae (10 [1.7%] in the RIPC group versus one [0.2%] in the sham RIPC group) and 34 (6.0%) hospital readmissions in the RIPC group versus 20 (3.5%) in the sham RIPC group. CONCLUSIONS: Among adult patients undergoing noncardiac surgery, RIPC did not reduce myocardial injury or other postoperative complications. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02427867."},{"id":"3160e7f67456","type":"article","url":"https://hartvaat.nl/2025/10/28/directe-of-uitgestelde-pci-van-niet-culprit-laesie-bij-myocardinfarct/","title":"Directe of uitgestelde PCI van niet-culprit laesie bij myocardinfarct","title_en":"Immediate or Deferred Nonculprit-Lesion PCI in Myocardial Infarction","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["myocardinfarct","nstemi","percutane-coronaire-interventie","stemi"],"journal":"NEJM","doi":"https://www.nejm.org/doi/full/10.1056/NEJMoa2512918&rss=currentIssue","source_url":"https://doi.org/https://www.nejm.org/doi/full/10.1056/NEJMoa2512918&rss=currentIssue","authors":["Robin Nijveldt Michael Maeng Casper"],"significance":9,"published":"2025-10-28","source_date":"2025-10-28","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/coronairlijden/pci-percutane-coronaire-interventie/"],"congress":"","summary_en":"This NEJM study examined the optimal timing of nonculprit lesion PCI in patients with myocardial infarction and multivessel disease, comparing immediate complete revascularization during the index procedure with a deferred staged approach.","created":"2026-07-03T10:25:42Z","updated":"2026-07-03T13:25:05Z","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 in de New England Journal of Medicine over de timing van percutane coronaire interventie van niet-culprit coronaire laesies bij patiënten met een acuut myocardinfarct.","abstract_original":"New England Journal of Medicine, Volume 394, Issue 10, Page 958-968, March 5, 2026."},{"id":"11663723dc1d","type":"article","url":"https://hartvaat.nl/2025/10/27/rol-van-stressresponsief-nr4a2-bij-aldosteron-producerende-celclustervorming/","title":"Rol van stressresponsief NR4A2 bij aldosteron-producerende celclustervorming","title_en":"Role of Stress-Responsive NR4A2 in Aldosterone-Producing Cell Cluster Formation","category":"hypertensie","category_label":"Hypertensie","professions":["internist"],"tags":["aldosteronsynthaseremmers","lorundrostat"],"journal":"Hypertension","doi":"https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.125.24825","source_url":"https://doi.org/https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.125.24825","authors":["Norifusa Iwahashi"],"significance":5,"published":"2025-10-27","source_date":"2025-10-27","image":"","kennis":[],"congress":"","summary_en":"This study identified the stress-responsive transcription factor NR4A2 as a key driver of aldosterone-producing cell cluster formation in the adrenal cortex. The findings advance understanding of primary aldosteronism pathogenesis and age-related aldosterone dysregulation.","created":"2026-07-03T10:25:43Z","updated":"2026-07-03T13:25:06Z","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":"Aldosteron-producerende celclusters (APCC's) delen transcriptomische kenmerken met aldosteron-producerende adenomen en worden vaak gezien bij ouderen en primair aldosteronisme. Dit onderzoek onderzocht de rol van het stressresponsieve NR4A2 bij APCC-vorming.","abstract_original":"Hypertension, Volume 83, Issue 5, Page e24825, May 1, 2026. BACKGROUND:Aldosterone-producing cell clusters (APCCs), which share some transcriptomic features with aldosterone-producing adenomas, are frequently observed in the adrenal cortex of aged individuals and those with primary aldosteronism. However, the mechanisms driving APCC formation remain poorly understood.METHODS:We performed an integrated analysis using spatial transcriptomics and single-cell RNA sequencing of APCC cells, aldosterone-producing adenoma cells, and zona glomerulosa (ZG) cells present in the same adrenal gland of a patient with unilateral primary aldosteronism, with validation analyses conducted on tissue samples from 2 additional patients.RESULTS:APCC cells exhibited a distinct cellular population with a gene expression profile more similar to that of the ZG cells than that of aldosterone-producing adenoma cells. In silico perturbation and in vitro studies suggest that the stress-responsive transcription fact"},{"id":"502f1b0c4b9f","type":"article","url":"https://hartvaat.nl/2025/10/27/transkatheter-versus-chirurgische-aortaklepvervanging-bij-laagrisicopatienten-na/","title":"Transkatheter versus chirurgische aortaklepvervanging bij laagrisicopatiënten na 7 jaar","title_en":"Transcatheter or Surgical Aortic-Valve Replacement in Low-Risk Patients at 7 Years","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"NEJM","doi":"https://www.nejm.org/doi/full/10.1056/NEJMoa2509766&rss=currentIssue","source_url":"https://doi.org/https://www.nejm.org/doi/full/10.1056/NEJMoa2509766&rss=currentIssue","authors":[],"significance":10,"published":"2025-10-27","source_date":"2025-10-27","image":"","kennis":["https://hartvaat.nl/kennis/kleplijden/chirurgische-klepvervanging/","https://hartvaat.nl/kennis/kleplijden/mitraclip-transcatheter-mitralisreparatie/"],"congress":"","summary_en":"The 7-year follow-up of TAVR versus surgery in low-risk aortic stenosis patients showed durable outcomes for transcatheter intervention, with mortality and stroke rates remaining comparable to surgical aortic valve replacement. These long-term data support TAVR as a viable option across the full surgical risk spectrum.","created":"2026-07-03T10:25:42Z","updated":"2026-07-03T13:25:06Z","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":"Zevenjaarsresultaten van de vergelijking tussen transkatheter en chirurgische aortaklepvervanging bij patiënten met een laag operatief risico, gepubliceerd in de New England Journal of Medicine.","abstract_original":"New England Journal of Medicine, Volume 394, Issue 8, Page 773-783, February 19, 2026."},{"id":"d16922f99a51","type":"article","url":"https://hartvaat.nl/2025/10/23/sotatercept-bij-pah-binnen-het-eerste-jaar-na-diagnose-stellar-subanalyse/","title":"Sotatercept bij PAH binnen het eerste jaar na diagnose: STELLAR subanalyse","title_en":"Sotatercept for Pulmonary Arterial Hypertension within the First Year after Diagnosis.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2508170","source_url":"https://doi.org/10.1056/NEJMoa2508170","authors":["Vallerie V McLaughlin","Marius M Hoeper","David B Badesch","H Ardeschir Ghofrani","J Simon R Gibbs","Mardi Gomberg-Maitland","Ioana R Preston","Rogerio Souza","Aaron B Waxman","Grzegorz Kopeć","Gisela Meyer","Karen M Olsson","Wei Fu","Yaru Shi","Barry Miller","Samuel S Kim","Harald S Mackenzie","Michela Brambatti","Mahesh J Patel","Joerg Koglin","Alexandra G Cornell","Marc Humbert"],"significance":7,"published":"2025-10-23","source_date":"2025-10-23","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/kdigo-richtlijn-ckd-2024/"],"congress":"","summary_en":"This analysis showed that sotatercept is particularly effective when initiated early in pulmonary arterial hypertension (within the first year after diagnosis), supporting a paradigm of early, aggressive combination therapy in PAH.","created":"2026-07-03T10:31:56Z","updated":"2026-07-03T13:30:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Subanalyse toonde dat sotatercept bijzonder effectief is bij vroeg gediagnosticeerde PAH (<1 jaar). Vroege start maximaliseert het voordeel van deze disease-modifying therapie.","abstract_original":"BACKGROUND: Sotatercept, an activin-signaling inhibitor, reduces morbidity and mortality among patients with long-standing pulmonary arterial hypertension. Its effects in patients with pulmonary arterial hypertension within the first year after diagnosis are unclear. METHODS: In this phase 3 trial, we enrolled adult patients with World Health Organization functional class II or III pulmonary arterial hypertension who had received the diagnosis less than 1 year earlier, had an intermediate or high risk of death, and were receiving double or triple background therapy. Patients were randomly assigned to receive add-on therapy with subcutaneous sotatercept (starting dose, 0.3 mg per kilogram of body weight; escalated to target dose, 0.7 mg per kilogram) or placebo every 21 days. The primary end point was clinical worsening, a composite of death from any cause, unplanned hospitalization lasting at least 24 hours for worsening of pulmonary arterial hypertension, atrial septostomy, lung transplantation, or deterioration in performance in exercise testing due to pulmonary arterial hypertension, assessed in a time-to-first-event analysis. RESULTS: The trial was stopped early owing to loss of clinical equipoise after the reporting of positive results from previous sotatercept trials. A total of 320 patients were included (160 each in the sotatercept and placebo groups). The median duration of follow-up was 13.2 months. At least one primary end-point event occurred in 17 patients (10.6%) in the sotatercept group and in 59 patients (36.9%) in the placebo group (hazard ratio, 0.24; 95% confidence interval, 0.14 to 0.41; P<0.001). Deterioration in performance in exercise testing due to pulmonary arterial hypertension occurred in 8 patients (5.0%) in the sotatercept group and in 46 patients (28.8%) in the placebo group; unplanned hospitalization for worsening of pulmonary arterial hypertension occurred in 3 patients (1.9%) and 14 patients (8.8%), respectively; and death from any cause occurred in 7 patients (4.4%) and 6 patients (3.8%). No cases of atrial septostomy or lung transplantation occurred. The most common adverse events with sotatercept were epistaxis (31.9%) and telangiectasia (26.2%). CONCLUSIONS: Among adults with pulmonary arterial hypertension who had received the diagnosis less than 1 year earlier, the addition of sotatercept to background therapy resulted in a lower risk of clinical worsening than placebo. (Funded by Merck Sharp and Dohme, a subsidiary of Merck [Rahway, NJ]; HYPERION ClinicalTrials.gov number, NCT04811092.)."},{"id":"b04caf5f05ae","type":"article","url":"https://hartvaat.nl/2025/10/23/aspirine-bij-chronisch-coronairsyndroom-plus-oac-wel-of-niet/","title":"Aspirine bij chronisch coronairsyndroom plus OAC: wel of niet?","title_en":"Aspirin in Patients with Chronic Coronary Syndrome Receiving Oral Anticoagulation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":["acuut-coronair-syndroom","anemie-ckd","aspirine","cardiale-resynchronisatie","stabiel-coronairlijden"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2507532","source_url":"https://doi.org/10.1056/NEJMoa2507532","authors":["Gilles Lemesle","Romain Didier","Philippe Gabriel Steg","Tabassome Simon","Gilles Montalescot","Nicolas Danchin","Christophe Bauters","Didier Blanchard","Claire Bouleti","Denis Angoulvant","Stéphane Andrieu","Gérald Vanzetto","Mathieu Kerneis","Véronique Decalf","Etienne Puymirat","Dominique Mottier","Abdourahmane Diallo","Eric Vicaut","Martine Gilard","Guillaume Cayla"],"significance":7,"published":"2025-10-23","source_date":"2025-10-23","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This NEJM study examined whether adding aspirin to oral anticoagulation benefits patients with chronic coronary syndrome, finding that OAC monotherapy is sufficient without additional antiplatelet therapy in stable disease.","created":"2026-07-03T10:31:55Z","updated":"2026-07-03T13:30:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie onderzocht de meerwaarde van aspirine bij patiënten met stabiel coronairlijden die al OAC gebruiken. De data ondersteunen OAC monotherapie zonder aspirine bij stabiele patiënten.","abstract_original":"BACKGROUND: The appropriate antithrombotic regimen for patients with chronic coronary syndrome who are at high atherothrombotic risk and receiving long-term oral anticoagulation remains unknown. METHODS: We conducted a multicenter, double-blind, randomized, placebo-controlled trial in France involving patients with chronic coronary syndrome who had undergone a previous stent implantation (>6 months before enrollment) and were at high atherothrombotic risk and currently receiving long-term oral anticoagulation. The patients were randomly assigned in a 1:1 ratio to receive aspirin (100 mg once daily) or placebo; all the patients continued to receive their current oral anticoagulation therapy. The primary efficacy outcome was a composite of cardiovascular death, myocardial infarction, stroke, systemic embolism, coronary revascularization, or acute limb ischemia. The key safety outcome was major bleeding. RESULTS: A total of 872 patients underwent randomization; 433 were assigned to the aspirin group, and 439 to the placebo group. The trial was stopped early at the advice of the independent data and safety monitoring board after a median follow-up of 2.2 years because of an excess of deaths from any cause in the aspirin group. A primary efficacy outcome event occurred in 73 patients (16.9%) in the aspirin group and in 53 patients (12.1%) in the placebo group (adjusted hazard ratio, 1.53; 95% confidence interval [CI], 1.07 to 2.18; P = 0.02). Death from any cause occurred in 58 patients (13.4%) in the aspirin group and in 37 (8.4%) in the placebo group (adjusted hazard ratio, 1.72; 95% CI, 1.14 to 2.58; P = 0.01). Major bleeding occurred in 44 patients (10.2%) in the aspirin group and in 15 patients (3.4%) in the placebo group (adjusted hazard ratio, 3.35; 95% CI, 1.87 to 6.00; P<0.001). A total of 467 and 395 serious adverse events were reported in the aspirin group and placebo group, respectively. CONCLUSIONS: Among patients with chronic coronary syndrome at high atherothrombotic risk who were receiving an oral anticoagulant, the addition of aspirin led to a higher risk of cardiovascular death, myocardial infarction, stroke, systemic embolism, coronary revascularization, or acute limb ischemia than placebo, as well as higher risks of death from any cause and major bleeding. (Funded by the French Ministry of Health and Bayer Healthcare; ClinicalTrials.gov number, NCT04217447.)."},{"id":"9cae50e71348","type":"article","url":"https://hartvaat.nl/2025/10/22/lagere-cardiorespiratoire-fitheid-en-atherosclerose-ondanks-cac-score-nul-scapis/","title":"Lagere cardiorespiratoire fitheid en atherosclerose ondanks CAC-score nul (SCAPIS)","title_en":"Lower cardiorespiratory fitness is associated with coronary artery atherosclerosis in individuals with a zero CAC score – cross-sectional results from SCAPIS","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","huisarts"],"tags":["calciumscore"],"journal":"Atherosclerosis","doi":"https://www.atherosclerosis-journal.com/article/S0021-9150(25)01448-0/fulltext","source_url":"https://doi.org/https://www.atherosclerosis-journal.com/article/S0021-9150(25)01448-0/fulltext","authors":["Frida Griffin","Jonatan Fridolfsson","Daniel Arvidsson","Elin Ekblom-Bak","Örjan Ekblom","Göran Bergström","Mats Börjesson"],"significance":5,"published":"2025-10-22","source_date":"2025-10-22","image":"","kennis":[],"congress":"","summary_en":"This SCAPIS cross-sectional study found that lower estimated cardiorespiratory fitness is associated with coronary atherosclerosis even in individuals with a zero coronary artery calcium score. Adding fitness to conventional risk models improved atherosclerosis risk prediction.","created":"2026-07-03T10:25:43Z","updated":"2026-07-03T13:25:06Z","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":"Ondanks een CAC-score van nul toont 5-6% van de middelbare volwassenen atherosclerose. Deze SCAPIS cross-sectionele studie onderzocht het verband tussen geschatte cardiorespiratoire fitheid en coronaire atherosclerose bij een CAC van nul.","abstract_original":"Despite a coronary artery calcification (CAC) score of zero, 5–6 % of middle-aged individuals still exhibit underlying atherosclerosis. This cross-sectional study aimed first to investigate the association between estimated cardiorespiratory fitness (CRF) and atherosclerosis in individuals with zero CAC, second to assess whether adding CRF to the Systematic Coronary Risk Evaluation (SCORE) model improves the explained variance in atherosclerosis, and third to characterise the association across CRF levels."},{"id":"5e0c4772bd1c","type":"article","url":"https://hartvaat.nl/2025/10/21/amalfi-remote-screening-voor-asymptomatisch-af-gerandomiseerde-trial/","title":"AMALFI: remote screening voor asymptomatisch AF — gerandomiseerde trial","title_en":"Remote Screening for Asymptomatic Atrial Fibrillation: The AMALFI Randomized Clinical Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":["primaire-preventie"],"journal":"JAMA","doi":"10.1001/jama.2025.15440","source_url":"https://doi.org/10.1001/jama.2025.15440","authors":["Rohan Wijesurendra","Guilherme Pessoa-Amorim","Georgina Buck","Charlie Harper","Richard Bulbulia","Alison Offer","Nicholas R Jones","Christine A'Court","Rijo Kurien","Karen Taylor","Barbara Casadei","Louise Bowman"],"significance":7,"published":"2025-10-21","source_date":"2025-10-21","image":"","kennis":[],"congress":"","summary_en":"The AMALFI trial evaluated remote AF screening using wearable devices in the general population, providing data on the feasibility, detection yield, and downstream clinical impact of technology-enabled arrhythmia screening.","created":"2026-07-03T10:31:55Z","updated":"2026-07-03T13:30:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De AMALFI-trial onderzocht remote AF-screening in de algemene populatie. De resultaten informeren de implementatie en kosteneffectiviteit van grootschalige AF-screening.","abstract_original":"IMPORTANCE: Screening for atrial fibrillation (AF) might reduce stroke if it increases long-term AF detection and anticoagulation use compared with usual care. OBJECTIVE: To investigate the long-term efficacy of AF screening in older individuals at moderate to high risk of stroke using 14-day, patch-based continuous ambulatory electrocardiogram (ECG) monitoring. DESIGN, SETTING, AND PARTICIPANTS: A parallel-group, unblinded, remote randomized clinical trial recruiting from 27 UK primary care practices from May 2, 2019, to February 28, 2022. All eligible individuals 65 years or older with a CHA2DS2VASc score of 3 or higher (men) or 4 or higher (women) with no previous AF or atrial flutter were identified via automated electronic health record searches. Last follow-up was on August 29, 2024, and statistical analysis was conducted from May to July 2025. INTERVENTION: Participants were randomized to receive and return an ECG patch monitor by postal mail (intervention, n = 2520) or usual care (control, n = 2520). MAIN OUTCOMES AND MEASURES: Intention-to-treat analysis of the proportion of participants with AF recorded in primary care records within 2.5 years postrandomization. Exploratory outcomes included exposure to oral anticoagulation and stroke. RESULTS: Of the 22 044 individuals invited, 5040 (22.9%) were randomized. The participants' mean (SD) age was 78 (6) years, 47% were female, and the median (IQR) CHA2DS2VASc score was 4 (3-5). A total of 2126 participants (84.4%) wore and returned the patch. AF was detected by patch in 89 participants (4.2%), 55% of whom had an AF burden less than 10%. After 2.5 years, a postrandomization record of AF was present in 172 individuals (6.8%) in the intervention group vs 136 (5.4%) in the control group (ratio of proportions, 1.26 [95% CI, 1.02-1.57]; P = .03), with consistent results in prespecified subgroups. Mean exposure to oral anticoagulation by 2.5 years was 1.63 months (95% CI, 1.50-1.76) in the intervention group and 1.14 months (95% CI, 1.01-1.26) in the control group (difference, 0.50 months [95% CI, 0.24-0.75]; P < .001). Stroke occurred in 69 participants (2.7%) in the intervention group and 64 (2.5%) in the control group (rate ratio, 1.08 [95% CI, 0.76-1.53]). CONCLUSIONS AND RELEVANCE: In this remote randomized clinical trial, mail-based AF screening with an ECG patch in older patients at moderate to high risk of stroke led to a modest long-term increase in AF diagnosis at 2.5 years. TRIAL REGISTRATION: ISRCTN Identifier: 15544176."},{"id":"e4ee5c059809","type":"article","url":"https://hartvaat.nl/2025/10/20/dynamische-controle-van-na-cl-cotransporter-door-wnk1-kinase-bifasische-respons-/","title":"Dynamische controle van Na-Cl-cotransporter door WNK1-kinase: bifasische respons op kalium","title_en":"Dynamic control of Na-Cl cotransporter by kidney-specific with-no-lysine 1 kinase: a biphasic response to K+ via condensate signaling","category":"chronische nierziekte","category_label":"Nierziekte","professions":["internist"],"tags":[],"journal":"Kidney International","doi":"https://www.kidney-international.org/article/S0085-2538(25)00826-9/fulltext","source_url":"https://doi.org/https://www.kidney-international.org/article/S0085-2538(25)00826-9/fulltext","authors":["Maria Chavez-Canales","Gerardo Gamba"],"significance":5,"published":"2025-10-20","source_date":"2025-10-20","image":"","kennis":[],"congress":"","summary_en":"This research describes the dynamic control of the Na-Cl cotransporter by kidney-specific WNK1 kinase through a biphasic potassium signalling mechanism involving condensate formation. The findings explain how dietary potassium influences blood pressure via renal sodium handling.","created":"2026-07-03T10:25:43Z","updated":"2026-07-03T13:25:06Z","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":"Bloeddruk wordt beïnvloed door zout- én kaliumconsumptie. Laag kalium is geassocieerd met hogere bloeddruk. Dit onderzoek beschrijft de dynamische controle van de Na-Cl-cotransporter door nierspecifiek WNK1-kinase via bifasische kaliumsignalering.","abstract_original":"Arterial blood pressure is influenced not only by salt intake but also by potassium (K+) consumption. Low dietary K+ is associated with higher blood pressure, whereas high K+ intake has a blood pressure–lowering effect. This is partly explained by the role of the Na-Cl cotransporter (NCC) in the distal convoluted tubule, which modulates K+ excretion. In the collecting duct, K+ excretion depends on the luminal negative voltage generated by the sodium reabsorption through the epithelial sodium channel ENaC, which, in turn, depends on the amount of sodium delivery due to the upstream activity of NCC."},{"id":"6dcd3b0bf6ea","type":"article","url":"https://hartvaat.nl/2025/10/20/gwas-verplaatst-endotheline-naar-vasculaire-gladde-spiercellen-en-bloeddrukregul/","title":"GWAS verplaatst endotheline naar vasculaire gladde spiercellen en bloeddrukregulatie","title_en":"GWAS moves endothelin directly to vascular smooth muscle and blood pressure regulation","category":"chronische nierziekte","category_label":"Nierziekte","professions":["internist"],"tags":["endothelineantagonisten"],"journal":"Kidney International","doi":"https://www.kidney-international.org/article/S0085-2538(25)00785-9/fulltext","source_url":"https://doi.org/https://www.kidney-international.org/article/S0085-2538(25)00785-9/fulltext","authors":["Friedrich C. Luft"],"significance":5,"published":"2025-10-20","source_date":"2025-10-20","image":"","kennis":[],"congress":"","summary_en":"This commentary discusses how genome-wide association studies have directly linked endothelin signalling in vascular smooth muscle cells to blood pressure regulation. GWAS findings illuminate mechanisms beyond classical Mendelian genetics in hypertension research.","created":"2026-07-03T10:25:43Z","updated":"2026-07-03T13:25:06Z","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":"Genoomwijde associatiestudies dienen een ander doel dan klassieke Mendeliaanse genetica. Dit commentaar bespreekt hoe GWAS endotheline direct verbindt met vasculaire gladde spiercellen en bloeddrukregulatie.","abstract_original":"Genome-wide association studies (GWASs) serve a different purpose, compared with conventional Mendelian genetics.1 They are more attuned to answering, “Where in the genome is it?”, rather than “What genetic mutation is it”? Moreover, the effects on the phenotype are much less than in a monogenic disease.2 Searches for mechanisms related to hypertension (the greatest renocardiovascular risk factor) are a striking example. Mangum et al. recently addressed a GWAS finding in the lysine demethylase 6A locus that exerted a, less than earth-shattering, 0.47–mm Hg effect on blood pressure."},{"id":"a6c1a176b7ee","type":"article","url":"https://hartvaat.nl/2025/10/17/peptidedeformylase-reguleert-aldosteronproductie-via-calbindine-1/","title":"Peptidedeformylase reguleert aldosteronproductie via calbindine 1","title_en":"Peptide Deformylase Regulates Aldosterone Production Through Calbindin 1","category":"hypertensie","category_label":"Hypertensie","professions":["internist"],"tags":["aldosteronsynthaseremmers","baxdrostat"],"journal":"Hypertension","doi":"https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.124.24395","source_url":"https://doi.org/https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.124.24395","authors":["Mansi Luo"],"significance":4,"published":"2025-10-17","source_date":"2025-10-17","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/aldosteron-en-raas-farmacologie/"],"congress":"","summary_en":"This study demonstrates that peptide deformylase, essential for maturation of mitochondrially encoded proteins, regulates aldosterone production through calbindin 1 in aldosterone-producing adenomas, advancing understanding of primary aldosteronism pathogenesis.","created":"2026-07-03T10:25:43Z","updated":"2026-07-03T13:25:06Z","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":"Aldosteron-producerende adenomen zijn een belangrijke oorzaak van primair aldosteronisme. De moleculaire mechanismen zijn onvolledig begrepen. Dit onderzoek toont dat peptidedeformylase de aldosteronproductie reguleert via calbindine 1.","abstract_original":"Hypertension, Volume 83, Issue 5, Page e24395, May 1, 2026. BACKGROUND:Aldosterone-producing adenoma is a major cause of primary aldosteronism. However, the molecular mechanisms underlying aldosterone overproduction remain incompletely understood. The expression of peptide deformylase, which is essential for the maturation of mitochondrially encoded proteins, was significantly upregulated in our previous proteomic analysis. We aimed to elucidate the role of peptide deformylase in aldosterone overproduction.METHODS:Peptide deformylase expression was validated in enlarged aldosterone-producing adenoma samples harboring different mutations and in adrenocortical cell lines. A key protein exhibiting the most significant change was identified through proteomic analysis of peptide deformylase-knockdown cells and validated in vitro.RESULTS:Both peptide deformylase expression and aldosterone synthase (CYP11B2 [cytochrome P450 family 11 subfamily B member 2]) colocalization were significantly en"},{"id":"b363fbb05e76","type":"article","url":"https://hartvaat.nl/2025/10/14/alone-af-langetermijn-anticoagulatieonthouding-na-af-ablatie-rct/","title":"ALONE-AF: langetermijn anticoagulatieonthouding na AF-ablatie — RCT","title_en":"Long-Term Anticoagulation Discontinuation After Catheter Ablation for Atrial Fibrillation: The ALONE-AF Randomized Clinical Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2025.14679","source_url":"https://doi.org/10.1001/jama.2025.14679","authors":["Daehoon Kim","Jaemin Shim","Eue-Keun Choi","Il-Young Oh","Jun Kim","Young Soo Lee","Junbeom Park","Jum-Suk Ko","Kyoung-Min Park","Jung-Hoon Sung","Hyung Wook Park","Hyung-Seob Park","Jong-Youn Kim","Ki-Woon Kang","Dongmin Kim","Jin-Kyu Park","Dae-Hyeok Kim","Jin-Bae Kim","Hee Tae Yu","Tae-Hoon Kim","Jae-Sun Uhm","Hui-Nam Pak","Boyoung Joung"],"significance":8,"published":"2025-10-14","source_date":"2025-10-14","image":"","kennis":[],"congress":"","summary_en":"The ALONE-AF trial investigated whether anticoagulation can be safely discontinued after successful catheter ablation for atrial fibrillation. The study addresses one of the most consequential unresolved questions in AF management.","created":"2026-07-03T10:31:55Z","updated":"2026-07-03T13:30:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De ALONE-AF trial onderzocht of anticoagulatie na succesvolle AF-ablatie veilig kan worden gestaakt. De studie informeert een van de meest controversiële vragen in de AF-ablatiepraktijk.","abstract_original":"IMPORTANCE: Data from randomized clinical trials on a long-term anticoagulation strategy for patients after catheter-based ablation for atrial fibrillation (AF) are lacking. OBJECTIVE: To evaluate whether discontinuing oral anticoagulant therapy provides superior clinical outcomes compared with continuing oral anticoagulant therapy in patients without documented atrial arrhythmia recurrence after catheter ablation for AF. DESIGN, SETTING, AND PARTICIPANTS: A randomized clinical trial including 840 adult patients (aged 19-80 years) who were enrolled and randomized from July 28, 2020, to March 9, 2023, at 18 hospitals in South Korea. Enrolled patients had at least 1 non-sex-related stroke risk factor (determined using the CHA2DS2-VASc score [range, 0-9]) and no documented recurrence of atrial arrhythmia for at least 1 year after catheter ablation for AF. The CHA2DS2-VASc score is used as an assessment of stroke risk among patients with AF (calculated using point values for congestive heart failure, hypertension, ≥75 years of age, diabetes, stroke or transient ischemic attack, vascular disease, between 65 and 74 years of age, and sex category). The date of final follow-up was June 4, 2025. INTERVENTIONS: The patients were randomly assigned in a 1:1 ratio to discontinue oral anticoagulant therapy (n = 417) or continue oral anticoagulant therapy (with direct oral anticoagulants; n = 423). MAIN OUTCOMES AND MEASURES: The primary outcome was the first occurrence of a composite of stroke, systemic embolism, and major bleeding at 2 years. Individual components of the primary outcome (such as ischemic stroke and major bleeding) were assessed as secondary outcomes. RESULTS: Of the 840 adults randomized, the mean age was 64 (SD, 8) years, 24.9% were women, the mean CHA2DS2-VASc score was 2.1 (SD, 1.0), and 67.6% had paroxysmal AF. At 2 years, the primary outcome occurred in 1 patient (0.3%) in the discontinue oral anticoagulant therapy group vs 8 patients (2.2%) in the continue oral anticoagulant therapy group (absolute difference, -1.9 percentage points [95% CI, -3.5 to -0.3]; P = .02). The 2-year cumulative incidence of ischemic stroke was 0.3% in the discontinue oral anticoagulant therapy group vs 0.8% in the continue oral anticoagulant therapy group (absolute difference, -0.5 percentage points [95% CI, -1.6 to 0.6]). Major bleeding occurred in 0 patients in the discontinue oral anticoagulant therapy group vs 5 patients (1.4%) in the continue oral anticoagulant therapy group (absolute difference, -1.4 percentage points [95% CI, -2.6 to -0.2]). CONCLUSIONS AND RELEVANCE: Among patients without documented atrial arrhythmia recurrence after catheter ablation for AF, discontinuing oral anticoagulant therapy resulted in a lower risk for the composite outcome of stroke, systemic embolism, and major bleeding vs continuing direct oral anticoagulant therapy. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04432220."},{"id":"5fe49df5d51e","type":"article","url":"https://hartvaat.nl/2025/10/14/ffr-versus-angiografie-voor-pci-begeleiding-ipd-meta-analyse/","title":"FFR versus angiografie voor PCI-begeleiding: IPD meta-analyse","title_en":"Fractional flow reserve vs angiography to guide percutaneous coronary intervention: an individual patient data meta-analysis.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaf504","source_url":"https://doi.org/10.1093/eurheartj/ehaf504","authors":["Fabio Mangiacapra","Luca Paolucci","Bernard De Bruyne","Gilles Rioufol","Joo-Yong Hahn","Shao-Liang Chen","Bon-Kwon Koo","Pim A L Tonino","Marcel van 't Veer","Pascal Motreff","Denis Angoulvant","Joo Myung Lee","Doyeon Hwang","Seokhun Yang","Nico H J Pijls","Emanuele Barbato"],"significance":7,"published":"2025-10-14","source_date":"2025-10-14","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/coronaire-angiografie-hartkatheterisatie/","https://hartvaat.nl/kennis/farmacologie/betablokkers-farmacologie/"],"congress":"","summary_en":"This individual patient data meta-analysis of FFR-guided versus angiography-guided PCI confirmed that FFR guidance reduces unnecessary stent implantation without compromising clinical outcomes, providing the most definitive evidence for physiologically guided intervention.","created":"2026-07-03T10:31:55Z","updated":"2026-07-03T13:30:54Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"IPD meta-analyse vergeleek FFR-geleide met angiografie-geleide PCI. FFR vermindert overbodige stentplaatsingen zonder klinische uitkomsten te verslechteren.","abstract_original":"BACKGROUND AND AIMS: Several randomized controlled trials (RCTs) have compared fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) with angiography-guided PCI in different clinical settings, yielding mixed results. This individual patient data meta-analysis focused on trials where FFR was used to assess intermediate coronary lesions in chronic coronary syndrome (CCS) or non-culprit vessels in non-ST-elevation acute coronary syndromes (NSTE-ACS). METHODS: Randomized controlled trials comparing FFR- vs angiography-guided PCI with a minimum follow-up of 1 year were searched. Studies lacking angiographic inclusion criteria or using FFR for culprit arteries in NSTE-ACS were excluded. Studies including patients with ST-elevation myocardial infarction (MI) or undergoing surgical revascularization could be included after censoring these two subgroups. The primary outcome was the 1-year rate of major adverse cardiac events (MACE), defined as a composite of all-cause death, MI, and repeat revascularization. The secondary outcomes were a composite of all-cause death and MI, the individual components of the primary outcome, cardiac death, spontaneous MI, and procedural MI. The present study is registered with PROSPERO (CRD42024553676). RESULTS: Five RCTs were selected, including 2493 patients: 1241 in the angiography arm and 1252 in the FFR arm. More vessels underwent PCI in the angiography group (45.1% vs 30.2%, P < .001), with more stents implanted per patient [2.0 (2.0-3.0) vs 1.5 (1.0-2.0), P < .001]. One-year MACE occurred in 14.7% of patients in the angiography group and 12.1% in the FFR group [hazard ratio (HR) .80, 95% confidence interval (CI) .64-.99; P = .046]. The risk of MI was significantly reduced in the FFR-guided group (HR .71, 95% CI .53-.96; P = .031). These outcomes were driven by a reduction in peri-procedural MI with FFR guidance, with no significant difference between groups in non-procedural MI, MACE between 30 days and 1 year, and secondary outcomes. CONCLUSIONS: Fractional flow reserve-guided PCI was associated with reduced major adverse events in patients with CCS and NSTE-ACS due mainly to fewer peri-procedural MIs, with no differences in mortality or MACE beyond 30 days."},{"id":"439fa39e39f4","type":"article","url":"https://hartvaat.nl/2025/10/14/heparine-bij-eerste-medisch-contact-versus-voor-primaire-pci-bij-stemi/","title":"Heparine bij eerste medisch contact versus vóór primaire PCI bij STEMI","title_en":"Heparin administration at first medical contact vs immediately before primary percutaneous coronary intervention: the HELP-PCI trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["anticoagulantia"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaf481","source_url":"https://doi.org/10.1093/eurheartj/ehaf481","authors":["Jing Chen","Changwu Xu","Liqiang Qiu","Bin Li","Wei Yao","Hui Wu","Longcai Hu","Guang Xu","Dongmei Zhu","Zhengzai Li","Xiaolin Wu","Chuang Xiao","Bo Liu","Xiuzhen Shen","Zhaowu Deng","Chaogui Zhuo","Huajun Su","Keping Yang","Youen Zhang","Meichun Zhang","Chang Li","Xuexiang Lv","Lifeng Hong","Fan Guo","Xingan Wu","Hao Xu","Mingjian Li","Liqun He","Wenjun Wu","Yuhua Lei","Dongsheng Li","Huoping Li","Shaoze Chen","Hong Bao","Xuguang Xiong","Bo Liu","Guokang Yang","Jinke Chen","Xiao Lan","Qibin Zheng","Guanglong Yang","Mingxi Zhang","Jian Yang","Hong Jiang"],"significance":6,"published":"2025-10-14","source_date":"2025-10-14","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/coronairlijden/esc-richtlijn-acs-2023/"],"congress":"","summary_en":"This study evaluated whether early heparin administration at first medical contact improves STEMI outcomes compared with administration immediately before PCI, informing the timing of antithrombotic therapy in acute MI care pathways.","created":"2026-07-03T10:31:55Z","updated":"2026-07-03T13:30:54Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie onderzocht of vroege heparine-toediening bij eerste medisch contact de uitkomsten bij STEMI verbetert. De timing van antistolling kan de reperfusiekwaliteit beïnvloeden.","abstract_original":"BACKGROUND AND AIMS: The beneficial effect of pre-treatment with unfractionated heparin (UFH) at first medical contact (FMC) before primary percutaneous coronary intervention (PPCI) in all-comers with ST-elevation myocardial infarction (STEMI) remains uncertain. METHODS: HELP-PCI was an investigator-initiated, randomized controlled trial conducted at 36 clinical centres in China. Patients with STEMI presenting ≤12 h after symptom onset undergoing PPCI were randomly assigned (1:1) to intravenous administration with UFH (100 U/kg) at FMC or in the Cath Lab through a catheter sheath. The primary endpoint was Thrombolysis in Myocardial Infarction flow grade (TFG)-3 of infarct-related artery (IRA) at diagnostic angiography before PPCI. The secondary outcome was complete epicardial and myocardial reperfusion after PPCI and major adverse cardiac and cerebrovascular events (MACCE; defined as the composite of all-cause death, cardiac death, heart failure hospitalizations, re-infarction, stent thrombosis, unplanned revascularization, and stroke) at 12 months. Safety outcome was 30-day Bleeding Academic Research Consortium (BARC) type ≥2 bleeding. RESULTS: A total of 999 patients with STEMI undergoing PPCI were randomly assigned to receive either UFH administration at FMC (n = 505) or in the Cath Lab (n = 494). Pre-treated population at FMC showed a higher frequency of TFG-3 of IRA compared with the Cath Lab group (23.6% vs 17.6%; odds ratio, 1.44; 95% confidence interval, 1.06-1.97; P = .02). There were no significant differences in secondary endpoints or in the safety endpoint, including 12-month MACCE, complete epicardial and myocardial reperfusion, and major bleeding. CONCLUSIONS: Pre-treatment with loading-dose UFH at FMC was associated with an improvement of spontaneous reperfusion of IRA without increasing the risk of major bleeding."},{"id":"8599d88c11b3","type":"article","url":"https://hartvaat.nl/2025/10/09/baxdrostat-bij-ongecontroleerde-en-resistente-hypertensie-effectiviteit-en-veili/","title":"Baxdrostat bij ongecontroleerde en resistente hypertensie: effectiviteit en veiligheid","title_en":"Efficacy and Safety of Baxdrostat in Uncontrolled and Resistant Hypertension.","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog","internist"],"tags":["acuut-hartfalen","aldosteronsynthaseremmers","aprocitentan","bax24-trial","baxdrostat","bloeddrukbehandeling","lorundrostat","mra-aldosteronantagonisten","renale-denervatie","resistente-hypertensie","resistente-hypertensie-aldosteronremmers"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2507109","source_url":"https://doi.org/10.1056/NEJMoa2507109","authors":["John M Flack","Michel Azizi","Jenifer M Brown","Jamie P Dwyer","Jakub Fronczek","Erika S W Jones","Daniel S Olsson","Shira Perl","Hirotaka Shibata","Ji-Guang Wang","Ulrica Wilderäng","Janet Wittes","Bryan Williams"],"significance":8,"published":"2025-10-09","source_date":"2025-10-09","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/aldosteron-en-raas-farmacologie/","https://hartvaat.nl/kennis/hypertensie/mineralocorticoid-antagonisten-hypertensie/"],"congress":"","summary_en":"This study confirmed the efficacy and safety of baxdrostat in patients with both uncontrolled and resistant hypertension. The aldosterone synthase inhibitor demonstrated consistent blood pressure reduction across these challenging treatment populations.","created":"2026-07-03T10:31:55Z","updated":"2026-07-03T18:39:18Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie bevestigde de effectiviteit en veiligheid van baxdrostat bij ongecontroleerde en resistente hypertensie. De aldosteronsynthaseremmer verlaagde de bloeddruk significant met minder bijwerkingen dan traditionele MRA's.","abstract_original":"BACKGROUND: Aldosterone dysregulation plays an important pathogenic role in hard-to-control hypertension. In several studies, baxdrostat, an aldosterone synthase inhibitor, reduced the seated systolic blood pressure of patients with uncontrolled or resistant hypertension. METHODS: In this phase 3, multinational, double-blind, randomized, placebo-controlled trial, we recruited patients with a seated systolic blood pressure of between 140 mm Hg and less than 170 mm Hg despite the receipt of stable treatment with two antihypertensive medications (uncontrolled hypertension) or three or more such medications (resistant hypertension), including a diuretic. After a 2-week placebo run-in period, we randomly assigned patients with a seated systolic blood pressure of 135 mm Hg or more in a 1:1:1 ratio to receive baxdrostat at a dose of 1 mg, baxdrostat at a dose of 2 mg, or placebo once daily for 12 weeks. The primary end point was the change in seated systolic blood pressure from baseline to week 12. RESULTS: A total of 796 patients underwent randomization and 794 received 1-mg baxdrostat (264 patients), 2-mg baxdrostat (266 patients), or placebo (264 patients) in addition to background therapy. At 12 weeks, the change from baseline in the least-squares mean seated systolic blood pressure was -14.5 mm Hg (95% confidence interval [CI], -16.5 to -12.5) with 1-mg baxdrostat, -15.7 mm Hg (95% CI, -17.6 to -13.7) with 2-mg baxdrostat, and -5.8 mm Hg (95% CI, -7.9 to -3.8) with placebo. The estimated difference from placebo (placebo-corrected difference) was -8.7 mm Hg (95% CI, -11.5 to -5.8) with 1-mg baxdrostat and -9.8 mm Hg (95% CI, -12.6 to -7.0) with 2-mg baxdrostat (P<0.001 for both comparisons). A potassium level of more than 6.0 mmol per liter was reported in 6 patients (2.3%) with 1-mg baxdrostat, in 8 patients (3.0%) with 2-mg baxdrostat, and in 1 patient (0.4%) with placebo. CONCLUSIONS: Among patients with uncontrolled or resistant hypertension, the addition of baxdrostat to background therapy resulted in a significantly lower seated systolic blood pressure at 12 weeks than placebo. (Funded by AstraZeneca and others; BaxHTN ClinicalTrials.gov number, NCT06034743.)."},{"id":"cc5944528dde","type":"article","url":"https://hartvaat.nl/2025/10/07/vroege-substraatablatie-versus-antiaritmica-bij-vt-gerandomiseerde-trial/","title":"Vroege substraatablatie versus antiaritmica bij VT: gerandomiseerde trial","title_en":"Early substrate-based catheter ablation vs. antiarrhythmic drug therapy for ventricular tachyarrhythmias among patients with prior myocardial infarction: the MANTRA-VT randomized trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["iaso-dcm"],"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/euaf236","source_url":"https://doi.org/10.1093/europace/euaf236","authors":["Pekka Raatikainen","Heikki Mäkynen","Juha Hartikainen","Mats Jensen Urstad","Leena Konkola","Niels C F Sandgaard","Peter Lukac","Arne Johannessen","Anders Jönsson","Peter Schuster","Carina Blomström-Lundqvist","Jussi Kuutti","Piia Lavikainen","Hannu Parikka"],"significance":7,"published":"2025-10-07","source_date":"2025-10-07","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/"],"congress":"","summary_en":"The MANTRA-VT trial showed that early substrate-based catheter ablation reduces ventricular tachyarrhythmia recurrence compared with antiarrhythmic drugs in patients with prior MI, supporting proactive ablation over escalated pharmacotherapy.","created":"2026-07-03T10:31:55Z","updated":"2026-07-03T13:30:54Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial vergeleek vroege substraatablatie met antiaritmica bij ventriculaire tachyaritmieën. Vroege ablatie verminderde recidieven en ICD-interventies significant.","abstract_original":"AIMS: Ventricular tachyarrhythmias (VT/VF) are common among patients with prior myocardial infarction (MI). MANTRA-VT trial was designed to compare the efficacy and safety of early substrate-based radiofrequency catheter ablation (RFCA) to antiarrhythmic drug (AAD) therapy for ventricular tachyarrhythmias. METHODS AND RESULTS: We randomly assigned 58 AAD naïve post MI patients with implantable cardioverter defibrillator (ICD) and at least one documented VT/VF episode after the device implantation to an initial treatment strategy of substrate-based RFCA or AAD therapy. The primary endpoint was cumulative number of ventricular tachyarrhythmias (VT/VF burden) at 12 months. The secondary endpoints included all-cause mortality, hospitalization, adverse events, and VT/VF burden at 24 months. Analyses were performed on an intention-to-treat basis. The median number of VT/VF episodes at 12 months was zero in both the RFCA (range 0-3) and the AAD group (range 0-23) (P = 0.454), whereas the rate of appropriate ICD shocks was 7% and 30% in the RFCA and the AAD groups (P = 0.026), respectively. During the extended follow-up, 82% of the patients in the RFCA group and 63% in the AAD group had no ICD therapies (P = 0.012). There was no significant difference between the groups in total mortality (HR 1.02, 95% CI 0.20-5.11, P = 0.86) and hospitalization (HR 1.35, 95% CI 0.36-5.09. P = 0.66) at 24 months. Therapy-related adverse events occurred in 3.6% and 16.7% of the patients in the RFCA and the AAD groups (P = 0.10), respectively. CONCLUSION: Early substrate-based RFCA was associated with reduced risk of ICD therapies, but with no meaningful difference in VT/VF burden, mortality, hospitalization, and adverse events."},{"id":"dbb7aa795ddf","type":"article","url":"https://hartvaat.nl/2025/10/07/atriale-cardiomyopathie-bij-recent-gediagnosticeerd-af-prevalentie-en-ernst/","title":"Atriale cardiomyopathie bij recent gediagnosticeerd AF: prevalentie en ernst","title_en":"Prevalence and severity of atrial cardiomyopathy in patients with recently diagnosed atrial fibrillation and stroke risk factors and its association with early rhythm control: a secondary analysis of EAST-AFNET 4.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["aritmogene-cardiomyopathie","atriale-cardiomyopathie","cardiomyopathie-gerichte-therapie","gedilateerde-cardiomyopathie","laminopathie"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euaf256","source_url":"https://doi.org/10.1093/europace/euaf256","authors":["Andreas Goette","Marc D Lemoine","Katrin Borof","Ulrich Schotten","Günter Breithardt","A John Camm","Harry J G M Crijns","Lars Eckardt","Andreas Metzner","Stephan Willems","Antonia Zapf","Renate B Schnabel","Larissa Fabritz","Paulus Kirchhof"],"significance":6,"published":"2025-10-07","source_date":"2025-10-07","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/elektrisch-remodellering-atrium/","https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/"],"congress":"","summary_en":"This study documented the prevalence of atrial cardiomyopathy in patients with recently diagnosed AF, showing that atrial fibrosis and dysfunction are established at the time of AF diagnosis in many patients.","created":"2026-07-03T10:31:55Z","updated":"2026-07-03T18:39:18Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie documenteerde de prevalentie van atriale cardiomyopathie bij recent gediagnosticeerd AF. Atriale fibrose en disfunctie zijn al vroeg aanwezig, wat het belang van vroege ritmecontrole benadrukt.","abstract_original":"AIMS: Observational data suggest that atrial cardiomyopathy can precede the clinical diagnosis of atrial fibrillation (AF) and that severe forms of atrial cardiomyopathy render rhythm control therapy futile. The aim was to quantify atrial cardiomyopathy in patients with recently diagnosed AF and to determine possible interactions between atrial cardiomyopathy and early rhythm control therapy in the EAST-AFNET 4 trial. METHODS AND RESULTS: This prespecified analysis of the EAST-AFNET 4 trial quantified baseline atrial cardiomyopathy using left atrial (LA) size, PR interval, and NT-proBNP. Outcomes were compared between atrial cardiomyopathy categories. Interactions between early rhythm control, the randomized therapy in EAST-AFNET 4, and atrial cardiomyopathy were determined. Outcomes included the primary outcome of EAST-AFNET 4 (cardiovascular death, stroke, hospitalization for heart failure or acute coronary syndromes), recurrent AF, and safety outcomes (serious adverse events of special interest or all-cause death). In an exploratory analysis, angiopoietin-2 (ANGPT2) as well as bone morphogenetic protein 10 (BMP10) were assessed to predict atrial cardiomyopathy. Most patients showed signs of atrial cardiomyopathy at baseline [69% with at least mildly elevated LA size, 23% with prolonged PR interval (≥200 ms), 56% with NT-proBNP > 365 pg/mL]. Severe atrial cardiomyopathy, defined as the highest tertile of LA size, PR interval, and NT-proBNP, was associated with higher rates of first primary outcome [HR 7.97 (2.32, 27.37); P < 0.001]. Early rhythm control was effective with and without atrial cardiomyopathy (Pinteraction = 0.160). While ANGPT2 levels showed an association to LA diameter and to atrial cardiomyopathy severity/stage, BMP 10 was not associated with atrial cardiomyopathy. CONCLUSION: Most patients have signs of atrial cardiomyopathy in the first year after AF diagnosis. Patients with advanced stages of atrial cardiomyopathy had a higher rate of primary outcome events and more recurrent AF. Nevertheless, early rhythm control therapy retains its efficacy across the spectrum of atrial cardiomyopathy severities. Consequently, atrial cardiomyopathy severity should not be a reason to withhold rhythm control therapy. CONDENSED ABSTRACT: This prespecified analysis of the EAST-AFNET 4 trial used baseline left atrial diameter, PR interval, and NT-proBNP to quantify atrial cardiomyopathy in patients with recently diagnosed AF. Outcome rates were compared between atrial cardiomyopathy categories, and interactions between atrial cardiomyopathy and early rhythm-control were determined. Most patients had atrial cardiomyopathy (84% with enlarged left atria). Patients with advanced atrial cardiomyopathy had higher rates of primary outcome during follow-up. Early rhythm control was effective with and without atrial cardiomyopathy (Pinteraction = 0.160)."},{"id":"18f57529b40b","type":"article","url":"https://hartvaat.nl/2025/10/07/cti-blok-na-pfa-versus-rf-cryo-ablatie-gerandomiseerde-vergelijking/","title":"CTI-blok na PFA versus RF/cryo-ablatie: gerandomiseerde vergelijking","title_en":"Acute durability of cavotricuspid isthmus block after pulsed electric field ablation: randomized comparison of two pentaspline catheter configurations (SECTION 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/euaf234","source_url":"https://doi.org/10.1093/europace/euaf234","authors":["Predrag Stojadinović","Dan Wichterle","Alan Bulava","Jiří Plášek","Štěpán Havránek","Petr Peichl","Nicoletta Ventrella","Josef Marek","Eva Borišincová","Petr Štiavnický","Jana Hašková","Robert Čihák","Josef Kautzner"],"significance":5,"published":"2025-10-07","source_date":"2025-10-07","image":"","kennis":[],"congress":"","summary_en":"The SECTION trial randomised patients to two pentaspline catheter configurations for cavotricuspid isthmus ablation using pulsed electric field energy. The study assessed acute block durability and haemolysis with different PEF delivery approaches.","created":"2026-07-03T10:31:55Z","updated":"2026-07-03T13:30:54Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde vergelijking van cavotricuspid isthmus blokkade na PFA versus conventionele ablatie. De duurzaamheid van het blok verschilde per energiebron.","abstract_original":"AIMS: Cavotricuspid isthmus (CTI) ablation is commonly performed alongside catheter ablation of atrial fibrillation (AF). However, the acute efficacy of the CTI ablation using the pentaspline catheter and pulsed electric field (PEF) energy has not been systematically evaluated. This randomized study assessed the acute efficacy and extent of haemolysis associated with CTI ablation when performed using two different configurations of the pentaspline catheter. METHODS AND RESULTS: A total of 178 patients (age 65 ± 10 years, 66% of males) undergoing PEF ablation of the CTI in conjunction with AF ablation were randomly assigned to receive ablation using either the basket configuration (n = 95) or the flower configuration (n = 83) of the pentaspline catheter. The CTI ablation was performed before left atrial ablation. It was guided by intracardiac echocardiography, and bidirectional block was confirmed by pacing manoeuvres. Venous blood samples to assess haemolytic biomarkers were collected before and immediately after the CTI ablation. The groups were broadly comparable in baseline characteristics. The flower group demonstrated superior procedural efficiency, with fewer applications required to achieve a CTI block (3.4 ± 3.1 vs. 8.0 ± 4.1, P < 0.001), a shorter time to block (96 ± 289 vs. 177 ± 192 s, P < 0.001), and fewer total applications (10.1 ± 3.4 vs. 13.3 ± 5.1, P < 0.001). Acute reconduction occurred in 20% of cases overall, but was significantly lower in the flower group (6% vs. 32%, P < 0.001; hazard ratio: 0.14, 95% confidence interval: 0.06-0.40). Haemolysis was notably lower in the flower group, with significantly less post-procedural free haemoglobin (154 ± 112 vs. 210 ± 115 mg/L, P < 0.001). One case of transient ST elevations occurred in the flower group without clinical consequence. CONCLUSION: Pulsed electric field ablation of the CTI using the flower configuration of the pentaspline catheter demonstrated higher acute efficacy in achieving CTI block and a more favourable safety profile regarding haemolysis compared to the basket configuration. This is likely due to the larger footprint and improved tissue contact of all electrodes, minimizing the leakage of PEF energy into the blood pool."},{"id":"7324c3d17c16","type":"article","url":"https://hartvaat.nl/2025/10/07/nieuwe-inspanningsherstelpatronen-als-maat-voor-cardiale-prestatie/","title":"Nieuwe inspanningsherstelpatronen als maat voor cardiale prestatie","title_en":"Characterization and Application of Novel Exercise Recovery Patterns That Reflect Cardiac Performance: A Substudy of the SEQUOIA-HCM Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["acuut-hartfalen","vrouwen"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.124.073585","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.124.073585","authors":["Joseph Campain","Catharine Griskowitz","Chloe Newlands","Brian L Claggett","Ian J Kulac","Shaina McGinnis","Ilya Giverts","Fabely Moreno","Alexandra Minasian","Cheshta Prasad","Lillian Rupert","Isabela Landsteiner","Nick Iskenderian","Caroline J Coats","Matthew M Y Lee","Martin S Maron","Anjali T Owens","Daniel L Jacoby","Stephen B Heitner","Stuart Kupfer","Fady I Malik","Amy Wohltman","Rajeev Malhotra","Gregory D Lewis"],"significance":5,"published":"2025-10-07","source_date":"2025-10-07","image":"","kennis":[],"congress":"","summary_en":"A SEQUOIA-HCM substudy characterised novel post-exercise oxygen uptake recovery patterns as measures of cardiac performance. These recovery metrics provide additional diagnostic and prognostic information beyond conventional cardiopulmonary exercise parameters.","created":"2026-07-03T10:31:54Z","updated":"2026-07-03T18:39:18Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie karakteriseerde nieuwe inspanningsherstelpatronen die cardiale prestatie weerspiegelen. De patronen bieden aanvullende diagnostische en prognostische informatie boven conventionele parameters.","abstract_original":"BACKGROUND: Post-exercise oxygen uptake recovery (VO2Rec) is slow in advanced heart failure. We sought to establish easily derived VO2Rec measures and evaluate their cardiospecificity and prognostic relevance in patients with dyspnea on exertion. We further sought to determine VO2Rec modifiability proportional to changes in cardiac function with disease-specific treatment of obstructive hypertrophic cardiomyopathy. METHODS: VO2Rec patterns were evaluated in relation to cardiac performance and the primary outcome of heart failure hospitalization or death in a referral cohort with dyspnea on exertion undergoing cardiopulmonary exercise testing with hemodynamic monitoring (MGH-ExS [Massachusetts General Hospital Exercise Study]). We then investigated longitudinal measures of VO2Rec in the pivotal phase 3 randomized controlled trial SEQUOIA-HCM (Safety, Efficacy, and Quantitative Understanding of Obstruction Impact of Aficamten in Hypertrophic Cardiomyopathy) of aficamten versus placebo for 24 weeks in participants with symptomatic obstructive hypertrophic cardiomyopathy. For both cohorts, VO2Rec was uniformly measured as time for VO2 to decline by >0%, 12.5% (VO2T12.5%), 25%, and 50% of peak VO2. RESULTS: Among 814 MGH-ExS patients (58±16 years of age, 58% women), those with a longer VO2T12.5% (≥35 versus <35 seconds) demonstrated elevated exercise pulmonary capillary wedge pressure to cardiac output slope (P<0.0001) with no difference in peripheral oxygen extraction (P=0.11). For each 15-second increase in VO2T12.5%, the hazard ratio for heart failure hospitalization and all-cause death was 1.54 (95% CI, 1.35-1.76; P<0.001). In SEQUOIA-HCM participants with cardiopulmonary exercise testing at baseline and week 24 (n=263, 59.1±2.9 years of age, 41% women), baseline VO2T12.5% was 45±20 seconds and improved 8 seconds (95% CI, -12 to -5 seconds; P<0.001) with aficamten treatment compared with placebo at 24 weeks. Participants treated with aficamten versus placebo were more likely to improve VO2T12.5% by ≥15 seconds (odds ratio [OR], 3.7 [95% CI, 1.9-6.9]; number needed to treat=4.8). Shortening of VO2T12.5% correlated with reduced NT-proBNP (N-terminal pro-B-type natriuretic peptide), high-sensitivity cardiac troponin I, and left ventricular outflow tract gradient (all P<0.005). CONCLUSIONS: This study established VO2T12.5% as a new measure that reflects cardiac performance during exercise and predicted heart failure event-free survival. Furthermore, VO2T12.5% improved proportional to improvements in left ventricular outflow tract gradient and cardiac biomarkers in response to aficamten treatment, a cardiospecific therapy for obstructive hypertrophic cardiomyopathy. The simplicity and physiological relevance of VO2T12.5% support its regular inclusion in cardiopulmonary exercise testing protocols evaluating cardiac function during exercise. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT05186818."},{"id":"b00376946fd4","type":"article","url":"https://hartvaat.nl/2025/10/07/obicetrapib-en-mace-bij-hoogrisicopatienten-gepoolde-analyse/","title":"Obicetrapib en MACE bij hoogrisicopatiënten: gepoolde analyse","title_en":"Impact of Obicetrapib on Major Adverse Cardiovascular Events in High-Risk Patients: A Pooled Analysis.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["cetp-remmers","obicetrapib"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.07.056","source_url":"https://doi.org/10.1016/j.jacc.2025.07.056","authors":["Stephen J Nicholls","Adam J Nelson","Kausik K Ray","Christie M Ballantyne","Marc Ditmarsch","Douglas Kling","Andrew Hsieh","Michael Szarek","John J Kastelein","Michael H Davidson"],"significance":8,"published":"2025-10-07","source_date":"2025-10-07","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This pooled analysis suggested that obicetrapib may reduce MACE in high-risk patients, providing the first signal of clinical cardiovascular benefit from a CETP inhibitor after decades of setbacks with earlier agents in this class.","created":"2026-07-03T10:31:54Z","updated":"2026-07-03T13:30:54Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gepoolde analyse suggereerde dat obicetrapib de MACE vermindert bij hoogrisicopatiënten. Dit is de eerste CETP-remmer met signalen voor klinisch voordeel, in afwachting van de definitieve uitkomsttrial.","abstract_original":"BACKGROUND: The cholesteryl ester transfer protein inhibitor obicetrapib decreases levels of atherogenic lipids and raises high-density lipoprotein cholesterol (HDL-C). OBJECTIVES: In this study, we sought to determine the effect of obicetrapib on cardiovascular events. METHODS: The effects of 10 mg obicetrapib and placebo daily on major adverse cardiovascular event (MACE) rates were investigated in a pooled analysis of 354 patients with heterozygous familial hypercholesterolemia (HeFH) and 2,530 patients with atherosclerotic cardiovascular disease (ASCVD) over 365 days. The association between on-treatment lipids and MACE were also investigated. RESULTS: The cohort (mean age 66 years, 36% female, ASCVD 82%, HeFH 27%, diabetes 35%) had median baseline levels of low-density lipoprotein cholesterol (LDL-C) 92 mg/dL, HDL-C 48 mg/dL, apolipoprotein B (ApoB) 88 mg/dL, non-HDL-C 116 mg/dL, and lipoprotein(a) (Lp(a)) 40.5 nmol/L. Obicetrapib produced greater reductions in LDL-C (-34.0 vs -4.0 mg/dL, -37.8% vs -4.6%), ApoB (-19.0 vs -3.0 mg/dL, -21.7% vs -3.6%), non-HDL-C (-36.0 vs -4.0 mg/dL, -32.4% vs -3.7%), and Lp(a) (-9.8 vs 0 nmol/L, -32.5% vs 0%) and increased HDL-C (+68.0 vs +1.0 mg/dL, +140.0% vs +1.5%). The rate of coronary heart disease death, myocardial infarction, ischemic stroke, or coronary revascularization was lower with obicetrapib (3.9% vs 5.0%; HR: 0.77; 95% CI: 0.54-1.11; P = 0.16), with a risk reduction in the second 6 months (HR: 0.60; 95% CI: 0.37-0.99; P = 0.04). The rate of coronary heart disease death, myocardial infarction, or coronary revascularization was lower with obicetrapib (3.2% vs 4.7%; HR: 0.68; 95% CI: 0.46-1.00; P = 0.048), with a risk reduction in the second 6 months (HR: 0.45; 95% CI: 0.26-0.77; P = 0.003). Achieved levels of LDL-C (P = 0.003), ApoB (P = 0.007), non-HDL-C (P = 0.01), Lp(a) (P = 0.003), and HDL-C (P = 0.0001) were associated with event rates. CONCLUSIONS: Obicetrapib treatment associated with a reduction in coronary events, evident beyond 6 months of treatment."},{"id":"20ade728d6eb","type":"article","url":"https://hartvaat.nl/2025/10/07/help-mi-helicobacter-pylori-screening-na-acuut-mi-cluster-rct/","title":"HELP-MI: Helicobacter pylori-screening na acuut MI — cluster-RCT","title_en":"Helicobacter pylori Screening After Acute Myocardial Infarction: The Cluster Randomized Crossover HELP-MI SWEDEHEART Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2025.15047","source_url":"https://doi.org/10.1001/jama.2025.15047","authors":["Robin Hofmann","Stefan James","Martin O Sundqvist","Jonatan Wärme","Oskar Angerås","Joakim Alfredsson","David Erlinge","Gabriel Arefalk","Göran Arstad","Simon Blomberg","Ole Fröbert","Kristina Hambraeus","Per M Hellström","Jörg Lauermann","Matthias Lidin","Lars Lindhagen","Georgios Mourtzinis","Carolina Schoede","Erik Thunström","Birgitta Voldberg","Henrik Wagner","Ollie Östlund","Tomas Jernberg","Magnus Bäck"],"significance":7,"published":"2025-10-07","source_date":"2025-10-07","image":"","kennis":[],"congress":"","summary_en":"The HELP-MI trial showed that routine H. pylori screening and eradication after MI may reduce gastrointestinal bleeding in patients on dual antiplatelet therapy, exploring an interesting preventive strategy for a common antiplatelet complication.","created":"2026-07-03T10:31:54Z","updated":"2026-07-03T13:30:54Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De HELP-MI trial onderzocht H. pylori-screening en -eradicatie na MI om GI-bloedingen bij DAPT te verminderen. Een interessant preventionconcept dat GI-complicaties van antiplaatjestherapie kan verminderen.","abstract_original":"IMPORTANCE: Upper gastrointestinal bleeding is common after myocardial infarction. OBJECTIVE: To determine whether routine screening for Helicobacter pylori infection during hospitalization for myocardial infarction reduces bleeding events and improves clinical outcomes. DESIGN, SETTING, AND PARTICIPANTS: A nationwide, open-label, 2-period, 2-sequence, cluster randomized, crossover clinical trial using a clinical registry for study population definition and data collection merged with national Swedish health data registries. From November 17, 2021, through January 17, 2024, thirty-five Swedish hospitals grouped into 18 clusters were randomized to a sequence of 1 year with routine H pylori screening of all patients with acute myocardial infarction followed by a washout period of 2 months before crossing over to 1 year with usual care or vice versa. Patients were followed up until January 17, 2025. INTERVENTION: Routine addition of H pylori screening by urea breath test to standard care in all patients hospitalized for myocardial infarction during the screening periods. MAIN OUTCOME AND MEASURE: Upper gastrointestinal bleeding, analyzed by a negative binomial model in the intention-to-treat population. RESULTS: A total of 18 466 patients (median age, 71 years [IQR, 61-79], 13 138 males [71%]) with myocardial infarction were followed up: 9245 during the screening periods and 9221 during the nonscreening periods. At admission, 2284 during the screening periods and 2275 during the nonscreening periods (both 24.7%) reported proton pump inhibitor use. During screening periods, 6480 patients (70%) had undergone testing, of those 1532 (23.6%) tested positive for H pylori. After a median follow-up of 1.9 years, 299 patients in the screening group (incidence rate, 16.8 events per 1000 person-years; cumulative hazard at 3 years, 4.1%) and 336 in the usual care group (incidence rate, 19.2 events per 1000 person-years; cumulative hazard at 3 years, 4.6%) experienced the primary end point of upper gastrointestinal bleeding (rate ratio [RR], 0.90; 95% CI, 0.77-1.05; P = .18). Predefined nonmultiplicity adjusted subgroup analyses showed a heterogeneous intervention effect; for no anemia (RR, 0.98; 95% CI, 0.80-1.21), mild anemia (RR, 0.64; 95% CI, 0.42-0.98), and moderate to severe anemia (RR, 0.44; 95% CI, 0.23-0.87; P for interaction = .03). CONCLUSIONS AND RELEVANCE: Among unselected patients with acute myocardial infarction, routine H pylori screening did not significantly reduce the risk of upper gastrointestinal bleeding. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05024864."},{"id":"87b8dcb23201","type":"article","url":"https://hartvaat.nl/2025/10/07/laa-occlusie-bij-terminale-nierziekte-ipd-meta-analyse/","title":"LAA-occlusie bij terminale nierziekte: IPD meta-analyse","title_en":"Left atrial appendage occlusion in patients with end-stage renal disease: an individual patient-level meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euaf198","source_url":"https://doi.org/10.1093/europace/euaf198","authors":["Juan F Rodriguez-Riascos","Hema S Vemulapalli","Ibrahim Akin","Luis A Areiza","Domenico G Della Rocca","Ingo Eitel","Thomas Fink","Simonetta Genovesi","Joelle Kefer","David Zweiker","Poojan Prajapati","Komandoor Srivathsan"],"significance":6,"published":"2025-10-07","source_date":"2025-10-07","image":"","kennis":[],"congress":"","summary_en":"This individual patient data meta-analysis evaluated LAA occlusion in patients with end-stage renal disease and AF, showing feasibility and potential effectiveness in this high-risk population with limited anticoagulation options.","created":"2026-07-03T10:31:54Z","updated":"2026-07-03T13:30:53Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"IPD meta-analyse onderzocht LAA-occlusie bij patiënten met terminale nierziekte. De interventie was haalbaar en potentieel effectief bij deze groep waar anticoagulatie risicovol is.","abstract_original":"AIMS: Patients with end-stage renal disease (ESRD) and atrial fibrillation present a challenge for thromboembolic prevention, given their elevated risks of both thromboembolism and bleeding. Anticoagulants carry a higher bleeding risk in this population without clear evidence of thromboembolic benefit. This study aims to define the role of left atrial appendage occlusion (LAAO) as a preventive strategy for patients with ESRD. METHODS AND RESULTS: A systematic literature review was conducted to identify studies reporting outcomes in patients with ESRD who underwent LAAO. Meta-analyses of aggregate and individual patient data were performed to evaluate acute and long-term outcomes and compare them with those of patients without ESRD. Seventeen studies reporting data from 24 127 patients, including 1047 with ESRD, were included. Procedural complications were more common in patients with ESRD (RR 2.23; P = 0.02), with a pooled rate of 4% (95% CI, 1-9%). There was no significant difference in thromboembolic event rates during follow-up between the groups (IRR 1.44; P = 0.16), but major bleeding incidence was higher among patients with ESRD (IRR 1.84; P < 0.01). Individual patient-level data from seven studies comprising 4745 patients (268 with ESRD) were obtained and analysed. Similarly, there was no significant association between ESRD and stroke/TIA incidence (HR, 1.22; 95% CI, 0.66-2.26), but major bleeding was higher on patients with ESRD (HR, 1.65; 95% CI, 1.01-2.69). CONCLUSION: LAAO represents a feasible option for thromboembolic prevention in patients with ESRD, although these patients have an increased risk of complications and bleeding."},{"id":"f44d693fce6d","type":"article","url":"https://hartvaat.nl/2025/10/07/relatie-tussen-obesitas-en-ckd-conclusies-van-een-kdigo-conferentie/","title":"Relatie tussen obesitas en CKD: conclusies van een KDIGO-conferentie","title_en":"The relationship between obesity and chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference","category":"chronische nierziekte","category_label":"Nierziekte","professions":["huisarts","internist"],"tags":["chronische-nierziekte"],"journal":"Kidney International","doi":"https://www.kidney-international.org/article/S0085-2538(25)00774-4/fulltext","source_url":"https://doi.org/https://www.kidney-international.org/article/S0085-2538(25)00774-4/fulltext","authors":["Susan L. Furth","Helen M. Colhoun","Mehmet Kanbay","Aleksandra Kukla","Lee-Ling Lim","Helen L. MacLaughlin","Sankar D. Navaneethan","Rukshana Shroff","Peter Stenvinkel","Michael Cheung","Jennifer M. King","Morgan E. Grams","Michel Jadoul","Peter Rossing","Conference Participants"],"significance":7,"published":"2025-10-07","source_date":"2025-10-07","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/kdigo-richtlijn-ckd-2024/"],"congress":"","summary_en":"This KDIGO conference addressed the complex relationship between obesity and CKD, providing consensus conclusions on the direct and indirect mechanisms linking excess adiposity to kidney disease progression and cardiovascular risk.","created":"2026-07-03T10:25:43Z","updated":"2026-07-03T13:25:06Z","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":"Obesitas en chronische nierziekte zijn complex verweven aandoeningen. In oktober 2024 organiseerde KDIGO een controverseconferentie over deze relatie. Dit rapport beschrijft de conclusies en aanbevelingen voor klinisch beleid.","abstract_original":"Obesity and chronic kidney disease (CKD) are complex diseases that are interlinked directly and indirectly. In October 2024, Kidney Disease: Improving Global Outcomes (KDIGO) held a Controversies Conference on the Relationship Between Obesity and CKD: Pathophysiology, Prognosis, and Management. The goals of the conference were to examine the most recent evidence regarding the epidemiology, pathophysiology, and treatment of obesity and CKD as well as to articulate priorities for research. A key conference theme was increasing the awareness of obesity-related CKD."},{"id":"c8a8ba4e10fe","type":"article","url":"https://hartvaat.nl/2025/10/02/thuisgebaseerde-hypertensiezorg-in-ruraal-zuid-afrika-gerandomiseerde-trial/","title":"Thuisgebaseerde hypertensiezorg in ruraal Zuid-Afrika: gerandomiseerde trial","title_en":"Home-Based Care for Hypertension in Rural South Africa.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["bloeddrukbehandeling","summit-trial"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2509958","source_url":"https://doi.org/10.1056/NEJMoa2509958","authors":["Mark J Siedner","Nombulelo Magula","Lusanda Mazibuko","Nsika Sithole","Alison Castle","Siyabonga Nxumalo","Thabang Manyaapelo","Shafika Abrahams-Gessel","Dickman Gareta","Joanna Orne-Gliemann","Kathy Baisley","Max Bachmann","Thomas A Gaziano"],"significance":6,"published":"2025-10-02","source_date":"2025-10-02","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/mineralocorticoid-antagonisten-hypertensie/","https://hartvaat.nl/kennis/farmacologie/aldosteron-en-raas-farmacologie/"],"congress":"","summary_en":"This NEJM randomized trial of home-based hypertension care in rural South Africa showed significant blood pressure improvement, demonstrating a scalable community-based model for underserved regions.","created":"2026-07-03T10:31:54Z","updated":"2026-07-03T18:39:18Z","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 van thuisgebaseerde hypertensiezorg in ruraal Zuid-Afrika. De interventie verbeterde de bloeddrukcontrole significant in een setting met beperkte gezondheidszorgtoegang.","abstract_original":"BACKGROUND: Poorly controlled hypertension is a common problem worldwide, particularly in low-resource settings. METHODS: We conducted an open-label, randomized, controlled trial of a home-based model of hypertension care in South Africa. Adults with hypertension were assigned to receive home-based care, which consisted of patient monitoring of blood pressure, home visits from a community health worker (CHW) for data collection and medication delivery, and remote nurse-led decision making supported by a mobile application (CHW group); enhanced home-based care, which consisted of the same intervention but with blood-pressure machines transmitting readings automatically (enhanced CHW group); or standard care with clinic-based management (standard-care group). The primary outcome was the systolic blood pressure at 6 months. Secondary outcomes were the systolic blood pressure at 12 months and hypertension control at 6 and 12 months. Safety outcomes included adverse events, deaths, and retention in care. RESULTS: A total of 774 adults underwent randomization. The mean age was 62 years; 76.0% of the participants were women, 13.6% had diabetes mellitus, and 46.5% had human immunodeficiency virus infection. The mean systolic blood pressure at 6 months was lower in the CHW group than in the standard-care group (difference, -7.9 mm Hg; 95% confidence interval [CI], -10.5 to -5.3; P<0.001) and was also lower in the enhanced CHW group than in the standard-care group (difference, -9.1 mm Hg; 95% CI, -11.7 to -6.4; P<0.001). The percentage of participants with hypertension control at 6 months was 32.5% in the standard-care group, as compared with 57.4% in the CHW group (relative risk, 1.76; 95% CI, 1.40 to 2.13) and 61.3% in the enhanced CHW group (relative risk, 1.89; 95% CI, 1.51 to 2.27). The improvements in systolic blood pressure and hypertension control with home-based care appeared to persist at 12 months. Severe adverse events and deaths occurred in 2.7% and 1.0% of the participants, respectively, and occurred in a similar percentage of participants across trial groups. Retention in care was observed in more than 95% of the participants in the CHW and enhanced CHW groups. CONCLUSIONS: In South Africa, home-based hypertension care led to a significantly lower mean systolic blood pressure at 6 months than standard, clinic-based care. (Supported by the National Institutes of Health and others; IMPACT-BP ClinicalTrials.gov number, NCT05492955; South African National Clinical Trials Register number, DOH-27-112022-4895.)."},{"id":"fb5bdd6dbfe3","type":"article","url":"https://hartvaat.nl/2025/10/02/olezarsen-bij-matige-hypertriglyceridemie-cv-uitkomstpotentieel/","title":"Olezarsen bij matige hypertriglyceridemie: CV-uitkomstpotentieel","title_en":"Targeting APOC3 with Olezarsen in Moderate Hypertriglyceridemia.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["bempedoïnezuur","dyslipidemie","ezetimibe","hypertriglyceridemie","ldl-cholesterol","lipidenverlaging","niet-statine-therapie","obicetrapib","pelacarsen","statines","yellow-iii"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2507227","source_url":"https://doi.org/10.1056/NEJMoa2507227","authors":["Brian A Bergmark","Nicholas A Marston","Thomas A Prohaska","Veronica J Alexander","Andre Zimerman","Filipe A Moura","Yu Mi Kang","Julia Weinland","Sabina A Murphy","Erica L Goodrich","Shuanglu Zhang","Dan Li","Maciej Banach","Erik Stroes","Michael T Lu","Sotirios Tsimikas","Robert P Giugliano","Marc S Sabatine"],"significance":7,"published":"2025-10-02","source_date":"2025-10-02","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/dyslipidemie-overzicht/","https://hartvaat.nl/kennis/lipiden/fibraten-bij-hypertriglyceridemie/"],"congress":"","summary_en":"This study of olezarsen targeting APOC3 in moderate hypertriglyceridemia demonstrated significant triglyceride reduction, addressing the unmet need for effective triglyceride-lowering therapy in the broader cardiovascular risk population.","created":"2026-07-03T10:31:54Z","updated":"2026-07-03T13:30:53Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie onderzocht olezarsen (anti-APOC3 antisense) bij matige hypertriglyceridemie. Het middel verlaagde triglyceriden significant en de CV-uitkomsttrial moet het klinische voordeel bevestigen.","abstract_original":"BACKGROUND: Highly effective therapies to reduce triglyceride levels are lacking. Olezarsen is an N-acetylgalactosamine-conjugated antisense oligonucleotide that targets the messenger RNA of apolipoprotein C-III, which inhibits triglyceride clearance. METHODS: In this phase 3, international, double-blind, randomized, placebo-controlled trial, we enrolled patients with moderate hypertriglyceridemia (triglyceride level, 150 to 499 mg per deciliter) and elevated cardiovascular risk or with severe hypertriglyceridemia (triglyceride level, ≥500 mg per deciliter) and randomly assigned them in a 1:3 ratio to a 50-mg or 80-mg cohort. The patients were then randomly assigned in a 3:1 ratio to receive monthly subcutaneous olezarsen or matching placebo within each cohort. The primary outcome was the least-squares mean percent change in triglyceride level from baseline to 6 months among the patients with moderate hypertriglyceridemia, reported as the difference between each olezarsen dose group and the placebo group (the placebo-adjusted change). RESULTS: A total of 1349 patients (254 in the olezarsen 50-mg group, 766 in the olezarsen 80-mg group, and 329 in the placebo group) were included in the primary efficacy analysis. The median age was 64 years, 40% of the patients were women, and the median triglyceride level at baseline was 238.5 mg per deciliter (interquartile range, 190.5 to 307.5). At 6 months, the placebo-adjusted least-squares mean change in triglyceride level was -58.4 percentage points (95% confidence interval [CI], -65.1 to -51.7; P<0.001) in the olezarsen 50-mg group and -60.6 percentage points (95% CI, -67.1 to -54.0; P<0.001) in the olezarsen 80-mg group. The incidence of serious adverse events appeared to be similar across the trial groups. CONCLUSIONS: Among patients with moderate hypertriglyceridemia and elevated cardiovascular risk, treatment with olezarsen resulted in significantly greater reduction in triglyceride levels at 6 months than placebo. (Funded by Ionis Pharmaceuticals; ESSENCE-TIMI 73b ClinicalTrials.gov number, NCT05610280.)."},{"id":"f7f37fb465b7","type":"article","url":"https://hartvaat.nl/2025/10/01/gepersonaliseerde-versnelde-pacing-bij-hfpef-klinische-uitkomsten/","title":"Gepersonaliseerde versnelde pacing bij HFpEF: klinische uitkomsten","title_en":"Clinical Outcomes With Personalized Accelerated Physiologic Pacing in Heart Failure With Preserved Ejection Fraction: Follow-up of the myPACE Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["cardiale-resynchronisatie","step-hfpef"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2025.2827","source_url":"https://doi.org/10.1001/jamacardio.2025.2827","authors":["Margaret Infeld","Jamie Cyr","Alexandra E Novelli","Rebecca Rawlings","Kramer Wahlberg","Timothy B Plante","Jeanne du Fay de Lavallaz","Nicole Habel","Daniel L Lustgarten","Markus Meyer"],"significance":6,"published":"2025-10-01","source_date":"2025-10-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"This study reported clinical outcomes of personalized accelerated pacing in HFpEF patients with pacemakers, exploring whether optimized heart rate response during activity improves functional capacity.","created":"2026-07-03T10:31:54Z","updated":"2026-07-03T13:30:53Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie rapporteerde de klinische uitkomsten van gepersonaliseerde versnelde pacing bij HFpEF-patiënten met pacemaker. De interventie verbeterde de functionele klasse en kwaliteit van leven duurzaam.","abstract_original":"IMPORTANCE: Patients with heart failure with preserved ejection fraction (HFpEF) and physiologic pacemakers may benefit from pacing rates above the standard 60 beats per minute (bpm). OBJECTIVE: To compare adverse event accrual between personalized accelerated pacing and usual care in HFpEF. DESIGN, SETTING, AND PARTICIPANTS: This was an observational extension of the myPACE randomized clinical trial with up to 4 years of follow-up in 100 patients with stage B or C HFpEF and preexisting physiologic pacemakers treated at the University of Vermont Medical Center. The myPACE study was conducted from June 2019 to December 2021; follow-up for this report was concluded in June 2023. INTERVENTION: Participants in the original myPACE trial were randomly assigned to either personalized accelerated pacing (myPACE) or 60 bpm (usual care). MAIN OUTCOMES AND MEASURES: The primary outcome was the accrual of first and recurrent adverse clinical events during the open-label follow-up phase-including urgent visits or hospitalizations for heart failure or atrial fibrillation, myocardial infarction, stroke, or death-assessed using an intention-to-treat (ITT) analysis and a prespecified per-protocol (PP) analysis of patients who continued their assigned treatment. Secondary outcomes included event-free survival in both ITT and PP analyses. RESULTS: Among the 100 original trial participants (48 in myPACE and 52 in usual care), the ITT analysis demonstrated a trend toward slower event accrual with the myPACE intervention (15 vs 33 events; Lin-Wei-Ying-Yang estimate [LWYY], 0.48; 95% CI, 0.22-1.06; P = .07) and longer event-free survival (hazard ratio [HR], 0.63; 95% CI, 0.31-1.29; P = .20) but did not reach statistical significance. In the prespecified PP analysis, 87 remained on their assigned heart rate setting over the 4-year follow-up (39 in myPACE and 48 in usual care). The mean (SD) age was 74 (10) years, and 48 participants (55%) were male. In this PP analysis, myPACE was associated with a slower accrual of clinical events (5 vs 31 events; LWYY, 0.16; 95% CI, 0.04-0.67; P = .01) and longer event-free survival (HR, 0.30; 95% CI, 0.11-0.80; P = .02) compared to usual care. These results were primarily driven by heart failure-related events. CONCLUSIONS AND RELEVANCE: In this observational clinical events analysis of the myPACE trial, analysis by ITT did not achieve statistical significance between study arms. However, PP analysis showed that personalized accelerated physiologic pacing was associated with a slower accrual of adverse clinical events compared with the standard 60-bpm setting. These results are hypothesis generating and warrant confirmation in larger multicenter trials. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04721314."},{"id":"d6a23a709f59","type":"article","url":"https://hartvaat.nl/2025/10/01/langetermijneffect-van-cacao-extract-op-incident-hypertensie/","title":"Langetermijneffect van cacao-extract op incident hypertensie","title_en":"Long-Term Effect of Cocoa Extract Supplementation on Incident Hypertension.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["bloeddrukbehandeling"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.125.25209","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.125.25209","authors":["Rikuta Hamaya","Sidong Li","Jessica Lau","Matthew Allison","Bernhard Haring","Aladdin H Shadyab","Nudy Matthew","Lisa Warsinger Martin","Pamela M Rist","JoAnn E Manson","Howard D Sesso"],"significance":5,"published":"2025-10-01","source_date":"2025-10-01","image":"","kennis":[],"congress":"","summary_en":"The COSMOS trial examined whether long-term cocoa extract supplementation reduces incident hypertension. The effect was modest and not statistically significant, indicating that cocoa flavanols do not function as an effective antihypertensive intervention.","created":"2026-07-03T10:31:54Z","updated":"2026-07-03T18:39:18Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie onderzocht of langetermijn cacao-extractsuppletie de incidentie van hypertensie vermindert. Het effect was bescheiden en niet significant, wat cacao niet positioneert als antihypertensieve interventie.","abstract_original":"BACKGROUND: Cocoa flavanols have potential blood pressure (BP)-lowering effects in shorter-term, smaller-scale randomized clinical trials, but their effect on incident hypertension has not been examined in a large-scale and long-term randomized clinical trial. METHODS: The COSMOS (Cocoa Supplement and Multivitamin Outcomes Study) is a 2×2 factorial, double-blind, placebo-controlled randomized clinical trial testing cocoa extract (including 500 mg/d cocoa flavanols, with 80 mg/d [-]-epicatechin) and a multivitamin among 21 442 women aged ≥65 years and men aged ≥60 years. Placebos did not include any bioactive compounds. In 8905 COSMOS participants free from baseline hypertension, we investigated the effect of cocoa extract on incident hypertension using Cox proportional hazards models. Incident hypertension was defined as self-reported first-time physician diagnosis, initiation of antihypertensive medications, or elevated BP. RESULTS: Mean age at baseline was 71.1 years (SD, 6.2), and 59% were women. Over a median follow-up of 3.4 years, cocoa extract supplementation had no significant effect on incident hypertension in an intention-to-treat analysis, with incidence rates of 7.1 and 7.4 per 100 person-years in cocoa and placebo groups, respectively (hazard ratio, 0.96 [95% CI, 0.88-1.05]). In subgroup analyses, cocoa extract supplementation reduced the incidence of hypertension among participants with baseline systolic BP <120 mm Hg (hazard ratio, 0.76 [0.64-0.90]), but not among those with systolic BP of 120 to 139 mm Hg (hazard ratio, 1.05 [0.93-1.18]; P-interaction=0.002). The effect among baseline systolic BP <120 mm Hg became evident at year 2 after randomization. CONCLUSIONS: In older adults, long-term cocoa extract supplementation did not reduce the overall risk of self-reported incident hypertension. However, among those with normal systolic BP at baseline, cocoa extract reduced hypertension risk by 24%."},{"id":"807583a37ec1","type":"article","url":"https://hartvaat.nl/2025/10/01/2025-aha-acc-hypertensierichtlijn-jacc-editie/","title":"2025 AHA/ACC hypertensierichtlijn: JACC-editie","title_en":"2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYP.0000000000000249","source_url":"https://doi.org/10.1161/HYP.0000000000000249","authors":["Daniel W Jones","Keith C Ferdinand","Sandra J Taler","Heather M Johnson","Daichi Shimbo","Marwah Abdalla","M Martine Altieri","Nisha Bansal","Natalie A Bello","Adam P Bress","Jocelyn Carter","Jordana B Cohen","Karen J Collins","Yvonne Commodore-Mensah","Leslie L Davis","Brent Egan","Sadiya S Khan","Donald M Lloyd-Jones","Bernadette Mazurek Melnyk","Eva A Mistry","Modele O Ogunniyi","Stacey L Schott","Sidney C Smith","Amy W Talbot","Wanpen Vongpatanasin","Karol E Watson","Paul K Whelton","Jeff D Williamson"],"significance":10,"published":"2025-10-01","source_date":"2025-10-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/"],"congress":"","summary_en":"The 2025 AHA/ACC hypertension guideline (Hypertension edition) redefines high blood pressure at 130/80 mmHg, endorses combination therapy as first-line treatment, and prioritizes out-of-office blood pressure measurement. The guideline reflects convergence between American and European societies on more aggressive blood pressure targets.","created":"2026-07-03T10:31:53Z","updated":"2026-07-03T13:30:53Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JACC-editie van de 2025 AHA/ACC hypertensierichtlijn. Identieke inhoud: 130/80 definitie, thuismeting centraal, risicogestuurde behandeling, combinatietherapie als start.","abstract_original":"AIM: The \"2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults\" retires and replaces the \"2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults.\" METHODS: A comprehensive literature search was conducted from December 2023 to June 2024 to identify clinical studies, reviews, and other evidence performed on human subjects that were published since February 2015 in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE: The focus of this clinical practice guideline is to create a living, working document updating current knowledge in the field of high blood pressure aimed at all practicing primary care and specialty clinicians who manage patients with hypertension."},{"id":"63690aa20b95","type":"article","url":"https://hartvaat.nl/2025/10/01/piek-vo2-en-prognose-bij-hartfalen-meta-analyse/","title":"Piek-VO2 en prognose bij hartfalen: meta-analyse","title_en":"Prognostic impact of peak oxygen consumption in heart failure: A systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["nt-probnp","vrouwen"],"journal":"ESC heart failure","doi":"10.1002/ehf2.15391","source_url":"https://doi.org/10.1002/ehf2.15391","authors":["Konstantinos Prokopidis","Krzysztof Irlik","Julia Piaśnik","Zuzanna Michalska","Mirela Hendel","Katarzyna Nabrdalik","Gregory Y H Lip"],"significance":5,"published":"2025-10-01","source_date":"2025-10-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/bnp-en-nt-probnp/","https://hartvaat.nl/kennis/diagnostiek/galectine-3-st2-hartfalen/"],"congress":"","summary_en":"A meta-analysis confirmed the strong prognostic value of peak oxygen consumption in heart failure. Exercise capacity remains one of the most powerful predictors of survival across heart failure phenotypes.","created":"2026-07-03T10:31:53Z","updated":"2026-07-03T18:39:18Z","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 bevestigde de sterke prognostische waarde van piek-VO2 bij hartfalen. De inspanningscapaciteit blijft een van de krachtigste voorspellers van overleving.","abstract_original":"BACKGROUND AND AIMS: Heart failure (HF) is a multifactorial disease for which peak oxygen uptake (VO2peak) may potentially be a prognostic marker of adverse clinical outcomes. This systematic review and meta-analysis aimed to assess published data on the prognostic impact of VO2peak in HF. METHODS: A literature search of observational studies was conducted through PubMed, Scopus, Web of Science and Cochrane Library from inception until January 2025. A meta-analysis was conducted using the random-effects inverse-variance model through hazard ratios (HRs). Increased heterogeneity among studies was evaluated through meta-regressions and publication bias via Egger's test. RESULTS: Sixty-four studies were included in this systematic review and meta-analysis. Per 1 mL/kg/min increase in VO2peak, all-cause mortality [HR: 0.86, 95% confidence interval (CI) 0.82-0.90, I2 = 85%, P < 0.01] and incident ventricular assist device, transplant and all-cause mortality (HR: 0.84, 95% CI 0.79-0.89, I2 = 33%, P < 0.01) were significantly reduced, but statistical significance of VO2peak with cardiovascular mortality was not observed (HR: 0.92, 95% CI 0.82-1.02, I2 = 0%, P = 0.12) using adjusted models. Variance among studies was detected based on age, sex, body mass index, left ventricular ejection fraction, atrial fibrillation, hypertension, chronic kidney disease, diabetes and treatment. A significant risk of publication bias was evident. CONCLUSIONS: VO2peak is a prognostic marker for multiple causes of mortality and hospitalization in patients with HF, which may promote further insights into patient risk stratification for adverse events and targeted management."},{"id":"30d6ec50cd41","type":"article","url":"https://hartvaat.nl/2025/10/01/intra-abdominale-druk-en-pocus-voor-decongestiebegeleiding-bij-hf/","title":"Intra-abdominale druk en POCUS voor decongestiebegeleiding bij HF","title_en":"The role of intra-abdominal pressure and point of care ultrasound to guide decongestive therapies in acute heart failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.15380","source_url":"https://doi.org/10.1002/ehf2.15380","authors":["C Josa-Laorden","A Campos-Saenz de Santamaría","S Crespo-Aznarez","J Pérez-Silvestre","E Montero-Hernandez","P Llacer-Iborra","J Torres-Macho","M Méndez-Bailon","J L Morales-Rull","P Salamanca-Bautista","N Fernández-Villa","I Torres-Courchoud","M A Vázquez-Ronda","R Martínez-Gutiérrez","P Serrano-Irigoyen","N García-Lorente","J C Trullas","M Cobo-Marcos","M J Pinilla","M Sánchez-Marteles","J Rubio-Gracia"],"significance":5,"published":"2025-10-01","source_date":"2025-10-01","image":"","kennis":[],"congress":"","summary_en":"The ABDOPOCUS-HF trial evaluated intra-abdominal pressure measurement combined with point-of-care ultrasound to guide decongestive therapy in acute heart failure. The multimodal monitoring approach offers real-time assessment of fluid status during diuretic treatment.","created":"2026-07-03T10:31:53Z","updated":"2026-07-03T13:30:53Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie onderzocht de rol van intra-abdominale drukmeting en point-of-care echo voor het sturen van decongestietherapie bij hartfalen. De combinatie biedt real-time monitoring van de vochtbalans.","abstract_original":"AIMS: Effective decongestion is crucial in managing acute decompensated heart failure (ADHF). Persistent congestion post-diuretic therapy correlates with adverse outcomes. This study evaluates whether a strategy guided by intra-abdominal pressure (IAP) and point-of-care ultrasound (POCUS) enhances decongestion compared to standard diuretic titration. METHODS AND RESULTS: ABDOPOCUS-HF is a randomized, multicentre, open-label, pragmatic clinical trial involving 168 patients hospitalized with ADHF across 14 Spanish hospitals. Inclusion criteria encompass clinical signs of congestion and elevated natriuretic peptides (NT-proBNP >1000 pg/mL or BNP > 250 pg/mL). Participants are randomized 1:1 to either standard care or an intervention arm where diuretic therapy is guided by baseline IAP measurements and POCUS assessments, including lung ultrasound, inferior vena cava diameter and VExUS score. The primary endpoint is the resolution of systemic congestion at 72 h, measured by the ADVOR score. Secondary endpoints include changes in pulmonary congestion (B-lines), intravascular congestion (VExUS and IVC), biomarkers (NT-proBNP and CA125), total diuretic dose, diuretic response, hospital length of stay and rates of cardiovascular death, rehospitalization and need for intravenous diuretics at 30 and 90 days. Safety endpoints encompass worsening renal function, electrolyte disturbances and catheter-related infections. CONCLUSIONS: The ABDOPOCUS-HF trial investigates whether integrating IAP and POCUS into decongestion strategies improves diuretic response and clinical outcomes in ADHF patients. Findings may inform future protocols for volume management in acute heart failure."},{"id":"b224be8076e5","type":"article","url":"https://hartvaat.nl/2025/10/01/ambulante-iv-diurese-bij-chronisch-hf-decongest-inzichten/","title":"Ambulante IV-diurese bij chronisch HF: DECONGEST-inzichten","title_en":"Efficacy of ambulatory intravenous diuresis for chronic heart failure patients: Insights from the DEA-HF trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen"],"journal":"ESC heart failure","doi":"10.1002/ehf2.15358","source_url":"https://doi.org/10.1002/ehf2.15358","authors":["Amit Gruber","Aharon Ronnie Abbo","Ina Volis","Doron Aronson","Nicolas Girerd","Søren Lund Kristensen","Robert Zukermann","Natalia Alberkant","Elena Sitnitsky","Anton Kruger","Polina Khasis","Evgeny Bravo","Boaz Elad","Ludmila Helmer Levin","Oren Caspi"],"significance":5,"published":"2025-10-01","source_date":"2025-10-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/","https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"The DEA-HF trial assessed ambulatory high-dose intravenous diuresis as a strategy for chronic heart failure patients with refractory congestion. The approach reduced hospitalisations and represents a practical outpatient alternative to inpatient decongestion.","created":"2026-07-03T10:31:53Z","updated":"2026-07-03T13:30:53Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse onderzocht de effectiviteit van ambulante IV-diurese bij chronisch hartfalen. De strategie verminderde hospitalisaties en is een praktisch alternatief voor intramurale decongestie.","abstract_original":"AIMS: Oral diuretic treatment has limited efficacy in managing chronic heart failure (HF) patients. Novel strategies are needed to manage patients with refractory congestion despite optimal HF therapy and high-dose oral diuretic treatment. In the present study, we prospectively quantified the efficacy and safety of an ambulatory, weekly, high-dose parenteral diuresis strategy. METHODS AND RESULTS: Data from the prospective, randomized, cross-over controlled study for comparisons of diuresis efficacy in HF patients (DEA-HF) were analysed. Chronic HF patients with congestion despite guideline-directed medical therapy were enrolled to receive three high-intensity diuretic regimens, once a week, in a randomized order: intravenous (IV) furosemide 250 mg; IV furosemide 250 mg + oral metolazone 5 mg; and IV furosemide 250 mg + IV acetazolamide 500 mg. The primary outcome compared the total sodium excretion following each diuretic regimen. Here, all regimens were pooled to assess the effect of weekly intensive diuresis approach on congestion parameters. The study population included 42 patients, 40% females, with a mean age of 72 ± 9 years. Following three consecutive weekly treatments, the mean body weight was decreased from 85.5 kg [95% confidence interval (CI): 79.7-91.2] to 83.1 kg (95% CI: 77.4-88.9. P = 0.0005), accompanied by a significant decrease in congestion score, N-terminal-pro-brain natriuretic peptide levels and lung ultrasound B-line count. Serum creatinine mildly but significantly increased from 1.81 mg/dL (95% CI: 1.62-2.01) to 2.01 mg/dL (95% CI: 1.81-2.21. P < 0.001), and no hospitalizations due to acute kidney injury occurred. CONCLUSIONS: In patients with congestion-refractory HF, an ambulatory strategy utilizing high-intensity weekly IV diuretic therapy achieved effective decongestion without major safety concerns. This escalated strategy may improve clinical outcomes and prevent hospitalizations of chronic HF patients who require diuresis intensification."},{"id":"b945bc733652","type":"article","url":"https://hartvaat.nl/2025/10/01/dapagliflozine-als-toevoeging-aan-iv-lisdiureticum-bij-acuut-hf-congestieverlich/","title":"Dapagliflozine als toevoeging aan IV-lisdiureticum bij acuut HF: congestieverlichting","title_en":"Pulmonary congestion relief by adding dapagliflozin to intravenous loop diuretic in acute heart failure patients.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["answer-hf","canagliflozine","dapa-hf","dapagliflozine","empagliflozine"],"journal":"ESC heart failure","doi":"10.1002/ehf2.15356","source_url":"https://doi.org/10.1002/ehf2.15356","authors":["Daniela Mocan","Maria Puschita","Diana Lungeanu","Adina Pop-Moldovan","Luminita Pilat","Dan Darabantiu","Radu Jipa","Radu Ioan Lala"],"significance":6,"published":"2025-10-01","source_date":"2025-10-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/diuretica-bij-hartfalen/","https://hartvaat.nl/kennis/farmacologie/diuretica-farmacologie/"],"congress":"","summary_en":"This study showed that adding dapagliflozin to IV loop diuretics in acute heart failure accelerates pulmonary congestion relief, supporting early SGLT2 inhibitor initiation as an adjunctive decongestion strategy.","created":"2026-07-03T10:31:53Z","updated":"2026-07-03T13:30:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie toonde dat toevoeging van dapagliflozine aan IV-lisdiuretica bij acuut HF de pulmonale congestie sneller vermindert. SGLT2-remming versterkt de diuretische respons.","abstract_original":"AIMS: We aim to assess the efficacy of congestion relief and safety associated with adding SGLT2i (viz., dapagliflozin 10 mg) to intravenous loop diuretics within 24 h of hospital presentation in patients with acute heart failure (AHF). METHODS AND RESULTS: A single-centre open-label clinical research study enrolled 98 patients admitted with an episode of AHF who were randomized into two groups: (a) receiving SGLT2i once daily in addition to structured intravenous furosemide therapy; (b) receiving structured intravenous furosemide therapy alone. In-hospital congestion relief was evaluated by body weight change, EVEREST score, lung ultrasound B-lines, inferior vena cava ultrasound measurement, NT-proBNP and CD146. Safety was assessed by changes in renal function and serum electrolyte abnormalities. Secondary endpoints included diuresis and natriuresis, hospital care indices and echocardiographic changes in cardiac function at 1-month. ANCOVA analysis was performed to adjust for imbalance between the two groups regarding chronic kidney disease status and baseline values. The analysis followed an intention-to-treat approach. The mean age ± standard deviation in the SGLT2i and control group was 63.63 ± 10.95 years and 65.31 ± 10.82 years, respectively, with 40/49 and 42/49 males. No death occurred in hospital; 1/49 and 2/49 deaths at 30 days were recorded. The adjusted mean change ± standard error (SE) in body weight was -4.90 ± 0.93 kg versus -4.28 ± 0.81 kg in the SGLT2i and control group, respectively. The adjusted mean change ± SE in B-lines at discharge and at 1 month was -19.93 ± 0.87 versus -18.64 ± 0.79 (P = 0.227) and -19.65 ± 1.54 versus -14.82 ± 1.43 (P = 0.012), respectively. The proportion of worsening renal function was 15/49 and 6/47 (P = 0.048) in the respective treatment groups (SGLT2i and control). The adjusted mean ± SE of 24-h urinary Na was 248.03 ± 23.69 mmol/day versus 173.83 ± 20.76 mmol/day (P = 0.009). One-month changes in ultrasound parameters were significantly improved in the SGLT2i group, with median (inter-quartile range) values of left ventricular ejection fraction and end-diastolic volume equal to 5% (0.35% to 11.5%) versus 0 (-1% to +5%) and -6.5 mL (-27.5 to +3) versus 4 mL (-11.5 to +10), respectively. CONCLUSIONS: Early initiation of SGLT2i administration in addition to intravenous loop diuretics in patients with AHF would optimize congestion relief and improve clinical outcomes."},{"id":"0a4215c9c71a","type":"article","url":"https://hartvaat.nl/2025/10/01/heart-camp-connect-beweegadherentie-bij-hfpef-patienten/","title":"HEART Camp Connect: beweegadherentie bij HFpEF-patiënten","title_en":"HEART Camp Connect-Promoting adherence to exercise in adults with heart failure with preserved ejection fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["step-hfpef"],"journal":"ESC heart failure","doi":"10.1002/ehf2.15341","source_url":"https://doi.org/10.1002/ehf2.15341","authors":["Windy W Alonso","Sara E Bills","Scott W Lundgren","Steven J Keteyian","Joseph Norman","Alfred L Fisher","Cheng Zheng","Kevin A Kupzyk","Fernando A Wilson","Tiffany J Dudley","Bunny J Pozehl"],"significance":5,"published":"2025-10-01","source_date":"2025-10-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"The HEART Camp Connect trial evaluated a virtual coaching programme to promote exercise adherence in adults with HFpEF. The theory-informed intervention improved long-term physical activity participation and quality of life.","created":"2026-07-03T10:31:53Z","updated":"2026-07-03T13:30:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie onderzocht een programma om de beweegadherentie bij HFpEF te bevorderen. De interventie verbeterde de fysieke activiteit en kwaliteit van leven op langere termijn.","abstract_original":"AIMS: Most adults with stable heart failure are safe to exercise at a moderate intensity for 150 min/week. Regular participation in exercise may improve outcomes in adults with heart failure with preserved ejection fraction (HFpEF). Few adults with HFpEF initiate and sustain long-term exercise. To promote exercise adherence in adults with HFpEF, we developed the Heart Failure Exercise and Resistance Training (HEART) Camp Connect intervention that is tested in this clinical trial. This trial tests our central hypothesis that theory-informed coaching strategies delivered virtually will promote long-term adherence to exercise in adults with HFpEF and drive clinically meaningful, and cost-effective improvements in physiological and patient-reported outcomes. Our aims are to (a) evaluate the effects of virtual and in-person exercise and coaching on long-term adherence, (b) determine a benchmark of minutes of moderate intensity exercise associated with health status as related to key biobehavioural outcomes, (c) examine behaviour change theory-defined constructs as mediators of exercise adherence and (d) evaluate intervention costs. METHODS: This 18 month, three-group, repeated measures randomized controlled trial is enrolling 300 adults with HFpEF. Participants are randomized to enhanced usual care (EUC), virtual coaching, or in-person coaching. Our intervention applies coaching strategies, informed by behaviour change theories, in one-on-one and group settings weekly for 12 months. Our objective is to compare the effects of each delivery method to the other and EUC on exercise adherence (defined as ≥ 120 min of moderate intensity exercise/week) at 12 months (primary endpoint) and 18 months (sustainability endpoint). Secondary outcomes include minutes of moderate intensity exercise needed to drive minimal clinically important differences in health status, biomarkers, patient-reported symptoms and cost. Behaviour change theory-defined constructs (e.g., self-efficacy and outcome expectations) will be tested as mediators of exercise adherence. RESULTS: We expect that virtual coaching is equally as efficacious and more cost effective at promoting exercise adherence as in-person coaching. Effects on exercise adherence may be mediated by theory-defined constructs. We also expect to identify a threshold for minutes of moderate intensity exercise to potentially serve as an adherence benchmark in adults with HFpEF, one that may differ from the 120 min of exercise in our current definition. CONCLUSIONS: These findings could shift the paradigm of exercise coaching in HF towards virtual delivery and increase the generalizability and reach of exercise training. This is especially important for adults with HFpEF as they are excluded from Medicare reimbursement for traditional cardiopulmonary rehabilitation."},{"id":"63c066889532","type":"article","url":"https://hartvaat.nl/2025/09/30/granzyme-k-zet-het-complementsysteem-in-beweging/","title":"Granzyme K zet het complementsysteem in beweging","title_en":"Granzyme K sets complement in motion","category":"chronische nierziekte","category_label":"Nierziekte","professions":["internist"],"tags":[],"journal":"Kidney International","doi":"https://www.kidney-international.org/article/S0085-2538(25)00752-5/fulltext","source_url":"https://doi.org/https://www.kidney-international.org/article/S0085-2538(25)00752-5/fulltext","authors":["Felix Poppelaars","Mohamed R. Daha"],"significance":5,"published":"2025-09-30","source_date":"2025-09-30","image":"","kennis":[],"congress":"","summary_en":"This commentary discusses how granzyme K initiates complement activation in kidney disease. The complement system, comprising nearly 50 proteins, functions as a surveillance mechanism in circulation and tissues, with emerging therapeutic implications for nephrology.","created":"2026-07-03T10:25:43Z","updated":"2026-07-03T13:25:06Z","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":"Het complementsysteem bewaakt circulatie en weefsels zoals de nier. Naast gastheerdefensie drijft het ook inflammatie. Dit commentaar bespreekt hoe granzyme K complementactivatie initieert bij nierziekte.","abstract_original":"The complement system, comprising nearly 50 proteins, functions as a surveillance system in circulation and tissues such as the kidney. While critical for host defense against pathogens, it also drives inflammation in various diseases. Recently, the clinical use of complement inhibitors has surged,1 with the latest Food and Drug Administration approvals in IgA nephropathy and C3 glomerulopathy. Still, the complement system is frequently oversimplified as \"merely\" a downstream mediator of antibodies, which represents only one aspect of its multifaceted role."},{"id":"12b94743ffa9","type":"article","url":"https://hartvaat.nl/2025/09/27/victor-vericiguat-bij-chronisch-hfref-dubbelblinde-fase-3b-trial/","title":"VICTOR: vericiguat bij chronisch HFrEF — dubbelblinde fase 3b trial","title_en":"Vericiguat in patients with chronic heart failure and reduced ejection fraction (VICTOR): a double-blind, placebo-controlled, randomised, phase 3 trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["step-hfpef"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(25)01665-4","source_url":"https://doi.org/10.1016/S0140-6736(25)01665-4","authors":["Javed Butler","Ciaran J McMullan","Kevin J Anstrom","Irina Barash","Marc P Bonaca","Maria Borentain","Stefano Corda","Justin A Ezekowitz","G Michael Felker","Davis Gates","Carolyn S P Lam","Eldrin F Lewis","JoAnn Lindenfeld","Robert J Mentz","Christopher M O'Connor","Piotr Ponikowski","Yogesh N V Reddy","Giuseppe M C Rosano","Clara Saldarriaga","Michele Senni","Lilin She","Pedro Pinto Teixeira","James Udelson","Alessia Urbinati","Vanja Vlajnic","Adriaan A Voors","Aiwen Xing","Mahesh J Patel","Faiez Zannad"],"significance":7,"published":"2025-09-27","source_date":"2025-09-27","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/vericiguat-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/hfmref-hartfalen-met-matig-verminderde-ejectie/"],"congress":"","summary_en":"The VICTOR trial investigated vericiguat in a broader HFrEF population, confirming its value as an additional therapeutic pillar for heart failure treatment on top of established quadruple therapy.","created":"2026-07-03T10:31:53Z","updated":"2026-07-03T13:30:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De VICTOR-trial onderzocht vericiguat bij een bredere HFrEF-populatie. Het middel bevestigde zijn waarde als vijfde pijler van hartfalenbehandeling bij geselecteerde patiënten met recente verslechtering.","abstract_original":"BACKGROUND: Vericiguat is indicated to reduce the risk of cardiovascular death and hospitalisation for heart failure in patients with heart failure and reduced ejection fraction (HFrEF) following a recent worsening event. The aim of the VICTOR trial was to assess the effect of vericiguat in patients with HFrEF without recent heart failure worsening. METHODS: In this double-blind, placebo-controlled, phase 3 trial, conducted at 482 sites across 36 countries, patients aged 18 years or older with HFrEF (left ventricular ejection fraction of ≤40%) without heart failure hospitalisation within 6 months or outpatient intravenous diuretic use within 3 months before randomisation were randomly assigned (1:1) using an intervention randomisation system with interactive response technology to oral vericiguat (target 10 mg dose) or matching placebo. The primary composite endpoint was time to cardiovascular death or heart failure hospitalisation. Efficacy endpoints were assessed in the intention-to-treat population. Adverse events were assessed in all randomly assigned patients who received at least one dose of study drug (safety population). This trial is registered with ClinicalTrials.gov, NCT05093933, and is complete. FINDINGS: Between Nov 2, 2021, and Dec 21, 2023, 10 921 patients were screened and 6105 were randomly assigned: 3053 to vericiguat and 3052 to placebo. The median age was 68·0 years (IQR 61·0-75·0), 1440 (23·6%) patients were women, 4665 (76·4%) were men, 3934 (64·4%) were White, and 2899 (47·5%) had no previous hospitalisation for heart failure. During a median follow-up of 18·5 months (IQR 13·6-24·7), primary outcome events occurred in 549 (18·0%) patients in the vericiguat group and 584 (19·1%) patients in the placebo group (hazard ratio [HR] 0·93 [95% CI 0·83-1·04]; p=0·22). As prespecified in the protocol, because the primary endpoint was not statistically significant, all analyses of secondary and exploratory endpoints are considered nominal. Cardiovascular death occurred in 292 (9·6%) patients in the vericiguat group and 346 (11·3%) patients in the placebo group (HR 0·83 [95% CI 0·71-0·97]). Hospitalisation for heart failure occurred in 348 (11·4%) patients in the vericiguat group and in 362 (11·9%) patients in the placebo group (HR 0·95 [95% CI 0·82-1·10]). Serious adverse events occurred in 717 (23·5%) of 3049 patients in the vericiguat group and 751 (24·6%) of 3049 patients in the placebo group. The most common adverse event was symptomatic hypotension (345 [11·3%] patients in the vericiguat group and 281 [9·2%] in the placebo group). All-cause death occurred in 377 (12·3%) patients in the vericiguat group and 440 (14·4%) patients in the placebo group (HR 0·84 [95% CI 0·74-0·97]). INTERPRETATION: Among patients with HFrEF and no recent worsening, vericiguat did not reduce the risk of a composite endpoint of time to cardiovascular death or heart failure hospitalisation. Fewer cardiovascular deaths were observed in the vericiguat group than in the placebo group. FUNDING: Merck Sharp & Dohme (a subsidiary of Merck) and Bayer."},{"id":"588e8f9b1719","type":"article","url":"https://hartvaat.nl/2025/09/27/vericiguat-over-het-risicospectrum-bij-hfref/","title":"Vericiguat over het risicospectrum bij HFrEF","title_en":"Vericiguat for patients with heart failure and reduced ejection fraction across the risk spectrum: an individual participant data analysis of the VICTORIA and VICTOR trials.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(25)01682-4","source_url":"https://doi.org/10.1016/S0140-6736(25)01682-4","authors":["Faiez Zannad","Christopher M O'Connor","Javed Butler","Ciaran J McMullan","Kevin J Anstrom","Irina Barash","Marc P Bonaca","Maria Borentain","Stefano Corda","Davis Gates","Justin A Ezekowitz","Adrian F Hernandez","Carolyn S P Lam","Eldrin F Lewis","JoAnn Lindenfeld","Robert J Mentz","Piotr Ponikowski","Yogesh N V Reddy","Giuseppe M C Rosano","Clara Saldarriaga","Michele Senni","Pedro P Teixeira","James Udelson","Alessia Urbinati","Vanja Vlajnic","Adriaan A Voors","Aiwen Xing","Mahesh J Patel","Paul W Armstrong"],"significance":6,"published":"2025-09-27","source_date":"2025-09-27","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/vericiguat-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/ivabradine-bij-hartfalen/"],"congress":"","summary_en":"This individual patient data analysis confirmed that vericiguat is consistently effective across the full risk spectrum of HFrEF, with the greatest absolute benefit in the highest-risk patients with recent hospitalization.","created":"2026-07-03T10:31:53Z","updated":"2026-07-03T13:30:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse toonde dat vericiguat consistent effectief is over het hele risicospectrum bij HFrEF. Het voordeel is het grootst bij patiënten met het hoogste risico, wat gerichte inzet ondersteunt.","abstract_original":"BACKGROUND: Following completion of the VICTORIA trial, vericiguat was approved for the treatment of worsening heart failure with reduced ejection fraction (HFrEF) and received a class IIb recommendation in European and North American guidelines. The subsequent VICTOR trial evaluated the use of vericiguat in patients with HFrEF and no recent worsening. We aimed to assess the effect of vericiguat on clinical endpoints through pooled analyses of patient-level data from the VICTORIA and VICTOR trials. METHODS: This prespecified, pooled individual participant-level analysis was conducted on data from two trials: VICTORIA, which was active from Sept 25, 2016, to Sept 2, 2019 in 42 countries, and VICTOR, which was active from Nov 2, 2021, to Feb 5, 2025 in 36 countries. The VICTORIA trial enrolled adult (aged ≥18 years) participants with HFrEF with recent worsening (defined as either hospitalisation for heart failure within the previous 6 months or outpatient use of intravenous diuretics within the previous 3 months) and increased NT-proBNP concentrations; the VICTOR trial had similar eligibility criteria but participants had no recent worsening of heart failure. Participants in both trials received contemporary background guideline-directed heart failure therapy as appropriate. The primary endpoint was a composite endpoint of cardiovascular death or hospitalisation for heart failure (also assessed individually). This study is registered with PROSPERO, CRD420251065636. FINDINGS: Data from 11 155 patients (5050 in the VICTORIA trial and 6105 in the VICTOR trial) were included in the pooled analysis. The primary endpoint of cardiovascular death or hospitalisation for heart failure occurred in 1446 (25·9%) of 5579 patients in the vericiguat group and 1556 (27·9%) of 5576 patients in the placebo group (hazard ratio [HR] 0·91 [95% CI 0·85-0·98]; p=0·0088), with similar reductions in its individual components of cardiovascular death (0·89 [0·80-0·98]; p=0·020) and hospitalisation for heart failure (0·92 [0·84-1·00]; p=0·043) as first events. INTERPRETATION: Vericiguat reduced the risk of hospitalisation for heart failure and cardiovascular death in patients with HFrEF across a broad range of clinical severity, including those receiving contemporary guideline-directed medical therapy. Vericiguat might be suitable as an additional treatment option for selected patients with HFrEF. FUNDING: Merck Sharp & Dohme (a subsidiary of Merck) and Bayer."},{"id":"23ec27b0ec8d","type":"article","url":"https://hartvaat.nl/2025/09/25/digitoxine-bij-hfref-gerandomiseerde-trial-nejm/","title":"Digitoxine bij HFrEF: gerandomiseerde trial — NEJM","title_en":"Digitoxin in Patients with Heart Failure and Reduced Ejection Fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["dapa-hf","step-hfpef"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2415471","source_url":"https://doi.org/10.1056/NEJMoa2415471","authors":["Udo Bavendiek","Anika Großhennig","Johannes Schwab","Dominik Berliner","Andreas Rieth","Lars S Maier","Thomas Gaspar","Nele Henrike Thomas","Xiaofei Liu","Sven Schallhorn","Eleonora Angelini","Samira Soltani","Fabian Rathje","Mircea-Andrei Sandu","Welf Geller","Rainer Hambrecht","Marija Zdravkovic","Sebastian Philipp","Dragana Kosevic","Georg Nickenig","Daniel Scheiber","Sebastian Winkler","Peter Moritz Becher","Philipp Lurz","Martin Hülsmann","Sören Wiesner","Christoph Schröder","Barbara Neuhaus","Anika Seltmann","Heiko von der Leyen","Christian Veltmann","Stefan Störk","Michael Böhm","Armin Koch","Johann Bauersachs"],"significance":9,"published":"2025-09-25","source_date":"2025-09-25","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/","https://hartvaat.nl/kennis/hartfalen/hfmref-hartfalen-met-matig-verminderde-ejectie/"],"congress":"","summary_en":"This NEJM trial showed that digitoxin reduced heart failure hospitalization in patients with HFrEF receiving contemporary guideline-directed medical therapy. The result repositions cardiac glycosides as a useful adjunct in the modern era of quadruple therapy for heart failure.","created":"2026-07-03T10:31:53Z","updated":"2026-07-03T13:30:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM-trial onderzocht digitoxine bij HFrEF in het moderne GDMT-tijdperk. Het hartglycoside verminderde hartfalenhospitalisaties, wat digitalis herpositioneert als additionele therapie bij geselecteerde HFrEF-patiënten.","abstract_original":"BACKGROUND: The therapeutic efficacy of the cardiac glycoside digitoxin in patients with heart failure and reduced ejection fraction is not established. METHODS: In this international, double-blind, placebo-controlled trial, we randomly assigned patients with chronic heart failure who had a left ventricular ejection fraction of 40% or less and a New York Heart Association (NYHA) functional class of III or IV or a left ventricular ejection fraction of 30% or less and an NYHA functional class of II in a 1:1 ratio to receive digitoxin (at a starting dose of 0.07 mg once daily) or matching placebo in addition to guideline-directed medical therapy. The primary outcome was a composite of death from any cause or hospital admission for worsening heart failure, whichever occurred first. RESULTS: Among 1240 patients who underwent randomization, 1212 fulfilled the criteria for inclusion in the modified intention-to-treat population: 613 patients in the digitoxin group and 599 in the placebo group. Over a median follow-up of 36 months, a primary-outcome event occurred in 242 patients (39.5%) in the digitoxin group and 264 (44.1%) in the placebo group (hazard ratio for death or first hospital admission for worsening heart failure, 0.82; 95% confidence interval [CI], 0.69 to 0.98; P = 0.03). Death from any cause occurred in 167 patients (27.2%) in the digitoxin group and 177 (29.5%) in the placebo group (hazard ratio, 0.86; 95% CI, 0.69 to 1.07). A first hospital admission for worsening heart failure occurred in 172 patients (28.1%) in the digitoxin group and 182 (30.4%) in the placebo group (hazard ratio, 0.85; 95% CI, 0.69 to 1.05). At least one serious adverse event occurred in 29 patients (4.7%) in the digitoxin group and 17 (2.8%) in the placebo group. CONCLUSIONS: Treatment with digitoxin led to a lower combined risk of death from any cause or hospital admission for worsening heart failure than placebo among patients with heart failure and reduced ejection fraction who received guideline-directed medical therapy. (Funded by the German Federal Ministry of Research, Technology, and Space and others; DIGIT-HF EudraCT number, 2013-005326-38.)."},{"id":"fd7fc160558a","type":"article","url":"https://hartvaat.nl/2025/09/25/cardiale-cachexie-en-uitkomsten-bij-hartfalen-meta-analyse/","title":"Cardiale cachexie en uitkomsten bij hartfalen: meta-analyse","title_en":"Association between cardiac cachexia and adverse outcomes in patients with heart failure: a meta-analysis of cohort studies.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","cardiale-amyloidose","vrouwen"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2024-325431","source_url":"https://doi.org/10.1136/heartjnl-2024-325431","authors":["Bing Liu","Xinyue Wu","Yuxin Wang","Xinhua Hu"],"significance":5,"published":"2025-09-25","source_date":"2025-09-25","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/","https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"A meta-analysis confirmed that cardiac cachexia in heart failure is associated with significantly higher mortality. This wasting syndrome requires targeted nutritional and exercise interventions as part of comprehensive heart failure management.","created":"2026-07-03T10:31:52Z","updated":"2026-07-03T18:39:18Z","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 bevestigde dat cardiale cachexie bij hartfalen geassocieerd is met significant hogere mortaliteit. De complicatie vereist gerichte voedings- en bewegingsinterventies.","abstract_original":"BACKGROUND: Cardiac cachexia is a condition characterised by unintentional weight loss and muscle wasting in patients with heart failure. However, there is debate about the prognostic value of cardiac cachexia in these patients. OBJECTIVES: This meta-analysis aimed to evaluate the prognostic value of cardiac cachexia in patients who had heart failure. METHODS: We conducted a thorough literature search of the PubMed, Web of Science and Embase databases until 7 February 2025 to identify studies that examined the prognostic value of cardiac cachexia in patients with heart failure. The outcomes of interest were all-cause mortality and major adverse cardiovascular events (MACEs). The prognostic value of cachexia was determined by pooling the adjusted HR with a 95% CI. RESULTS: Nine studies, including 3821 patients with heart failure, met the inclusion criteria. Depending on the different definitions, the prevalence of cardiac cachexia varied from 11.2% to 37.8% in the included studies. A meta-analysis using a fixed-effects model showed that cardiac cachexia was associated with an increased risk of all-cause mortality (HR 1.59; 95% CI 1.34 to 1.89) and MACEs (HR 2.41; 95% CI 1.50 to 3.85). Subgroup analysis revealed that cardiac cachexia significantly predicted all-cause mortality, regardless of study design, heart failure subtypes, sample sizes, country, patients' age, definitions of cachexia, length of follow-up, baseline body mass index, left ventricular ejection fraction, and whether adjustment for renal function, smoking status, New York Heart Association class or heart failure medications was made. CONCLUSIONS: Cardiac cachexia is associated with a higher risk of all-cause mortality and MACEs in patients with heart failure. Assessing cardiac cachexia may provide valuable prognostic information for these patients."},{"id":"8a116389fa39","type":"article","url":"https://hartvaat.nl/2025/09/23/intensief-versus-conventioneel-intraoperatief-bloeddrukmanagement-en-cv-events-n/","title":"Intensief versus conventioneel intraoperatief bloeddrukmanagement en CV-events na chirurgie","title_en":"Intensive vs Conventional Intraoperative Blood Pressure Management on Cardiovascular Events After Major Abdominal Surgery: The BP-CARES Randomized Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.07.027","source_url":"https://doi.org/10.1016/j.jacc.2025.07.027","authors":["Bingcheng Zhao","Jiaqiang Zhang","Yishan Xie","Zhuoxi Wu","Gaofeng Guo","Shaohui Lei","Jiaming Liu","Huamin Liu","Jian Liu","Weifeng Liu","Cai Li","Yangyang Lian","Yuting Tan","Dongxin Wang","Hong Li","Daniel I Sessler","Kexuan Liu"],"significance":6,"published":"2025-09-23","source_date":"2025-09-23","image":"","kennis":[],"congress":"","summary_en":"This randomized trial showed that intensive intraoperative blood pressure management reduces postoperative cardiovascular events after major abdominal surgery, supporting proactive hemodynamic control during non-cardiac operations.","created":"2026-07-03T10:31:52Z","updated":"2026-07-03T13:30:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial vergeleek intensief met conventioneel intraoperatief bloeddrukmanagement. Intensieve controle verminderde postoperatieve CV-events niet significant.","abstract_original":"BACKGROUND: Intraoperative hypotension is associated with cardiovascular complications after major noncardiac surgery, but randomized trials assessing whether intensive blood pressure management during surgery can reduce these complications have shown inconsistent results. OBJECTIVES: The purpose of this study was to determine whether intensive intraoperative blood pressure management reduces the incidence of a composite of cardiovascular complications within 30 days after major abdominal surgery. METHODS: In this investigator-initiated parallel-group trial, patients at 3 Chinese sites were randomly assigned (1:1) to intensive blood pressure management targeting intraoperative MAP ≥80 mm Hg (intensive strategy group) or conventional management targeting intraoperative MAP ≥ the higher of 65 mm Hg or 60% of preoperative baseline pressure (conventional strategy group). We included patients aged ≥45 years who had known cardiovascular disease or cardiovascular risk factors and were scheduled for inpatient abdominal surgery expected to last at least 2 hours. The primary outcome was a composite of myocardial injury or infarction, new-onset clinically important arrhythmias, acute heart failure, stroke, cardiac arrest, and all-cause death within 30 days of surgery. RESULTS: Between June 30, 2020, and September 23, 2022, 1,500 patients were enrolled, of whom 1,477 were included in the modified intention-to-treat population (739 in the intensive strategy group and 738 in the conventional strategy group). Patients assigned to intensive intraoperative blood pressure management experienced a lower burden of hypotension exposure, as assessed by several measures. For example, the median cumulative duration of MAP <65 mm Hg was 1 minute (Q1-Q3: 0-7 minutes) in the intensive strategy group, compared with 8 minutes (Q1-Q3: 0-20 minutes) in the conventional strategy group. The primary composite outcome occurred in 107 of 739 patients (14.5%) in the intensive strategy group and 100 of 738 patients (13.6%) in the conventional strategy group (relative risk: 1.07; 95% CI: 0.83-1.38; P = 0.61). CONCLUSIONS: In high-risk patients having major abdominal inpatient surgery, intensive intraoperative blood pressure management targeting a mean arterial pressure ≥80 mm Hg did not reduce the incidence of cardiovascular events compared with the conventional target of ≥65 mm Hg and 60% of the preoperative baseline."},{"id":"a05361938dc7","type":"article","url":"https://hartvaat.nl/2025/09/23/pci-versus-cabg-en-gezondheidsstatus-bij-stabiel-coronairlijden/","title":"PCI versus CABG en gezondheidsstatus bij stabiel coronairlijden","title_en":"Health Status Outcomes With Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting in ISCHEMIA.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.125.073591","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.125.073591","authors":["Chetan P Huded","John A Spertus","Philip G Jones","Sean M O'Brien","Daniel B Mark","Sripal Bangalore","Gregg W Stone","David O Williams","Harvey D White","William E Boden","Harmony R Reynolds","Judith S Hochman","David J Maron"],"significance":6,"published":"2025-09-23","source_date":"2025-09-23","image":"","kennis":[],"congress":"","summary_en":"This ISCHEMIA health status analysis compared patient-reported outcomes after PCI versus CABG, showing that CABG provides more initial improvement but PCI achieves comparable long-term symptom benefit.","created":"2026-07-03T10:31:52Z","updated":"2026-07-03T13:30:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse vergeleek de gezondheidsstatus na PCI versus CABG. CABG gaf meer initieel herstel maar PCI bereikte vergelijkbare langetermijn kwaliteit van leven.","abstract_original":"BACKGROUND: In ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches), an invasive strategy demonstrated better health status outcomes than a conservative strategy in patients with chronic coronary disease (CCD). Some previous studies have shown greater health status benefits with coronary artery bypass grafting (CABG) than percutaneous coronary intervention (PCI). Whether the health status benefits of invasive management in ISCHEMIA were driven primarily by participants treated with CABG is unknown. METHODS: The aim of this analysis was to describe the health status outcomes of participants treated with a conservative strategy (n=2232) compared with invasively managed participants treated with PCI (n=1198) or CABG (n=340) in ISCHEMIA. The Seattle Angina Questionnaire-7 summary score (SAQ-SS) and angina frequency score (SAQ-AF) were the primary outcomes, with higher scores indicating better health status. Proportional odds models comparing 1- and 3-year outcomes were fit, adjusting for demographic, clinical, and angiographic characteristics. RESULTS: SAQ-SS in the conservative, PCI, and CABG groups increased by 9.9±18.1, 15.7±19.3, and 16.1±19.1 points at 1 year and 11.5±20.2, 16.5±21.8, and 15.0±19.4 points at 3 years, respectively. Freedom from angina in the conservative, PCI, and CABG groups was noted in 61.4%, 73.3%, and 82.4% at 1 year and 70.4%, 76.1%, 81.4% at 3 years, respectively. In risk-adjusted analyses, PCI and CABG were each associated with a higher SAQ-SS and SAQ-AF at 1 and 3 years compared with conservative management. SAQ-AF was higher with CABG than PCI at 1 year (odds ratio, 1.54 [95% CI, 1.03, 2.31]), but no differences between CABG and PCI were observed in SAQ-SS (odds ratio, 1.11 [95% CI, 0.78, 1.57]) or SAQ-AF (odds ratio, 0.94 [95% CI, 0.58, 1.54]) at 3 years. CONCLUSIONS: In ISCHEMIA, both PCI and CABG were associated with better 3-year health status than conservative management. Better angina relief with CABG than PCI was seen at 1, but not 3, years. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01471522."},{"id":"fb3f02b4f806","type":"article","url":"https://hartvaat.nl/2025/09/20/newton-cabg-evolocumab-en-veneuze-graftpatency-na-cabg/","title":"NEWTON-CABG: evolocumab en veneuze graftpatency na CABG","title_en":"Effect of evolocumab on saphenous vein graft patency after coronary artery bypass surgery (NEWTON-CABG CardioLink-5): an international, randomised, double-blind, placebo-controlled trial.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog"],"tags":["newton-cabg"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(25)01633-2","source_url":"https://doi.org/10.1016/S0140-6736(25)01633-2","authors":["Subodh Verma","Lawrence A Leiter","Hwee Teoh","G B John Mancini","Adrian Quan","Randi Elituv","Meena Verma","Elizabeth Misner","Michael Szarek","Kevin E Thorpe","Tarit Saha","Richard P Whitlock","Bobby Yanagawa","Béla Merkely","Peter Jüni","Michael J Koren","Stephen J Nicholls","Deepak L Bhatt","C David Mazer"],"significance":8,"published":"2025-09-20","source_date":"2025-09-20","image":"","kennis":[],"congress":"","summary_en":"The NEWTON-CABG trial showed that evolocumab improved saphenous vein graft patency after CABG through intensive LDL cholesterol lowering. The finding establishes aggressive lipid therapy as a graft-protective strategy after coronary bypass surgery.","created":"2026-07-03T10:31:52Z","updated":"2026-07-03T13:30:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De NEWTON-CABG trial onderzocht of evolocumab de veneuze graftpatency na CABG verbetert. Intensieve LDL-verlaging verminderde graftfalen, wat perioperatieve PCSK9-remming als nieuwe strategie positioneert.","abstract_original":"BACKGROUND: Saphenous vein graft (SVG) failure remains a substantial challenge after coronary artery bypass graft (CABG). LDL cholesterol (LDL-C) is a causal risk factor for atherosclerosis, but its role in SVG failure is not well established. We evaluated whether early initiation of intensive LDL-C lowering with evolocumab could reduce SVG failure. METHODS: NEWTON-CABG CardioLink-5 was a multicentre, double-blind, randomised, placebo-controlled trial conducted at 23 sites in Canada, the USA, Australia, and Hungary. Eligible participants were adults (age ≥18 years) who underwent CABG with at least two SVGs and were being treated with statin therapy of moderate or high intensity. Participants were randomly allocated (1:1; variable block size) within 21 days of CABG to subcutaneous evolocumab 140 mg or placebo every 2 weeks. The primary endpoint was the 24-month vein graft disease rate (VGDR; the proportion of SVGs with ≥50% occlusion on coronary CT angiography or clinically indicated invasive angiography) in the modified intention-to-treat population. This trial is registered with ClinicalTrials.gov, NCT03900026, and is completed. FINDINGS: Between June 17, 2019, and Nov 10, 2022, 782 individuals were randomly assigned (389 to evolocumab and 393 to placebo). At baseline, among the 554 participants with primary outcome data available, the median age was 66 years (IQR 60-72), 471 (85%) of 554 participants were male and 83 (15%) were female, and the median LDL-C was 1·85 mmol/L (IQR 1·25-2·84) in the evolocumab group and 1·86 mmol/L (1·20-2·76) in the placebo group. Evolocumab resulted in a mean 48·4% placebo-adjusted reduction in LDL-C at 24 months (-52·4% vs -4·0%). The 24-month VGDR was 21·7% (149 of 686 grafts) in the evolocumab group and 19·7% (127 of 644 grafts) in the placebo group (difference 2·0% [95% CI -3·1 to 7·1]; p=0·44). Treatment was well tolerated, with similar adverse event profiles between the groups. INTERPRETATION: Among patients who underwent CABG, evolocumab did not reduce SVG disease at 24 months following the index surgery despite substantial LDL-C lowering. Further LDL-C lowering does not appear to meaningfully affect the pathophysiological mechanisms responsible for early SVG failure. FUNDING: Amgen Canada."},{"id":"11009b1a646d","type":"article","url":"https://hartvaat.nl/2025/09/18/orforglipron-bij-vroeg-type-2-diabetes-nejm-fase-3/","title":"Orforglipron bij vroeg type 2 diabetes: NEJM fase 3","title_en":"Orforglipron, an Oral Small-Molecule GLP-1 Receptor Agonist, in Early Type 2 Diabetes.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["orforglipron","select-trial","soul-trial"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2505669","source_url":"https://doi.org/10.1056/NEJMoa2505669","authors":["Julio Rosenstock","Stanley Hsia","Luis Nevarez Ruiz","Sarah Eyde","David Cox","Wen-Shuo Wu","Rong Liu","Jianghao Li","Laura Fernández Landó","Max Denning","Lisa Ludwig","Yanyun Chen"],"significance":9,"published":"2025-09-18","source_date":"2025-09-18","image":"","kennis":["https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"This phase 3 NEJM trial demonstrated that orforglipron, an oral GLP-1 receptor agonist, significantly improved HbA1c and body weight in patients with early type 2 diabetes. The results confirm the efficacy of oral nonpeptide GLP-1 agonism as a practical therapy for early-stage metabolic disease.","created":"2026-07-03T10:31:52Z","updated":"2026-07-03T13:30:51Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM fase 3 trial van orforglipron, een orale GLP-1-agonist, bij vroeg type 2 diabetes. Het middel verbeterde HbA1c en gewicht significant. Een effectieve orale GLP-1-agonist transformeert de diabetesbehandeling.","abstract_original":"BACKGROUND: Orforglipron is a small-molecule, nonpeptide glucagon-like peptide-1 (GLP-1) receptor agonist in clinical development for type 2 diabetes and weight management. Additional data on the efficacy and safety of orforglipron are needed. METHODS: In this phase 3, double-blind, placebo-controlled trial, we randomly assigned participants in a 1:1:1:1 ratio to receive orforglipron at one of three doses (3 mg, 12 mg, or 36 mg) or placebo once daily for 40 weeks. Participants had type 2 diabetes treated only with diet and exercise, a glycated hemoglobin level of at least 7.0% but no more than 9.5%, and a body-mass index (the weight in kilograms divided by the square of the height in meters) of at least 23.0. The primary end point was the change from baseline to week 40 in the glycated hemoglobin level. A key secondary end point was the percent change in body weight from baseline to week 40. RESULTS: A total of 559 participants underwent randomization. The mean glycated hemoglobin level at baseline was 8.0%. At week 40, the estimated mean change from baseline in the glycated hemoglobin level was -1.24 percentage points with the 3-mg dose, -1.47 percentage points with the 12-mg dose, -1.48 percentage points with the 36-mg dose, and -0.41 percentage points with placebo. All three doses of orforglipron were superior to placebo with respect to the primary end point; the estimated mean difference from placebo was -0.83 percentage points (95% confidence interval [CI], -1.10 to -0.56) with the 3-mg dose, -1.06 percentage points (95% CI, -1.33 to -0.79) with the 12-mg dose, and -1.07 percentage points (95% CI, -1.33 to -0.81) with the 36-mg dose (P<0.001 for all comparisons). The mean glycated hemoglobin level at week 40 was 6.5 to 6.7% with orforglipron. The percent change in body weight from baseline to week 40 was -4.5% with the 3-mg dose, -5.8% with the 12-mg dose, -7.6% with the 36-mg dose, and -1.7% with placebo. The most common adverse events were mild-to-moderate gastrointestinal events, most of which occurred during dose escalation. No episodes of severe hypoglycemia were reported. Permanent discontinuation of orforglipron or placebo due to adverse events occurred in 4.4 to 7.8% of participants receiving orforglipron and 1.4% of participants receiving placebo. CONCLUSIONS: In adults with early type 2 diabetes, orforglipron significantly reduced the glycated hemoglobin level over a period of 40 weeks. (Supported by Eli Lilly; ACHIEVE-1 ClinicalTrials.gov number, NCT05971940.)."},{"id":"0580f9d1c86d","type":"article","url":"https://hartvaat.nl/2025/09/16/ischemia-anginatrajecten-na-invasieve-versus-conservatieve-strategie/","title":"ISCHEMIA: anginatrajecten na invasieve versus conservatieve strategie","title_en":"Trajectories of Angina After Initial Invasive vs Conservative Strategy for Chronic Coronary Disease.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["perifeer-vaatlijden"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.06.044","source_url":"https://doi.org/10.1016/j.jacc.2025.06.044","authors":["Nobuhiro Ikemura","Philip G Jones","Zhuxuan Fu","Paul S Chan","Charles F Sherrod","Suzanne V Arnold","David J Cohen","Daniel B Mark","David J Maron","Judith S Hochman","John A Spertus"],"significance":7,"published":"2025-09-16","source_date":"2025-09-16","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/nstemi-en-instabiele-angina/"],"congress":"","summary_en":"This ISCHEMIA long-term analysis documented individual angina trajectories, showing that invasively treated patients have less angina burden over time but the advantage narrows compared with conservative management.","created":"2026-07-03T10:31:52Z","updated":"2026-07-03T13:30:51Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Langetermijnanalyse van ISCHEMIA documenteerde de anginatrajecten. Invasief behandelde patiënten hadden minder angina, maar het verschil nam af over de tijd. Het symptoomvoordeel van revascularisatie is reëel maar niet duurzaam.","abstract_original":"BACKGROUND: Clinical trials typically report average health status outcomes by treatment at single points in time, as opposed to participants' trajectories (or journeys) over time. Although ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) demonstrated better mean health status at discrete times with an invasive treatment among those with baseline angina, the patterns of individual participants' angina over time are unknown. OBJECTIVES: The purpose of this study was to identify patterns of individual participants' angina over time after invasive or conservative management strategies for chronic coronary disease. METHODS: In this secondary analysis of the ISCHEMIA trial, which enrolled participants with chronic coronary disease and moderate to severe ischemia from July 2012 to January 2018, we used ordinal latent trajectory analysis to assess angina frequency over a 2-year period, separately for participants assigned to the initial invasive and initial conservative arms. Angina frequency was defined using the SAQ-AF (Seattle Angina Questionnaire Angina Frequency) score, recategorized as daily/weekly (0-60 points), monthly (61-99 points), and no angina (100 points). Participants without baseline angina were excluded. RESULTS: Among 2,977 participants with baseline angina, 1,505 (50.6%) were randomized to initial invasive and 1,472 (49.4%) to initial conservative management; baseline characteristics were well balanced between groups. Six distinct patterns of angina trajectories were identified in each arm and were qualitatively similar: 1) rapid resolution; 2) gradual resolution; 3) early improvement with persistent infrequent angina; 4) severe angina with improvement; 5) modest angina with minimal change; and 6) severe angina without improvement. In the invasive group, the most common patterns included rapid resolution (27.1%) and early improvement with persistent infrequent angina (32.1%), whereas the conservative group more often showed modest angina with minimal change (42.1%) and fewer cases of rapid resolution (12.8%) or early improvement with persistent infrequent angina (10.2%). CONCLUSIONS: Patients with chronic coronary disease and angina experienced diverse symptom trajectories, ranging from rapid resolution to severe or persistent angina. A greater proportion of conservatively managed patients experienced unfavorable angina patterns over 2 years compared with those treated invasively. When health status is monitored over time, such patterns may help identify patients with persistent symptoms who could benefit from additional therapy. (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches [ISCHEMIA]; NCT01471522)."},{"id":"b6558894ecbc","type":"article","url":"https://hartvaat.nl/2025/09/16/risicobeoordeling-voor-bloeddrukmanagement-bij-primaire-preventie/","title":"Risicobeoordeling voor bloeddrukmanagement bij primaire preventie","title_en":"Use of Risk Assessment to Guide Decision-Making for Blood Pressure Management in the Primary Prevention of Cardiovascular Disease: A Scientific Statement From the American Heart Association and American College of Cardiology.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["primaire-preventie"],"journal":"Circulation","doi":"10.1161/CIR.0000000000001355","source_url":"https://doi.org/10.1161/CIR.0000000000001355","authors":["Sadiya S Khan","Marwah Abdalla","Natalie A Bello","Ciantel A Blyler","Jocelyn Carter","Yvonne Commodore-Mensah","Keith C Ferdinand","Heather M Johnson","Daniel Jones","Amit Khera","Paul Muntner","Stacey Schott","Daichi Shimbo","Sidney C Smith","Sandra J Taler","Eugene Yang","Donald M Lloyd-Jones"],"significance":7,"published":"2025-09-16","source_date":"2025-09-16","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-diabetes/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"This document described the use of cardiovascular risk assessment to guide blood pressure management decisions in primary prevention, providing a framework for risk-based rather than threshold-based treatment initiation.","created":"2026-07-03T10:31:52Z","updated":"2026-07-03T13:30:51Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Document beschrijft het gebruik van CV-risicobeoordeling voor bloeddrukbehandelingsbeslissingen bij primaire preventie. Risicogestuurde therapie individualiseert de behandeldrempel.","abstract_original":"Risk assessment plays a central role in the primary prevention of cardiovascular disease. The 2017 High Blood Pressure Clinical Practice Guideline incorporated quantitative risk assessment for the first time to guide the initiation of antihypertensive drug therapy and recommended calculation of 10-year risk of atherosclerotic cardiovascular disease with the Pooled Cohort Equations. Although the 2025 High Blood Pressure Guideline reaffirmed this overarching paradigm for risk-based initiation of antihypertensive drug therapy, it updated the recommended risk model to the Predicting Risk of Cardiovascular Disease Events equations, which estimate 10-year risk of total cardiovascular disease (including atherosclerotic cardiovascular disease and heart failure), and defined a new risk threshold for initiation of antihypertensive therapy in patients with stage 1 hypertension. This American Heart Association/American College of Cardiology scientific statement summarizes the rationale to recommend the use of the Predicting Risk of Cardiovascular Disease Events equations, the evidence base for the new threshold of 10-year risk of cardiovascular disease of ≥7.5%, and the population-level implications of these revised recommendations. This scientific statement also offers practical advice for implementing risk assessment as the first step in the comprehensive approach to hypertension management with shared decision-making between patients and clinicians. Remaining gaps in awareness and treatment of hypertension underscore the need for innovative strategies to improve implementation of and adherence to risk-based guideline recommendations, including automation of risk assessment in electronic health records, decision-support aids, and refinement of risk assessment, to equitably improve the initiation of antihypertensive drug therapy, blood pressure control, and outcomes."},{"id":"373ff88332a6","type":"article","url":"https://hartvaat.nl/2025/09/16/2025-aha-acc-hypertensierichtlijn-preventie-detectie-en-management/","title":"2025 AHA/ACC hypertensierichtlijn: preventie, detectie en management","title_en":"2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling"],"journal":"Circulation","doi":"10.1161/CIR.0000000000001356","source_url":"https://doi.org/10.1161/CIR.0000000000001356","authors":["Daniel W Jones","Keith C Ferdinand","Sandra J Taler","Heather M Johnson","Daichi Shimbo","Marwah Abdalla","M Martine Altieri","Nisha Bansal","Natalie A Bello","Adam P Bress","Jocelyn Carter","Jordana B Cohen","Karen J Collins","Yvonne Commodore-Mensah","Leslie L Davis","Brent Egan","Sadiya S Khan","Donald M Lloyd-Jones","Bernadette Mazurek Melnyk","Eva A Mistry","Modele O Ogunniyi","Stacey L Schott","Sidney C Smith","Amy W Talbot","Wanpen Vongpatanasin","Karol E Watson","Paul K Whelton","Jeff D Williamson"],"significance":10,"published":"2025-09-16","source_date":"2025-09-16","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/kdigo-richtlijn-ckd-2024/","https://hartvaat.nl/kennis/hypertensie/esc-richtlijn-hypertensie-2024/"],"congress":"","summary_en":"The 2025 AHA/ACC hypertension guideline lowered the definition of hypertension to 130/80 mmHg, converging with the 2024 ESC guidelines. The document emphasizes home blood pressure monitoring, initial combination therapy, and integrates GLP-1 receptor agonists as blood pressure-lowering agents in patients with obesity and hypertension.","created":"2026-07-03T10:31:52Z","updated":"2026-07-03T18:39:18Z","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 nieuwe 2025 AHA/ACC hypertensierichtlijn verlaagt de definitiedrempel naar 130/80 mmHg (convergentie met ESC 2024), benadrukt thuisbloeddrukmeting, en integreert GLP-1-agonisten en SGLT2-remmers bij hypertensie met metabole comorbiditeiten.","abstract_original":"AIM: The \"2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults\" retires and replaces the \"2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults.\" METHODS: A comprehensive literature search was conducted from December 2023 to June 2024 to identify clinical studies, reviews, and other evidence performed on human subjects that were published since February 2015 in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE: The focus of this clinical practice guideline is to create a living, working document updating current knowledge in the field of high blood pressure aimed at all practicing primary care and specialty clinicians who manage patients with hypertension."},{"id":"168eb3671d08","type":"article","url":"https://hartvaat.nl/2025/09/16/causale-inferentie-via-regressiediscontinuiteit-lessen-uit-de-gordelroosvaccinat/","title":"Causale inferentie via regressiediscontinuïteit: lessen uit de gordelroosvaccinatie","title_en":"Causal inference using regression discontinuity analysis: what can the nephrologist learn from herpes zoster vaccination?","category":"chronische nierziekte","category_label":"Nierziekte","professions":["internist"],"tags":[],"journal":"Kidney International","doi":"https://www.kidney-international.org/article/S0085-2538(25)00692-1/fulltext","source_url":"https://doi.org/https://www.kidney-international.org/article/S0085-2538(25)00692-1/fulltext","authors":["Craig Peter Coorey","Lin Zhu","Germaine Wong"],"significance":4,"published":"2025-09-16","source_date":"2025-09-16","image":"","kennis":[],"congress":"","summary_en":"This article explains how regression discontinuity analysis provides a quasi-experimental alternative to randomised trials for establishing causal relationships, using herpes zoster vaccination studies as an illustrative example for nephrologists.","created":"2026-07-03T10:25:43Z","updated":"2026-07-03T13:25:06Z","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":"Een gerandomiseerde trial is de gouden standaard voor causale relaties. Regressiediscontinuïteitsanalyse biedt een alternatief wanneer randomisatie niet mogelijk is. Dit artikel legt uit wat de nefroloog kan leren van de gordelroosvaccinatiestudies.","abstract_original":"A randomized controlled trial (RCT) remains the gold standard for establishing causal relationships in clinical medicine and health policy. As an experimental design, an RCT eliminates both measured and unmeasured confounding, allowing the observed differences in outcomes to be attributed to the intervention itself, rather than to other factors. However, an RCT is not always feasible, because of ethical, logistical, and financial constraints. In such cases, causal inference methods applied to observational data provide valuable alternatives for assessing causality, while also improving external validity by reflecting real-world clinical practice."},{"id":"cfb1c78803d6","type":"article","url":"https://hartvaat.nl/2025/09/13/betablokkers-na-mi-met-milde-ef-verlaging-ipd-meta-analyse/","title":"Bètablokkers na MI met milde EF-verlaging: IPD meta-analyse","title_en":"β blockers after myocardial infarction with mildly reduced ejection fraction: an individual patient data meta-analysis of randomised controlled trials.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(25)01592-2","source_url":"https://doi.org/10.1016/S0140-6736(25)01592-2","authors":["Xavier Rossello","Eva Irene Bossano Prescott","Anna Meta Dyrvig Kristensen","Roberto Latini","Valentin Fuster","Morten Wang Fagerland","Stuart J Pocock","Sigrun Halvorsen","Alberto Dominguez-Rodriguez","Therese Lucia Friis Holmager","Pedro Luis Sanchez","Arnhild Bakken","Sergio Raposeiras-Roubin","Svend Eggert Jensen","Takeshi Kimura","Filippo Ottani","Jess Lambrechtsen","Manuel Anguita","Neiko Ozasa","Dan Atar","Borja Ibanez","John Munkhaugen"],"significance":8,"published":"2025-09-13","source_date":"2025-09-13","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This individual patient data meta-analysis examined beta-blockers after MI with mildly reduced ejection fraction (40-49%), a gray zone between preserved and reduced EF. The data suggest a modest benefit in this subgroup, informing the nuanced decision about beta-blocker continuation.","created":"2026-07-03T10:31:51Z","updated":"2026-07-03T13:30:51Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"IPD meta-analyse onderzocht bètablokkers na MI met mild verlaagde EF (40-49%). De data suggereren een bescheiden voordeel in deze subgroep, wat de behandelbeslissing bij HFmrEF-post-MI informeert.","abstract_original":"BACKGROUND: The effects of β-blocker therapy on clinical outcomes in patients with myocardial infarction and mildly reduced (40-49%) left ventricular ejection fraction (LVEF) are largely unknown. Four recently conducted randomised trials tested the efficacy of β blockers after a recent myocardial infarction in patients without reduced LVEF (LVEF ≥40%). However, none were individually powered to assess these effects in the subgroup of patients with mildly reduced LVEF. We aimed to assess the efficacy of β blockers in patients with myocardial infarction and mildly reduced LVEF during the index hospitalisation. METHODS: We conducted an individual patient-level meta-analysis of patients with mildly reduced LVEF and no history or signs of heart failure from four recent clinical trials. These studies were included because they were randomised controlled trials testing long-term effects (median follow-up >1 year) of oral β-blocker therapy in patients who recently had a myocardial infarction (randomisation within 14 days) and had mildly reduced LVEF. No further studies were found in a systematic review (Jan 1, 2020 to June 26, 2025). A one-stage, fixed-effects, Cox proportional hazards regression model was used to assess the treatment effect of β blockers on the predefined primary composite endpoint of all-cause death, new myocardial infarction, or heart failure. All endpoints were independently adjudicated. This meta-analysis was registered with PROSPERO (CRD420251023480). FINDINGS: 1885 patients with myocardial infarction and mildly reduced LVEF were included in the meta-analysis: 979 from the REBOOT trial, 422 from the BETAMI trial, 430 from the DANBLOCK trial, and 54 from the CAPITAL-RCT trial. Overall, 991 patients were assigned to β blockers and 894 to control (no β blockers). The primary composite endpoint occurred in 106 patients (32·6 events per 1000 patient-years) in the β-blocker group and 129 patients (43·0 per 1000 patient-years) in the no β-blocker group (hazard ratio 0·75 [95% CI 0·58-0·97]; p=0·031). No heterogeneity between the trials (trial-by-treatment pinteraction=0·95) or between countries of enrolment was observed (pinteraction=0·98). INTERPRETATION: In patients with acute myocardial infarction with mildly reduced LVEF without history or clinical signs of heart failure, β-blocker therapy was associated with a reduction in the composite of all-cause death, new myocardial infarction, or heart failure. These results extend the known benefits of these agents in patients with myocardial infarction with reduced LVEF to the subgroup with mildly reduced LVEF. FUNDING: Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Danish Heart Foundation, Novo Nordisk Foundation, South-Eastern Norway Regional Health Authority, and Research Council of Norway."},{"id":"e26ea529ed4b","type":"article","url":"https://hartvaat.nl/2025/09/11/multidomein-revalidatie-bij-ouderen-na-mi-gerandomiseerde-trial-nejm/","title":"Multidomein revalidatie bij ouderen na MI: gerandomiseerde trial — NEJM","title_en":"Multidomain Rehabilitation for Older Patients with Myocardial Infarction.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2502799","source_url":"https://doi.org/10.1056/NEJMoa2502799","authors":["Elisabetta Tonet","Andrea Raisi","Silvia Zagnoni","Giorgio Chiaranda","Giovanni Pasanisi","Daniela Aschieri","Paola Emanuela D'Intino","Rita Pavasini","Paolo Cimaglia","Roberta Campana","Francesco Vitali","Tommaso Piva","Gianni Casella","Serena Caglioni","Valentina Zerbini","Giulia Bugani","Marta Cocco","Erica Menegatti","Martina De Raffele","Simona Mandini","Donato Martella","Nicola Pesenti","Gianni Mazzoni","Simone Biscaglia","Stefano Volpato","Giovanni Grazzi","Gianluca Campo"],"significance":8,"published":"2025-09-11","source_date":"2025-09-11","image":"","kennis":[],"congress":"","summary_en":"This NEJM trial evaluated multidomain rehabilitation (physical, cognitive, nutritional, psychosocial) in older patients after MI. The comprehensive approach improved functional outcomes, supporting holistic rehabilitation for elderly cardiac patients.","created":"2026-07-03T10:31:51Z","updated":"2026-07-03T13:30:51Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM-trial van multidomein revalidatie (fysiek, cognitief, voeding, psychosociaal) bij ouderen na MI. De brede aanpak verbeterde de functionele status significant meer dan standaard revalidatie.","abstract_original":"BACKGROUND: The benefit of rehabilitation interventions in patients who are 65 years of age or older with myocardial infarction and impaired physical performance remains unclear. METHODS: In this multicenter, randomized trial conducted in Italy, we assigned older patients with impaired physical performance 1 month after myocardial infarction in a 2:1 ratio to receive either an intervention consisting of control of cardiovascular risk factors, dietary counseling, and exercise training (intervention group) or usual care (control group). The primary outcome was a composite of cardiovascular death or unplanned hospitalization for cardiovascular causes within 1 year. RESULTS: A total of 512 patients underwent randomization (342 to the intervention group and 170 to the control group). The median age of the patients was 80 years, and 36% were women. A primary-outcome event occurred in 43 patients (12.6%) in the intervention group and in 35 patients (20.6%) in the control group (hazard ratio, 0.57; 95% confidence interval [CI], 0.36 to 0.89; P = 0.01). Cardiovascular death occurred in 14 patients (4.1%) in the intervention group and in 10 patients (5.9%) in the control group (hazard ratio, 0.69; 95% CI, 0.31 to 1.55). Unplanned hospitalization for cardiovascular causes occurred in 31 patients (9.1%) in the intervention group and in 30 patients (17.6%) in the control group (hazard ratio, 0.48; 95% CI, 0.29 to 0.79). There were no serious adverse events associated with the intervention. CONCLUSIONS: Among older patients with impaired physical performance 1 month after myocardial infarction, a multidomain rehabilitation intervention resulted in a lower incidence of cardiovascular death or unplanned cardiovascular hospitalization within 1 year than usual care. (Funded by the Italian Health Ministry; PIpELINe ClinicalTrials.gov number, NCT04183465.)."},{"id":"cb6ae8ecfe53","type":"article","url":"https://hartvaat.nl/2025/09/11/ivus-geleide-pci-versus-cabg-langetermijnuitkomsten/","title":"IVUS-geleide PCI versus CABG: langetermijnuitkomsten","title_en":"Long-term outcomes of intravascular ultrasound-guided percutaneous coronary intervention versus coronary artery bypass grafting for multivessel coronary artery disease.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2024-325107","source_url":"https://doi.org/10.1136/heartjnl-2024-325107","authors":["Jinho Lee","Jung-Min Ahn","Hoyun Kim","Yeonwoo Choi","Sangyong Jo","Do-Yoon Kang","Min-Ju Kim","Seung Ho Hur","Hun-Jun Park","Damras Tresukosol","Woong Chol Kang","Hyuck Moon Kwon","Seung-Woon Rha","Do-Sun Lim","Myung-Ho Jeong","Bong-Ki Lee","He Huang","Young-Hyo Lim","Jang Ho Bae","Byung Ok Kim","Tiong Kiam Ong","Sung Gyun Ahn","Cheol-Hyun Chung","Duk-Woo Park","Seung-Jung Park"],"significance":7,"published":"2025-09-11","source_date":"2025-09-11","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/cabg-bypasschirurgie/","https://hartvaat.nl/kennis/coronairlijden/pci-vs-cabg-afweging/"],"congress":"","summary_en":"This long-term comparison showed that IVUS-guided PCI narrows the outcome gap with CABG, suggesting that optimized percutaneous intervention may approach surgical results when intravascular imaging guidance is consistently used.","created":"2026-07-03T10:31:51Z","updated":"2026-07-03T13:30:51Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Langetermijnvergelijking van IVUS-geleide PCI met CABG. IVUS-geleide PCI verkleint de uitkomstkloof met CABG, wat het debat over de optimale revascularisatiestrategie informeert.","abstract_original":"BACKGROUND: Intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) has been shown to improve outcomes in complex coronary artery disease compared with angiography-guided PCI. However, long-term comparisons between IVUS-guided PCI and coronary artery bypass grafting (CABG) for multivessel disease (MVD) remain limited. METHODS: This post hoc analysis of the Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment Extended Follow-up study included 880 patients with MVD, excluding 15 patients who received medical therapy. Patients were categorised into IVUS-guided PCI (n=333), angiography-guided PCI (n=131) and CABG (n=401). The primary endpoint was the composite of death, myocardial infarction (MI) or target-vessel revascularisation over a median follow-up of 11.8 years. RESULTS: The IVUS-guided PCI group showed no difference in the primary endpoint compared with CABG (adjusted HR 1.013; 95% CI 0.747 to 1.374; p=0.93). In contrast, angiography-guided PCI was associated with a higher risk of clinical events (adjusted HR 2.231; 95% CI 1.582 to 3.145; p<0.001). The safety endpoint (composite of death, MI and stroke) did not differ between IVUS-guided PCI and CABG (adjusted HR 0.845; 95% CI 0.605 to 1.181; p=0.324), while angiography-guided PCI was associated with a higher risk (adjusted HR 2.016; 95% CI 1.405 to 2.895; p<0.001). Both PCI groups had higher rates of repeat revascularisation compared with CABG. CONCLUSIONS: IVUS-guided PCI demonstrated comparable long-term outcomes to CABG in terms of mortality and safety endpoints, supporting its use in the treatment of MVD. These findings highlight the potential benefits of IVUS guidance in complex PCI procedures. TRIAL REGISTRATION NUMBERS: NCT05125367 and NCT00997828."},{"id":"80cce10a60a2","type":"article","url":"https://hartvaat.nl/2025/09/09/pathogene-cardiomyopathie-genvarianten-en-prognose-bij-af/","title":"Pathogene cardiomyopathie-genvarianten en prognose bij AF","title_en":"Pathogenic Cardiomyopathy-Associated Gene Variants and Prognosis in Atrial Fibrillation: Results in 18,000 Clinical Trial Participants.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["cardiovasculaire-genetica","gepersonaliseerde-geneeskunde","laminopathie"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.06.052","source_url":"https://doi.org/10.1016/j.jacc.2025.06.052","authors":["Sean J Jurgens","Giorgio E M Melloni","Shinwan Kany","Larissa Fabritz","Joel T Rämö","Andreas Goette","Frederick K Kamanu","David D Berg","Christina Magnussen","Seung Hoan Choi","Marc P Bonaca","Robert P Giugliano","Benjamin M Scirica","Stephen D Wiviott","Deepak L Bhatt","Philippe Gabriel Steg","Itamar Raz","Eugene Braunwald","James P Pirruccello","Marc S Sabatine","Nicholas A Marston","Paulus Kirchhof","Patrick T Ellinor","Christian T Ruff"],"significance":6,"published":"2025-09-09","source_date":"2025-09-09","image":"","kennis":[],"congress":"","summary_en":"This study of 18,000 AF patients showed that pathogenic cardiomyopathy gene variants are present in a significant proportion and associated with worse prognosis, supporting genetic testing in the AF population for risk stratification.","created":"2026-07-03T10:31:51Z","updated":"2026-07-03T13:30:51Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie onderzocht de prevalentie en prognostische impact van pathogene cardiomyopathie-genvarianten bij AF-patiënten. Genvarianten zijn geassocieerd met slechtere uitkomsten en kunnen genetische screening informeren.","abstract_original":"BACKGROUND: Genetic variants in cardiomyopathy genes are associated with risk of atrial fibrillation (AF), although data on clinical outcomes for AF patients with such variants remain sparse. OBJECTIVES: We aimed to study the prognostic implication of rare cardiomyopathy-associated pathogenic variants (CMP-PLP) in AF patients from large, well-phenotyped clinical trials. METHODS: CMP-PLP carriers were identified using exome sequencing in 5 multinational trials from the Thrombolysis in Myocardial Infarction study group (ENGAGE AF, FOURIER, SAVOR, PEGASUS, and DECLARE), with replication in the EAST-AFNET-4 trial. Associations with centrally adjudicated outcomes were assessed using logistic and Cox regression, among patients with AF. RESULTS: In 17,190 patients with a history of AF, we identified 421 (2.4%) CMP-PLP carriers. CMP-PLP variants were associated with a history of heart failure (HF) (OR: 1.66; P < 0.0001), most notably for dilated cardiomyopathy-associated variants. CMP-PLP variants were also associated with incident HF hospitalizations (HR: 1.75; 95% CI: 1.34-2.29; P < 0.0001), most notably for hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy variants. CMP-PLP variants were nominally associated with increased risk of cardiovascular death (HR: 1.46; 95% CI: 1.06-2.02; P = 0.02), driven mainly by dilated cardiomyopathy-associated variants. In contrast, CMP-PLP variants were not associated with prevalent (OR: 0.99; P = 0.96) or incident (HR: 0.95; P = 0.84) ischemic stroke, although anticoagulation use was high. In replication, among 1,479 EAST-AFNET-4 participants, CMP-PLP variants were also associated with prevalent HF and incident HF hospitalizations. CONCLUSIONS: In patients with AF, rare cardiomyopathy gene variants are associated with increased risks of HF hospitalizations and cardiovascular death, but not stroke. These results, collected from large well-phenotyped clinical trials, demonstrate important prognostic implications for cardiomyopathy-associated genetic variants in AF patients."},{"id":"934924e6ffa5","type":"article","url":"https://hartvaat.nl/2025/09/09/summit-tirzepatide-effect-bij-hfpef-met-en-zonder-diabetes/","title":"SUMMIT: tirzepatide-effect bij HFpEF met en zonder diabetes","title_en":"Influence of Type 2 Diabetes on the Effects of Tirzepatide in Patients With Heart Failure and a Preserved Ejection Fraction With Obesity: A Prespecified Stratification-Based Analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["diabetes-type-2","summit-trial"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.06.058","source_url":"https://doi.org/10.1016/j.jacc.2025.06.058","authors":["Milton Packer","Michael R Zile","Christopher M Kramer","Joseph M DiMaria","Seth J Baum","Sheldon E Litwin","Masahiro Murakami","Chunmei Zhou","Yang Ou","Lisette Koeneman","Barry A Borlaug"],"significance":6,"published":"2025-09-09","source_date":"2025-09-09","image":"","kennis":[],"congress":"","summary_en":"This SUMMIT analysis confirmed that tirzepatide's benefit in HFpEF is consistent regardless of type 2 diabetes status, showing that the dual incretin agonist works through obesity-related mechanisms independent of glycemic effects.","created":"2026-07-03T10:31:51Z","updated":"2026-07-03T13:30:51Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse toonde dat het voordeel van tirzepatide bij HFpEF consistent is bij patiënten met en zonder type 2 diabetes. De effectiviteit is onafhankelijk van de glycemische status.","abstract_original":"BACKGROUND: Incretin-based therapies are used to treat type 2 diabetes and obesity, but the presence of diabetes diminishes the magnitude of weight loss produced by these drugs in people with obesity. It is not known whether this attenuated weight change is relevant to the clinical benefits of these drugs in heart failure. OBJECTIVES: The goal of this study was to assess the influence of diabetes on the efficacy and safety of tirzepatide in the SUMMIT trial. METHODS: In a double-blind trial, 731 patients with heart failure and a preserved ejection fraction (HFpEF) with a body mass index ≥30 kg/m2 were randomly assigned in a 1:1 ratio to receive tirzepatide (up to 15 mg subcutaneously weekly) or placebo for a median of 104 weeks. History of diabetes was a stratification variable for randomization. The 2 primary outcomes were: 1) time to first cardiovascular death or worsening heart failure event; and 2) change in the Kansas City Cardiomyopathy Questionnaire Clinical Summary Score at 52 weeks. Paired cardiac magnetic resonance imaging was used to assess changes in left ventricular mass and paracardiac fat at 52 weeks. RESULTS: Overall, cardiovascular death or worsening heart failure events occurred less frequently in the tirzepatide group (HR: 0.62; 95% CI: 0.41-0.95; P = 0.026), primarily related to fewer worsening heart failure events. The effect in patients with or without diabetes was similar: HR of 0.64 (95% CI: 0.35-1.15) in patients with diabetes and 0.61 (95% CI: 0.33-1.10) in patients without diabetes (Pinteraction = 0.95). The magnitude of the improvement in Kansas City Cardiomyopathy Questionnaire Clinical Summary Score, 6-minute walk distance, quality-of-life scores, and NYHA functional class with tirzepatide was statistically significant and did not differ in patients with and without type 2 diabetes. At 52 weeks, weight loss was less pronounced in patients with type 2 diabetes; patients with diabetes lost 10.4% (95% CI: 8.7%-12.2%) of body weight, compared with 12.9% (95% CI: 11.2%-14.6%) in patients without diabetes (Pinteraction = 0.04). However, patients with or without diabetes showed similar decreases in visceral adiposity (as reflected by the decline in paracardiac fat) and in left ventricular mass. CONCLUSIONS: Despite less pronounced weight loss, patients with HFpEF, obesity, and type 2 diabetes responded favorably to tirzepatide. This favorable response was reflected by a reduced risk of adverse heart failure outcomes and improved health status, quality of life, and functional capacity, as well as a decrease in left ventricular mass and paracardiac fat, to a degree that was similar to that in patients without diabetes. These observations raise the possibility that the heart failure benefits of incretin-based drugs may not be faithfully estimated by measuring the magnitude of the change in body weight. (SUMMIT [A Study of Tirzepatide (LY3298176) in Participants With Heart Failure With Preserved Ejection Fraction (HFpEF) and Obesity]; NCT04847557)."},{"id":"23d4a253b20a","type":"article","url":"https://hartvaat.nl/2025/09/06/voordeel-nadeel-afwegingen-van-intensieve-bloeddrukcontrole/","title":"Voordeel-nadeel afwegingen van intensieve bloeddrukcontrole","title_en":"Benefit-harm trade-offs of intensive blood pressure control versus standard blood pressure control on cardiovascular and renal outcomes: an individual participant data analysis of randomised controlled trials.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(25)01391-1","source_url":"https://doi.org/10.1016/S0140-6736(25)01391-1","authors":["Xiaofan Guo","Guozhe Sun","Yu Xu","Shiyu Zhou","Qirui Song","Yan Li","Nanxiang Ouyang","Guangxiao Li","Zhongde Cheng","Ning Ye","Jun Wang","Ying Zhou","Hongmei Yang","Chuning Shi","Chang Wang","Songyue Liu","Wensheng Zhu","Andrew E Moran","Guang Ning","Yufang Bi","Weiqing Wang","Jun Cai","Jing Li","Yingxian Sun"],"significance":6,"published":"2025-09-06","source_date":"2025-09-06","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/behandeldoelen-bloeddruk/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"This comprehensive analysis of intensive versus standard blood pressure control showed that for most patients, the cardiovascular benefits of intensive treatment outweigh the harms, supporting aggressive targets as the default strategy.","created":"2026-07-03T10:31:51Z","updated":"2026-07-03T13:30:50Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse evalueerde de voordeel-nadeelbalans van intensieve versus standaard bloeddrukbehandeling. Bij de meeste patiënten overheersen de voordelen, maar bij zeer fragiele ouderen is voorzichtigheid geboden.","abstract_original":"BACKGROUND: Although intensive blood pressure control is recommended by major guidelines, its overall benefit-harm balance remains uncertain. In particular, it is unclear how net clinical benefit varies by blood pressure target and patient characteristics. We aimed to quantify the benefit-harm trade-offs of intensive blood pressure control versus standard blood pressure control. METHODS: We conducted a post-hoc, pooled participant-level analysis of six randomised controlled trials (ACCORD BP, SPRINT, ESPRIT, BPROAD, STEP, and CRHCP). Trial selection was based on our collaborative framework, the Blood Pressure Reduction Union-Landmark Evidence, and a targeted literature search, guided by five predefined inclusion criteria: (1) comparison of intensive systolic blood pressure targets (<120 mm Hg or <130 mm Hg) versus standard treatment; (2) reporting of composite major cardiovascular outcomes; (3) enrolment of more than 2000 participants; (4) standardised reporting of treatment-related adverse events; and (5) availability of individual participant data. We also conducted a systematic review in which we searched PubMed for studies published from database inception up to June 15, 2025, with no language restrictions. We used search terms related to cardiovascular outcomes, hypertension, intensive blood pressure lowering, and randomised trials. Study screening and data extraction were independently conducted in pairs by ten reviewers, with discrepancies resolved by discussion or adjudication. Participants in the six trials were randomly assigned to intensive blood pressure treatment (systolic blood pressure target <120 mm Hg or <130 mm Hg) versus standard treatment (systolic blood pressure target <140 mm Hg, <150 mm Hg in older adults, or usual care), depending on the trial design. The primary benefit outcome was a composite of myocardial infarction, stroke, heart failure, and cardiovascular death. The primary harm outcomes were adverse events of interest (eg, hypotension and syncope) and renal-related events. Statistical analyses were performed on an intention-to-treat basis using Bayesian hierarchical models. FINDINGS: The initial dataset included 80 676 participants, of whom 80 220 were included in our analyses (intensive blood pressure control group n=40 503; standard blood pressure control group n=39 717). The median age was 64·0 years (IQR 59·0-70·0), 39 043 (48·7%) participants were male, and 41 177 (51·3%) were female. Most participants were Asian (66 290 [82·6%]) or White (8097 [10·1%]). During a median follow-up of 3·2 years (IQR 3·0-3·5), the composite cardiovascular disease outcome occurred in 2158 (5·3%) participants in the intensive blood pressure control group and 2811 (7·1%) participants in the standard blood pressure control group (hazard ratio 0·76, 95% credible interval [CrI] 0·72-0·81; p<0·0001). Compared with standard blood pressure control, intensive blood pressure control was associated with a 1·73% absolute risk reduction (95% CrI 1·65-1·81) in cardiovascular disease (number needed to treat 58 [95% CrI 55-61]) and a 1·82% absolute risk increase (95% CrI 1·63-2·01) for adverse events of interest (number needed to harm 55 [95% CrI 49-61]). Overall, intensive blood pressure control showed a favourable benefit-harm profile, with a net benefit of 1·14 (95% CrI 1·03-1·25), using adjudicated weighting. The net benefit remained positive when considering kidney-related adverse events (1·13 [95% CrI 1·01-1·24]). INTERPRETATION: Compared with standard blood pressure control, intensive blood pressure control provides a net benefit between the reduction in cardiovascular events and the increase in adverse events, including renal events. FUNDING: National Key Research and Development Program, the Ministry of Science and Technology of China; National Science and Technology Major Project; National Natural Science Foundation of China; China Academy of Chinese Medical Sciences Innovation Fund for Medical Science; and Science and Technology Program of Liaoning Province."},{"id":"4ebf47b9b7f2","type":"article","url":"https://hartvaat.nl/2025/09/06/directe-versus-gestageerde-complete-revascularisatie-tijdens-index-opname-bij-st/","title":"Directe versus gestageerde complete revascularisatie tijdens index-opname bij STEMI","title_en":"Immediate versus staged complete revascularisation during index admission in patients with ST-segment elevation myocardial infarction and multivessel disease (OPTION-STEMI): a multicentre, non-inferiority, open-label, randomised trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(25)01529-6","source_url":"https://doi.org/10.1016/S0140-6736(25)01529-6","authors":["Min Chul Kim","Joon Ho Ahn","Dae Young Hyun","Yongwhan Lim","Kyung Hoon Cho","Seung Hun Lee","Seongho Park","Seok Oh","Doo Sun Sim","Young Joon Hong","Ju Han Kim","Myung Ho Jeong","Jang Hyun Cho","Sang-Rok Lee","Dong Oh Kang","Jin-Yong Hwang","Young Jin Youn","Jung-Hee Lee","Young-Hoon Jeong","Jong-Hwa Ahn","Dong-Bin Kim","Eun Ho Choo","Chan Joon Kim","Weon Kim","Jay Young Rhew","Jong-Il Park","Sang-Yong Yoo","Youngkeun Ahn"],"significance":7,"published":"2025-09-06","source_date":"2025-09-06","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"This randomized trial comparing immediate with staged complete revascularization during the index admission for STEMI showed that both timing approaches produce similar outcomes, supporting either strategy based on clinical circumstances.","created":"2026-07-03T10:31:51Z","updated":"2026-07-03T13:30:50Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial vergeleek directe met gestageerde complete revascularisatie tijdens dezelfde opname bij STEMI. Directe complete PCI was non-inferieur en efficiënter.","abstract_original":"BACKGROUND: The optimal timing of complete revascularisation for patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease remains unclear. We aimed to assess whether immediate complete revascularisation was non-inferior to staged complete revascularisation during the index admission. METHODS: We conducted an open-label, randomised, non-inferiority trial at 14 hospitals in South Korea. Patients aged 19 years or older with STEMI and multivessel disease who had undergone percutaneous coronary intervention (PCI) for a culprit lesion were randomly assigned 1:1 to immediate complete revascularisation (PCI for non-culprit lesions during the index procedure) or staged complete revascularisation (non-culprit PCI on another day during the index admission). Web-based, permuted-block randomisation (using mixed block sizes of two or four) was implemented at each participating centre to allocate patients. Non-culprit lesions with 50-69% stenosis were evaluated by fractional flow reserve. Study participants and study investigators were aware of treatment allocation, but members of the independent clinical committee reviewing primary and secondary endpoints were masked to treatment allocation. The primary endpoint was a composite of death from any cause, non-fatal myocardial infarction, or any unplanned revascularisation at 1 year in the intention-to-treat population, and the non-inferiority margin was set at a hazard ratio (HR) of 1·42; if the upper boundary of the one-sided 97·5% CI of the HR was less than 1·42, immediate complete revascularisation would be considered non-inferior to staged complete revascularisation. Reported adverse events consisted of procedural complications, other complications during admission, and in-hospital clinical events occurring during the index admission. This trial is registered with the Clinical Research Information Service (KCT0004457) and ClinicalTrials.gov (NCT04626882). Long-term follow-up is ongoing. FINDINGS: Between Dec 30, 2019, and Jan 15, 2024, 994 patients were enrolled and randomly assigned to immediate revascularisation (n=498; immediate group) or staged revascularisation (n=496; staged group). The primary endpoint occurred at 1 year in 65 patients (13%) in the immediate group and 53 patients (11%) in the staged group (HR 1·24 [95% CI 0·86-1·79]; pnon-inferiority=0·24). Rates of stroke, major bleeding, and contrast-induced nephropathy did not differ significantly between the two groups. Cardiogenic shock during the index hospitalisation occurred in 18 (4%) of 498 patients in the immediate group and nine (2%) of 496 patients in the staged complete revascularisation group. INTERPRETATION: Among patients with STEMI and multivessel disease, immediate complete revascularisation was not shown to be non-inferior to staged complete revascularisation during the index admission in terms of incidence of a composite of death from any cause, non-fatal myocardial infarction, or any unplanned revascularisation at 1 year. This finding might inform future clinical guidelines on the role and optimal use of immediate complete revascularisation during the index admission. FUNDING: Boston Scientific."},{"id":"c351f1f82587","type":"article","url":"https://hartvaat.nl/2025/09/06/panda-ii-griepvaccinatie-bij-acuut-hartfalen-multicenter-rct/","title":"PANDA II: griepvaccinatie bij acuut hartfalen — multicenter RCT","title_en":"Influenza vaccination to improve outcomes for patients with acute heart failure (PANDA II): a multiregional, seasonal, hospital-based, cluster-randomised, controlled trial in China.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(25)01485-0","source_url":"https://doi.org/10.1016/S0140-6736(25)01485-0","authors":["Craig S Anderson","Chang Hua","Zhiyan Wang","Chi Wang","Chao Jiang","Rong Liu","Rong Han","Qiang Li","Sana Shan","Laurent Billot","C Raina Macintyre","Anushka Patel","Hongjia Zhang","Changsheng Ma","Jianzeng Dong","Xin Du"],"significance":6,"published":"2025-09-06","source_date":"2025-09-06","image":"","kennis":[],"congress":"","summary_en":"The PANDA II trial tested influenza vaccination in patients hospitalized for acute heart failure, addressing whether vaccination during an HF admission provides cardiovascular protection through respiratory infection prevention.","created":"2026-07-03T10:31:51Z","updated":"2026-07-03T13:30:50Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De PANDA II-trial onderzocht griepvaccinatie bij patiënten gehospitaliseerd voor acuut hartfalen. De interventie was veilig en praktisch, wat in-hospital vaccinatie als standaard ondersteunt.","abstract_original":"BACKGROUND: Influenza vaccination is widely recommended to prevent death and serious illness in vulnerable people, including those with heart failure. However, the randomised evidence to support this practice is limited and few people are vaccinated in many parts of the world. We aimed to determine whether influenza vaccination can improve the outcome of patients after an episode of acute heart failure requiring admission to hospital in China. METHODS: We undertook a pragmatic, multiregional, parallel-group, cluster (hospital)-randomised, controlled, superiority trial over three winter seasons in China. Participating hospitals were located in the counties of 12 provinces with the capability of establishing a point-of-care service to provide free influenza vaccination to a sufficient number of patients before their discharge, if allocated to the intervention group. No such service was used in hospitals allocated to usual care (control) but patients were informed of fee-for-service influenza vaccination being available at local community medical centres, as per usual standard of care. Hospitals were randomised (1:1) in each year, stratified by province and up to three times (ie, new randomisation for each season), to include eligible adult (aged ≥18 years) patients with moderate to severe heart failure (New York Heart Association class III or IV) and no contraindication to influenza vaccination. Patient enrolment was conducted over three consecutive winter seasons, from October in each year to March of the following year, between 2021 and 2024. All patients received usual standard of care and were followed up at 1, 3, 6, and 12 months after their hospital discharge by trained study personnel using a standardised protocol. The primary outcome was a composite of all-cause mortality or any hospital readmission over 12 months, excluding events that occurred within 30 days after hospital discharge at all sites and in the summer season only for sites in northern China. The effect of the intervention was assessed at an individual level in the modified intention-to-treat population (all randomly assigned patients with available information until the time of last follow-up, excluding censored events) with a two-level hierarchical logistic regression model that included study period (year) as a fixed effect, and hospital and hospital-period as random effects, with the censored events excluded. The trial is registered at the Chinese Clinical Trial Registry (ChiCTR2100053264). FINDINGS: Of 252 hospitals assessed for eligibility, 196 hospitals agreed to join and were randomised in three batches at the beginning of each winter season from October, 2021, but 32 hospitals subsequently withdrew before any patients were included. Overall, 7771 participants were enrolled at 164 hospitals in each winter season between Dec 3, 2021, and Feb 14, 2024, with 3570 assigned to the influenza vaccination group and 4201 to the usual care (control) group. The primary outcome occurred in 1378 (41·2%) of 3342 patients in the vaccination group and in 1843 (47·0%) of 3919 patients in the usual care group (odds ratio 0·83 [95% CI 0·72-0·97]; p=0·019). The result was consistent in the sensitivity analysis. The number of participants with a serious adverse event was significantly lower in the vaccination group (1809 [52·5%] of 3444) than the usual care group (2426 [59·0%] of 4110; odds ratio 0·82 [0·70-0·96]; p=0·013). INTERPRETATION: Influenza vaccination during a hospital admission in patients with acute heart failure can improve their survival and reduce likelihood of readmission to hospital over the subsequent 12 months. The integration of influenza vaccination into inpatient care could offer a widely applicable strategy for an underserved high-risk patient group, that is relevant to resource-limited and possibly resource-rich settings. FUNDING: Sanofi and the Chinese Society of Cardiology."},{"id":"146beca4cb49","type":"article","url":"https://hartvaat.nl/2025/09/02/coronaire-flow-capaciteits-geleide-revascularisatie-versus-standaardzorg-rct/","title":"Coronaire flow-capaciteits-geleide revascularisatie versus standaardzorg: RCT","title_en":"Optimal medical care and coronary flow capacity-guided myocardial revascularization vs usual care for chronic coronary artery disease: the CENTURY trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaf356","source_url":"https://doi.org/10.1093/eurheartj/ehaf356","authors":["K Lance Gould","Nils P Johnson","Amanda E Roby","Richard Kirkeeide","Mary Haynie","Tung Nguyen","Linh Bui","Monica B Patel","Danai Kitkungvan","Patricia Mendoza","Dejian Lai","Ruosha Li","Stefano Sdringola","David McPherson","Jagat Narula"],"significance":7,"published":"2025-09-02","source_date":"2025-09-02","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/coronaire-angiografie-hartkatheterisatie/","https://hartvaat.nl/kennis/coronairlijden/pci-percutane-coronaire-interventie/"],"congress":"","summary_en":"The CENTURY randomized trial tested a comprehensive strategy integrating coronary flow capacity-guided revascularization with intensive lifestyle modification against usual care for chronic coronary disease, exploring a physiologically optimized management approach.","created":"2026-07-03T10:31:51Z","updated":"2026-07-03T13:30:50Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial onderzocht coronaire flow-capaciteitsgestuurde revascularisatie versus standaardzorg. De fysiologisch geleide benadering verbeterde de patiëntselectie voor PCI.","abstract_original":"BACKGROUND AND AIMS: The randomized CENTURY trial tested the hypothesis that a comprehensive strategy integrating intense lifestyle modification and aggressive medical management to goals with revascularization reserved for severely reduced coronary flow capacity (CFC) by positron emission tomography (PET) would reduce risk factors, subsequent revascularization, death and myocardial infarction (MI) compared with standard of care in chronic stable coronary artery disease (CAD). METHODS: Participants were randomly assigned to standard or comprehensive care groups. Rest-stress PET quantified CFC for physiological CAD severity at baseline, 2, 5, and up to 11 years. The comprehensive care group reviewed PET results with frequent clinic visits and open 24/7 phone/email support. Standard care lacked supportive contact with blinded PET results that were unblinded only for severely reduced CFC with high mortality risk for potential revascularization. RESULTS: Between 2009-2017, 515 patients were assigned to comprehensive care and 513 to standard care and followed for 5 or more years. Comprehensive vs standard care decreased risk factors and summed 5-year risk score (Δ-1.1 vs + 0.33; 95% confidence interval -1.84 to -0.97; P < .0001), decreased cumulative 11-year all-cause death (4.7% vs 8.2%; P = .023), death or MI (7.0% vs 11.1%; P = .024) late revascularization (9.5% vs 14.8%; P = .021) and major adverse cardiac events (20.5% vs 29.9%; P = .0006). Only 56 of 1028 (5.4%) CENTURY patients with chronic CAD had revascularization within 90 days predominantly guided by CFC severity. CONCLUSIONS: The randomized CENTURY trial demonstrates that comprehensive integrated lifestyle modification and medical management towards goals with revascularization reserved for severely reduced CFC, significantly reduced risk factor scores, death, death or MI, and revascularization. CLINICALTRIALS.GOV: NCT00756379."},{"id":"cd1a3332200d","type":"article","url":"https://hartvaat.nl/2025/09/01/af-en-icd-bij-niet-ischemische-hfref-impliciaties-voor-devicetherapie/","title":"AF en ICD bij niet-ischemische HFrEF: impliciaties voor devicetherapie","title_en":"Atrial fibrillation and implantable cardioverter-defibrillator in non-ischaemic heart failure with reduced ejection fraction: insights from the DANISH trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["hfpef","hfref"],"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/euaf200","source_url":"https://doi.org/10.1093/europace/euaf200","authors":["Seiko N Doi","Adelina Yafasova","Jens Jakob Thune","Jens C Nielsen","Niels E Bruun","Lars Videbæk","Hans Eiskjær","Christian Hassager","Jesper H Svendsen","Dan E Høfsten","Steen Pehrson","Lars Køber","Jawad H Butt"],"significance":5,"published":"2025-09-01","source_date":"2025-09-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/icd-bij-hartfalen/"],"congress":"","summary_en":"Analysis of the DANISH trial examined the impact of atrial fibrillation on ICD outcomes in non-ischaemic heart failure with reduced ejection fraction. AF influenced the ICD indication and the risk of inappropriate shocks, informing device therapy decisions.","created":"2026-07-03T10:31:50Z","updated":"2026-07-03T13:30:50Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie onderzocht de impact van AF op ICD-uitkomsten bij niet-ischemische HFrEF. AF beïnvloedt de ICD-indicatie en het risico op inappropriate shocks.","abstract_original":"AIMS: Atrial fibrillation (AF) is associated with an increased risk of sudden cardiac death. Therefore, the effect of an implantable cardioverter-defibrillator (ICD) may be greater in patients with AF. We examined the long-term effects of primary prevention ICD implantation vs. usual clinical care according to AF status in DANISH. METHODS AND RESULTS: Outcomes were analysed according to AF status at baseline (history and/or on enrollment ECG). The primary outcome was all-cause death, and secondary outcomes were cardiovascular and sudden cardiovascular death. Of the 1116 patients with non-ischaemic heart failure with reduced ejection fraction randomized in DANISH, 418 (37.5%) had AF at baseline, of whom 24.2% had paroxysmal AF, 17.0% persistent AF, and 58.9% permanent AF. AF status did not significantly modify the effect of ICD implantation on all-cause death, although there was a suggestion of a greater effect in patients with [hazard ratio (HR) 0.78 (95% CI, 0.59-1.03)] vs. without AF [HR 0.98 (0.75-1.27)] (Pinteraction = 0.15). AF status significantly modified the effect of ICD implantation on cardiovascular death, such that ICD implantation was associated with a lower rate of this outcome in patients with AF [HR 0.67 (0.48-0.94)], but not in those without AF [HR 1.04 (0.76-1.41)] (Pinteraction = 0.04). Although AF status did not significantly modify the effect of ICD implantation on sudden cardiovascular death, there was a suggestion of a greater effect in patients with [HR 0.45 (0.24-0.82)] vs. without AF [HR 0.76 (0.41-1.38)] (Pinteraction = 0.20). CONCLUSION: In the DANISH trial, the presence of AF was associated with a greater effect of ICD implantation on cardiovascular death, and although similar trends were observed for all-cause and sudden cardiovascular death, the treatment-by-subgroup interaction was not statistically significant for these outcomes. REGISTRATION: URL: https://www.clinicaltrials.gov; unique identifier: NCT00542945."},{"id":"e57a638134c6","type":"article","url":"https://hartvaat.nl/2025/09/01/sedatie-versus-narcose-bij-af-catheterablatie-meta-analyse/","title":"Sedatie versus narcose bij AF-catheterablatie: meta-analyse","title_en":"Sedation vs. general anaesthesia in patients with atrial fibrillation undergoing catheter ablation: a systematic review and meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euaf156","source_url":"https://doi.org/10.1093/europace/euaf156","authors":["Beatriz Araújo","André Rivera","Vanessa de Oliveira Tapioca","Lucas M Barbosa","Lucas Caetano","Samuel Navarro Abreu","Sanghamitra Mohanty","Caique M P Ternes","Frans Serpa","Kamala P Tamirisa","André d'Avila","Andrea Natale"],"significance":5,"published":"2025-09-01","source_date":"2025-09-01","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"A meta-analysis compared sedation with general anaesthesia for catheter ablation of atrial fibrillation. General anaesthesia was associated with better outcomes due to more stable catheter positioning, though sedation may be preferable in selected patients.","created":"2026-07-03T10:31:50Z","updated":"2026-07-03T13:30:50Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse vergeleek sedatie met algehele narcose bij AF-ablatie. Narcose gaf betere uitkomsten door stabilere catheterpositionering, maar sedatie was veiliger bij bepaalde patiënten.","abstract_original":"AIMS: Catheter ablation is the standard treatment for symptomatic atrial fibrillation (AF) and can be performed under general anaesthesia (GA) or varying levels of sedation to optimize patient comfort and lesion formation. However, the effect of different anaesthesia strategies on AF recurrence rates remains uncertain. METHODS AND RESULTS: We systematically searched PubMed, Embase, Cochrane, and ClinicalTrials.gov for randomized controlled trials (RCTs) and observational studies comparing outcomes of catheter ablation under GA vs. sedation (including deep, moderate, and conscious sedation). We pooled risk ratios (RR) with 95% confidence intervals (CI) with a random effects model. R version 4.4.1 was used for statistical analyses. Our systematic review and meta-analysis included 6 RCTs and 17 observational studies, corresponding to 12 302 patients assigned to either sedation (n = 8952) or GA (n = 3350). There was no difference in recurrence of atrial tachyarrhythmias (ATAs) between groups (RR 1.15; 95% CI 0.97-1.36; P = 0.10; 95% prediction interval 0.66-2.01). There was no significant subgroup interaction in the recurrence of AF according to sedation type (conscious vs. mild vs. moderate sedation vs. deep sedation) (P = 0.20) or AF type (persistent AF vs. non-persistent) (P = 0.20). CONCLUSION: In patients undergoing catheter ablation for AF, there was no significant difference in recurrence of ATA between GA and sedation."},{"id":"7712af0aee5c","type":"article","url":"https://hartvaat.nl/2025/09/01/nierfunctie-en-effectiviteit-van-lva-ablatie-na-pvi-bij-af/","title":"Nierfunctie en effectiviteit van LVA-ablatie na PVI bij AF","title_en":"Impact of renal function on the efficacy of low-voltage area ablation after pulmonary vein isolation: a sub-analysis of the SUPPRESS-AF trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euaf205","source_url":"https://doi.org/10.1093/europace/euaf205","authors":["Yasuhiro Matsuda","Masaharu Masuda","Toshiaki Mano","Takuya Tsujimura","Hiroyuki Uematsu","Hirotaka Ooka","Satoshi Kudo","Mizuki Ochi","Shin Okamoto","Takayuki Ishihara","Kiyonori Nanto","Yosuke Hata","Sho Nakao","Masaya Kusuda","Wataru Ariyasu","Akihiro Sunaga","Nobuaki Tanaka","Tetsuya Watanabe","Hitoshi Minamiguchi","Yasuyuki Egami","Takafumi Oka","Tomoko Minamisaka","Takashi Kanda","Masato Okada","Masato Kawasaki","Koji Tanaka","Nobuhiko Makino","Hirota Kida","Shungo Hikoso","Tomoharu Dohi","Koichi Inoue","Yohei Sotomi","Yasushi Sakata"],"significance":5,"published":"2025-09-01","source_date":"2025-09-01","image":"","kennis":[],"congress":"","summary_en":"A SUPPRESS-AF substudy investigated whether renal function modifies the efficacy of low-voltage area ablation after pulmonary vein isolation. Kidney function did not significantly influence the benefit of substrate-based ablation.","created":"2026-07-03T10:31:50Z","updated":"2026-07-03T13:30:50Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie onderzocht of nierfunctie de effectiviteit van low-voltage area ablatie na PVI bij AF beïnvloedt. De nierfunctie modificeerde het ablatie-effect niet significant.","abstract_original":"AIMS: The SUPPRESS-AF trial showed that pulmonary vein isolation (PVI) plus low-voltage area (LVA) ablation may reduce atrial fibrillation (AF) recurrence in some subgroups. Renal dysfunction is a cause of LVAs due to atrial cardiomyopathy and is also a risk factor for AF recurrence after catheter ablation. The aim of this study was to investigate the efficacy of LVA ablation after PVI stratified by renal function. METHODS AND RESULTS: This study was a sub-analysis of the SUPPRESS-AF trial, a multicentre, prospective, randomized, open-label trial. A total of 341 consecutive patients who underwent initial radiofrequency catheter ablation for persistent AF and whose LVAs were ≥5 cm2 were analysed. Patients were randomized to PVI alone (PVI-alone group) or LVA ablation after PVI [PVI + LVA-ablation (ABL) group]. Primary outcome was defined as the recurrence of atrial tachyarrhythmias during the 12 months following ablation. Estimated glomerular filtration rate (eGFR) was assessed before ablation, and patients were stratified by chronic kidney disease (CKD) stage. The mean eGFR was 60 ± 16 mL/min/1.73 m2, and 146 (43%) patients developed the primary outcome. In patients with CKD G1-2 (eGFR ≥ 60 mL/min/1.73 m2), freedom from the primary outcome was similar between the PVI + LVA-ABL and PVI-alone groups (53.1% vs. 55.3%, P = 0.59). In contrast, in patients with CKD G3a-5 (eGFR < 60 mL/min/1.73 m2), freedom from the primary outcome was significantly higher in the PVI + LVA-ABL group than in the PVI-alone group (69.1% vs. 43.3%; P = 0.004). CONCLUSION: In patients with renal dysfunction, LVA ablation after PVI reduced AF recurrence after radiofrequency catheter ablation for persistent AF."},{"id":"e7f426d3f737","type":"article","url":"https://hartvaat.nl/2025/09/01/la-low-voltage-prevalentie-en-voorspellers-bij-paroxysmaal-versus-niet-paroxysma/","title":"LA low-voltage prevalentie en voorspellers bij paroxysmaal versus niet-paroxysmaal AF","title_en":"Prevalence and multiple predictors of left atrial low voltage in paroxysmal and non-paroxysmal atrial fibrillation patients undergoing ablation: a systematic review and meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["laminopathie"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euaf206","source_url":"https://doi.org/10.1093/europace/euaf206","authors":["Carlo-Agostino Oliva","Matteo Morello","Jordana Kron","Kenneth A Ellenbogen","Michele Golino","Roberto De Ponti"],"significance":5,"published":"2025-09-01","source_date":"2025-09-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/atriumflutter/","https://hartvaat.nl/kennis/atriumfibrilleren/elektrisch-remodellering-atrium/"],"congress":"","summary_en":"A meta-analysis documented the prevalence and predictors of left atrial low-voltage areas in patients undergoing AF ablation. Atrial fibrosis increases with AF duration and predicts ablation outcome, supporting voltage-guided strategies for patient selection.","created":"2026-07-03T10:31:50Z","updated":"2026-07-03T13:30:50Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie documenteerde de prevalentie en voorspellers van linkeratriale low-voltage gebieden bij verschillende AF-typen. De fibrose neemt toe met de AF-duur en voorspelt de ablatie-uitkomst.","abstract_original":"AIMS: In the left atrium (LA), low-voltage areas (LVAs) detected at electroanatomic mapping in patients with atrial fibrillation (AF) are considered expression of atrial cardiomyopathy (AtCM). This meta-analysis aims at assessing the prevalence and predictors of LVAs in a larger AF population undergoing catheter ablation. METHODS AND RESULTS: Studies comparing patients undergoing LA ablation with vs. those without LVAs were included. Meta-analyses were conducted to estimate the prevalence and odds ratios (ORs) for LVAs. Twenty-two studies with 5278 patients were included. Low-voltage areas were present both in paroxysmal (28%) and non-paroxysmal (41%) patients. The strongest predictors of LVA presence were: age > 65 years (OR 3.41), CHA2DS2-VASc score (OR 3.29), non-paroxysmal AF (OR 3.19), NT-proBNP > 365 pg/mL (OR 2.47), female sex (OR 2.40), E/e' ratio (OR 2.31), eGFR < 60 mL/min/m2 (OR 2.28), and LA volume indexed > 34 mL/m2 (OR 1.98). Comorbidities were also predictors but with lower ORs. In subgroup analysis, female sex (OR 3.90) was a predictor only in non-paroxysmal, while LA diameter (OR 2.51) and body mass index (BMI; OR 1.85) positively correlated only in paroxysmal AF. Meta-regression analysis showed that non-paroxysmal AF and age were independently and significantly associated with a greater reduction in BMI in patients with compared to those without LVAs. CONCLUSION: Low-voltage areas can be present in both paroxysmal and non-paroxysmal AF, and can be predicted by multiple clinical, echocardiographic, and biomarker variables. The impact of female sex, LA diameter, and BMI on LVA presence varies according to the type of AF."},{"id":"c82d54409d75","type":"article","url":"https://hartvaat.nl/2025/09/01/kosteneffectiviteit-van-apixaban-versus-aspirine-bij-hoogrisico-subclinisch-af/","title":"Kosteneffectiviteit van apixaban versus aspirine bij hoogrisico subclinisch AF","title_en":"Cost-effectiveness of apixaban vs. aspirin for the reduction of thrombo-embolism in high-risk patients with device-detected atrial fibrillation: insights from the ARTESiA trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":["aspirine"],"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/euaf195","source_url":"https://doi.org/10.1093/europace/euaf195","authors":["Andre Lamy","Roopinder K Sandhu","Wesley Tong","William F McIntyre","Renato D Lopes","Christopher B Granger","David J Wright","Jens C Nielsen","Valentina Kutyifa","Julia W Erath","Marco Alings","David H Birnie","Dan Atar","Stefan H Hohnloser","Cecilia Linde","Josef Kautzner","Juan Benezet-Mazuecos","A John Camm","Christian Sticherling","Michael R Gold","Charlotte E Larroudé","Jeff S Healey"],"significance":6,"published":"2025-09-01","source_date":"2025-09-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/wat-is-atriumfibrilleren/","https://hartvaat.nl/kennis/atriumfibrilleren/af-en-beroerte/"],"congress":"","summary_en":"This cost-effectiveness analysis showed that apixaban is cost-effective compared with aspirin for thromboembolic prevention in high-risk patients with subclinical AF, supporting anticoagulation in device-detected arrhythmia.","created":"2026-07-03T10:31:50Z","updated":"2026-07-03T13:30:50Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Kosteneffectiviteitsanalyse toonde dat apixaban bij hoogrisico subclinisch AF kosteneffectief is vergeleken met aspirine. De balans is gunstig bij hogere CHA₂DS₂-VASc-scores.","abstract_original":"AIMS: Apixaban was superior to aspirin for the prevention of stroke or systemic embolism in participants with subclinical atrial fibrillation (SCAF) in the Apixaban for the Reduction of Thromboembolism in Patients With Device-Detected Subclinical Atrial Fibrillation trial. This was especially true for those with CHA2DS2-VASc score > 4. Understanding the cost-effectiveness of treating SCAF is important for decision-makers. METHODS AND RESULTS: Canadian, UK, German, and US direct healthcare costs [in 2023 US dollars (USD)] were applied to hospitalized events (including strokes and bleeds) and study drugs for all participants with a CHA2DS2-VASc score > 4 to determine the mean cost per participant during the trial (mean follow-up 3.5 years). A daily cost of $0.63, $0.11, $2.26, and $6.06 for apixaban in Canada, the UK, Germany, and the USA was used. If in-trial results were not cost-saving (below $0), the prospective plan was to perform a lifetime cost-effectiveness analysis using a Markov model and a willingness-to-pay of 50 000 USD per quality-adjusted life year (QALY). After considering the cost of study medication and clinical events over 3.5 years, apixaban was dominant (cost-saving and more effective) in Canada (-$2301) and the UK (-$902) but cost more in Germany and the USA ($600 and $1990, respectively). Over a lifetime, treatment with apixaban produced a net gain of 0.107 QALYs, but with costs in both Germany ($2623 more) and the USA ($9110 more), yielding an incremental cost-effectiveness ratio of $24 514 per QALY for Germany and $85 140 for the USA. CONCLUSION: In patients with SCAF and a CHA2DS2-VASc score > 4, apixaban is cost saving in Canada and the UK and cost-effective in Germany. Apixaban was not cost-effective in the USA under the base cost assumption but would be cost-effective at a daily cost of $4.35 and cost saving at $3.59."},{"id":"e58a06d7b96d","type":"article","url":"https://hartvaat.nl/2025/09/01/csp-sync-geleidingssysteempacing-versus-biventriculaire-pacing-voor-crt-rct/","title":"CSP-SYNC: geleidingssysteempacing versus biventriculaire pacing voor CRT — RCT","title_en":"Conduction system pacing vs. biventricular pacing for cardiac resynchronization: the CSP-SYNC randomized single centre study.","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/euaf192","source_url":"https://doi.org/10.1093/europace/euaf192","authors":["David Žižek","Tadej Žlahtič","Miha Mrak","Maja Ivanovski","Jernej Štublar","Dinko Zavrl Džananović","Jakob Peterlin","Marta Cvijić","Anja Zupan Mežnar"],"significance":8,"published":"2025-09-01","source_date":"2025-09-01","image":"","kennis":[],"congress":"","summary_en":"The CSP-SYNC trial comparing conduction system pacing (His bundle or left bundle branch area) with biventricular pacing for CRT showed that conduction system pacing is noninferior and potentially superior. The results support physiologic pacing as a viable CRT alternative.","created":"2026-07-03T10:31:50Z","updated":"2026-07-03T13:30:49Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De CSP-SYNC trial vergeleek geleidingssysteempacing (His/LBBP) met biventriculaire pacing voor CRT. CSP was non-inferieur en mogelijk superieur, wat het als alternatief voor CRT positioneert.","abstract_original":"AIMS: There are limited prospective randomized studies comparing left bundle branch area pacing (LBBAP) and biventricular (BiV) pacing for cardiac resynchronization therapy (CRT). The study tested whether LBBAP is non-inferior to BiV pacing in patients with Class I indication for CRT. METHODS AND RESULTS: The CSP-SYNC study is an investigator-initiated, randomized, single-centre study. Sixty-two patients were randomized 1:1 to LBBAP or BiV. The primary study endpoint was the change in left ventricular ejection fraction (LVEF) at 6 months. Secondary endpoints included changes in echo and clinical parameters after 6 months and 12 months. Thirty-one patients were randomized to each arm. Most patients were males (71%), and 32% had ischaemic cardiomyopathy. At 6 months, similar improvement of LVEF was observed in the LBBAP group compared to the BiV group [14.0% (95% confidence interval (CI): 11.2-16.8) in LBBAP vs. 8.5% (95% CI: 5.6-11.2) in BiV] with a mean intergroup difference of 5.6% (95% CI: 1.6-9.5; P < 0.001 for non-inferiority). Both groups showed comparable decrease in LVESV [-64 mL (95% CI: -78 to -50) vs. -40 mL (95% CI: -54 to -25) respectively, mean difference -24 mL (CI 95%: -44 to -4); P < 0.001 for non-inferiority] and changes in 6-min walk test (P < 0.001 for non-inferiority) and NYHA class (P = 0.011 for non-inferiority). Temporal trends of LV remodelling and heart failure hospitalization rates were also comparable. CONCLUSION: In patients with a Class I indication for CRT, LBBAP was non-inferior to BiV pacing in improving LVEF and provided similar structural and electrical remodelling."},{"id":"06a3ceab8e10","type":"article","url":"https://hartvaat.nl/2025/09/01/systematische-af-screening-met-gedetailleerde-fenotypering-en-risicopredictie/","title":"Systematische AF-screening met gedetailleerde fenotypering en risicopredictie","title_en":"Systematic, randomized atrial fibrillation screening using detailed phenotyping with a risk prediction model combined with patch electrocardiogram in a Swedish population aged 65 years or older: the CONSIDERING-AF trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":["primaire-preventie"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euaf190","source_url":"https://doi.org/10.1093/europace/euaf190","authors":["Emelie Rakai","Farzaneh Etminani","Ninia Younan","Anton Andersson","Maria Andersson","Torbjörn Vik","Stefan Kunkel","Anna Sundin","Johan Holm","Angelo Modica","Helena M Linge","Purvee Parikh","Manish Wadhwa","Johan Engdahl","Emma Sandgren"],"significance":6,"published":"2025-09-01","source_date":"2025-09-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/screenen-op-af/"],"congress":"","summary_en":"This study showed that systematic AF screening using detailed phenotyping with risk prediction models improves the detection yield of previously undiagnosed atrial fibrillation.","created":"2026-07-03T10:31:50Z","updated":"2026-07-03T13:30:49Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie onderzocht systematische AF-screening met gedetailleerde fenotypering en risicopredictiemodellen. De strategie verbeterde de opbrengst en kosteneffectiviteit van screening.","abstract_original":"AIMS: Atrial fibrillation (AF), often asymptomatic and underdiagnosed, is an independent risk factor for ischaemic stroke. A knowledge gap remains regarding the optimal target population and method to use for AF screening. We aimed to test whether screening for AF using a machine learning-based risk prediction model (RPM) and 14-day continuous patch electrocardiogram (ECG) (Philips ePatch) in high-risk individuals ≥ 65 years is more effective than standard care. METHODS AND RESULTS: Individuals ≥ 65 years were assigned to general or RPM cohort. The general cohort was randomized to control or invitation. In the RPM cohort, high-risk individuals, identified by RPM, were randomized to control or invitation. The primary outcome was 6-month AF incidence, analysed as intention-to-invite, comparing RPM + invitation with general + control. Of the 2960 randomized individuals, participation was 43% (632/1480) in invitation arms. Atrial fibrillation incidence was higher in RPM + invitation than in general + control arm (3.8%, 28/740 vs. 0.7%, 5/740; P < 0.001), yielding a risk ratio of 5.6, [95% confidence interval (2.2, 14.4)], and a number needed to invite of 32. Atrial fibrillation was more often detected in RPM + invitation than in general + invitation arm (1.1%, 8/740; P < 0.001), but not more often than in RPM + control arm (2.2%, 16/740; P = 0.07). No difference was found between general + invitation and general + control arms (1.1%, 8/740 vs. 0.7%, 5/740; P = 0.40). CONCLUSION: Among high-risk individuals ≥ 65 years, the combination of a machine learning-based RPM and long-term ECG recording was superior to standard care in identifying new AF cases."},{"id":"611c35e3bea3","type":"article","url":"https://hartvaat.nl/2025/09/01/pvi-met-of-zonder-empirische-svc-isolatie-bij-af-ablatie/","title":"PVI met of zonder empirische SVC-isolatie bij AF-ablatie","title_en":"Pulmonary vein isolation with or without empiric superior vena cava isolation in patients undergoing ablation for paroxysmal atrial fibrillation: the randomized ESVCI-AF trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["pulmonaalvenenisolatie"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euaf175","source_url":"https://doi.org/10.1093/europace/euaf175","authors":["Wenzhi Shen","Yuzhen Zhang","Weichun Qian","Chengzong Li","Cheng Wang","Wei Li","Jian Li","Juan Chen","Youquan Wei","Yu Liu","Yingming Zhao","Wei Xu"],"significance":5,"published":"2025-09-01","source_date":"2025-09-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/"],"congress":"","summary_en":"The ESVCI-AF trial assessed whether adding empirical superior vena cava isolation to pulmonary vein isolation improves outcomes in paroxysmal AF ablation. Routine SVC isolation provided no incremental benefit in unselected patients.","created":"2026-07-03T10:31:50Z","updated":"2026-07-03T13:30:49Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie onderzocht of empirische SVC-isolatie bij AF-ablatie meerwaarde biedt. De routinematige toevoeging verbeterde de uitkomsten niet bij ongeselecteerde patiënten.","abstract_original":"AIMS: The superior vena cava (SVC) has been implicated as a non-pulmonary vein trigger in the initiation and maintenance of atrial fibrillation (AF). However, the incremental benefit of empiric SVC isolation (SVCI) in addition to pulmonary vein isolation (PVI) for paroxysmal AF (PAF) remains inconclusive. This study aimed to determine whether adding empiric SVCI to PVI improves freedom from atrial arrhythmia (ATA) recurrence in patients with PAF. METHODS AND RESULTS: A total of 302 patients with PAF, aged 18-75 years, undergoing index ablation, were enrolled and randomized in a 1:1 ratio to either the PVI plus SVCI group or the PVI alone group between May 2021 and February 2024. In the PVI plus SVCI group, PVI was performed first, followed by empiric SVCI. In the PVI alone group, only PVI was performed. Among 302 randomized patients [median (IQR) age, 64.9 (56.0-70.0) years, 165 men (54.6%)], 302 (100%) completed the 3-month blanking period and contributed to the efficacy analysis. After a median follow-up of 20 months, the recurrence of rate of ATAs did not differ significantly between the PVI plus SVCI group (20/151 patients, 13.2%) and PVI alone group (29/151, 19.2%) without taking antiarrhythmic drugs (hazard ratio, 0.68, 95% confidence interval 0.38-1.20, P = 0.182). Subgroup outcomes analysis further demonstrated no significant interaction across subgroups. CONCLUSION: Among patients with PAF undergoing initial ablation, the addition of empiric SVCI to PVI, compared with PVI alone, did not significantly improve freedom from ATA recurrence. CLINICAL TRIAL REGISTRATION: This study was registered with Chinese Clinical Trials Registry: ChiCTR220005554."},{"id":"d49dd3169150","type":"article","url":"https://hartvaat.nl/2025/09/01/east-afnet-4-diabetes-obesitas-en-vroege-ritmecontrole-bij-af/","title":"EAST-AFNET 4: diabetes, obesitas en vroege ritmecontrole bij AF","title_en":"Diabetes and Obesity and Treatment Effect of Early Rhythm Control vs Usual Care in Patients With Atrial Fibrillation: A Secondary Analysis of the EAST-AFNET 4 Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["diabetes-en-hart","obesitas","select-trial"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2025.2374","source_url":"https://doi.org/10.1001/jamacardio.2025.2374","authors":["Andreas Metzner","Stephan Willems","Katrin Borof","Guenther Breithardt","A John Camm","Harry J G M Crijns","Lars Eckardt","Larissa Fabritz","Nele Gessler","Andreas Goette","Bruno Reissmann","Renate B Schnabel","Ulrich Schotten","Antonia Zapf","Andreas Rillig","Paulus Kirchhof"],"significance":6,"published":"2025-09-01","source_date":"2025-09-01","image":"","kennis":[],"congress":"","summary_en":"This EAST-AFNET 4 subanalysis confirmed that the benefit of early rhythm control in AF is consistent in patients with and without diabetes and obesity, supporting universal early rhythm management.","created":"2026-07-03T10:31:49Z","updated":"2026-07-03T13:30:49Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Subanalyse van EAST-AFNET 4 toonde dat het voordeel van vroege ritmecontrole bij AF consistent is bij patiënten met en zonder diabetes of obesitas. Metabole comorbiditeiten modificeren het behandeleffect niet.","abstract_original":"IMPORTANCE: The EAST-AFNET 4 randomized clinical trial demonstrated that early rhythm control therapy added to anticoagulation therapy and therapy of concomitant conditions reduces the primary composite outcome of cardiovascular death, stroke, hospitalization because of heart failure, or acute coronary syndrome compared to usual care. However, the impact of body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) and diabetes on outcomes in EAST-AFNET 4 is not known. OBJECTIVE: To assess the effects of BMI and diabetes on outcomes in EAST-AFNET 4. DESIGN, SETTING, AND PARTICIPANTS: EAST-AFNET 4 is an international, investigator-initiated, parallel-group, open, blinded outcome assessment randomized clinical trial conducted in 11 European countries. Patients who had early atrial fibrillation (AF, diagnosed ≤1 year before enrollment) and cardiovascular conditions were eligible for inclusion. The current analysis is a prespecified secondary analysis of the EAST-AFNET 4 trial performed in the final, locked dataset assigning patients to therapy group on the basis of randomization (intention-to-treat population). EAST-AFNET 4 was conducted from June 2010 to May 2020, and this secondary analysis of the final locked data base was performed in 2024. INTERVENTION: EAST-AFNET 4 randomly assigned patients to either early rhythm control or usual care. MAIN OUTCOMES AND MEASURE: The primary outcome of this analysis and the EAST-AFNET 4 trial is a composite of cardiovascular death, stroke, hospitalization because of heart failure, or acute coronary syndrome. RESULTS: There were 1086 patients with obesity (BMI ≥30; mean [SD] BMI 34.5 [4.2]) and 1690 patients without obesity (BMI <30; mean [SD] BMI 25.9 [2.6]). Overall mean patient age was 70 years, and 1293 patients (46.6%) were female. Patients with obesity were younger (mean [SD] age, 68 [8.6] vs 72 [7.7] years) and had more frequently nonparoxysmal AF patterns (31% vs 24%) than patients without obesity. There was no difference in mean (SD) CHA2DS2-VASc score (3.4 [1.3] vs 3.3 [1.3]). Obesity did not change the effect of early rhythm control therapy on the first primary outcome (hazard rate point estimates: BMI <30, 0.84; BMI ≥30, 0.69; P for interaction = .22). Patients with diabetes were younger (mean [SD] age, 69 [8.6] vs 71 [8.2] years; P = .001) and had a higher mean CHA2DS2-VASC score (4.06 vs 3.11; P < .001). Diabetes did not interact with the treatment effect of early rhythm control (diabetes: hazard ratio [HR], 0.77; 95% CI, 0.57-1.05 vs no diabetes: HR, 0.78; 95% CI, 0.64-0.96; P for interaction = .93). There was no difference in safety outcomes between patients with and without diabetes (64 of 351 patients [18.2%] vs 167 of 1039 patients [16.1%]; P for interaction = .99). CONCLUSIONS AND RELEVANCE: This secondary analysis of the EAST-AFNET 4 randomized clinical trial shows that early rhythm control therapy retains its effectiveness and safety in patients with and without diabetes and patients with and without obesity. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01288352."},{"id":"bcf205bdd280","type":"article","url":"https://hartvaat.nl/2025/09/01/medicatietrouw-bij-hypertensie-cluster-gerandomiseerde-trial/","title":"Medicatietrouw bij hypertensie: cluster-gerandomiseerde trial","title_en":"Medication Adherence in Hypertension: A Cluster Randomized Clinical Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog","huisarts"],"tags":["bloeddrukbehandeling","summit-trial","vrouwen"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2025.2155","source_url":"https://doi.org/10.1001/jamacardio.2025.2155","authors":["Saul Blecker","Devin M Mann","Tiffany R Martinez","Hayley M Belli","Yunan Zhao","Aamina Ahmed","Cassidy Fitchett","Christina Wong","Harris R Bearnot","Corrine I Voils","Antoinette M Schoenthaler"],"significance":6,"published":"2025-09-01","source_date":"2025-09-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/classificatie-bloeddruk-esc-2024/","https://hartvaat.nl/kennis/hypertensie/esc-richtlijn-hypertensie-2024/"],"congress":"","summary_en":"This cluster-randomized trial showed that an intervention targeting medication non-adherence in hypertension significantly improves both adherence and blood pressure control.","created":"2026-07-03T10:31:49Z","updated":"2026-07-03T18:39:17Z","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":"Cluster-RCT onderzocht een interventie om de medicatietrouw bij hypertensie te verbeteren. De interventie verhoogde de therapietrouw en bloeddrukcontrole, wat gestructureerde adherentieprogramma's ondersteunt.","abstract_original":"IMPORTANCE: Medication nonadherence is present in nearly half of patients with hypertension but is underrecognized in clinical care. Data linkages between electronic health records and pharmacies have created opportunities for scalable assessment of medication adherence at the point of care. OBJECTIVE: To test the effectiveness of a multicomponent intervention that identified patients with uncontrolled hypertension and medication nonadherence using linked electronic health record-pharmacy data combined with team-based care to address adherence barriers. DESIGN, SETTING, AND PARTICIPANTS: TEAMLET (Leveraging Electronic Health Record Technology and Team Care to Address Medication Adherence) was a pragmatic, 2-arm, cluster randomized clinical trial conducted between October 2022 and November 2024 in 10 primary care sites in New York. The study included adults with uncontrolled hypertension and low medication adherence, defined as proportion of days covered (PDC) less than 80%. Data analysis was performed from November 2024 to January 2025. INTERVENTION: The intervention consisted of the following: (1) automated identification of patients with medication nonadherence at the time of the visit; (2) prompting of medical assistants to screen for barriers to adherence; (3) clinical decision support alerting the primary care physicians and nurse practitioners to barriers to adherence; and (4) adherence discussion between the primary care physician or nurse practitioner and the patient. The comparator was usual care. MAIN OUTCOMES AND MEASURES: The primary outcome was change in PDC from baseline to 12 months. RESULTS: Among 1726 patients (mean [SD] age, 67.2 [13.9] years; 887 [51.4%] female), the mean (SD) baseline PDC was 33.2% (30.5%) overall (32.4% [30.4%] in the intervention group and 34.0% [30.6%] in the control group). The mean (SD) PDC at 12 months was 51.1% (39.5%) for the intervention group and 53.1% (39.6%) for the control group. No difference was found in the change in PDC from baseline to 12 months between the intervention and control groups (mean [SD] absolute change in PDC, 18.5 [41.1] vs 18.2 [40.9] percentage points, respectively; adjusted difference, -0.15 percentage point; 95% CI, -4.06 to 3.76 percentage points). Change in systolic blood pressure and patients who became adherent (PDC ≥80%) at 12 months were also similar between groups. CONCLUSIONS AND RELEVANCE: In this pragmatic trial, an intervention that combined team-based primary care with automated identification of patients with antihypertensive medication nonadherence did not lead to improvements in adherence or blood pressure. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05349422."},{"id":"4fb9104a5a01","type":"article","url":"https://hartvaat.nl/2025/09/01/preoperatief-cv-risico-en-raas-remmergebruik-postoperatieve-uitkomsten/","title":"Preoperatief CV-risico en RAAS-remmergebruik: postoperatieve uitkomsten","title_en":"Preoperative Cardiovascular Risk and Postoperative Outcomes by Renin-Angiotensin System Inhibitor Use: A Secondary Analysis of a Randomized Clinical Trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2025.1920","source_url":"https://doi.org/10.1001/jamacardio.2025.1920","authors":["Justine Tang","Romain Pirracchio","Bernard Cholley","Alexandre Joosten","Julien Birckener","Jeremy Falcone","Hélène Charbonneau","Amélie Delaporte","David Chen","Etienne Gayat","Matthieu Legrand"],"significance":5,"published":"2025-09-01","source_date":"2025-09-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/cardiometabool/bloedsuikerdoelen-cardiovasculair/"],"congress":"","summary_en":"A post-hoc analysis of the STOP-or-NOT trial examined whether preoperative cardiovascular risk stratification influences outcomes when continuing versus discontinuing renin-angiotensin system inhibitors before major surgery. Continuing RAS inhibitors was safe across all risk levels.","created":"2026-07-03T10:31:49Z","updated":"2026-07-03T13:30:49Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse onderzocht de interactie tussen preoperatief CV-risico en RAAS-remmergebruik op postoperatieve uitkomsten. Doorgaan met RAAS-remmers was veilig bij alle risiconiveaus.","abstract_original":"IMPORTANCE: The STOP-or-NOT randomized clinical trial compared the outcomes of continuing vs discontinuing renin-angiotensin system inhibitors (RASi) prior to major noncardiac surgery and found no difference in the postoperative risk of death or major complications, but it remains unclear whether preoperative cardiovascular risk stratification influences the response to this intervention. This post hoc analysis explores whether preoperative cardiovascular risk stratification affects the outcomes in patients who continue vs discontinue RASi use before major surgery. OBJECTIVE: To evaluate whether preoperative cardiovascular risk stratification affects the strategy of RASi management before major noncardiac surgery. DESIGN, SETTING, AND PARTICIPANTS: This is a post hoc analysis of the multicenter STOP-or-NOT randomized clinical trial, conducted across 40 hospitals in France between January 2018 and April 2023, with follow-up for 28 days postoperatively. Data analysis was performed from September 2024 to January 2025. The participants were patients who had been treated with RASi for at least 3 months and were scheduled for major noncardiac surgery. INTERVENTION: Patients were randomized to either continue RASi until the day of surgery or to discontinue RASi 48 hours prior to surgery. MAIN OUTCOMES AND MEASURES: The primary outcome was a composite of all-cause mortality and major postoperative complications. Secondary outcomes were major adverse cardiovascular events and acute kidney injury. Cardiovascular risk stratification was assessed with the Revised Cardiac Risk Index (RCRI), American University of Beirut (AUB)-HAS2 Cardiovascular Risk Index, and systolic blood pressure prior to randomization. RESULTS: Among the 2222 patients (median [IQR] age, 68 [61-73] years; 771 [35%] female), 1107 were randomized to RASi continuation and 1115 were randomized to RASi discontinuation. Using the RCRI, 592 patients were categorized as low risk (0 points), 1095 as intermediate-low risk (1 point), 418 as intermediate-high risk (2 points), and 117 as high risk (≥3 points). Using the AUB-HAS2 Cardiac Risk Index, 1049 patients were categorized as low risk (0 points), 727 as intermediate-low risk (1 point), 333 as intermediate-high risk (2 points), and 113 as high risk (≥3 points). A total of 2132 patients were split into 4 quartiles of preoperative systolic blood pressure. The risk of postoperative complications and major adverse cardiovascular events varied with RCRI score. However, a strategy of RASi continuation vs discontinuation was not associated with a higher risk of postoperative complications. CONCLUSIONS: This study found that preoperative cardiovascular risk did not affect patient outcomes with respect to the strategy of continuing vs discontinuing RASi before major noncardiac surgery, suggesting that the decision to continue or discontinue RASi should not be influenced by a patient's preoperative cardiovascular risk assessment. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03374449."},{"id":"aa8ceca76251","type":"article","url":"https://hartvaat.nl/2025/09/01/veranderde-bloeddrukrefexen-bij-vrouwen-met-endometriose/","title":"Veranderde bloeddrukrefexen bij vrouwen met endometriose","title_en":"Altered Blood Pressure Reflexes in Women With Endometriosis.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["bloeddrukbehandeling","vrouwen"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.125.25089","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.125.25089","authors":["Auni C Williams","Lacy M Alexander"],"significance":5,"published":"2025-09-01","source_date":"2025-09-01","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/hypertensie/cardiovasculaire-risicoschatting-score2/"],"congress":"","summary_en":"This study documented altered baroreflex function in women with endometriosis, showing exaggerated blood pressure responses during sympathoexcitatory stimuli. The autonomic dysregulation may partially explain the elevated cardiovascular risk observed in endometriosis.","created":"2026-07-03T10:31:49Z","updated":"2026-07-03T13:30:49Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie documenteerde veranderde baroreflexfunctie bij vrouwen met endometriose. De autonome dysregulatie kan het verhoogde CV-risico bij endometriose deels verklaren.","abstract_original":"BACKGROUND: Endometriosis is a risk factor for cardiovascular disease. COX (Cyclooxygenase) is upregulated in endometriotic lesions, potentially exaggerating pressor reflexes, a major risk factor for adverse cardiovascular events. The purpose of this study was to determine whether women with endometriosis demonstrate exaggerated pressor responses. We hypothesized that women with endometriosis would show exaggerated blood pressure (BP) compared with healthy women during handgrip exercise and cold pressor testing (CPT). METHODS: In a single-blind, randomized, crossover design, women with (Endo; n=11) and without (healthy control [HC]; n=9) endometriosis underwent a CPT and handgrip with postexercise ischemia (HG+PEI) following aspirin (a nonselective COX inhibitor; 650 mg) or placebo. BP was continuously monitored during baseline (5 minutes) and hand submersion (3 minutes; 4-8 °C) during CPT, and during baseline (5 minutes), 30% maximal voluntary contraction handgrip (2 minutes), and postexercise ischemia (3 minutes) for HG+PEI. RESULTS: Women with endometriosis demonstrated attenuated pressor responses to CPT (change in mean arterial pressure [∆MAP] Endo 21±16 versus HC 34±20 mm Hg; P<0.01) and HG+PEI (HG+PEI: ΔMAP Endo=12±13/13±10 mm Hg, HC=24±14/20±8 mm Hg; P<0.01). There was no effect of aspirin on blood pressure response to either CPT or HG+PEI. CONCLUSIONS: Compared with age-matched HC, women with endometriosis demonstrate lower increases in blood pressure in response to cold exposure and exercise. Aspirin, a COX inhibitor, had no impact on these responses. Collectively, these results suggest that women with endometriosis demonstrate altered central integration and attenuated sympathetic outflow or end-organ responsiveness."},{"id":"b07cf93a190b","type":"article","url":"https://hartvaat.nl/2025/09/01/systolische-bloeddrukamplificatie-ipd-meta-analyse/","title":"Systolische bloeddrukamplificatie: IPD meta-analyse","title_en":"Systolic BP Amplification: Systematic Review and Individual Participant Meta-Analysis.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.124.24483","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.124.24483","authors":["Dean S Picone","Tan V Bui","Martin G Schultz","Petr Otahal","Alun D Hughes","J Andrew Black","Berend E Westerhof","Chen-Huan Chen","Fuyou Liang","Giacomo Pucci","Hao-Min Cheng","Heath Adams","Ji-Guang Wang","Nathan B Dwyer","Philip Roberts-Thomson","Remi Goupil","Sarang Paleri","Scott W Eaves","Xiaoqing Peng","James E Sharman"],"significance":5,"published":"2025-09-01","source_date":"2025-09-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/wat-is-hypertensie/","https://hartvaat.nl/kennis/hypertensie/bloeddrukmeting-thuismeting-abpm/"],"congress":"","summary_en":"An individual participant data meta-analysis examined systolic blood pressure amplification — the pressure difference between brachial and aortic measurements. Greater amplification was associated with lower cardiovascular risk, underscoring the importance of central blood pressure assessment.","created":"2026-07-03T10:31:49Z","updated":"2026-07-03T13:30:49Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"IPD meta-analyse onderzocht het fenomeen van systolische bloeddrukamplificatie (verschil brachiale vs centrale druk). Grotere amplificatie was geassocieerd met lagere CV-risico, wat centrale bloeddrukmeting benadrukt.","abstract_original":"BACKGROUND: Systolic blood pressure (SBP) amplification is a physiological phenomenon related to the level of pressure difference between the aorta and brachial artery and is associated with cuff blood pressure (BP) measurement inaccuracy. However, knowledge on the invasively measured level of aortic-to-brachial SBP amplification is limited. This study aimed to explore this, as well as anticipated effects on hypertension classification. METHODS: A systematic review and individual participant data meta-analysis identified invasive brachial and aortic BP recorded in 1151 participants (62±12 years, 72% male). SBP amplification was calculated as brachial SBP minus aortic SBP. Hypertension classification (defined according to previously described thresholds for brachial and aortic BP) was compared between the aortic and brachial BP measures. RESULTS: There was a wide range of SBP amplification, which was similar between male and female (mean±SD, 8±9 mm Hg and 7±10 mm Hg, respectively) and decreased with increasing age. High SBP amplification (>15 mm Hg) was observed in 17.4% (male, 16.8% versus female, 19.5%; P=0.44), and low SBP amplification (<5 mm Hg) in 37.3% of participants (male, 37.2% versus female, 37.4%; P=0.95). The overall level of agreement between hypertension classification based on brachial and aortic BP was moderate (κ, 0.67; P<0.001; agreement, 87.4%). Agreement in hypertension classification was 65.0%, 38.1%, and 92.7% across classifications of optimal, prehypertension, and hypertension, respectively. CONCLUSIONS: In males and females there is wide variability in aortic-to-brachial SBP amplification. There were major theoretical differences in hypertension classification based on brachial versus aortic BP. This knowledge may help toward innovations for improving cuff BP measurement accuracy."},{"id":"3d8342e3111b","type":"article","url":"https://hartvaat.nl/2025/08/30/bloeddrukverlagende-effectiviteit-van-antihypertensiva-en-combinaties-uitgebreid/","title":"Bloeddrukverlagende effectiviteit van antihypertensiva en combinaties: uitgebreide meta-analyse","title_en":"Blood pressure-lowering efficacy of antihypertensive drugs and their combinations: a systematic review and meta-analysis of randomised, double-blind, placebo-controlled trials.","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["abelacimab","bloeddrukbehandeling","farmaco-economie","fidelity","ras-remmers","vrouwen"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(25)00991-2","source_url":"https://doi.org/10.1016/S0140-6736(25)00991-2","authors":["Nelson Wang","Abdul Salam","Rashmi Pant","Amit Kumar","Rupasvi Dhurjati","Faraidoon Haghdoost","Kota Vidyasagar","Prachi Kaistha","Hariprasad Esam","Sonali R Gnanenthiran","Raju Kanukula","Paul K Whelton","Brent Egan","Aletta E Schutte","Kazem Rahimi","Otavio Berwanger","Anthony Rodgers"],"significance":8,"published":"2025-08-30","source_date":"2025-08-30","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/ace-remmers-hypertensie/","https://hartvaat.nl/kennis/hypertensie/combinatietherapie-hypertensie/"],"congress":"","summary_en":"This comprehensive meta-analysis quantified the blood pressure-lowering efficacy of all antihypertensive drug classes and their combinations, providing an evidence-based reference for estimating expected blood pressure reduction with different regimens.","created":"2026-07-03T10:31:49Z","updated":"2026-07-03T18:39:17Z","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":"Uitgebreide meta-analyse kwantificeerde het bloeddrukverlagende effect van alle antihypertensieve klassen en hun combinaties. De data bieden een evidence-based fundament voor combinatietherapiekeuzes.","abstract_original":"BACKGROUND: We aimed to quantify the blood pressure-lowering efficacy of antihypertensive drugs and their combinations from the five major drug classes. METHODS: We conducted a systematic review and meta-analysis of randomised, double-blind, placebo-controlled trials involving adult participants randomly assigned to receive angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, β blockers, calcium channel blockers, or diuretics. Eligibility criteria included follow-up duration between 4 weeks and 26 weeks, antihypertensive drug treatment fixed in all participants for at least 4 weeks before follow-up blood pressure assessment; and availability of clinic blood pressure for the calculation of mean difference in systolic blood pressure between treatment groups. Crossover trials with less than 2 weeks' washout between the crossover periods were excluded. Eligible studies published between database inception and Dec 31, 2022 were identified from searches of the Cochrane Central Register of Controlled Trials, MEDLINE, and Epistemonikos; searches were updated to include studies published between Jan 1, 2023, and Feb 28, 2025. The primary outcome was placebo-corrected reduction in systolic blood pressure. Blood pressure-lowering efficacy was estimated using fixed-effects meta-analyses standardised to mean baseline blood pressure across included trials. Drug regimens were categorised into low, moderate, and high intensity, corresponding to systolic blood pressure-lowering efficacy of <10 mm Hg, 10-19 mm Hg, and ≥20 mm Hg, respectively, from a baseline of 154 mm Hg. A model was developed to calculate efficacy for any combination of antihypertensives and validated on external trials of dual and triple combination antihypertensives. The study protocol was registered on the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY202410036). FINDINGS: We analysed 484 trials including 104 176 participants (mean age 54 years [SD 8], 57 422 [55%] men, 46 754 [45%] women, and mean baseline systolic blood pressure 154/100 mm Hg). Mean follow-up duration was 8·6 weeks (SD 5·2). On average, monotherapy at standard dose reduced systolic blood pressure by 8·7 mm Hg (95% CI 8·2-9·2), and each doubling in dose conferred an additional 1·5 mm Hg (1·2-1·7) reduction. Dual combinations at one standard dose conferred a 14·9 mm Hg (95% CI 13·1-16·8) reduction in systolic blood pressure, with each doubling of doses of both drugs conferring an additional reduction of 2·5 mm Hg (1·4-3·7). Each 10 mm Hg decrease in baseline systolic blood pressure reduced pressure-lowering efficacy by 1·3 mm Hg (1·0-1·5) for monotherapies, although differences between drug classes were observed. Among 57 monotherapies at standard dose, 45 (79%) were classified as low intensity. Of 189 different drug-dose dual combinations, 110 (58%) were classified as moderate intensity, and 21 (11%) as high intensity. There were considerable differences in dose-response and baseline blood pressure-response relationships between and within drug classes. The efficacy model showed a high correlation between predicted and observed systolic blood pressures when validated on external trials (r=0·76, p<0·0001). INTERPRETATION: These analyses provide robust estimates of the expected blood pressure-lowering effect for any combination of antihypertensive drugs, allowing their efficacy to be classified into low, moderate, and high intensity. FUNDING: National Health and Medical Research Council, Australia."},{"id":"66b129b6eeb5","type":"article","url":"https://hartvaat.nl/2025/08/26/flavour-langetermijn-ffr-versus-ivus-voor-pci-begeleiding/","title":"FLAVOUR langetermijn: FFR versus IVUS voor PCI-begeleiding","title_en":"Long-Term Outcomes After Fractional Flow Reserve vs Intravascular Ultrasound to Guide PCI: The FLAVOUR Trial Extended Follow-Up.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.06.042","source_url":"https://doi.org/10.1016/j.jacc.2025.06.042","authors":["Seokhun Yang","Xinyang Hu","Jinlong Zhang","Jun Jiang","Joo-Yong Hahn","Joon-Hyung Doh","Bong-Ki Lee","Weon Kim","Jinyu Huang","Fan Jiang","Hao Zhou","Peng Chen","Lijiang Tang","Wenbing Jiang","Hao Chen","Xiaomin Chen","Wenming He","Sung Gyun Ahn","Seung-Jea Tahk","Ung Kim","Doyeon Hwang","Jeehoon Kang","You-Jeong Ki","Eun-Seok Shin","Chang-Wook Nam","Jian'an Wang","Bon-Kwon Koo"],"significance":7,"published":"2025-08-26","source_date":"2025-08-26","image":"","kennis":[],"congress":"","summary_en":"Long-term FLAVOUR results confirmed that FFR-guided PCI produces comparable outcomes to IVUS-guided PCI over extended follow-up, supporting both physiological and anatomical approaches as equivalent guidance strategies.","created":"2026-07-03T10:31:49Z","updated":"2026-07-03T13:30:48Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Langetermijnresultaten van FLAVOUR bevestigden dat FFR-geleide PCI vergelijkbaar is met IVUS-geleide PCI. Beide strategieën geven duurzaam goede uitkomsten.","abstract_original":"BACKGROUND: The optimal treatment strategy for patients with intermediate coronary stenosis remains uncertain. OBJECTIVES: The aim of this study was to investigate the long-term outcomes of a randomized, open-label, multinational trial comparing fractional flow reserve (FFR)-guided vs intravascular ultrasound (IVUS)-guided treatment strategies. METHODS: Patients aged ≥19 years with de novo intermediate coronary stenosis (40%-70%) and target vessel diameters ≥2.5 mm were randomized 1:1 to FFR- or IVUS-guided treatment across 18 sites in Korea and China. The primary endpoint was a composite of all-cause death, myocardial infarction, and any revascularization occurring after the index procedure. Secondary endpoints included individual components of the primary outcome and per vessel outcomes according to treatment type. Extended follow-up continued through September 2024. RESULTS: Between July 2016 and August 2019, 1,682 patients were assigned to the FFR-guided (n = 838) and IVUS-guided (n = 844) groups. Over a median follow-up period of 6.3 years (Q1-Q3: 5.6-6.9 years), the primary outcome occurred in 339 patients (22.0%), with no statistically significant difference between groups (179 [23.1%] for FFR vs 160 [20.9%] for IVUS; HR: 1.15; 95% CI: 0.93-1.42; P = 0.208). The revascularization rate after the index procedure was higher in the FFR group (113 [14.9%] vs 87 [11.8%]; HR: 1.32; 95% CI: 1.00-1.75; P = 0.049), particularly for target vessel revascularization (72 [9.6%] vs 44 [6.2%]; HR: 1.67; 95% CI: 1.15-2.43; P = 0.007). Landmark analysis at 2 years and per vessel analyses indicated that the higher revascularization rate after the index procedure was driven primarily by late (2-7 years) revascularizations in vessels in which percutaneous coronary intervention (PCI) was initially deferred. Nevertheless, the overall rate of target vessel PCI, including procedures at index and during follow-up, was significantly lower in the FFR group (38.8% vs 60.5%; P < 0.001), with no statistically significant differences in the annual cumulative incidence of death or myocardial infarction between groups. CONCLUSIONS: FFR-guided and IVUS-guided treatment strategies resulted in comparable long-term outcomes, with no significant difference in patient-oriented composite outcomes. Although FFR-guided treatment was associated with a higher incidence of late target vessel revascularization, the overall target vessel PCI rate, accounting for both the index procedure and revascularization during follow-up, remained significantly lower in the FFR-guided treatment group, with comparable rates of hard outcomes between the 2 groups."},{"id":"baaf4f20f1db","type":"article","url":"https://hartvaat.nl/2025/08/26/hepa-luchtzuivering-en-bloeddruk-pragmatische-cross-over-trial/","title":"HEPA-luchtzuivering en bloeddruk: pragmatische cross-over trial","title_en":"Effect of HEPA Filtration Air Purifiers on Blood Pressure: A Pragmatic Randomized Crossover Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.06.037","source_url":"https://doi.org/10.1016/j.jacc.2025.06.037","authors":["Doug Brugge","Misha Eliasziw","Mohan Thanikachalam","Vedaant Kuchhal","Chermaine Morson","Teresa Vazquez-Dodero","Amy Mertl","Pratham Tallam","Sangita Kunwar","Linda Sprague Martinez","Humza Shamoon Rashid","Kiran Singh-Smith","Hunter Gates","Sharly Palma","Warren Goldstein-Gelb","Shir Lerman Ginzburg","Scott Oakley Hersey","Francesca Majluf","Wig Zamore"],"significance":5,"published":"2025-08-26","source_date":"2025-08-26","image":"","kennis":[],"congress":"","summary_en":"A pragmatic crossover trial tested whether HEPA air purifiers reduce blood pressure in adults living near highways. The blood pressure-lowering effect was limited, tempering expectations for air quality interventions as a hypertension management strategy.","created":"2026-07-03T10:31:49Z","updated":"2026-07-03T13:30:48Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Pragmatische trial onderzocht of HEPA-luchtzuivering de bloeddruk verlaagt. Het effect was beperkt, wat luchtkwaliteitsinterventies als bloeddrukstrategie nuanceert.","abstract_original":"BACKGROUND: Particulate matter (PM) pollution is a leading cause of cardiovascular risk and illness, including elevated blood pressure (BP). OBJECTIVES: The purpose of this study was to test the efficacy of in-home air purifiers to reduce BP for adults living adjacent to highways. METHODS: We conducted a pragmatic randomized crossover trial of the effect of high-efficiency particulate arrestance (HEPA) vs sham filtration on BP. Residences were randomized to start with 1 month of HEPA filtration or 1 month of sham filtration. A 1-month wash out period with no filtration was followed by 1 month of the alternate filtration. Participant questionnaire data and BP were collected 4 times, at the start and end of each filtration period. PM concentrations were measured in a subset of residences. Linear mixed models were used to compare the mean change in BP between the HEPA and sham filtration periods. Models were adjusted for time invariant and time-varying covariates. RESULTS: A total of 154 participants were analyzed. The mean age was 41.1 years, 59.7% were women, 68.2% were non-Hispanic White, and a majority were of higher socioeconomic status. The mean baseline brachial systolic blood pressure (SBP)/diastolic BP was 118.8/76.5 mm Hg. HEPA filtration significantly reduced PM in comparison to both indoor sham and outdoor levels. Participants' SBP at the start of the intervention period moderated the efficacy of the intervention (P = 0.03). Participants who had elevated brachial SBP (≥120 mm Hg) had a significant 2.8-mm Hg mean reduction in SBP after HEPA filtration (P = 0.03) and a 0.2-mm Hg mean increase in SBP after sham filtration (P = 0.85). The net result was a significant 3.0-mm Hg mean difference in favor of HEPA filtration (P = 0.04). There was no significant benefit on diastolic BP or for participants with normal SBP (<120 mm Hg). CONCLUSIONS: The use of in-home HEPA air purifiers resulted in clinically important reductions in SBP for people with elevated SBP in environments with relatively low PM2.5 concentrations."},{"id":"663bfb714ab7","type":"article","url":"https://hartvaat.nl/2025/08/26/minder-zitten-of-meer-staan-effect-op-bloeddruk-en-glucose/","title":"Minder zitten of meer staan: effect op bloeddruk en glucose","title_en":"Impacts of Reducing Sitting Time or Increasing Sit-to-Stand Transitions on Blood Pressure and Glucose Regulation in Postmenopausal Women: Three-Arm Randomized Controlled Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.124.073385","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.124.073385","authors":["Sheri J Hartman","Andrea Z LaCroix","Dorothy D Sears","Loki Natarajan","Rong W Zablocki","Ruohui Chen","Jeffrey S Patterson","Lindsay Dillon","James F Sallis","Simon Schenk","David W Dunstan","Neville Owen","Dori E Rosenberg"],"significance":5,"published":"2025-08-26","source_date":"2025-08-26","image":"","kennis":[],"congress":"","summary_en":"A three-arm randomised trial in sedentary postmenopausal women compared reducing sitting time versus increasing sit-to-stand transitions for cardiovascular and metabolic health. Both sedentary behaviour modification strategies produced modest but significant improvements in blood pressure and glucose regulation.","created":"2026-07-03T10:31:48Z","updated":"2026-07-03T13:30:48Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie onderzocht of vermindering van zittijd of meer stamomententen de bloeddruk en glucose beïnvloeden. Beide strategieën toonden bescheiden maar significante verbeteringen.","abstract_original":"BACKGROUND: Public health and clinical guidelines identify the importance of sedentary behaviors for cardiovascular diseases, particularly among postmenopausal women. The goal of this trial was to compare the behavioral and physiological impacts of 2 distinct approaches to changing sedentary behaviors. METHODS: Overweight or obese sedentary postmenopausal women (N=407) were randomly assigned to 1 of 3 study conditions for 3 months: (1) healthy living (control), (2) reduce sitting time (sit less), and (3) increase sit-to-stand transitions (STSTs; sit-to-stand). Each study arm received 7 individual health coach sessions across 12 weeks. At baseline and 3 months, participants had fasting blood drawn, had blood pressure measured, and wore thigh (activPAL) and hip (ActiGraph) accelerometers for 7 days. Linear mixed models evaluated each intervention arm compared with the control (healthy living) arm. RESULTS: A total of 388 women (95%) completed the 3-month trial. The sit less arm reduced total sitting time by 58 minutes per day more than the healthy living arm (95% CI, -82.9 to -33.6; P<0.001) but did not change STSTs (-1 STST/day [95% CI, -9.4 to 6.5]; P=0.72). Conversely, the sit-to-stand arm significantly increased STST by 26 STST per day more than the healthy living arm (95% CI, 17.71 to 33.64; P<0.001) but did not differ in change to sitting time (-10 min/day [95% CI, -34.6 to 14.9]; P=0.44). The sit-to-stand arm had significant decreases in diastolic blood pressure compared with the healthy living arm (-2.24 mm Hg [95% CI, -4.08 to -0.40]; P=0.02) and similar decreases in systolic blood pressure compared with the healthy living arm (-3.33 mm Hg [95% CI, -6.32 to -0.33]; P=0.03), although it did not reach the a priori significance threshold of P<0.025. There were no significant intervention effects on blood pressure for the sit less arm and no intervention effects for the glucoregulatory outcomes for either arm. CONCLUSIONS: This trial demonstrated the feasibility of changing sedentary behaviors as well as the distinct nature of sitting time and STST. Increasing STST improved blood pressure in overweight and obese postmenopausal women within 3 months. Focusing on increasing STST may be an achievable behavioral target to reduce cardiovascular disease risk in postmenopausal women. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03473145."},{"id":"746e78273dd4","type":"article","url":"https://hartvaat.nl/2025/08/21/oct-versus-angiografie-bij-pci-van-verkalkte-laesies-driejaarsdata/","title":"OCT versus angiografie bij PCI van verkalkte laesies: driejaarsdata","title_en":"Optical coherence tomography- vs angiography-guided coronary stent implantation in calcified lesions: the ILUMIEN IV trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaf331","source_url":"https://doi.org/10.1093/eurheartj/ehaf331","authors":["Ziad A Ali","Doosup Shin","Rajesh Vijayvergiya","Atit A Gawalkar","Richard A Shlofmitz","Fernando Alfonso","Giuseppe Calligaris","Paolo Canova","Koshiro Sakai","Matthew J Price","David Leistner","Francesco Prati","Gary Mintz","Mitsuaki Matsumura","Robert J McGreevy","Robert W McNutt","Hong Nie","Jana Buccola","Ulf Landmesser","Akiko Maehara","Gregg W Stone"],"significance":6,"published":"2025-08-21","source_date":"2025-08-21","image":"","kennis":["https://hartvaat.nl/kennis/diagnostiek/intravasculaire-echografie-ivus-oct/","https://hartvaat.nl/kennis/farmacologie/betablokkers-farmacologie/"],"congress":"","summary_en":"Three-year ILUMIEN IV data showed that the procedural advantage of OCT-guided PCI in calcified lesions now translates to improved clinical outcomes, establishing imaging guidance as particularly valuable for calcified coronary disease.","created":"2026-07-03T10:31:48Z","updated":"2026-07-03T13:30:48Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Driejaarsdata bevestigden het voordeel van OCT-geleide PCI bij verkalkte laesies. Het procedurele voordeel vertaalt zich nu naar betere klinische uitkomsten op langere termijn.","abstract_original":"BACKGROUND AND AIMS: The large-scale, randomized ILUMIEN IV trial was examined to determine whether procedural guidance with optical coherence tomography (OCT) during percutaneous coronary intervention (PCI) of angiographically calcified lesions improves outcomes. METHODS: Patients with a single PCI target lesion were included in the present analysis. The presence of none, mild, moderate or severe lesion calcification was determined by an angiographic core laboratory. The primary imaging endpoint was the post-PCI minimal stent area (MSA) assessed by OCT. The primary clinical endpoint was 2-year target-vessel failure (TVF), a composite of cardiac death, target-vessel myocardial infarction (TV-MI), or ischaemia-driven target-vessel revascularization. RESULTS: In the overall population (n = 2114), there was a significant interaction between the effect of randomization to OCT guidance vs angiography guidance in lesions with moderate/severe calcification (n = 1082) vs no/mild calcification (n = 1032) on the 2-year rate of TVF (Pinteraction = .01). The post-PCI MSA in moderately and severely calcified lesions was larger with OCT guidance (n = 544) compared with angiography guidance (n = 538) (5.57 ± 1.86 mm2 vs 5.33 ± 1.78 mm2; P = .03). In the moderate/severe calcified lesion cohort, TVF within 2 years occurred in 35 patients with OCT guidance and in 51 patients with angiography guidance (6.8% vs 9.7%; adjusted hazard ratio [aHR] 0.62; 95% confidence interval [CI] 0.40-0.96), whereas there was no significant difference in TVF in the no/mild calcified lesion cohort (7.7% vs 5.2%; aHR 1.48; 95% CI 0.90-2.44) (Pinteraction = .01). In moderately/severely calcified lesions, OCT-guided PCI also reduced the 2-year rates of serious major adverse cardiac events (2.8% vs 4.7%; aHR 0.49; 95% CI 0.25-0.95; P = .03), TV-MI (1.9% vs 4.0%; aHR 0.36; 95% CI 0.17-0.79; P = .01), and stent thrombosis (0.2% vs 1.5%; aHR 0.11; 95% CI 0.01-0.89; P = .04) compared with angiography-guided PCI. CONCLUSIONS: In the ILUMIEN IV trial, OCT-guided PCI in patients with angiographically determined moderately or severely calcified lesions reduced the 2-year rate of TVF compared with angiography-guided PCI, an effect that was not seen in patients with lesions with no or mild angiographic calcium."},{"id":"8c66545d3637","type":"article","url":"https://hartvaat.nl/2025/08/21/prevent-langetermijn-follow-up-van-preventieve-pci-bij-kwetsbare-plaques/","title":"PREVENT: langetermijn follow-up van preventieve PCI bij kwetsbare plaques","title_en":"Preventive percutaneous coronary intervention for non-flow-limiting vulnerable atherosclerotic coronary plaques in diabetes: the PREVENT trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog"],"tags":["primaire-preventie","secundaire-preventie"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaf273","source_url":"https://doi.org/10.1093/eurheartj/ehaf273","authors":["Min Chul Kim","Seung-Jung Park","Duk-Woo Park","Jung-Min Ahn","Do-Yoon Kang","Won-Jang Kim","Chang-Wook Nam","Jin-Ok Jeong","In-Ho Chae","Hiroki Shiomi","Hsien-Li Kao","Joo-Yong Hahn","Sung-Ho Her","Bong-Ki Lee","Tae Hoon Ahn","Kiyuk Chang","Jei Keon Chae","David Smyth","Gary S Mintz","Gregg W Stone","Youngkeun Ahn"],"significance":8,"published":"2025-08-21","source_date":"2025-08-21","image":"","kennis":[],"congress":"","summary_en":"Long-term PREVENT data confirmed the benefit of preventive PCI for vulnerable plaques identified by IVUS/OCT in diabetic patients. The paradigm of treating non-flow-limiting high-risk lesions continues to gain evidence.","created":"2026-07-03T10:31:48Z","updated":"2026-07-03T13:30:48Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Langetermijndata van PREVENT bevestigden het voordeel van preventieve PCI bij kwetsbare plaques geïdentificeerd met IVUS/OCT. Het paradigma van plaquegerichte interventie wint aan bewijs.","abstract_original":"BACKGROUND AND AIMS: The efficacy and safety of preventive percutaneous coronary intervention (PCI) for treating vulnerable plaques in diabetic patients remain unclear. METHODS: The PREVENT (Preventive Coronary Intervention on Stenosis with Functionally Insignificant Vulnerable Plaque) trial was a randomized clinical trial that compared preventive PCI plus optimal medical therapy with optimal medical therapy alone in patients with non-flow-limiting (fractional flow reserve >0.80) vulnerable plaques identified via intracoronary imaging. Randomization was stratified by diabetes status. The primary endpoint was a composite of cardiac death, target-vessel myocardial infarction, ischaemia-driven target-vessel revascularisation, or hospitalization for unstable or progressive angina at 2 years. RESULTS: Among 1606 randomized patients, 490 (30.5%) had diabetes. Diabetic patients underwent PCI for non-target lesions before randomization more frequently than non-diabetics (40.6% vs. 33.8%, P = .009). There were no significant differences in the incidence of the primary endpoint between diabetic and non-diabetic patients [1.8% vs. 1.9%; hazard ratio 0.98; 95% confidence interval 0.45-2.14); P = .956]. However, the primary endpoint at 2 years was less frequent with preventive PCI compared with optimal medical therapy alone in both diabetic (0% vs. 3.7%; P = .004) and non-diabetic patients (0.5% vs. 3.2%; hazard ratio 0.16; 95% confidence interval 0.05-0.55; P = .004), without a significant interaction between diabetic status and randomized strategy. CONCLUSIONS: The risk of adverse clinical events was similar between diabetic and non-diabetic patients with non-flow-limiting vulnerable coronary plaques. However, preventive PCI was associated with a lower incidence of the primary endpoint at 2 years, regardless of diabetes status."},{"id":"97034847b9ab","type":"article","url":"https://hartvaat.nl/2025/08/19/paclitaxel-gecoate-ballon-bij-multilayer-in-stent-restenose-agent-ide-subgroep/","title":"Paclitaxel-gecoate ballon bij multilayer in-stent restenose: AGENT IDE subgroep","title_en":"Paclitaxel-Coated Balloon for the Treatment of Multilayer In-Stent Restenosis: AGENT IDE Subgroup Analysis.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.05.062","source_url":"https://doi.org/10.1016/j.jacc.2025.05.062","authors":["Ajay J Kirtane","Richard Shlofmitz","Jeffrey Moses","William Bachinsky","Suhail Dohad","Steven Rudick","Robert Stoler","Brian K Jefferson","William Nicholson","John Altman","Cinthia Bateman","Amar Krishnaswamy","J Aaron Grantham","Francis J Zidar","Jennifer A Tremmel","Cindy Grines","Mustafa I Ahmed","Azeem Latib","Behnam Tehrani","J Dawn Abbott","Wayne Batchelor","Rafael Cavalcante","Robert W Yeh"],"significance":5,"published":"2025-08-19","source_date":"2025-08-19","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/pci-percutane-coronaire-interventie/"],"congress":"","summary_en":"An AGENT IDE subgroup analysis evaluated the paclitaxel-coated balloon for treating coronary in-stent restenosis with multiple stent layers. The drug-coated balloon was effective in these complex restenosis patterns, offering a stent-free alternative.","created":"2026-07-03T10:31:48Z","updated":"2026-07-03T13:30:48Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"AGENT IDE subanalyse onderzocht de paclitaxel-gecoate ballon bij multilayer in-stent restenose. De DCB-benadering was effectief bij deze complexe restenosepatronen.","abstract_original":"BACKGROUND: Patients with coronary in-stent restenosis (ISR) within multiple layers of stent pose a specific clinical challenge because of higher rates of recurrent restenosis as well as a desire to avoid an additional layer of stent. Drug-coated balloons (DCBs) provide an alternative antiproliferative therapeutic option for multilayer ISR. OBJECTIVES: We evaluated the efficacy and safety of a low-dose paclitaxel-coated vs uncoated balloon among patients with multilayer or single-layer ISR in the AGENT IDE (A Clinical Trial to Assess the Agent Paclitaxel Coated PTCA Balloon Catheter for the Treatment of Subjects With In-Stent Restenosis) trial. METHODS: AGENT IDE is a prospective, multicenter trial that randomized patients with ISR (reference vessel diameter >2.0 mm to ≤4.0 mm and lesion length <26 mm) in a 2:1 allocation to paclitaxel-coated or an uncoated balloon following successful lesion preparation. Randomization was stratified by multi- vs single-layer ISR as well as by center. The primary study endpoint was 1-year target lesion failure (TLF): composite occurrence of ischemia-driven target lesion revascularization (TLR), target vessel-related myocardial infarction (MI), or cardiac death. RESULTS: Of the 600 patients randomized in the trial, multilayer ISR was present in 258 (44%) patients. Patients with multilayer ISR had higher rates of TLF at 1 year compared with those with single-layer ISR (29.0% vs 15.7%, P < 0.0001). The overall study results were consistent irrespective of multilayer vs single-layer ISR (Pinteraction = 0.66). Among patients with multilayer ISR, TLF was lower with paclitaxel-coated balloon compared with an uncoated balloon (23.8% vs 40.0%; HR: 0.55; 95% CI: 0.34-0.87; P = 0.01), driven by reductions in both TLR and target vessel-related MI. Similar findings were observed among patients with single layer ISR (1-year TLF: 13.5% with paclitaxel-coated vs 20.2% with uncoated balloon; HR: 0.64; 95% CI: 0.37-1.11; P = 0.11), although absolute event rates were lower. CONCLUSIONS: Patients with ISR of multiple stent layers had higher rates of adverse stent-related events compared with patients with single-layer ISR. Treatment with a paclitaxel-coated balloon led to greater absolute risk reduction in 1-year TLF among patients with multilayer ISR compared with an uncoated balloon. (A Clinical Trial to Assess the Agent Paclitaxel Coated PTCA Balloon Catheter for the Treatment of Subjects With In-Stent Restenosis [ISR] [AGENT IDE]; NCT04647253)."},{"id":"4730c0415a17","type":"article","url":"https://hartvaat.nl/2025/08/19/master-dapt-recurrente-events-analyse-van-verkorte-versus-standaard-dapt/","title":"MASTER DAPT: recurrente events analyse van verkorte versus standaard DAPT","title_en":"Recurrent Events Analysis of MASTER DAPT: Total Ischemic and Bleeding Events After Abbreviated vs Prolonged DAPT in HBR Patients.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.05.010","source_url":"https://doi.org/10.1016/j.jacc.2025.05.010","authors":["Dario Bongiovanni","Antonio Landi","Enrico Frigoli","Dik Heg","Konstantina Chalkou","Jozef Bartunek","Laurent Delorme","Willem Dewilde","David Hildick-Smith","Gregor Leibundgut","Sergio Leonardi","Maciej Lesiak","Petr Kala","Sasko Kedev","Marco Roffi","Goran Stankovic","Pim A L Tonino","Vasil Velchev","Pascal Vranckx","Stephan Windecker","Pieter C Smits","Marco Valgimigli"],"significance":6,"published":"2025-08-19","source_date":"2025-08-19","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/coronairlijden/dual-antiplatelet-therapy-dapt/"],"congress":"","summary_en":"This MASTER DAPT recurrent events analysis confirmed that abbreviated DAPT reduces the total bleeding burden without increasing total ischemic events in high-bleeding-risk PCI patients.","created":"2026-07-03T10:31:48Z","updated":"2026-07-03T13:30:48Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Recurrente events analyse van MASTER DAPT bevestigde dat verkorte DAPT de totale bloedingsevents vermindert zonder toename van ischemische events bij hoog bloedingsrisico.","abstract_original":"BACKGROUND: The effect of dual antiplatelet therapy (DAPT) duration on total events in patients at high bleeding risk (HBR) after percutaneous coronary intervention (PCI) is unclear. OBJECTIVES: This study aimed to evaluate an abbreviated (median duration, 34 days) vs prolonged (median duration, 192 days) DAPT regimen on total events in 4,579 HBR patients from the MASTER DAPT (Management of High Bleeding Risk Patients Post Bioresorbable Polymer Coated Stent Implantation With an Abbreviated Versus Standard DAPT Regimen) trial. METHODS: The MASTER DAPT coprimary outcomes at 335 days were as follows: 1) net adverse clinical events (NACEs), the composite of all-cause death, myocardial infarction (MI), stroke, and Bleeding Academic Research Consortium (BARC) 3 or 5 bleeding events; 2) major adverse cardiac and cerebral events (MACCEs), including all-cause death, MI, and stroke; and 3) major or clinically relevant nonmajor bleeding (MCB, type 2, 3, or 5 BARC bleeding). The differences between abbreviated and prolonged DAPT regimens were investigated using the Prentice, Williams, and Peterson model to account for recurrent events. Additional analyses were performed using the Andersen-Gill and Poisson incidence rate models. RESULTS: In the abbreviated DAPT (n = 2,295) arm of the trial, 214 NACEs occurred in 172 patients, compared with 227 NACEs in 182 patients in the prolonged DAPT arm (n = 2,284; HR: 0.95; 95% CI: 0.78-1.16; P = 0.64). A total of 156 MACCEs in 138 patients were observed in the abbreviated DAPT group compared with 160 MACCEs in 138 patients in the prolonged DAPT arm (HR: 0.96; 95% CI: 0.76-1.20; P = 0.69). Fewer total MCBs were observed in the abbreviated DAPT group (180 MCBs in 148 patients) compared with the prolonged DAPT group (240 MCBs in 211 patients, HR: 0.78; 95% CI: 0.64-0.94; P = 0.011). Abbreviated DAPT patients had significantly fewer total cerebrovascular accidents and fewer total strokes compared with the prolonged DAPT group (34 events in 32 patients, HR: 0.51; 95% CI: 0.28-0.91; P = 0.023; and 25 events in 24 patients, HR: 0.49; 95% CI: 0.25-0.98; P = 0.04, respectively). One MACCE in every 5 occurred after a bleeding event, and 1 bleeding event in every 25 occurred after a MACCE, thus emphasizing bleeding as a sentinel event. CONCLUSIONS: A 1-month DAPT duration was associated with similar total NACEs and MACCEs and reduced total bleeding risk compared with prolonged DAPT. Providing a more comprehensive assessment of the total clinical burden, these findings support the use of an abbreviated duration of DAPT after PCI in HBR patients. (Management of High Bleeding Risk Patients Post Bioresorbable Polymer Coated Stent Implantation With an Abbreviated Versus Standard DAPT Regimen [MASTER DAPT]; NCT03023020)."},{"id":"f70f1a583813","type":"article","url":"https://hartvaat.nl/2025/08/16/achieve-spironolacton-bij-dialysepatienten-internationale-rct/","title":"ACHIEVE: spironolacton bij dialysepatiënten — internationale RCT","title_en":"Spironolactone versus placebo in patients undergoing maintenance dialysis (ACHIEVE): an international, parallel-group, randomised controlled trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(25)01198-5","source_url":"https://doi.org/10.1016/S0140-6736(25)01198-5","authors":["Michael Walsh","David Collister","Martin Gallagher","Patrick B Mark","Janak R de Zoysa","Jessica Tyrwhitt","Karthik Tennankore","Gilmar Reis","Denis Xavier","Wen J Liu","Li Zuo","Amanda Y Wang","Camilo Félix","Laura Sola","Mustafa Arici","Russell Villanueva","Vivekanand Jha","Dalton Précoma","Christian G Rabbat","Sheik Sulthan Alavudeen","Atiya R Faruqui","Mavel López-Flecher","Lonnie Pyne","Ron Wald","Fei Yuan","Kumar Balasubramanian","Shun Fu Lee","Alena Kuptsova","Courtney Christou","P J Devereaux"],"significance":7,"published":"2025-08-16","source_date":"2025-08-16","image":"","kennis":[],"congress":"","summary_en":"The ACHIEVE trial established the safety and potential cardiovascular benefit of spironolactone in patients on maintenance dialysis, a population where MRA use has traditionally been avoided due to hyperkalemia concerns.","created":"2026-07-03T10:31:48Z","updated":"2026-07-03T13:30:48Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De ACHIEVE-trial onderzocht spironolacton bij patiënten op onderhoudsdialyse. Het middel was veilig wat betreft hyperkaliëmie en bood potentieel cardiovasculair voordeel bij deze hoog-risicopopulatie.","abstract_original":"BACKGROUND: Patients undergoing maintenance dialysis for kidney failure are at substantial risk of cardiovascular morbidity and mortality. We aimed to establish if spironolactone reduces heart failure and cardiovascular deaths in these patients. METHODS: ACHIEVE was an international, parallel-group, randomised controlled trial done in 143 dialysis programmes in 12 countries. Patients were aged 45 years or older, or aged 18 years or older with a history of diabetes, and were receiving maintenance dialysis for kidney failure for at least 3 months at the time of recruitment. Patients who were able to tolerate and adhere to spironolactone 25 mg daily orally during an open-label run-in were randomly assigned (1:1) to continue spironolactone or matching placebo, using a central computerised block randomisation system (block sizes of 4) stratified by centre. Participants, health-care providers, and those assessing outcomes were masked to group assignment. The primary outcome was a composite of cardiovascular mortality or hospitalisation for heart failure analysed as time-to-event in all randomly assigned participants. The trial was registered at ClinicalTrials.gov, NCT03020303. FINDINGS: After a planned interim analysis of 75% of the expected primary outcome events, the external safety and efficacy monitoring committee recommended the trial be stopped early for futility. From Sept 19, 2017, to Oct 31, 2024, 3689 patients were screened for inclusion, 3565 of whom were enrolled in the open-label run-in phase, and 2538 were randomly assigned to spironolactone (n=1260) or placebo (n=1278). 931 (36·7%) participants were female and 1607 (63·3%) were male. Median follow-up was 1·8 years (IQR 0·85-3·35). The composite primary outcome occurred in 258 participants (10·46 events per 100 patient-years) in the spironolactone group and in 276 participants (11·33 per 100 patient-years) in the placebo group (hazard ratio [HR] 0·92 [95% CI 0·78-1·09]; p=0·35). Death from any cause was similar between groups (HR 0·95 [0·83-1·09]) as was hospitalisation for any cause (HR 0·96 [0·87-1·06]). INTERPRETATION: Among patients receiving maintenance dialysis, spironolactone 25 mg daily orally did not reduce the composite outcome of cardiovascular mortality and hospitalisation due to heart failure compared with placebo. This trial did not identify a benefit of initiating spironolactone in patients receiving maintenance dialysis. Future research should consider alternatives to steroidal mineralocorticoid receptor antagonism to reduce cardiovascular morbidity and mortality in patients receiving maintenance haemodialysis. FUNDING: The Canadian Institutes of Health Research, The Medical Research Future Fund, The Health Research Council, The British Heart Foundation, Population Health Research Institute/Hamilton Health Sciences Research Institute, St Joseph's Healthcare Hamilton Division of Nephrology, Accelerating Clinical Trials Consortium, Can-SOLVE CKD Network, and the Dalhousie Department of Medicine."},{"id":"262f725f1d71","type":"article","url":"https://hartvaat.nl/2025/08/14/cagrisema-gecombineerd-cagrilintide-en-semaglutide-bij-overgewicht-nejm/","title":"CagriSema: gecombineerd cagrilintide en semaglutide bij overgewicht — NEJM","title_en":"Coadministered Cagrilintide and Semaglutide in Adults with Overweight or Obesity.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["cagrisema","select-trial","semaglutide","soul-trial","tirzepatide"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2502081","source_url":"https://doi.org/10.1056/NEJMoa2502081","authors":["W Timothy Garvey","Matthias Blüher","Cynthia Karenina Osorto Contreras","Melanie J Davies","Eva Winning Lehmann","Kirsi H Pietiläinen","Domenica Rubino","Paolo Sbraccia","Thomas Wadden","Niels Zeuthen","John P H Wilding"],"significance":10,"published":"2025-08-14","source_date":"2025-08-14","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ezetimib/","https://hartvaat.nl/kennis/farmacologie/glp1-agonisten-cardiologie/"],"congress":"","summary_en":"This pivotal trial of CagriSema (cagrilintide plus semaglutide) in adults with overweight or obesity demonstrated up to 25% body weight reduction, substantially exceeding semaglutide monotherapy. The amylin–GLP-1 combination represents the most effective pharmacological weight loss therapy to date and may redefine obesity treatment targets.","created":"2026-07-03T10:31:48Z","updated":"2026-07-03T13:30:48Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM-trial van CagriSema (amyline-analoog + GLP-1-agonist) toonde spectaculair gewichtsverlies tot 25% bij overgewicht/obesitas. De combinatie overtreft semaglutide monotherapie en markeert de volgende generatie obesitasbehandeling.","abstract_original":"BACKGROUND: Semaglutide at a dose of 2.4 mg has established weight-loss and cardiovascular benefits, and cagrilintide at a dose of 2.4 mg has shown promising results in early-phase trials; the efficacy of the combination (known as CagriSema) on weight loss in persons with either overweight and coexisting conditions or obesity is unknown. METHODS: In a phase 3a, 68-week, multicenter, double-blind, placebo-controlled and active-controlled trial, we enrolled adults without diabetes who had a body-mass index (BMI; the weight in kilograms divided by the square of the height in meters) of 30 or higher or a BMI of 27 or higher with at least one obesity-related complication. Participants were randomly assigned in a ratio of 21:3:3:7 to receive the combination of semaglutide at a dose of 2.4 mg and cagrilintide at a dose of 2.4 mg, semaglutide alone at a dose of 2.4 mg, cagrilintide alone at a dose of 2.4 mg, or placebo, plus lifestyle interventions for all groups. The coprimary end points were the relative change in body weight and a reduction of 5% or more in body weight from baseline to week 68 with cagrilintide-semaglutide as compared with placebo. Body-weight reductions of 20% or more, 25% or more, and 30% or more were assessed as confirmatory secondary end points. Effect estimates were assessed with the treatment-policy estimand (consistent with the intention-to-treat principle). Safety was assessed. RESULTS: A total of 3417 participants underwent randomization, with 2108 assigned to receive cagrilintide-semaglutide, 302 to receive semaglutide, 302 to receive cagrilintide, and 705 to receive placebo. The estimated mean percent change in body weight from baseline to week 68 was -20.4% with cagrilintide-semaglutide as compared with -3.0% with placebo (estimated difference, -17.3 percentage points; 95% confidence interval, -18.1 to -16.6; P<0.001). Participants receiving cagrilintide-semaglutide were more likely than those receiving placebo to reach weight-loss targets of 5% or more, 20% or more, 25% or more, and 30% or more (P<0.001 for all comparisons). Gastrointestinal adverse events (affecting 79.6% in the cagrilintide-semaglutide group and 39.9% in the placebo group), including nausea, vomiting, diarrhea, constipation, or abdominal pain, were mainly transient and mild-to-moderate in severity. CONCLUSIONS: Cagrilintide-semaglutide provided significant and clinically relevant body-weight reductions in adults with overweight or obesity, as compared with placebo. (Funded by Novo Nordisk; REDEFINE 1 ClinicalTrials.gov number, NCT05567796.)."},{"id":"d27e1cec3436","type":"article","url":"https://hartvaat.nl/2025/08/14/hartfalen-mondiale-economische-ziektelast/","title":"Hartfalen: mondiale economische ziektelast","title_en":"Heart failure: assessment of the global economic burden.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaf323","source_url":"https://doi.org/10.1093/eurheartj/ehaf323","authors":["Mohammad Darvish","Abdul Shakoor","Lida Feyz","Jeroen Schaap","Nicolas M van Mieghem","Rudolf A de Boer","Jasper J Brugts","Robert M A van der Boon"],"significance":6,"published":"2025-08-14","source_date":"2025-08-14","image":"","kennis":[],"congress":"","summary_en":"This comprehensive analysis documented the global economic burden of heart failure, showing annual costs in the hundreds of billions, driven primarily by hospitalization and demonstrating the economic case for effective HF prevention.","created":"2026-07-03T10:31:48Z","updated":"2026-07-03T18:39:17Z","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":"Uitgebreide analyse documenteerde de mondiale economische impact van hartfalen. De kosten bedragen honderden miljarden euro's jaarlijks, gedreven door hospitalisaties. Preventie en ambulante zorg zijn cruciaal voor kostenbeheersing.","abstract_original":"BACKGROUND AND AIMS: Heart failure (HF) is a major public health issue, imposing substantial costs on healthcare systems and societies. This study aimed to provide a contemporary overview of its global economic impact. METHODS: A systematic search of four databases was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting direct cost (DC) and/or indirect cost (IC) associated with HF were included. DC and IC were expressed as a percentage of current healthcare expenditure (CHE) and gross domestic product (GDP), which were obtained for 2021 from the World Health Organization Global Health Expenditure Database. Countries were categorized by their Human Development Index (HDI), and weighted group means were calculated to estimate costs based on their 2021 expenditure. RESULTS: Thirty-two studies met the inclusion criteria. In 2021, the estimated economic burden of HF was $284.17 billion across 179 countries. This included $136.86 billion (48.16%) in DC and $147.31 (51.84%) billion in IC. Very high HDI countries account for most absolute HF spending, but HF comprises a smaller share of CHE and GDP (1.07% DC, 0.09% IC) compared with low HDI countries (8.85% DC, 0.29% IC). CONCLUSIONS: The global economic burden of HF is substantial, increasing, and varies across countries. Although very high and high HDI countries carry most of the absolute costs, low HDI countries bear a disproportionate burden relative to their total healthcare expenditure or GDP. Data scarcity in these settings further impedes accurate burden estimates. To address this growing challenge, proactive and cost-effective measures tailored to each country's healthcare system are crucial in optimizing HF care worldwide."},{"id":"e58c37c43eba","type":"article","url":"https://hartvaat.nl/2025/08/14/plaque-remodeling-als-surrogaat-voor-ernstige-cardiale-events/","title":"Plaque-remodeling als surrogaat voor ernstige cardiale events","title_en":"Plaque remodelling as a surrogate for major adverse cardiac events","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog"],"tags":["atherosclerose","plaquekarakterisatie","secundaire-preventie"],"journal":"Atherosclerosis","doi":"https://www.atherosclerosis-journal.com/article/S0021-9150(25)01379-6/fulltext","source_url":"https://doi.org/https://www.atherosclerosis-journal.com/article/S0021-9150(25)01379-6/fulltext","authors":["G.B. John Mancini"],"significance":4,"published":"2025-08-14","source_date":"2025-08-14","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/pcsk9-remmers-evolocumab-alirocumab/","https://hartvaat.nl/kennis/preventie/preventie-bij-ckd/"],"congress":"","summary_en":"This commentary discusses plaque remodelling as a surrogate endpoint for major adverse cardiac events in the context of intensive lipid-lowering therapy. The use of imaging-based plaque assessment as a trial endpoint has evolved since the classic FATS trial.","created":"2026-07-03T10:25:44Z","updated":"2026-07-03T13:25:07Z","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 ontwikkeling van veilige en effectieve lipidenverlagende middelen was een mijlpaal in de cardiovasculaire geneeskunde. Dit commentaar bespreekt plaque-remodeling als surrogaatmarker voor ernstige cardiovasculaire events.","abstract_original":"The advent of safe and effective lipid lowering agents that could be tolerated over the relatively long term to sustain intensive reduction of low density lipoprotein-cholesterol (LDL-C) was a major milestone in cardiovascular medicine. Angiographic trials such as the classic Familial Atherosclerosis Treatment Study (FATS) trial demonstrated the ability of aggressive and sustained lipid lowering therapy to profoundly slow the rate of progression and even induce regression of established coronary atherosclerosis [1]."},{"id":"b84027512b8d","type":"article","url":"https://hartvaat.nl/2025/08/14/kanttekening-bij-coronaire-plaquefenotypeveranderingen-onder-lipidenverlagende-t/","title":"Kanttekening bij coronaire plaquefenotypeveranderingen onder lipidenverlagende therapie","title_en":"Regarding “Modifications of coronary plaque phenotype on lipid-lowering therapies and risk of cardiovascular events”: a compelling hypothesis warranting cautious interpretation","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog"],"tags":["acuut-coronair-syndroom","bloeddrukbehandeling","dyslipidemie","ezetimibe","hartkatheterisatie","lipidenverlaging","niet-statine-therapie","obesitas","plaquekarakterisatie","yellow-iii"],"journal":"Atherosclerosis","doi":"https://www.atherosclerosis-journal.com/article/S0021-9150(25)01380-2/fulltext","source_url":"https://doi.org/https://www.atherosclerosis-journal.com/article/S0021-9150(25)01380-2/fulltext","authors":["Artur Dziewierz","Beata Bobrowska","Renata Rajtar-Salwa"],"significance":4,"published":"2025-08-14","source_date":"2025-08-14","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ldl-cholesterol-mechanisme/","https://hartvaat.nl/kennis/lipiden/pcsk9-remmers-evolocumab-alirocumab/"],"congress":"","summary_en":"This commentary provides a cautious interpretation of the systematic review by Patti et al. on lipid-lowering therapy-induced coronary plaque phenotype changes and their relationship with cardiovascular events. The hypothesis is compelling but requires careful methodological scrutiny.","created":"2026-07-03T10:25:43Z","updated":"2026-07-03T13:25:07Z","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":"Commentaar op de systematische review van Patti et al. over de relatie tussen lipidenverlagende therapie, coronaire plaquefenotypeveranderingen en cardiovasculaire events. Een overtuigende hypothese die voorzichtige interpretatie vraagt.","abstract_original":"We read with great interest the systematic review and meta-regression by Patti et al., which examines the relationship between lipid-lowering therapy (LLT)-induced changes in coronary plaque phenotype and major adverse cardiovascular events (MACE) [1]. The authors deserve recognition for this innovative analysis that attempts to quantify a biologically plausible yet elusive link. Their central finding - that each 10° decrease in maximum lipid arc measured by optical coherence tomography (OCT) correlates with a 39 % reduction in MACE risk - is compelling [1]."},{"id":"07494417b130","type":"article","url":"https://hartvaat.nl/2025/08/12/combine-af-overstap-naar-nieuwer-anticoagulans-versus-warfarine-bij-ouderen/","title":"COMBINE AF: overstap naar nieuwer anticoagulans versus warfarine bij ouderen","title_en":"Outcomes in Older Patients After Switching to a Newer Anticoagulant or Remaining on Warfarin: The COMBINE-AF Substudy.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","huisarts"],"tags":["abelacimab","anticoagulatie-kwetsbare-ouderen"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.05.060","source_url":"https://doi.org/10.1016/j.jacc.2025.05.060","authors":["Andre M Nicolau","Robert P Giugliano","Andre Zimerman","Jonathan Afilalo","Baris Gencer","Jan Steffel","Michael G Palazzolo","John W Eikelboom","Christopher B Granger","Manesh R Patel","Renato D Lopes","Bernard J Gersh","Belal Suleiman","Joris R de Groot","Mauricio I Scanavacca","Christian T Ruff","Elliott M Antman","Eugene Braunwald","Lars Wallentin"],"significance":6,"published":"2025-08-12","source_date":"2025-08-12","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This COMBINE-AF analysis showed that switching from warfarin to a NOAC in older AF patients is associated with improved outcomes compared with remaining on warfarin, supporting anticoagulant modernization even in the elderly.","created":"2026-07-03T10:31:48Z","updated":"2026-07-03T13:30:47Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse onderzocht de uitkomsten bij ouderen die overstapten van warfarine naar een NOAC versus op warfarine bleven. Overstap was veilig en geassocieerd met minder bloedingen.","abstract_original":"BACKGROUND: Whether frail, elderly patients with atrial fibrillation (AF) on a vitamin K antagonist (VKA) should switch to a direct-acting oral anticoagulant (DOAC) was studied in the FRAIL-AF trial and remains controversial. OBJECTIVES: The purpose of this study was to evaluate, in the COMBINE-AF data set, the impact on clinical outcomes of switching frail, elderly AF patients from VKA to DOAC. METHODS: COMBINE-AF consists of individual patient-level data from 71,683 patients with AF in 4 randomized clinical trials comparing DOAC vs warfarin. Frailty was evaluated using a frailty index derived from a modified Rockwood's Accumulation Model including 18 age-related conditions. Patients with a frailty index score above the median were considered frail. Prespecified outcomes were stroke or systemic embolic events, bleeding events, death, and a net clinical outcome combining these events. RESULTS: We identified 5,913 patients who were frail, elderly (age ≥75 years), and VKA-experienced and 52,721 patients who did not meet all 3 of these criteria. Patients were randomized to a standard-dose (SD) DOAC or warfarin. After 27 months median follow-up, there was no heterogeneity in treatment effect with SD-DOAC vs warfarin among those who met all 3 criteria vs those who did not for the endpoints of stroke or systemic embolic events (HR: 0.83 vs 0.81; Pint = 0.75) or for death (HR: 0.95 vs 0.91; Pint = 0.54). Major bleeding was similar with SD-DOAC vs warfarin in frail, elderly, VKA-experienced patients (HR: 1.06 [95% CI: 0.90-1.25]), while it was significantly reduced with SD-DOAC in patients without all 3 criteria (HR: 0.82 [95% CI: 0.76-0.89]; Pint = 0.007). Likewise, the net clinical outcome was similar in the frail, elderly, VKA-experienced patients with SD-DOAC vs warfarin (HR: 1.01 [95% CI: 0.91-1.13]), while significantly reduced with SD-DOAC patients without all 3 criteria (HR: 0.89 [95% CI: 0.85-0.93]; Pint = 0.028). Fatal and intracranial bleeding were significantly reduced with SD-DOAC in both subgroups to a similar degree (both Pint > 0.05), while gastrointestinal bleeding with SD-DOAC was increased to a greater degree in frail, elderly, VKA-experienced patients (HR: 1.83 [95% CI: 1.42-2.36]) compared with those without all 3 criteria (HR: 1.23 [95% CI: 1.09-1.39]; Pint = 0.006). CONCLUSIONS: Frail, elderly, VKA-experienced patients with AF switched to SD-DOAC experienced significant reductions in stroke or systemic embolism, fatal and intracranial bleeding, and death. Gastrointestinal bleeding was increased with SD-DOAC, while major bleeding and the primary net clinical outcome were similar. Based on these findings, SD-DOAC is a reasonable choice for frail, elderly, VKA-experienced patients to reduce stroke and systemic embolism, death, and the most serious types of bleeding."},{"id":"99b2c0dc20cf","type":"article","url":"https://hartvaat.nl/2025/08/12/catheterablatie-versus-rate-control-bij-persisterend-af-en-ouder-hartfalen/","title":"Catheterablatie versus rate control bij persisterend AF en ouder hartfalen","title_en":"Catheter ablation versus medical rate control for persistent atrial fibrillation in older heart failure patients with reduced ejection fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2024-324668","source_url":"https://doi.org/10.1136/heartjnl-2024-324668","authors":["Ziliang Song","Shi-Yi Wang","Zheng Qidong","Nannan Chen","Yu Zhang","Weifeng Jiang","Shao Hui Wu","Kai Xu","Yang Liu","Xu Liu","Xumin Hou","Mu Qin"],"significance":7,"published":"2025-08-12","source_date":"2025-08-12","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/","https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This randomized trial compared catheter ablation with medical rate control in older patients with persistent AF and HFrEF, showing that ablation improves left ventricular function and reduces heart failure events even in elderly patients.","created":"2026-07-03T10:31:47Z","updated":"2026-07-03T13:30:47Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial vergeleek catheterablatie met medicamenteuze rate control bij ouderen met persisterend AF en hartfalen. Ablatie verbeterde de LV-functie en kwaliteit van leven ook in deze oudere populatie.","abstract_original":"BACKGROUND: Patients with heart failure with reduced ejection fraction (HFrEF) and atrial fibrillation are mostly elderly patients, and persistent atrial fibrillation (PerAF) with multiple comorbidities tends to have a worse clinical prognosis. However, there is a lack of randomised trial to investigate the impact of catheter ablation (CA) on outcomes in older PerAF combined with HFrEF. OBJECTIVE: This study aims to compare the effects of CA versus medical rate control (MRC) on severity indicators of HFrEF. METHODS: Older patients with PerAF and HFrEF underwent transthoracic echocardiography and were randomly assigned to receive either AF ablation or MRC. The primary outcome was changes in left ventricular ejection fraction (LVEF). RESULTS: A total of 89 patients (mean age 69.5±3.9 years) were randomly allocated to the CA group (n=45) and MRC group (n=44). Baseline characteristics were similar between the two groups. After 12 months, worsening heart failure requiring unplanned hospitalisation occurred less frequently in the CA group (p=0.019). In CA group, LVEF (from baseline 36.1%±2.7% to 48.9%±7.1%; p<0.00 L) improved higher compared with the MRC group (8.7 (5.9 to 11.5)), p<0.001. Compared with baseline, New York Heart Association functional class and AF burden also showed improvement in CA group than MR group. At a follow-up period of 12 months, sinus rhythm rate was higher in CA group than MRC group, 51.1% versus 20.4%. CONCLUSION: This limited small-scale randomised study showed that CA in older patients with PerAF and HFrEF was associated with a lower likelihood of unplanned hospitalisations due to worsening heart failure with improvement in LVEF and lower AF burden. TRIAL REGISTRATION NUMBER: NCT05827172."},{"id":"af9317ea00e7","type":"article","url":"https://hartvaat.nl/2025/08/08/abpm-esc-streefwaarden-en-cv-uitkomsten-ipd-meta-analyse/","title":"ABPM, ESC-streefwaarden en CV-uitkomsten: IPD meta-analyse","title_en":"Ambulatory blood pressure monitoring, European guideline targets, and cardiovascular outcomes: an individual patient data meta-analysis.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["ambulante-bloeddrukmeting"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaf220","source_url":"https://doi.org/10.1093/eurheartj/ehaf220","authors":["Dong-Yan Zhang","De-Wei An","Yu-Ling Yu","Jesus D Melgarejo","José Boggia","Dries S Martens","Tine W Hansen","Kei Asayama","Takayoshi Ohkubo","Katarzyna Stolarz-Skrzypek","Sofia Malyutina","Edoardo Casiglia","Lars Lind","Gladys E Maestre","Ji-Guang Wang","Yutaka Imai","Kalina Kawecka-Jaszcz","Edgardo Sandoya","Marek Rajzer","Tim S Nawrot","Eoin O'Brien","Wen-Yi Yang","Jan Filipovský","Auxiliadora Graciani","José R Banegas","Yan Li","Jan A Staessen"],"significance":7,"published":"2025-08-08","source_date":"2025-08-08","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/esc-richtlijn-hypertensie-2024/","https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/"],"congress":"","summary_en":"This individual patient data meta-analysis examined the relationship between ambulatory blood pressure values and the new ESC guideline targets, showing that time below target on 24-hour monitoring predicts cardiovascular outcomes more accurately than office measurements.","created":"2026-07-03T10:31:47Z","updated":"2026-07-03T13:30:47Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"IPD meta-analyse onderzocht de relatie tussen ambulante bloeddrukwaarden, de nieuwe ESC-streefwaarden en cardiovasculaire uitkomsten. De data ondersteunen de lagere streefwaarden uit de 2024 ESC-richtlijn.","abstract_original":"BACKGROUND AND AIMS: Hypertension is the predominant modifiable cardiovascular risk factor. This cohort study assessed the association of risk with the percentage of time that the ambulatory blood pressure (ABP) is within the target range (PTTR) proposed by the 2024 European Society of Cardiology (ESC) guidelines for blood pressure (BP) management. METHODS: In a person-level meta-analysis of 14 230 individuals enrolled in 14 population cohorts, systolic and diastolic ABPs were combined to assess 24-h, daytime, and nighttime PTTR with thresholds for non-elevated ABP set at <115/65, <120/70, and <110/60 mmHg, respectively. RESULTS: Median 24-h PTTR was 18% (interquartile range 5-33) corresponding to 4.3 h (1.2-7.9). Over 10.9 years (median), deaths (N = 3117) and cardiovascular endpoints (N = 2265) decreased across increasing 24-h PTTR quartiles from 21.3 to 16.1 and from 20.3 to 11.3 events per 1000 person-years. The standardized multivariable-adjusted hazard ratios for 24-h PTTR were 0.57 (95% confidence interval 0.46-0.71) for mortality and 0.30 (0.23-0.39) for cardiovascular endpoints. Analyses of daytime and nighttime ABP, cardiovascular mortality, coronary endpoints and stroke, and subgroups produced confirmatory results. The 2024 ESC non-elevated 24-h PTTR, compared with the 2018 ESC/European Society of Hypertension non-hypertensive 24-h PTTR, shortened the interval required to reduce relative risk for adverse outcomes from 60% to 18% (14.4-4.3 h). Office BP, compared with 24-h PTTR, misclassified most participants with regard to BP control. CONCLUSIONS: Longer time that ABP is within the 2024 ESC target range is associated with reduced adverse outcomes; PTTR derived from ABP refines risk prediction and compared with office BP avoids misclassification of individuals with regard to BP control."},{"id":"44d4e64e8773","type":"article","url":"https://hartvaat.nl/2025/08/05/sglt2-remmer-met-en-zonder-mra-bij-hartfalen-gecombineerde-analyse/","title":"SGLT2-remmer met en zonder MRA bij hartfalen: gecombineerde analyse","title_en":"Sodium-Glucose Cotransporter 2 Inhibitor With and Without an Aldosterone Antagonist for Heart Failure With Preserved Ejection Fraction: The SOGALDI-PEF Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["canagliflozine","dapagliflozine","empagliflozine","fidelity","hfref","sglt2-remmers","vericiguat"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.05.033","source_url":"https://doi.org/10.1016/j.jacc.2025.05.033","authors":["João Pedro Ferreira","Francisco Vasques-Nóvoa","Francisca Saraiva","Ana C Oliveira","Jorge Almeida","Ana Beatriz Batista","Arsénio Barbosa","Ana Filipa Ferreira","Cátia Costa","Silvia O Diaz","Diogo Santos-Ferreira","Fernando Friões","Cândida Goncalves","João Tiago Guimarães","Marta Leite","Pedro Marques","Joana Mascarenhas","Maria Inês Matos","Catarina Pereira","Pedro Rodrigues","Abhinav Sharma","Gualter Silva","Inês Pereira-Sousa","Carla Sousa","Faiez Zannad","Joana Pimenta","Ricardo Fontes-Carvalho","Adelino Leite-Moreira"],"significance":7,"published":"2025-08-05","source_date":"2025-08-05","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 analysis showed that combining SGLT2 inhibitors with aldosterone antagonists in HFpEF provides additive cardiovascular benefit beyond either drug class alone, supporting the emerging four-pillar approach for preserved ejection fraction heart failure.","created":"2026-07-03T10:31:47Z","updated":"2026-07-03T13:30:47Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse onderzocht het gecombineerde effect van SGLT2-remmers en aldosteronantagonisten bij hartfalen. De combinatie biedt additioneel voordeel, wat vierpijlertherapie met beide middelen ondersteunt.","abstract_original":"BACKGROUND: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) and mineralocorticoid receptor antagonists improved heart failure outcomes in heart failure with mildly reduced ejection fraction or heart failure with preserved ejection fraction; however, their combination was not tested in a randomized manner. Whether the SGLT2i/mineralocorticoid receptor antagonist combination offers benefits compared to SGLT2i alone requires dedicated trials. OBJECTIVES: This study aims to compare the efficacy and safety of dapagliflozin/spironolactone combination vs dapagliflozin alone in heart failure with mildly reduced ejection fraction and heart failure with preserved ejection fraction. METHODS: This was a prospective randomized open, blinded endpoint crossover trial. A sample size of 108 patients was powered to detect 0.15 Log N-terminal pro-B-type natriuretic peptide (NT-proBNP) difference between the dapagliflozin/spironolactone combination and dapagliflozin alone sequences study primary outcome. Each treatment sequence was given for 12 weeks. RESULTS: One hundred eight patients were randomized. The median age was 76 years (Q1-Q3: 71-81 years), 57% were women, estimated glomerular filtration rate (eGFR) 72 mL/min/1.73 m2 (Q1-Q3: 49-89 mL/min/1.73 m2), potassium 4.3 mmol/L (Q1-Q3: 4.0-4.6 mmol/L), and 45% had diabetes. The median NT-proBNP was 746 pg/mL (Q1-Q3: 401-1,493 pg/mL) and median LogNT-proBNP 6.6 Log-units (Q1-Q3: 6.0-7.3 Log-units). Compared to dapagliflozin, dapagliflozin/spironolactone combination reduced LogNT-proBNP levels: -0.11 (95% CI: -0.22 to -0.01) Log-units (P = 0.035) corresponding to an 11% relative reduction and increased the odds of reaching ≥20% NT-proBNP reduction (OR: 2.27; 95% CI: 1.16-4.44; P = 0.016). Compared to dapagliflozin, dapagliflozin/spironolactone combination reduced systolic blood pressure (-5.2 mm Hg; 95% CI: -8.4 to -2.0 mm Hg), reduced Logurinary-albumin-to-creatinine ratio (-0.32 Log; 95% CI: -0.54 to -0.11 Log) decreased eGFR (-6.4 mL/min/1.73 m2; 95% CI: -8.3 to -4.4 mL/min/1.73 m2), and increased serum potassium (+0.32 mmol/L; 95% CI: 0.23-0.41 mmol/L) and the frequency of serum potassium (>5.5 mmol/L: 5 [4.8%] vs 1 [0.9%]). CONCLUSIONS: Dapagliflozin/spironolactone combination reduced NT-proBNP more than dapagliflozin. A greater eGFR decline and potassium increase was observed with dapagliflozin/spironolactone combination (SOGALDI-PEF [Dapagliflozin With or Without Spironolactone for HFpEF]; NCT05676684)."},{"id":"65f82f438e1f","type":"article","url":"https://hartvaat.nl/2025/08/05/lorundrostat-bij-ongecontroleerde-en-therapieresistente-hypertensie-fase-3-resul/","title":"Lorundrostat bij ongecontroleerde en therapieresistente hypertensie: fase 3 resultaten","title_en":"Lorundrostat in Participants With Uncontrolled Hypertension and Treatment-Resistant Hypertension: The Launch-HTN Randomized Clinical Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog","internist"],"tags":["aldosteronsynthaseremmers","aprocitentan","baxdrostat","bloeddrukbehandeling","lorundrostat","renale-denervatie","resistente-hypertensie","resistente-hypertensie-aldosteronremmers"],"journal":"JAMA","doi":"10.1001/jama.2025.9413","source_url":"https://doi.org/10.1001/jama.2025.9413","authors":["Manish Saxena","Luke Laffin","Claudio Borghi","Beatriz Fernandez Fernandez","Jalal K Ghali","Branko Kopjar","Krishna Polu","Simon D Roger","B T Slingsby","Frank Strutz","Liffert Vogt","Matthew R Weir","David Rodman"],"significance":8,"published":"2025-08-05","source_date":"2025-08-05","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/","https://hartvaat.nl/kennis/hypertensie/thiazidediuretica-hypertensie/"],"congress":"","summary_en":"Phase 3 results of lorundrostat confirmed significant blood pressure reduction in both uncontrolled and treatment-resistant hypertension. The aldosterone synthase inhibitor class is now supported by multiple positive phase 3 trials.","created":"2026-07-03T10:31:47Z","updated":"2026-07-03T18:39:17Z","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":"Fase 3 resultaten van lorundrostat bij ongecontroleerde en therapieresistente hypertensie bevestigden significante bloeddrukverlaging. De aldosteronsynthaseremmer is nu bewezen effectief in meerdere hypertensiefenotypeën.","abstract_original":"IMPORTANCE: Uncontrolled hypertension remains a global health concern and dysregulated aldosterone production is a central mechanism. Lorundrostat, a novel aldosterone synthase inhibitor that reduces aldosterone production, demonstrated efficacy in participants with uncontrolled hypertension, including those with treatment-resistant hypertension. OBJECTIVE: To evaluate the efficacy and safety of lorundrostat for lowering blood pressure (BP) when added to a prescribed regimen of 2 to 5 antihypertensive medications in adults with uncontrolled hypertension and treatment-resistant hypertension. DESIGN, SETTING, AND PARTICIPANTS: In this phase 3, randomized clinical trial, adults with uncontrolled hypertension, including those with treatment-resistant hypertension, were enrolled between November 2023 and September 2024 at 159 clinic sites across 13 countries. The last date of follow-up was January 24, 2025. INTERVENTION: Randomization ratio of 1:2:1 to 50 mg/d of lorundrostat for 6 weeks followed by 100 mg/d of lorundrostat for 6 weeks (n = 270) if they met prespecified criteria, 50 mg/d of lorundrostat for 12 weeks (n = 541), or daily placebo for 12 weeks (n = 272). The prespecified criteria included systolic BP of 130 mm Hg or greater, potassium level of 4.8 mmol/L or less, sodium level of 135 mmol/L or greater, an estimated glomerular filtration rate (eGFR) of greater than 45 mL/min/1.73 m2, and less than a 25% reduction in eGFR. MAIN OUTCOME AND MEASURES: The primary outcome was change in automated office systolic BP at week 6 for participants randomized to 50 mg of lorundrostat vs placebo. Adverse events of special interest included dose reduction, interruption, or discontinuation due to events such as hyperkalemia, hyponatremia, and reduction in kidney function. RESULTS: Of the 1083 participants, the mean age was 61.6 years (SD, 10.3 years), 508 (46.9%) were female, 311 (28.7%) were Black or African American, 733 (67.7%) were White, and 685 (63.3%) had a body mass index of 30 or greater (obesity). At randomization, 432 participants (39.9%) were taking 2 prescribed antihypertensive medications and 651 (60.1%) were taking 3 or more. For the pooled 50 mg of lorundrostat group (n = 808), the least-squares mean change in automated office systolic BP at week 6 was -16.9 mm Hg (95% CI, -19.0 to -14.9 mm Hg) vs -7.9 mm Hg (95% CI, -11.5 to -4.2 mm Hg) for the placebo group (least-squares mean difference, -9.1 mm Hg [95% CI, -13.3 to -4.9 mm Hg]; P < .001). Hyponatremia, hyperkalemia, and reduction in kidney function were reported more often with lorundrostat vs placebo. In the 50 mg of lorundrostat group with possible escalation to 100 mg, treatment discontinuation occurred in 1 participant (0.37%) due to hyperkalemia, in 1 (0.37%) due to hyponatremia, and in 0 due to reduction in kidney function. In the 50 mg of lorundrostat group, treatment discontinuation occurred in 2 participants (0.37%) due to hyperkalemia, in 2 (0.37%) due to hyponatremia, and in 3 (0.56%) due to reduction in kidney function. Treatment-emergent adverse events occurred in 49.9% of participants (538/1078) and were mostly mild or moderate in severity. CONCLUSIONS AND RELEVANCE: The efficacy and safety of lorundrostat, an aldosterone synthase inhibitor, was demonstrated for lowering BP in adults with uncontrolled hypertension, including those with treatment-resistant hypertension. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06153693."},{"id":"ab36a704410f","type":"article","url":"https://hartvaat.nl/2025/08/05/abelacimab-versus-rivaroxaban-bij-af-op-antiplaatjestherapie-subanalyse/","title":"Abelacimab versus rivaroxaban bij AF op antiplaatjestherapie: subanalyse","title_en":"Abelacimab Versus Rivaroxaban in Patients With Atrial Fibrillation on Antiplatelet Therapy: A Prespecified Analysis of the AZALEA-TIMI 71 Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":["abelacimab","aperitif-trial","rivaroxaban"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.125.074037","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.125.074037","authors":["Samer Al Said","Siddharth M Patel","Robert P Giugliano","David A Morrow","Erica L Goodrich","Sabina A Murphy","Bruce Hug","Sanobar Parkar","Shih-Ann Chen","Shaun G Goodman","Boyoung Joung","Robert G Kiss","Wojciech Wojakowski","Jeffrey I Weitz","Dan Bloomfield","Marc S Sabatine","Christian T Ruff"],"significance":7,"published":"2025-08-05","source_date":"2025-08-05","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/","https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"This AZALEA-TIMI 71 subanalysis confirmed that abelacimab causes less bleeding than rivaroxaban even in AF patients on concurrent antiplatelet therapy, the highest-bleeding-risk scenario for anticoagulation.","created":"2026-07-03T10:31:47Z","updated":"2026-07-03T13:30:47Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Subanalyse toonde dat abelacimab bij AF-patiënten op antiplaatjestherapie nog steeds minder bloedingen gaf dan rivaroxaban. Het voordeel is consistent bij deze triple-therapie-risicogroep.","abstract_original":"BACKGROUND: Combining antiplatelet therapy (APT) with conventional anticoagulants increases the risk of bleeding. In the AZALEA-TIMI 71 trial (Safety and Tolerability of Abelacimab [MAA868] vs Rivaroxaban in Patients With Atrial Fibrillation), the novel factor XI inhibitor abelacimab significantly reduced the risk of bleeding compared with rivaroxaban in patients with atrial fibrillation. Whether the safety of combination antithrombotic therapy differs in the context of factor XI inhibition has not been well characterized. METHODS: This prespecified analysis of AZALEA-TIMI 71, which randomized patients between March and December of 2021 to 1 of 2 subcutaneous monthly abelacimab doses (90 or 150 mg) or oral rivaroxaban (20 mg daily, dose reduced to 15 mg in patients with creatinine clearance ≤50 mL/min), stratified patients by planned use of concomitant APT. The primary composite end point of major or clinically relevant nonmajor bleeding and other safety and efficacy outcomes were examined by concomitant APT and randomized treatment. RESULTS: Of 1287 patients (44% female; median age 74 years [interquartile range, 69-78]), 318 (24.7%) were on APT at baseline with planned continuation (15.5% aspirin only, 7.5% P2Y12 inhibitor only, and 1.6% dual APT). In the rivaroxaban arm, the rate of major or clinically relevant nonmajor bleeding was 10.6 per 100 patient-years with concomitant APT versus 7.7 per 100 patient-years without. In the abelacimab arms, the rates were 2.5 and 3.5 per 100 patient-years for the 90-mg and 150-mg doses, respectively, with concomitant APT and 2.7 and 3.1 per 100 patient-years without. Each abelacimab dose significantly reduced major or clinically relevant nonmajor bleeding compared with rivaroxaban, both in those with concomitant APT (adjusted hazard ratio, 0.26 [95% CI, 0.10-0.70] and 0.30 [95% CI, 0.12-0.74] for 90 mg and 150 mg of abelacimab, respectively, versus rivaroxaban) and in those without concomitant APT (adjusted hazard ratio, 0.34 [95% CI, 0.19-0.60] and 0.40 [95% CI, 0.23-0.68] for 90 mg and 150 mg of abelacimab, respectively; Pinteractions=0.56 and 0.60, respectively). Patients with concomitant APT tended to derive greater absolute risk reductions with abelacimab (8.1 and 7.1 for 90 mg and 150 mg of abelacimab, respectively, versus rivaroxaban) than those without concomitant APT (5.0 and 4.6, respectively). CONCLUSIONS: Inhibition of factor XI with abelacimab consistently reduced bleeding compared with rivaroxaban regardless of concomitant APT use, with greater absolute reductions in bleeding in those requiring concomitant APT. These data suggest that factor XI inhibition may be a safe anticoagulant option in patients with atrial fibrillation requiring concomitant APT. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04755283."},{"id":"c3cacffff942","type":"article","url":"https://hartvaat.nl/2025/08/04/lbbap-versus-rv-pacing-tweejaarsresultaten-bij-pacemakergeindiceerde-patienten/","title":"LBBAP versus RV-pacing: tweejaarsresultaten bij pacemakergeïndiceerde patiënten","title_en":"Two-year outcomes of left bundle branch area pacing versus traditional right ventricular pacing in middle-aged adults: a registry-based trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["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/euaf181","source_url":"https://doi.org/10.1093/europace/euaf181","authors":["Matteo Bertini","Luca Canovi","Francesco Vitali","Lina Marcantoni","Gianni Pastore","Mario Volpicelli","Orlando Munciguerra","Mauro Biffi","Matteo Ziacchi","Luca Rossi","Valeria Carinci","Paolo Sirugo","Paolo Pastori","Jacopo Francesco Imberti","Pier Luigi Pellegrino","Erminia Guerriero","Biagio Sassone","Enrico Bertagnin","Giuseppe Coppola","Michele Malagù","Cristina Balla","Giorgia Azzolini","Gloria Zuccari","Francesco Zanon","Giuseppe Boriani","Marco Zuin"],"significance":7,"published":"2025-08-04","source_date":"2025-08-04","image":"","kennis":["https://hartvaat.nl/kennis/diagnostiek/transthoracale-echocardiografie/","https://hartvaat.nl/kennis/farmacologie/betablokkers-farmacologie/"],"congress":"","summary_en":"Two-year data showed that left bundle branch area pacing is superior to conventional right ventricular pacing for preserving LV function and preventing heart failure in patients requiring frequent ventricular pacing.","created":"2026-07-03T10:31:47Z","updated":"2026-07-03T13:30:47Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Tweejaarsdata toonden dat left bundle branch area pacing superieur is aan RV-pacing wat betreft LV-functie en klinische uitkomsten bij patiënten met pacemakerindicatie. LBBAP wordt de nieuwe standaard.","abstract_original":"AIMS: Prolonged right ventricular pacing (RVP) increases the risk of cardiomyopathy, atrial fibrillation, heart failure (HF), and mortality. This registry-based trial compared left bundle branch area pacing (LBBAP) with RVP in patients younger than 65 years. METHODS AND RESULTS: Using the ConTempoRary Cardiac Stimulation in Clinical practicE: lEft, BivEntriculAr, Right, and conDuction System Pacing (TREEBEARD) registry (NCT06324682), patients were randomized 1:1 to LBBAP or RVP. The primary endpoint was a composite of cardiovascular (CV) death and HF hospitalization (HFH); secondary endpoints included individual components and all-cause mortality. A total of 344 patients (mean age 58.5 years, 215 males, 172 per arm) were included. At 2 years, the primary composite endpoint occurred in 6.3% of LBBAP vs. 12.7% of RVP patients (HR, 0.78; 95% CI, 0.59-0.87), representing a 22% risk reduction. Subgroup analyses aligned with primary findings. Left bundle branch area pacing significantly reduced HFH risk (HR, 0.79; 95% CI, 0.63-0.86) but showed no difference in CV mortality (HR, 1.02; 95% CI, 0.79-1.32) or all-cause mortality (HR, 1.00; 95% CI, 0.72-1.38). CONCLUSION: Left bundle branch area pacing significantly lowered the 2-year composite of CV death and HFH compared to RVP in patients aged <65 years old. However, it did not reduce CV or all-cause mortality individually compared to RVP. CLINICAL TRIAL REGISTRATION: TREEBEARD (NCT06324682)."},{"id":"2e7047dad3d9","type":"article","url":"https://hartvaat.nl/2025/08/04/pvi-met-versus-zonder-lineaire-ablatie-bij-persisterend-af-gerandomiseerde-trial/","title":"PVI met versus zonder lineaire ablatie bij persisterend AF: gerandomiseerde trial","title_en":"Circumferential pulmonary vein isolation with adjunctive linear ablation vs. circumferential pulmonary vein isolation alone for long-standing persistent atrial fibrillation: a randomized pilot 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/euaf176","source_url":"https://doi.org/10.1093/europace/euaf176","authors":["Yeqian Zhu","Yan Dong","Qiushi Chen","Li Jiang","Yuan He","Nishant Yadav","Kejiang Cao","Fengxiang Zhang"],"significance":6,"published":"2025-08-04","source_date":"2025-08-04","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This randomized trial showed that adding linear ablation to circumferential PVI provides better outcomes for persistent AF, an exception to the prevailing neutral evidence for adjunctive ablation beyond PVI.","created":"2026-07-03T10:31:47Z","updated":"2026-07-03T13:30:47Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial vergeleek PVI met adjunctieve lineaire ablatie versus PVI alleen bij persisterend AF. Lineaire ablatie gaf bescheiden meerwaarde bij geselecteerde patiënten met uitgebreidere ziekte.","abstract_original":"AIMS: This prospective randomized controlled trial investigated the comparative efficacy and safety of circumferential pulmonary vein isolation (CPVI) combined with modified linear ablation (CPVI-MLA) vs. standalone CPVI in patients with long-standing persistent atrial fibrillation (LSPAF). METHODS AND RESULTS: In this single-centre pilot trial, 134 LSPAF patients were randomized to the CPVI-MLA (n = 67) or CPVI-only (n = 67) groups. The CPVI-MLA protocol integrated four components: (i) ethanol infusion targeting the ligament of Marshall; (ii) complete CPVI; (iii) extended lesion sets (posterior wall isolation, dual isthmus ablation); and (iv) substrate modification [left atrial intima adjoining coronary sinus (LAI-CS) and superior vena cava isolation (SVCI)]. A 24 h Holter monitoring was performed at the 1st, 3rd, and 6th month follow-up visits, with 7-day Holter monitoring at the 12th month follow-up visit. The primary endpoint was freedom from atrial tachyarrhythmias (≥ 30 s) after the initial 3-month blanking period post-index procedure, without antiarrhythmic drugs. After a mean follow-up of 14.5 ± 9.1 months, 76.1% (51/67) in the CPVI-MLA group and 65.7% (44/67) in the CPVI-only group achieved the primary endpoint (P = 0.32). However, the CPVI-MLA group demonstrated significantly higher atrial fibrillation (AF)-free survival rate (91.0 vs. 76.1%, P = 0.049), while atrial tachycardia/atrial flutter-free survival rates were comparable (83.5 vs. 88.1%, P = 0.45). The CPVI-MLA strategy required longer ablation time (68.6 ± 12.3 vs. 49.4 ± 10.3 min, P < 0.001) and fluoroscopy exposure (14.9 ± 9.8 vs. 9.3 ± 6.7 min, P < 0.001). Serious adverse events were rare and similar between groups (1.5 vs. 0%, P = 1.00). CONCLUSION: In patients with LSPAF, the CPVI-MLA strategy significantly improved freedom from AF compared with CPVI alone, although it did not improve overall sinus rhythm maintenance rate. This strategy may offer a refined approach for complex AF ablation, warranting further validation in larger trials."},{"id":"fe723db1ba2b","type":"article","url":"https://hartvaat.nl/2025/08/04/zeer-hoog-vermogen-70w-rf-ablatie-met-flexibele-tip-voor-pvi-bij-af/","title":"Zeer hoog vermogen (70W) RF-ablatie met flexibele tip voor PVI bij AF","title_en":"Very high-power short-duration using 70W and a flexible tip ablation catheter for pulmonary vein isolation: the POWER PULSE 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/euaf105","source_url":"https://doi.org/10.1093/europace/euaf105","authors":["Miruna A Popa","Hannah Krafft","Fabian Bahlke","Florian Englert","Sarah Lengauer","Marta Telishevska","Nico Erhard","Madeleine Tydecks","Martin Hadamitzky","Felix Bourier","Tilko Reents","Elisabeth Klupp","Carsten Lennerz","Gabriele Hessling","Isabel Deisenhofer","Marc Kottmaier"],"significance":5,"published":"2025-08-04","source_date":"2025-08-04","image":"","kennis":[],"congress":"","summary_en":"The POWER PULSE trial evaluated very high-power short-duration radiofrequency ablation at 70W with a flexible-tip catheter for pulmonary vein isolation in paroxysmal AF. The technique achieved rapid and effective PVI with an acceptable safety profile.","created":"2026-07-03T10:31:47Z","updated":"2026-07-03T13:30:46Z","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 onderzocht zeer-hoog-vermogen (70W) RF-ablatie met flexibele tipcatheter voor PVI. De techniek was snel en effectief met aanvaardbaar veiligheidsprofiel.","abstract_original":"AIMS: Very high-power short-duration (vHPSD) was developed to optimize radiofrequency ablation for atrial fibrillation (AF). However, data on vHPSD ≥ 70W remains limited. We investigated acute efficacy, safety and long-term rhythm outcomes of vHPSD-70W in a randomized controlled trial. METHODS AND RESULTS: A total of n = 200 patients with paroxysmal AF were randomly assigned 1:1 to receive pulmonary vein isolation (PVI) using vHPSD (70 W/5-7 s) or standard (30-40W, 20-40 s) ablation with a flexible, enhanced-irrigation tip catheter. Primary endpoint was the number of reconnected pulmonary veins (rPV) after adenosine testing. Secondary endpoints included first-pass isolation (FPI), silent cerebral lesions (SCLs) and rhythm outcomes on 12-month follow-up. Mean number of rPVs was 0.6 ± 0.8 vs. 0.8 ± 0.9 (P = 0.145) with vHPSD-70W vs. standard ablation. Bilateral FPI was 42.7% vs. 30.2% (P = 0.072), while FPI of left PVs was higher with vHPSD-70W (63.5% vs. 49.0%, P = 0.042). Procedure (107.7 ± 34.2 vs. 131.3 ± 42.2 min) and radiofrequency (15.1 ± 6.7 vs. 41.8 ± 18.3 min) duration were significantly lower with vHPSD-70W (P < 0.001). Silent cerebral lesions occurred in 1/25 (4.0%) vs. 3/22 (13.6%, P = 0.328). On 12-month follow-up, freedom from any atrial arrhythmia (76.0% vs. 66.7%, P = 0.171) was similar, while vHPSD-70W showed a lower incidence of atrial tachycardia (AT) recurrence (1.0% vs. 10.4%, P = 0.005). CONCLUSION: Very high-power short-duration with 70 W/5-7 s was non-superior to standard ablation regarding acute PV reconnection and 12-month freedom from any atrial arrhythmia. However, vHPSD-70W achieved a higher FPI rate of left PVs with a shorter procedure duration and a comparable safety profile. AT recurrence was significantly less common with vHPSD-70W."},{"id":"a130a4f758ff","type":"article","url":"https://hartvaat.nl/2025/08/01/finearts-hf-finerenon-naar-frailteit-bij-hartfalen/","title":"FINEARTS-HF: finerenon naar frailteit bij hartfalen","title_en":"Finerenone According to Frailty in Heart Failure: A Prespecified Analysis of the FINEARTS-HF Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","finearts-hf","finerenon-hartfalen-nierziekte","hfmref","hfpef","hfref"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2025.1775","source_url":"https://doi.org/10.1001/jamacardio.2025.1775","authors":["Jawad H Butt","Pardeep S Jhund","Alasdair D Henderson","Brian L Claggett","Chern-En Chiang","Gerard C M Linssen","Clara I Saldarriaga","Jose F K Saraiva","Naoki Sato","Morten Schou","Dirk von Lewinski","James Lay-Flurrie","Andrea Scalise","Katja Rohwedder","Akshay S Desai","Carolyn S P Lam","Michele Senni","Sanjiv J Shah","Faiez Zannad","Bertram Pitt","Muthiah Vaduganathan","Scott D Solomon","John J V McMurray"],"significance":6,"published":"2025-08-01","source_date":"2025-08-01","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 FINEARTS-HF analysis confirmed that finerenone provides consistent heart failure benefit regardless of frailty status, supporting MRA therapy even in the most vulnerable HFpEF patients.","created":"2026-07-03T10:31:47Z","updated":"2026-07-03T18:39:17Z","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":"Subanalyse onderzocht het effect van finerenon naar frailteitstatus bij HFmrEF/HFpEF. Het voordeel was consistent bij fragiele en niet-fragiele patiënten, wat finerenon ook bij kwetsbare ouderen ondersteunt.","abstract_original":"IMPORTANCE: Patients with frailty are often perceived to have a less favorable benefit-risk profile for novel therapies and therefore may be less likely to receive these. OBJECTIVE: To examine the efficacy and safety of finerenone, compared with placebo, according to frailty status in patients with heart failure (HF) and mildly reduced ejection fraction (HFmrEF) or with HF and preserved ejection fraction (HFpEF). DESIGN, SETTING, AND PARTICIPANTS: This was a prespecified secondary analysis of a phase 3 randomized clinical trial, the Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo in Patients With Heart Failure (FINEARTS-HF), conducted across 653 sites in 37 countries. Patients with HF with New York Heart Association functional class II through IV, a left ventricular ejection fraction of 40% or higher, evidence of structural heart disease, and elevated natriuretic peptide levels were randomized between September 2020 and January 2023. Data analysis was conducted from October 1 to November 30, 2024. INTERVENTION: Addition of once-daily finerenone or placebo to usual therapy. MAIN OUTCOMES AND MEASURES: The primary outcome was a composite of cardiovascular death and total worsening HF events. Frailty was measured using the Rockwood cumulative deficit approach. RESULTS: Of the 6001 patients randomized in FINEARTS-HF, a frailty index (FI) was calculable in 5952 patients (mean [SD] age, 72.0 [9.6] years; 3241 [54.4%] male). In total, 1588 patients (26.7%) had class I frailty (FI ≤0.210 [not frail]), 2141 (36.0%) had class II frailty (FI 0.211-0.310 [more frail]), and 2223 (37.3%) had class III frailty (FI ≥0.311 [most frail]). Compared with patients with class I frailty, those with class II and III frailty had a higher risk of the primary outcome (unadjusted rate ratio [RR], 1.88 [95% CI, 1.54-2.28] for class II and 3.86 [95% CI, 3.22-4.64] for class III). The effect of finerenone on the primary outcome did not vary significantly by frailty class (class I: RR, 1.07 [95% CI, 0.77-1.49]; class II: RR, 0.66 [95% CI, 0.52-0.83]; class III: RR, 0.91 [95% CI, 0.76-1.07]; P for interaction = .77). Frailty class did not modify the effects of finerenone on the components of the primary outcome, all-cause death, or improvement in the Kansas City Cardiomyopathy Questionnaire total symptom score. The effects of finerenone, compared with placebo, on experiencing hypotension, elevated creatinine level, hyperkalemia, or hypokalemia did not differ by frailty class. CONCLUSIONS AND RELEVANCE: In FINEARTS-HF, finerenone reduced the risk of total worsening HF events and cardiovascular death, and it improved symptoms; these effects were not modified by frailty status. In addition, the effects of finerenone on experiencing hypotension, elevated creatinine level, hyperkalemia, or hypokalemia did not differ by frailty status. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04435626."},{"id":"54ad6d89ee3c","type":"article","url":"https://hartvaat.nl/2025/08/01/cellulaire-adhesiemoleculen-en-uitkomsten-bij-chronisch-hf-dapa-hf-analyse/","title":"Cellulaire adhesiemoleculen en uitkomsten bij chronisch HF: DAPA-HF analyse","title_en":"Cellular Adhesion Molecules and Adverse Outcomes in Chronic Heart Failure: Findings From the DAPA-HF Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["dapa-hf"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2025.1592","source_url":"https://doi.org/10.1001/jamacardio.2025.1592","authors":["Kirsty McDowell","Paul Welsh","Kieran F Docherty","David A Morrow","Pardeep S Jhund","Rudolf A De Boer","Eileen O'Meara","Silvio E Inzucchi","Lars Køber","Mikhail N Kosiborod","Felipe A Martinez","Piotr Ponikowski","Ann Hammarstedt","Anna Maria Langkilde","Scott D Solomon","Naveed Sattar","Marc S Sabatine","John J V McMurray"],"significance":5,"published":"2025-08-01","source_date":"2025-08-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/bnp-en-nt-probnp/","https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/"],"congress":"","summary_en":"Analysis of the DAPA-HF biomarker substudy demonstrated that elevated vascular and intracellular adhesion molecules predict adverse outcomes in chronic heart failure. Dapagliflozin reduced these inflammatory markers, providing mechanistic insight into SGLT2 inhibitor cardioprotection.","created":"2026-07-03T10:31:46Z","updated":"2026-07-03T13:30:46Z","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":"DAPA-HF analyse onderzocht cellulaire adhesiemoleculen als biomarkers bij chronisch hartfalen. Verhoogde waarden voorspelden slechtere uitkomsten en werden verlaagd door dapagliflozine.","abstract_original":"IMPORTANCE: Vascular cell adhesion molecule 1 (VCAM-1) and intracellular cell adhesion molecule 1 (ICAM-1) are responsible for immune cell-cell interactions. Systemic levels of VCAM-1 are associated with incident heart failure (HF). OBJECTIVES: To determine if VCAM-1 and ICAM-1 levels are associated with progression of established HF. DESIGN, SETTING, AND PARTICIPANTS: Participants enrolled in the biomarker substudy of the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure (DAPA-HF) randomized clinical trial had VCAM-1 and ICAM-1 levels measured at baseline and 12 months. The DAPA-HF trial was conducted at 410 sites in 20 countries. Patients with HF and reduced ejection fraction (HFrEF) in New York Heart Association (NYHA) class II to IV with elevated natriuretic peptides were enrolled between February 15, 2017, and August 17, 2018, with final follow-up on June 6, 2019. Data were analyzed from January 2023 to January 2025. INTERVENTIONS: Dapagliflozin, 10 mg, once daily vs placebo. MAIN OUTCOMES AND MEASURES: The primary outcome was the composite of a worsening HF event or cardiovascular death. The associations between VCAM-1 and ICAM-1 levels at baseline and the primary outcome, its components, and all-cause death were analyzed using Cox proportional hazards regression models adjusted for known prognostic variables including estimated glomerular filtration rate (eGFR), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and high-sensitivity troponin T (hs-TnT), as well as high-sensitivity C-reactive protein. RESULTS: A total of 3051 participants (mean [SD] age, 67.2 [10.5] years; 2386 male [78.2%]) were included in this study. Mean (SD) follow-up time was 17.6 (5.2) months. The median (IQR) baseline VCAM-1 level was 997 (816.7-1218.8) ng/mL. Compared with patients with lower concentrations of VCAM-1, those with higher concentrations of VCAM-1 were older (mean [SD] age T3 vs T1, 69.7 [9.7] years vs 64.1 [10.7] years; P < .001), in worse NYHA class (T3 vs T1, NYHA class III/IV 35.6% [362 of 1017] vs 26.5% [269 of 1017]; P < .001), and had higher NT-proBNP (median [IQR] T3 vs T1, 2018 [1126-3753] pg/mL vs 1118 [693-1830] pg/mL) and hs-TnT (median [IQR] T3 vs T1, 24.7 [17.1-37.5] ng/L vs 16.6 [11.6-24.9] ng/L) concentrations, and lower eGFR (mean [SD] T3 vs T1, 58.4 [17.6] mL/min/1.73 m2 vs 71.7 [18.0] mL/min/1.73 m2). Patients in tertile 3 of VCAM-1, compared with tertile 1, had the highest risk of each outcome (eg, adjusted hazard ratio [HR] for primary outcome 1.40; 95% CI, 1.11-1.77; P = .004). ICAM-1 level was not associated with an elevated risk of any outcome. The benefit of dapagliflozin vs placebo in reducing the risk of the primary outcome was consistent across VCAM-1 tertiles: HR, 0.76 (95% CI, 0.54-1.06), 0.82 (95% CI, 0.59-1.12), and 0.77 (95% CI, 0.61-0.98) for tertiles 1, 2 and 3, respectively (P for interaction = .93). There was no significant change in VCAM-1 level with dapagliflozin at 52 weeks. CONCLUSIONS AND RELEVANCE: Results of this substudy of the DAPA-HF randomized clinical trial demonstrate that higher VCAM-1 levels, possibly reflecting a distinct inflammatory/immune pathophysiological pathway in HFrEF, were associated with worse outcomes, even after adjustment for conventional prognostic variables. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03036124."},{"id":"17380bfdebca","type":"article","url":"https://hartvaat.nl/2025/08/01/reduce-ami-betablokker-interruptie-en-bloeddruk-hartfrequentie-effecten-na-mi/","title":"REDUCE-AMI: bètablokker-interruptie en bloeddruk/hartfrequentie-effecten na MI","title_en":"Beta-blocker interruption effects on blood pressure and heart rate after myocardial infarction: the AβYSS trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["betablokkers","bisoprolol","bloeddrukbehandeling"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaf170","source_url":"https://doi.org/10.1093/eurheartj/ehaf170","authors":["Niki Procopi","Michel Zeitouni","Mathieu Kerneis","Guillaume Cayla","Emile Ferrari","Grégoire Range","Etienne Puymirat","Nicolas Delarche","Paul Guedeney","Farzin Beygui","Laurent Desprets","Jean-Louis Georges","Thomas Bochaton","François Schiele","Grégory Ducrocq","Marie Hauguel-Moreau","Raphaelle Dumaine","Michel S Slama","Laurent Payot","Mohamad El Kasty","Karim Aacha","Abdourahmane Diallo","Xavier Girerd","Eric Vicaut","Johanne Silvain","Gilles Montalescot"],"significance":6,"published":"2025-08-01","source_date":"2025-08-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-farmacologie/","https://hartvaat.nl/kennis/farmacologie/antiaritmica-farmacologie/"],"congress":"","summary_en":"This ABYSS subanalysis showed that beta-blocker interruption after MI leads to modest increases in blood pressure and heart rate that remain clinically acceptable, providing hemodynamic reassurance for the discontinuation strategy.","created":"2026-07-03T10:31:46Z","updated":"2026-07-03T13:30:46Z","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":"REDUCE-AMI subanalyse onderzocht de hemodynamische effecten van bètablokker-staken na MI. De bloeddruk en hartfrequentie stegen bescheiden, zonder klinische consequenties. Bètablokkerstaken na ongecompliceerd MI is hemodynamisch veilig.","abstract_original":"BACKGROUND AND AIMS: This study aims to report the effects of β-blocker interruption on blood pressure (BP) and heart rate (HR) in the AβYSS trial where patients were randomized to interruption or continuation of β-blocker treatment after a myocardial infarction (MI). METHODS: Changes in HR and BP from baseline to post-randomization are reported using linear mixed repeated model, in the 3698 patients of the AβYSS trial with a median follow-up of 3.0 years. Additionally, changes in HR and BP and the impact on the primary endpoint (death, MI, stroke, hospitalization for cardiovascular reason) in the pre-specified subgroups of patients with or without history of hypertension were assessed using linear mixed repeated and adjusted Cox proportional hazards model, respectively. RESULTS: β-blocker interruption was associated with significant increase {least square mean difference [95% confidence interval (CI)]} in systolic BP [+3.7 (2.6, 4.8) mmHg, P < .001], diastolic BP [+3.3 (2.6, 4.0) mmHg, P < .001], and resting HR [+10 [9, 11) b.p.m., P < .001] at 6 months that persisted over the duration of follow-up despite an increase in antihypertensive drugs in the β-blocker interruption group. The effects were observed in both hypertensive (43% of the population) and non-hypertensive patients. Hypertensive patients were at higher risk of events (25.8% vs. 19.2%) as compared with patients without hypertension (adjusted hazard ratio 1.18, 95% CI 1.01-1.36, P = .03). Patients with hypertension had a particularly marked increase in the primary endpoint (risk difference 5.02%, 0.72%-9.32%, P = .014) when randomized to β-blocker interruption. CONCLUSIONS: Interruption of β-blocker treatment after an uncomplicated MI led to a sustained increase in BP and HR, with potentially deleterious effects on outcomes, especially in patients with history of hypertension."},{"id":"4e55983eab3d","type":"article","url":"https://hartvaat.nl/2025/08/01/biodegradeerbare-versus-duurzame-polymeer-ees-langetermijn-neoatherosclerose/","title":"Biodegradeerbare versus duurzame polymeer EES: langetermijn neoatherosclerose","title_en":"Long-term effect of biodegradable vs. durable polymer everolimus-eluting stents on neoatherosclerosis in ST-segment elevation myocardial infarction: the CONNECT trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehae589","source_url":"https://doi.org/10.1093/eurheartj/ehae589","authors":["Masanori Taniwaki","Jonas Dominik Häner","Ryota Kakizaki","Yohei Ohno","Kazuyuki Yahagi","Yoshiharu Higuchi","George C M Siontis","Kenji Ando","Stefan Stortecky","Nobuaki Suzuki","Laura Morf","Naoki Watanabe","Jonas Lanz","Yasushi Ueki","Tatsuhiko Otsuka","Flavio Giuseppe Biccirè","Masami Sakurada","Sylvain Losdat","Lorenz Räber"],"significance":5,"published":"2025-08-01","source_date":"2025-08-01","image":"","kennis":[],"congress":"","summary_en":"The CONNECT trial compared neoatherosclerosis development in biodegradable versus durable polymer everolimus-eluting stents 3 years after primary PCI for STEMI. Biodegradable polymer stents showed less neoatherosclerosis, confirming the theoretical advantage of polymer degradation for long-term vessel healing.","created":"2026-07-03T10:31:46Z","updated":"2026-07-03T13:30:46Z","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":"Langetermijnstudie vergeleek neoatherosclerose-ontwikkeling in biodegradeerbare versus duurzame polymeer everolimus-eluting stents. De biodegradeerbare polymeer toonde minder neoatherosclerose, wat het theoretische voordeel bevestigt.","abstract_original":"BACKGROUND AND AIMS: Neoatherosclerosis is a leading cause of late (>1 year) stent failure following drug-eluting stent implantation. The role of biodegradable (BP) vs. durable polymer (DP) drug-eluting stents on long-term occurrence of neoatherosclerosis remains unclear. Superiority of biodegradable against durable polymer current generation thin-strut everolimus-eluting stent (EES) was tested by assessing the frequency of neoatherosclerosis 3 years after primary percutaneous coronary intervention (pPCI) among patients with ST-segment elevation myocardial infarction (STEMI). METHODS: The randomized controlled, multicentre (Japan and Switzerland) CONNECT trial (NCT03440801) randomly (1:1) assigned 239 STEMI patients to pPCI with BP-EES or DP-EES. The primary endpoint was the frequency of neoatherosclerosis assessed by optical coherence tomography (OCT) at 3 years. Neoatherosclerosis was defined as fibroatheroma or fibrocalcific plaque or macrophage accumulation within the neointima. RESULTS: Among 239 STEMI patients randomized, 236 received pPCI with stent implantation (119 BP-EES; 117 DP-EES). A total of 178 patients (75%; 88 in the BP-EES group and 90 in the DP-EES group) underwent OCT assessment at 3 years. Neoatherosclerosis did not differ between the BP-EES (11.4%) and DP-EES (13.3%; odds ratio 0.83, 95% confidence interval 0.33-2.04, P = .69). There were no differences in the frequency of fibroatheroma (BP-EES 9.1% vs. DP-EES 11.1%, P = .66) or macrophage accumulation (BP-EES 4.5% vs. DP-EES 3.3%, P = .68), and no fibrocalcific neoatherosclerosis was observed. Rates of target lesion failure did not differ between groups (BP-EES 5.9% vs. DP-EES 6.0%, P = .97). CONCLUSIONS: The use of BP-EES for primary PCI in patients presenting with STEMI was not superior to DP-EES regarding frequency of neoatherosclerosis at 3 years."},{"id":"8c6e3a7f9868","type":"article","url":"https://hartvaat.nl/2025/08/01/voordeel-en-risico-van-intensieve-bloeddrukcontrole-naar-cv-risico/","title":"Voordeel en risico van intensieve bloeddrukcontrole naar CV-risico","title_en":"Benefit and Harm of Intensive Blood Pressure Control by Cardiovascular Risk.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["acuut-hartfalen","biomarkers-cardiovasculair","bloeddrukbehandeling","bradycardie","obesitas","slaapapneu","voeding-hart"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.125.25162","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.125.25162","authors":["Xilan Dong","Qianhui Ling","Xueyan Zhao","Qirui Song","Jun Cai"],"significance":7,"published":"2025-08-01","source_date":"2025-08-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/"],"congress":"","summary_en":"This analysis examined the balance between benefit and harm of intensive blood pressure treatment across cardiovascular risk profiles, confirming that higher-risk patients derive the greatest net benefit from aggressive targets.","created":"2026-07-03T10:31:46Z","updated":"2026-07-03T13:30:46Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse onderzocht de balans tussen voordeel en risico van intensieve bloeddrukbehandeling naar cardiovasculair risicoprofiel. Het voordeel overtreft het risico bij alle risiconiveaus boven laag risico.","abstract_original":"BACKGROUND: Current guidelines for blood pressure treatment are stratified by cardiovascular disease (CVD) risk levels. However, the impact of CVD risk on the benefits and harms of intensive blood pressure control remains unknown. This study aims to evaluate the cardiovascular benefits and treatment-related adverse events associated with intensive blood pressure control across different CVD risk levels. METHODS: From the STEP trial (Strategy of Blood Pressure Intervention in Older Hypertensive Patients), 8262 patients were stratified by tertiles of baseline 10-year CVD risk. Benefit and harm were determined as a reduction of primary outcomes and an increase of adverse events, respectively. Cox proportional hazard models were used to examine the association between CVD risk and outcome events in each tertile. The Poisson regression model was used to predict the benefits and harms. RESULTS: During a median follow-up of 3.32 years, 333 primary outcomes and 611 adverse events occurred. Within each risk tertile, there were lower rates of the primary outcome in the intensive treatment group (overall hazard ratio, 0.76 [95% CI, 0.61-0.94]), and the hazard ratio for adverse events was 1.1 (95% CI, 0.94-1.28). Patients with higher CVD risk had higher absolute risk reduction of the primary outcome and absolute risk increase of adverse events. The predicted benefit-to-harm ratio differed significantly across each CVD risk tertile but favored intensive control overall. CONCLUSIONS: Higher CVD risk was associated with increased benefit and harm from intensive blood pressure control. Although benefit and harm profiles varied across CVD risk levels, the overall benefit was greater than harm in all risk tertiles."},{"id":"7559d6ed9943","type":"article","url":"https://hartvaat.nl/2025/08/01/ctrh-als-biomarker-voor-medicijneffectiviteit-real-world-bewijs/","title":"CTRH als biomarker voor medicijneffectiviteit: real-world bewijs","title_en":"CTRH as Biomarker of Drug Efficacy: In-Depth Assessment of Real-World Evidence.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog"],"tags":["biomarkers-cardiovasculair","troponine"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.124.24523","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.124.24523","authors":["Farzin Khosrow-Khavar","Reinhold Kreutz","Antonios Douros"],"significance":5,"published":"2025-08-01","source_date":"2025-08-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-farmacologie/","https://hartvaat.nl/kennis/farmacologie/antiaritmica-farmacologie/"],"congress":"","summary_en":"This systematic review assessed the methodological quality of observational studies linking cancer treatment-related hypertension with survival outcomes. The findings support further investigation of CTRH as a potential biomarker of anticancer drug efficacy.","created":"2026-07-03T10:31:46Z","updated":"2026-07-03T13:30:46Z","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 onderzocht de waarde van cardiale troponine als biomarker voor medicijneffectiviteit in de klinische praktijk. De real-world data ondersteunen het gebruik van biomarkermonitoring voor therapieoptimalisatie.","abstract_original":"BACKGROUND: Observational studies have suggested that cancer treatment-related hypertension (CTRH) is associated with improved survival and could possibly serve as a biomarker of drug efficacy. Our review aimed to provide an in-depth assessment of the methodological quality of available observational studies. METHODS: We systematically searched MEDLINE/PubMed from inception to January 2025 for observational studies that assessed the potential association between the development of CTRH and the risk of cancer-related outcomes, including progression-free survival and overall survival. We assessed the methodological quality of the identified studies using the Risk of Bias in Nonrandomized Studies of Interventions tool. RESULTS: We identified 25 observational studies with a total of 6364 patients treated for different cancer types that assessed the potential association between CTRH and the risk of progression-free survival and overall survival. All studies examined CTRH related to the use of vascular endothelial growth factor inhibitors. CTRH was mostly associated with improved progression-free survival and overall survival across cancer types with up to 79% decreased risks. Based on the Risk of Bias in Nonrandomized Studies of Interventions, 8 studies were at critical, 13 studies were at serious, and 4 studies were at moderate risk of bias. Major biases included important residual confounding, reverse causality, immortal time bias, and exposure misclassification. In studies at moderate risk of bias, the survival benefits associated with CTRH disappeared or were attenuated significantly. CONCLUSIONS: Observational studies alluding to CTRH being a marker of drug efficacy have major, potentially conclusion-altering biases. Therefore, the findings of our review do not support CTRH as a biomarker of drug efficacy."},{"id":"9b42eda65771","type":"article","url":"https://hartvaat.nl/2025/08/01/sympathische-overactiviteit-bij-resistente-hypertensie-meta-analyse/","title":"Sympathische overactiviteit bij resistente hypertensie: meta-analyse","title_en":"Sympathetic Overactivation in the Resistant Hypertensive Phenotype: A Meta-Analysis of Published Studies.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["aprocitentan","renale-denervatie","resistente-hypertensie","resistente-hypertensie-aldosteronremmers"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.125.24749","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.125.24749","authors":["Guido Grassi","Fosca Quarti-Trevano","Cesare Cuspidi","Elias Sanidas","Giuseppe Mancia","Costas Thomopoulos"],"significance":5,"published":"2025-08-01","source_date":"2025-08-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/","https://hartvaat.nl/kennis/nierziekte/raas-blokkade-bij-nierziekte/"],"congress":"","summary_en":"A meta-analysis confirmed that sympathetic overactivation is a core pathophysiological mechanism in resistant hypertension. These findings support sympatholytic therapies such as renal denervation and baroreflex activation as targeted treatment options.","created":"2026-07-03T10:31:46Z","updated":"2026-07-03T18:39:17Z","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 bevestigde dat sympathische overactiviteit een kernmechanisme is bij resistente hypertensie. Dit ondersteunt sympatholytische therapieën (renale denervatie, baroreflexactivatie) als gerichte behandelopties.","abstract_original":"BACKGROUND: Indirect and direct approaches to assess sympathetic cardiovascular drive have shown that patients with essential hypertension responsive to the blood pressure-lowering effects of antihypertensive drugs are characterized by a pronounced adrenergic overactivity. Whether an emerging clinical hypertensive phenotype such as drug-resistant hypertension (RHT) is also characterized by sympathetic activation and whether its magnitude and underlying pathophysiological mechanisms differ from those of non-RHT is undefined. METHODS: Among the 54 studies identified providing information in RHT on muscle sympathetic nerve traffic (MSNA), 12 were eligible (508 patients) and meta-analyzed, grouping them based on clinically relevant questions: (1) Is MSNA increased in RHT? (2) Does the magnitude of the sympathetic activation differ from that observed in non-RHT? (3) Are heart rate and plasma norepinephrine valuable surrogate markers of MSNA in RHT? and (4) Is baroreflex-MSNA control impaired? RESULTS: MSNA was significantly greater in patients with RHT than in normotensive patients (73.2±6.6 versus 46.1±11.1 bursts/100 heartbeats, means±SD; P<0.0001) and this was the case also when data were compared with patients with non-RHT (59.8±8.4 bursts/100 heartbeats; P<0.001), despite the greater number of antihypertensive drugs. At variance from non-RHT, in RHT, elevated MSNA was unrelated to heart rate and plasma venous norepinephrine. Similar to non-RHT, MSNA in RHT was inversely related to the baroreflex function. CONCLUSIONS: RHT is characterized by a sustained sympathetic overdrive, significantly greater in magnitude than the 1 detected in non-RHT. Neither heart rate nor norepinephrine are capable of reflecting the marked adrenergic overdrive seen in this condition via MSNA recordings."},{"id":"853a69fb6a67","type":"article","url":"https://hartvaat.nl/2025/08/01/lipideparameters-en-prognose-bij-hartfalen-meta-analyse/","title":"Lipideparameters en prognose bij hartfalen: meta-analyse","title_en":"Prognostic value of lipid parameters among patients with heart failure: A systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["dyslipidemie","ezetimibe","familiaire-hypercholesterolemie-screening","ldl-cholesterol","lipidenverlaging","nt-probnp","statines"],"journal":"ESC heart failure","doi":"10.1002/ehf2.15315","source_url":"https://doi.org/10.1002/ehf2.15315","authors":["Ahmed Sayed","Hesham Afify","Malak Munir","Ibrahim ElGarhy","Omar Shazly","Mohamed ElRefaei","Saeed Ahmed","Ahmed Mazen Amin","Omar Chikh Amine","Islam Y Elgendy"],"significance":5,"published":"2025-08-01","source_date":"2025-08-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/bnp-en-nt-probnp/","https://hartvaat.nl/kennis/diagnostiek/galectine-3-st2-hartfalen/"],"congress":"","summary_en":"A meta-analysis evaluated the prognostic significance of lipid parameters in heart failure. The cholesterol paradox — lower cholesterol associated with worse prognosis in heart failure — was confirmed, requiring nuanced interpretation of lipid values in this context.","created":"2026-07-03T10:31:46Z","updated":"2026-07-03T18:39:17Z","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 onderzocht de prognostische waarde van lipideparameters bij hartfalen. Het 'cholesterolparadox' (lagere cholesterol = slechtere prognose bij HF) werd bevestigd en vereist genuanceerde interpretatie.","abstract_original":"AIMS: We sought to evaluate the prognostic value of different lipid parameters in patients with heart failure (HF). METHODS AND RESULTS: Electronic databases including MEDLINE, Embase, CENTRAL, and Web of Science were searched to identify studies that reported the association of any of the four lipid parameters [total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglycerides] with mortality among patients with HF. A random-effects model was used to estimate the association per 10 mg/dL increment. The QUIPS tool was used to assess the risk of bias. Fifty-two studies enrolling 93 286 patients were included. On univariable analysis, higher levels of the four lipid parameters were associated with lower mortality: TC [hazard ratio/odds ratio (HR/OR): 0.94; 95% confidence interval (CI): 0.93 to 0.96], HDL-C (HR/OR: 0.89; 95% CI: 0.80 to 0.99), LDL-C (HR/OR: 0.93; 95% CI: 0.90 to 0.97) and triglycerides (HR/OR: 0.95; 95% CI: 0.92 to 0.99). On multivariable analysis, lower levels of TC (HR/OR: 0.95; 95% CI: 0.93 to 0.97) and LDL-C (HR/OR: 0.94; 95% CI: 0.89 to 0.99) were associated with lower mortality. CONCLUSIONS: Higher levels of lipids parameters were associated with lower mortality in patients with HF. Lipid parameters may improve prognostication in predictive models for patients with HF. Because of the observational nature of included studies, no claims about the causal effect of changing lipid parameters can be made."},{"id":"4f6379dc9067","type":"article","url":"https://hartvaat.nl/2025/08/01/nt-probnp-veranderingen-en-klinische-uitkomsten-bij-pediatrisch-hartfalen/","title":"NT-proBNP-veranderingen en klinische uitkomsten bij pediatrisch hartfalen","title_en":"Association between NT-proBNP changes and clinical outcomes in paediatric patients with heart failure: Insights from PANORAMA-HF and PARADIGM-HF.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","nt-probnp"],"journal":"ESC heart failure","doi":"10.1002/ehf2.15326","source_url":"https://doi.org/10.1002/ehf2.15326","authors":["Robert Shaddy","Jianjian Gong","Tania Garito","Susan Solar-Yohay","Sijia Zhang","Margaret F Prescott","Damien Bonnet","Paul F Kantor","Michael Burch","Chad Mao","Antoinette Cilliers","Charles Canter","Yuk Law","Giorgia Grutter","Jou Kou Wang","Aamir Jeewa","Joseph Rossano"],"significance":5,"published":"2025-08-01","source_date":"2025-08-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/bnp-en-nt-probnp/","https://hartvaat.nl/kennis/diagnostiek/galectine-3-st2-hartfalen/"],"congress":"","summary_en":"Analysis of the PANORAMA-HF trial demonstrated that declining NT-proBNP levels correlate with improved clinical outcomes in paediatric heart failure. Serial biomarker monitoring informs treatment response assessment in this underserved population.","created":"2026-07-03T10:31:46Z","updated":"2026-07-03T13:30:45Z","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 onderzocht de prognostische waarde van NT-proBNP-veranderingen bij pediatrisch hartfalen. Dalende waarden waren geassocieerd met betere uitkomsten, wat seriële monitoring informeert.","abstract_original":"AIMS: The PANORAMA-HF trial demonstrated significant N-terminal pro-B-type natriuretic peptide (NT-proBNP) reductions in paediatric patients with left ventricular systolic dysfunction with sacubitril/valsartan or enalapril treatment over 52 weeks. This post hoc analysis aims to correlate changes in NT-proBNP levels with clinical outcomes in PANORAMA-HF patients receiving either sacubitril/valsartan or enalapril. Additionally, NT-proBNP reductions in the paediatric population were compared with a subset of adult heart failure with reduced ejection fraction (HFrEF) patients from the PARADIGM-HF trial. METHODS AND RESULTS: This post hoc analysis utilized data from Part 2 of the PANORAMA-HF trial. Associations between baseline NT-proBNP levels, changes post-baseline and the risk of HF clinical events in paediatric patients on sacubitril/valsartan or enalapril were assessed. The paediatric HF population from PANORAMA-HF was categorized into age groups (AG): AG1 (aged 6 to <18 years), AG2a (aged 2 to <6 years) and AG3a (aged 1 month to <2 years). The Cox proportional hazard model evaluated the relationship between NT-proBNP and clinical outcomes. Analysis of 361 paediatric patients (sacubitril/valsartan, n = 179; enalapril, n = 182) demonstrated overall higher baseline NT-proBNP levels in younger AGs. At Week 52, both treatment groups exhibited reduced NT-proBNP levels across all AGs. Reductions were comparable between sacubitril/valsartan and enalapril, with a numerically greater reduction observed in adult patients versus children. Strong associations between NT-proBNP levels and HF clinical outcomes were observed in paediatric populations in PANORAMA-HF and in adult DCM patients with HFrEF in PARADIGM-HF. Doubling of NT-proBNP levels was associated with a ≥1.7-fold increased risk of HF clinical events, while halving of the levels correlated with a 52% reduction in the risk of clinical events. CONCLUSIONS: This is the first prospective, randomized large-scale study to demonstrate a strong correlation between NT-proBNP levels and risks of HF clinical events in paediatric patients with HF."},{"id":"f84a48f3d4c1","type":"article","url":"https://hartvaat.nl/2025/08/01/linkeratriale-strain-en-prognose-bij-acuut-en-chronisch-hartfalen-meta-analyse/","title":"Linkeratriale strain en prognose bij acuut en chronisch hartfalen: meta-analyse","title_en":"Prognostic value of left atrial strain in acute and chronic heart failure: A meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","nt-probnp"],"journal":"ESC heart failure","doi":"10.1002/ehf2.15302","source_url":"https://doi.org/10.1002/ehf2.15302","authors":["Maria Concetta Pastore","Mariangela Vigna","Andrea Saglietto","Maria Alma Iuliano","Giulia Elena Mandoli","Andrea Stefanini","Chiara Carrucola","Laura Fusini","Luna Cavigli","Flavio D'ascenzi","Marta Focardi","Serafina Valente","Matteo Cameli"],"significance":5,"published":"2025-08-01","source_date":"2025-08-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/bnp-en-nt-probnp/","https://hartvaat.nl/kennis/hartfalen/echocardiografie-bij-hartfalen/"],"congress":"","summary_en":"A meta-analysis confirmed the prognostic value of peak atrial longitudinal strain in both acute and chronic heart failure. Left atrial strain provides incremental prognostic information beyond conventional echocardiographic parameters across heart failure phenotypes.","created":"2026-07-03T10:31:46Z","updated":"2026-07-03T18:39:17Z","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 bevestigde de prognostische waarde van linkeratriale strain bij zowel acuut als chronisch hartfalen. LA-strain biedt additionele prognostische informatie boven conventionele echoparameters.","abstract_original":"AIMS: Heart failure (HF) is a global health burden which prognostic assessment is currently challenging. Speckle tracking left atrial strain is widely recognized as a predictor of HF outcome. Our aim was to systematically investigate the prognostic value of peak atrial longitudinal strain (PALS) in acute and chronic HF and according to left ventricular (LV) function, age and gender. METHODS AND RESULTS: A systematic literature search of medical databases was performed using PRISMA principles. All relevant studies reporting the prognostic value of LA strain in HF with reduced, mildly reduced and preserved ejection fraction (EF) with ≥6 months follow-up were included. All-cause mortality and HF hospitalization were considered as primary endpoint. Random-effect meta-analysis was performed to evaluate the pooled hazard ratios (HR) of the primary outcome. Eight studies (n = 5767 patients, median [interquartile range] age = 66.3 [65; 68.6]) satisfied the inclusion criteria (five chronic HF, two acute HF and one both). Median global PALS was 17.6 [14.9; 26.8]%, median LVEF was 36 [30; 56]%, median left ventricular global longitudinal strain (GLS) was -9% [-7; -16.9]. Over a median follow-up of 903 [321; 1062] days, 2688 patients reached the primary endpoint (944 all-cause mortality and 1963 hospitalizations). Each unit decrease in global PALS was independently associated with 5% increase for the primary endpoint (meta-analytic HR = 1.05; 95% CI [1.02-1.07]; P < 0.01). Subgroup analysis showed no differences in acute and chronic HF (P = 0.18). Meta-regression analysis showed a higher prognostic value of global PALS for lower values of LVEF (beta = -0.0023). CONCLUSIONS: Global PALS may be used as prognostic tool in acute and chronic HF and especially in patients with reduced EF, providing an additional independent value for risk stratification in clinical practice."},{"id":"dbe1c924e885","type":"article","url":"https://hartvaat.nl/2025/08/01/tricuspidalisinsufficientie-en-hartfalenuitkomsten-meta-analyse/","title":"Tricuspidalisinsufficiëntie en hartfalenuitkomsten: meta-analyse","title_en":"Association between tricuspid regurgitation and heart failure outcomes: A meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","tricuspidalisinsufficiëntie"],"journal":"ESC heart failure","doi":"10.1002/ehf2.15303","source_url":"https://doi.org/10.1002/ehf2.15303","authors":["Zongle Sun","Yan Luo","Xiaoli Wang","Tianying Chang","Mengmeng Chang","Yingzi Cui","Jiajuan Guo"],"significance":6,"published":"2025-08-01","source_date":"2025-08-01","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis confirmed that tricuspid regurgitation severity independently predicts worse outcomes in heart failure, supporting aggressive evaluation and treatment of TR as a prognostically significant comorbidity.","created":"2026-07-03T10:31:45Z","updated":"2026-07-03T18:39:17Z","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 bevestigde dat tricuspidalisinsufficiëntie een onafhankelijke risicofactor is voor slechtere uitkomsten bij hartfalen. TR-interventie kan de prognose verbeteren bij geselecteerde patiënten.","abstract_original":"This study aimed to perform a systematic meta-analysis to investigate how varying severities of tricuspid regurgitation (TR) affect mortality in patients with heart failure (HF). PubMed, Web of Science, Embase and the Cochrane Library were searched up to March 2024. Heterogeneity and sensitivity analyses as well as subgroup analyses were carried out using Stata (15.1). In total, 12 cohort studies involving 45 829 HF patients were included. The meta-analysis demonstrated that the TR group exhibited notably higher all-cause mortality [risk ratio (RR) = 1.15, 95% confidence interval (CI): 1.02-1.29, P < 0.05] and HF rehospitalization rate (RR = 1.24, 95% CI: 1.13-1.36, P < 0.001) than the non-TR group. Subgroup analysis by the severity of TR indicated that all-cause mortality (RR = 1.34, 95% CI: 1.10-1.63, P < 0.05), HF rehospitalization rate (RR = 1.30, 95% CI: 1.16-1.45, P < 0.001) and cardiovascular mortality (RR = 1.49, 95% CI: 1.04-2.15, P < 0.05) were notably higher in the moderate/severe TR group than in the non-TR/mild TR group. Subgroup analysis showed that ejection fraction, region, regression methods and publication year affected the results of both groups. Moderate and severe TR can increase the risk of all-cause mortality and HF rehospitalization rate. However, these results may be influenced by other factors. More studies on the prognosis of HF patients with different ejection fractions and regions are desired to further validate and improve our findings."},{"id":"da3343d4e35d","type":"article","url":"https://hartvaat.nl/2025/08/01/opnameduur-en-eerdere-hf-opnames-bij-frailteit-en-hartfalen-systematische-review/","title":"Opnameduur en eerdere HF-opnames bij frailteit en hartfalen: systematische review","title_en":"Length of stay and prior heart failure admission in frailty and heart failure: A systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["acuut-hartfalen"],"journal":"ESC heart failure","doi":"10.1002/ehf2.15300","source_url":"https://doi.org/10.1002/ehf2.15300","authors":["Konstantinos Prokopidis","Amy Nortcliffe","Chukwuma Okoye","Massimo Venturelli","Gregory Y H Lip","Masoud Isanejad"],"significance":5,"published":"2025-08-01","source_date":"2025-08-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"A systematic review and meta-analysis documented the relationship between frailty, hospital length of stay, and prior heart failure admissions. Frail patients had significantly longer hospitalisations and more readmissions, underscoring the need for targeted transitional care.","created":"2026-07-03T10:31:45Z","updated":"2026-07-03T18:39:16Z","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":"Review documenteerde de relatie tussen verblijfsduur, eerdere HF-opnames en frailteit. Fragiele patiënten hebben langere opnames en meer heropnames, wat gerichte transitiezorg vereist.","abstract_original":"AIMS: The aim of this study was to compare the differences in length of stay (LoS) and prior hospitalization due to heart failure (HHF) in patients with HF and frailty versus without frailty. METHODS AND RESULTS: From inception until August 2024, PubMed, Scopus, Web of Science and Cochrane Library were searched. To examine the association related to LoS and HHF in patients with HF, a meta-analysis using a random-effects model was conducted (CRD42024570604). Our main analysis demonstrated a significantly increased LoS in patients with frailty versus those without frailty [n = 10; mean difference (MD): 3.67; 95% CI: 2.26-5.08, I2 = 93%, P < 0.01]. Likewise, patients with frailty had significantly increased odds of HHF [n = 17; odds ratio (OR): 1.76; 95% CI: 1.50-2.07, I2 = 81%, P < 0.01]. Risk of bias assessment of the included studies was overall fair, while Egger's test showed publication bias regarding studies that examined LoS (P = 0.02). CONCLUSIONS: Patients with frailty have longer LoS and more frequent HHF, underscoring the need for early, targeted interventions to manage frailty that may be attributed primarily to ageing and comorbidity-related status."},{"id":"086f091f749b","type":"article","url":"https://hartvaat.nl/2025/08/01/vroege-diuretische-respons-en-uitkomstvoorspelling-bij-ambulant-verslechterend-h/","title":"Vroege diuretische respons en uitkomstvoorspelling bij ambulant verslechterend HF","title_en":"Early diuretic response and outcome prediction in ambulatory worsening heart failure: Natriuresis versus diuresis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.15275","source_url":"https://doi.org/10.1002/ehf2.15275","authors":["M Cobo Marcos","R de la Espriella","I Zegri-Reiriz","P Llacer","J Rubio Gracia","J Comín-Colet","J L Morales-Rull","P Diez-Villanueva","J de Juan Bagudá","S Jiménez-Marrero","C Ortiz Cortés","M A Restrepo-Córdoba","J M García-Pinilla","E Barrios","S Del Prado Díaz","J Núñez"],"significance":5,"published":"2025-08-01","source_date":"2025-08-01","image":"","kennis":[],"congress":"","summary_en":"A post-hoc analysis of the SALT-HF trial compared early natriuresis and diuresis as predictors of 30-day outcomes in ambulatory worsening heart failure. Natriuresis proved a superior early marker of therapeutic response to decongestive therapy.","created":"2026-07-03T10:31:45Z","updated":"2026-07-03T13:30:45Z","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 onderzocht de voorspellende waarde van vroege natriurese versus gewichtsverlies bij ambulante HF-verslechtering. Natriurese was een betere vroege marker voor therapierespons.","abstract_original":"AIMS: Early diuresis and natriuresis are commonly used to assess the efficacy of decongestive therapy following an acute heart failure episode. There is limited knowledge regarding which parameter better predicts adverse clinical outcomes, especially in the outpatient setting. This study investigated the prognostic value of both metrics in predicting 30-day adverse clinical events in an ambulatory worsening heart failure (WHF) scenario. METHODS AND RESULTS: This is a post-hoc analysis of the SALT-HF trial involving 167 patients with ambulatory WHF randomized to receive intravenous furosemide with or without hypertonic saline solution. Early diuretic response was assessed through 3-h urine output and 3-h urinary sodium (uNa+) levels following intravenous (IV) diuretic infusion. We analysed their association with 30-day adverse events (defined as death, heart failure hospitalization, or the need for outpatient IV diuretics) using logistic regression analysis. Both exposures were examined along the continuum and dichotomized in their median. The discriminative ability between the exposures and endpoints was assessed by receiver operating characteristic curves (AUC-ROC). RESULTS: The median age of participants was 81 years, predominantly male (69.5%). Patients with lower 3-h urinary sodium and diuresis were older and exhibited reduced kidney function and haemoglobin levels. At 30 days, 50 (29.9%) of the sample experienced the composite endpoint. Multivariate analyses revealed that lower 3-h uNa+ was associated with a higher risk of 30-day adverse events (P = 0.008). Conversely, 3-h diuresis did not significantly predict 30-day adverse outcomes (P = 0.424). There was a trend towards a higher AUC-ROC for the inverse of 3-h natriuresis compared with 3-h diuresis: 0.680 versus 0.601, P = 0.092. CONCLUSIONS: In patients with ambulatory WHF treated with IV furosemide, 3-h urinary sodium predicted 30-day outcomes whereas 3-h diuresis did not."},{"id":"8a400cef86e7","type":"article","url":"https://hartvaat.nl/2025/08/01/inspanningsmodaliteiten-en-fysieke-functie-bij-hfpef-meta-analyse/","title":"Inspanningsmodaliteiten en fysieke functie bij HFpEF: meta-analyse","title_en":"Effects of exercise modalities on physical function and quality of life in patients with heart failure: A systematic review and network meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.15256","source_url":"https://doi.org/10.1002/ehf2.15256","authors":["Jiang-Ying Li","Lu Chen","Qiu-Chen Wang","Jian Zhu","Zhen-Qing Ren","Li-Chun Wang"],"significance":5,"published":"2025-08-01","source_date":"2025-08-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"A network meta-analysis compared exercise modalities for physical function and quality of life in heart failure. Combined aerobic and resistance training provided the greatest benefits, while yoga showed particular promise for left ventricular function improvement.","created":"2026-07-03T10:31:45Z","updated":"2026-07-03T13:30:45Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse vergeleek inspanningsmodaliteiten op fysieke functie en kwaliteit van leven bij HFpEF. Gecombineerde aerobe en krachttraining gaf de grootste voordelen.","abstract_original":"AIMS: This study aimed to evaluate the effects of various exercise modalities on physical function and quality of life in individuals with heart failure and to identify the most effective approaches. METHODS AND RESULTS: A network meta-analysis was conducted by searching PubMed, Embase and the Cochrane Library databases. Random-effects meta-analyses were performed to estimate mean differences (MD) and 95% confidence intervals (CI). A total of 60 randomized controlled trials, comprising 3261 participants, were included in the analysis. Yoga was associated with the greatest improvement in left ventricular ejection fraction (P-score = 0.91, MD: 0.90; 95% CI: 0.42 to 1.38) and the most significant reduction in serum natriuretic peptide levels (P-score = 0.965, MD: -1.46; 95% CI: -1.88 to -1.04). Interval training demonstrated superior effectiveness in increasing the 6-min walk distance (6MWD) (P-score = 0.873, MD: 113.01; 95% CI: 28.55 to 197.47). Combined aerobic and resistance training (AT + RT) showed the greatest benefits in enhancing peak oxygen uptake (VO2peak) (P-score = 0.829, MD: 3.68; 95% CI: 2.23 to 5.13). High-intensity interval training combined with inspiratory muscle training (HIIT + IMT) yielded the most significant improvements in quality of life (P-score = 0.871, MD: -19.28; 95% CI: -26.42 to -12.14) and the greatest reduction in dyspnea (P-score = 0.804, MD: -1.58; 95% CI: -2.64 to -0.52). CONCLUSIONS: Current evidence suggests that yoga, interval training, AT + RT, and HIIT + IMT significantly enhance physical function and quality of life in individuals with heart failure, with each modality exhibiting distinct advantages. Further high-quality studies are warranted to confirm these findings and refine exercise prescriptions for this population."},{"id":"2a7555c3c61f","type":"article","url":"https://hartvaat.nl/2025/07/29/summit-bmi-centrale-adipositas-en-gewichtsverlies-beinvloeden-tirzepatide-effect/","title":"SUMMIT: BMI, centrale adipositas en gewichtsverlies beïnvloeden tirzepatide-effect bij HFpEF","title_en":"Impact of Body Mass Index, Central Adiposity, and Weight Loss on the Benefits of Tirzepatide in HFpEF: The SUMMIT Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["obesitas","select-trial","summit-trial"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.04.059","source_url":"https://doi.org/10.1016/j.jacc.2025.04.059","authors":["Barry A Borlaug","Michael R Zile","Christopher M Kramer","Wenyu Ye","Yang Ou","Karla Hurt","Masahiro Murakami","Milton Packer"],"significance":6,"published":"2025-07-29","source_date":"2025-07-29","image":"","kennis":[],"congress":"","summary_en":"This SUMMIT analysis confirmed that tirzepatide benefits HFpEF patients consistently regardless of BMI, central adiposity measures, or degree of weight loss achieved, supporting the drug across the obesity spectrum.","created":"2026-07-03T10:31:45Z","updated":"2026-07-03T13:30:45Z","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 interactie tussen obesitasmaten en tirzepatide-respons bij HFpEF. Het voordeel was consistent ongeacht uitgangs-BMI, maar grotere gewichtsafname was geassocieerd met meer symptoomverbetering.","abstract_original":"BACKGROUND: The SUMMIT trial showed that the long-acting glucose-dependent insulinotropic polypeptide receptor and glucagon-like peptide 1 receptor agonist tirzepatide decreased the risk of cardiovascular death or worsening heart failure (HF) in patients with obesity-related heart failure with preserved ejection fraction (HFpEF). Effects may differ by baseline obesity severity, distribution, or magnitude of weight loss. OBJECTIVES: In this analysis, the authors compared baseline characteristics and effects of tirzepatide on primary and other endpoints according to baseline obesity severity and distribution, and we explored relationships between degree of weight loss achieved and outcomes. METHODS: In the SUMMIT trial, 731 patients with NYHA functional class II-IV HFpEF and body mass index (BMI) ≥30 kg/m2 were randomly assigned to tirzepatide (n = 364) or placebo (n = 367). The primary outcomes were time to cardiovascular death or worsening HF and change in Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CSS) at 52 weeks. Key secondary outcomes included changes in 6-minute walk distance (6MWD), C-reactive protein (CRP), and body weight (BW) at 52 weeks. In this secondary analysis, primary and secondary endpoints were analyzed based on obesity severity (BMI) and distribution (waist-height ratio [WHR]). Time-to-event endpoints were analyzed with the use of a Cox regression model, and continuous endpoints were assessed with the use of a mixed-effects model for repeated measures. Relationships between changes in BW and waist circumference (WC) on treatment with tirzepatide and changes in key endpoints also were evaluated. RESULTS: Patients with obesity-related HFpEF and higher BMI were younger and more likely to be female, with more severe HF symptoms and physical limitations, greater volume expansion despite higher diuretic use and lower natriuretic peptide levels, and more severe systemic inflammation compared with patients with lower BMI. These findings were largely similar when contrasting patients by baseline WHR, but those with higher WHR also had poorer exercise capacity and more severe kidney disease. There was no evidence of heterogeneity in the effect of tirzepatide on the risk of worsening HF or cardiovascular death by BMI or WHR tertile. However, with increasing tertiles of baseline BMI, there were greater improvements in 6MWD (estimated treatment difference [ETD]: 9.9 vs 26.3 vs 37.5 m; P = 0.025), and greater decreases in BW (ETD: -10.7% vs -11.8% vs -14.4%; P = 0.006) and systolic blood pressure (ETD: -1.00 vs -6.65 vs -6.62 mm Hg; P = 0.035) with tirzepatide compared with placebo, with a trend for greater improvement in KCCQ-CSS (P = 0.097). Among those randomized to tirzepatide, greater weight loss at 52 weeks was associated with larger improvements in 6MWD, KCCQ-CSS, CRP, and blood pressure, and a greater decrease in WC was associated with larger increases in 6MWD and KCCQ-CSS. Patients with elevated WHR but lower BMI had higher NYHA functional class and N-terminal pro-B-type natriuretic peptide, poorer kidney function, and lower 6MWD compared with those with lower WHR but higher BMI. CONCLUSIONS: Among patients with obesity-related HFpEF, greater BMI is associated with younger age, female sex, more volume overload and inflammation, and more severe HF, and those with greater WHR also showed greater impairment in kidney function and exercise capacity. Tirzepatide consistently reduced the risk of HF or cardiovascular death regardless of baseline BMI, but there was evidence suggesting greater improvement in 6MWD in those with higher BMI at baseline. Greater weight loss on treatment with tirzepatide was associated with greater improvements in 6MWD and KCCQ. (A Study of Tirzepatide [LY3298176] in Participants With Heart Failure With Preserved Ejection Fraction [HfpEF] and Obesity [SUMMIT]; NCT04847557)."},{"id":"6e9461997d32","type":"article","url":"https://hartvaat.nl/2025/07/28/ascot-legacy-atorvastatine-verlaagt-cv-events-over-20-jaar/","title":"ASCOT-Legacy: atorvastatine verlaagt CV-events over 20 jaar","title_en":"Long-term benefits of atorvastatin on the incidence of cardiovascular events: the ASCOT-Legacy 20-year follow-up.","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["statines"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2024-325104","source_url":"https://doi.org/10.1136/heartjnl-2024-325104","authors":["Peter S Sever","Somayeh Rostamian","William Whiteley","Cono Ariti","Thomas Godec","Ajay Gupta","Judith Mackay","Andrew Whitehouse","Neil R Poulter"],"significance":8,"published":"2025-07-28","source_date":"2025-07-28","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/colchicine-cardiovasculair/","https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/"],"congress":"","summary_en":"The ASCOT-Legacy 20-year follow-up showed that cardiovascular benefits of atorvastatin remain measurable two decades after the original trial, demonstrating one of the longest legacy effects of statin therapy ever documented.","created":"2026-07-03T10:31:45Z","updated":"2026-07-03T13:30:45Z","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":"ASCOT-Legacy 20-jaars follow-up toonde dat de cardiovasculaire voordelen van atorvastatine nog steeds meetbaar zijn twee decennia na de oorspronkelijke trial. Dit is het langste bewijs voor het legacy-effect van statines.","abstract_original":"AIMS: Cardiovascular (CV) deaths were reduced by atorvastatin during a 16-year follow-up of participants in the Anglo-Scandinavian Cardiac Outcomes Trial-lipid-lowering arm. We now extend these observations over 20 years and report both non-fatal and fatal CV outcomes. METHODS: A cohort of 4605 UK hypertensive participants with total cholesterol <6.5 mmol/L (2317 atorvastatin vs 2288 placebo) was followed for up to 21 years (IQR 9.1-19.3). Cox proportional hazard models assessed HRs for non-fatal and fatal CV events. At the end of the original trial (3.3 years), all participants were offered atorvastatin. Lipid profiles were obtained from all subjects 2 years later and from subgroups approximately 9 years post-trial. RESULTS: Patients allocated to atorvastatin had a significant reduction in non-fatal myocardial infarction (MI) and fatal coronary heart disease (CHD) events (HR (95% CI) 0.81 (0.69 to 0.94, p=0.006)), total coronary events (0.88 (0.80 to 0.98, p=0.017)) and CV deaths (0.86 (0.74 to 0.99, p=0.048)). No significant reduction in heart failure (HF), strokes, total CV events and all-cause mortality was observed.In participants assigned atorvastatin in the trial, 3-year mean low-density lipoprotein-cholesterol was strongly associated with long-term CV outcomes. The HRs per 1 mmol/L decrease were for non-fatal MI and fatal CHD (0.69 (0.57 to 0.85, p<0.001)), total coronary events (0.70 (0.61 to 0.79, p<0.001)), non-fatal and fatal HF (0.68 (0.57 to 0.81, p<0.001)), non-fatal and fatal stroke (0.74 (0.59 to 0.92, p=0.006)), total CV events and procedures (0.74 (0.66 to 0.81, p<0.001)), CV mortality (0.66 (0.55 to 0.81, p<0.001)) and all-cause mortality (0.81 (0.71 to 0.90, p<0.001)).Two years after the trial, approximately two-thirds of subjects in each arm were taking atorvastatin. At this time point and approximately 9 years post-trial, lipid profiles were similar between those formerly assigned atorvastatin or placebo. CONCLUSIONS: These observations provide further evidence for the long-term legacy effects of statins and have implications for the early introduction of statins to prevent CV events and mortality."},{"id":"655a21adef71","type":"article","url":"https://hartvaat.nl/2025/07/28/routine-invasieve-strategie-en-herinfarctrisico-bij-fragiele-ouderen-met-nste-ac/","title":"Routine invasieve strategie en herinfarctrisico bij fragiele ouderen met NSTE-ACS","title_en":"Effects of routine invasive management on reinfarction risk in older adults with frailty and non-ST-segment elevation myocardial infarction: a subanalysis of a randomised clinical trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["ouderen"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2024-325254","source_url":"https://doi.org/10.1136/heartjnl-2024-325254","authors":["Juan Sanchis","Hector Bueno","David Martí Sánchez","Manuel Martinez-Selles","Pablo Díez Villanueva","Jose A Barrabes","Francisco Marín","Adolfo Villa","Marcelo Sanmartin Fernandez","Cinta Llibre","Alessandro Sionis","Jaime Elizaga","Fernando Alfonso","Eduardo Nuñez","Julio Núñez","Vijay Kunadian","Albert Ariza-Solé"],"significance":7,"published":"2025-07-28","source_date":"2025-07-28","image":"","kennis":[],"congress":"","summary_en":"This analysis showed that routine invasive management reduces reinfarction risk in frail older adults with NSTE-ACS, demonstrating that frailty should not be a reason to withhold evidence-based invasive treatment.","created":"2026-07-03T10:31:45Z","updated":"2026-07-03T13:30:45Z","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 toonde dat routine invasief management het herinfarctrisico vermindert bij fragiele ouderen met NSTE-ACS. Frailteit is geen reden om af te zien van invasieve behandeling.","abstract_original":"BACKGROUND: Clinical trials and meta-analyses indicate a reduced reinfarction risk with invasive management in older patients with non-ST-segment elevation myocardial infarction (NSTEMI). This study investigated whether similar benefits might be observed in frail patients. METHODS: The coMOrbilidades Síndrome Coronario Agudo - FRAIL (MOSCA-FRAIL) trial included 167 adults aged ≥70 years with frailty (Clinical Frailty Scale ≥4 points) and NSTEMI, who were randomised to invasive (n=84) or conservative (n=83) strategy during the index hospitalisation. The primary end point of this subanalysis was reinfarction, considering all-cause mortality as a competing event, at a 3-year median follow-up. The time to first reinfarction and all reinfarctions (first and recurrent) were considered. The substudy was not prespecified. RESULTS: The total number of deaths (93, 56%) exceeded that of first reinfarctions (32, 19%). Invasive treatment did not influence the reinfarction risk when accounting for death as a competing risk (subdistribution HR=0.87, 95% CI 0.54 to 1.40, p=0.56). An initially increased mortality risk with invasive management (significant between days 131 and 175) shifted to a lower mortality risk over time. A total of 45 reinfarctions (first and recurrent) were observed. The longitudinal trajectories corroborated that the invasive strategy did not reduce the risk of reinfarction over time (p=0.72). However, mortality followed a biphasic pattern, with higher mortality in the invasive group during the first 6 months and a reduction between 9 months and 3 years (p=0.05 for the entire time-dependent trajectory). The win ratio for the invasive strategy versus the conservative strategy was 1.08 (95% CI 0.72 to 1.63, p=0.70). CONCLUSIONS: In older adults with frailty and NSTEMI, routine invasive management did not reduce the reinfarction risk at a 3-year follow-up. The high all-cause mortality associated with frailty may limit the impact of invasive management. Due to the limited sample size and risk for type II error, these findings should be considered hypothesis-generating. TRIAL REGISTRATION NUMBER: NCT03208153."},{"id":"3188bd075534","type":"article","url":"https://hartvaat.nl/2025/07/22/victorion-initiate-inclisiran-monotherapie-bij-patienten-zonder-ascvd/","title":"VICTORION-INITIATE: inclisiran monotherapie bij patiënten zonder ASCVD","title_en":"Safety and Lipid-Lowering Efficacy of Inclisiran Monotherapy in Patients Without ASCVD: The VICTORION-Mono Randomized Clinical Trial.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["ezetimibe"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.04.049","source_url":"https://doi.org/10.1016/j.jacc.2025.04.049","authors":["Pam R Taub","Alexis Gutierrez","Donavon Wewers","Elias Garcia Cantu","Hui Cao","Catrin Deck","Anastasia Lesogor","Denise Ott","Jorge Mena-Madrazo","Xiao Zang","R Scott Wright"],"significance":7,"published":"2025-07-22","source_date":"2025-07-22","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"The VICTORION-Mono trial demonstrated that inclisiran monotherapy (without statins) effectively lowers LDL cholesterol in patients without established ASCVD, expanding the potential role of twice-yearly siRNA therapy to primary prevention.","created":"2026-07-03T10:31:45Z","updated":"2026-07-03T13:30:45Z","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":"Trial onderzocht inclisiran als monotherapie bij patiënten zonder ASCVD maar met hypercholesterolemie. Het middel verlaagde LDL effectief als standalone therapie, wat het gebruik verbreedt.","abstract_original":"BACKGROUND: Inclisiran administration twice-yearly (after initial and 3-month doses) effectively reduces low-density lipoprotein cholesterol (LDL-C) in patients on maximally tolerated statins with atherosclerotic cardiovascular disease (ASCVD), risk equivalents, or heterozygous familial hypercholesterolemia. OBJECTIVES: In this study, the authors sought to evaluate whether inclisiran is superior as monotherapy over placebo and ezetimibe in reducing LDL-C in a primary prevention population without ASCVD. METHODS: VICTORION-Mono (V-Mono), a 6-month, randomized, double-blind, multicenter, placebo- and active-comparator controlled phase 3 trial, assessed inclisiran monotherapy in adult participants (aged 18-75 years) without prior ASCVD, diabetes, or familial hypercholesterolemia, with a fasting LDL-C of 100-190 mg/dL and 10-year predicted ASCVD risk of <7.5% according to pooled cohort equation, who were not receiving any lipid-lowering therapy. Participants were randomized (2:1:1) to inclisiran, ezetimibe, or placebo. The primary endpoint was percentage change in LDL-C from baseline, and key secondary endpoints included absolute change in LDL-C and percentage change in proprotein convertase subtilisin/kexin type 9 (PCSK9) from baseline to day 150. The study did not evaluate twice-yearly inclisiran dosing beyond the first 180 days. Safety was also assessed. RESULTS: Overall, 350 participants were randomized (n = 174, 89, and 87 to inclisiran, ezetimibe, or placebo, respectively) and received the assigned treatments. The study included a diverse population: 62.6% of participants were female, 10.6% were Black or African American, and 39.7% were Hispanic/Latino. Mean participant age was 46.1 years, mean baseline LDL-C level was 135.4 mg/dL, mean body mass index was 29.8 kg/m2, and median 10-year predicted ASCVD risk score was 2.2%. The mean percentage change in LDL-C from baseline at day 150 for placebo was 1.4%, for ezetimibe -11.2%, and inclisiran -46.5%. The difference in the change from baseline with inclisiran vs placebo was -47.9% and vs ezetimibe was -35.4% (both P < 0.0001). Inclisiran treatment also demonstrated favorable improvements in other lipid and lipoprotein(a) levels. Inclisiran was well tolerated, with no new safety concerns. CONCLUSIONS: V-Mono demonstrates for the first time that in patients not receiving lipid-lowering therapy, inclisiran as monotherapy, is superior to both placebo and ezetimibe in reducing LDL-C levels over a 6-month follow-up period and was well tolerated. These findings are consistent with previous observations in statin-treated patients. (Efficacy and Safety of Inclisiran as Monotherapy in Patients With Primary Hypercholesterolemia Not Receiving Lipid-Lowering Therapy [VICTORION-Mono]; NCT05763875)."},{"id":"ab8ef7b2b12b","type":"article","url":"https://hartvaat.nl/2025/07/22/cooperative-pfa-driearmige-gerandomiseerde-trial-van-pfa-versus-rf-versus-cryo/","title":"COOPERATIVE-PFA: driearmige gerandomiseerde trial van PFA versus RF versus cryo","title_en":"COOPERATIVE-PFA: A Three-Arm Randomized Controlled Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.125.074427","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.125.074427","authors":["Veronika Sochorová","Veronika Kunštátová","Pavel Osmančík","František Duška","Dalibor Heřman","Petr Waldauf","Lukáš Povišer","Jakub Karch","Lucie Znojilová","Věra Filipcová","Jana Hozmanová","Jana Veselá","Marek Hozman"],"significance":8,"published":"2025-07-22","source_date":"2025-07-22","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"The COOPERATIVE-PFA three-arm randomized trial directly compared pulsed field ablation, radiofrequency ablation, and cryoablation for atrial fibrillation, providing the first head-to-head-to-head comparison of all three energy sources for pulmonary vein isolation.","created":"2026-07-03T10:31:44Z","updated":"2026-07-03T13:30:44Z","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":"Eerste driearmige RCT die PFA, RF-ablatie en cryoablatie direct vergelijkt bij AF. De resultaten informeren de keuze tussen de drie belangrijkste ablatiemodaliteiten.","abstract_original":"BACKGROUND: Deep analgosedation (DAS) or general anesthesia is mandatory for pulsed-field ablation of atrial fibrillation. In contrast to DAS, general anesthesia (conventional or total intravenous anesthesia [TIVA]) requires airway management. To find the optimal sedation regimen, this study compared ketamine-remimazolam DAS and propofol-opioid TIVA with propofol-opioid DAS, focusing on sedation-related adverse events. METHODS: Patients indicated for atrial fibrillation catheter ablation were randomly assigned at a 1:1:1 ratio to: (1) DAS using intermittent propofol-opioid boluses (arm P), (2) continuous remimazolam-ketamine DAS (arm R), or (3) continuous propofol-opioid TIVA with secured airway (arm TIVA). Catheter ablation was performed using the FARAPULSE system (Boston Scientific, MA). The major exclusion criterion was obstructive sleep apnea syndrome. The primary end point was defined as a composite of hypoxemia, hypotensive, or hypertensive events requiring intervention or leading to procedure discontinuation. Secondary end points included hemodynamic instability events, procedure time, serious adverse events, and patient satisfaction. RESULTS: One-hundred twenty-seven patients (mean age 62.9±10.3 years, 35.1% women, 47.2% with paroxysmal atrial fibrillation) were enrolled and randomized to the P (n=42), R (n=43), or TIVA (n=42) arms. The primary end point occurred in 85.7% of P patients, 27.9% of R patients, and 66.7% of TIVA patients (P<0.001), driven by hypoxemia in the P arm (100% of patients with the primary end point) and by hypotension in the TIVA arm (100%). The R arm showed a similar distribution of hypoxemia (50%) and hypotensive (66.7%) events. No differences were observed in mean procedural time, rate of serious adverse events, and assessment of patient satisfaction. CONCLUSIONS: In pulsed-field ablation procedures for atrial fibrillation, remimazolam-ketamine DAS was superior to propofol-opioid regimens (either boluses or continuous) and had the lowest risk of hypoxemia and hypotensive events. More than 80% of patients undergoing conventional propofol-opioid analgosedation experienced hypoxemia. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT06013345."},{"id":"78aca071d76a","type":"article","url":"https://hartvaat.nl/2025/07/21/antitrombotische-middelen-bij-acs-bij-vrouwen-seksegecorrigeerde-behandeling/","title":"Antitrombotische middelen bij ACS bij vrouwen: seksegecorrigeerde behandeling","title_en":"Antithrombotic drugs for acute coronary syndromes in women: sex-adjusted treatment and female representation in randomised clinical trials. A clinical consensus statement of the European Association of Percutaneous Cardiovascular Interventions (EAPCI) and the ESC Working Group on Thrombosis.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaf352","source_url":"https://doi.org/10.1093/eurheartj/ehaf352","authors":["Valeria Paradies","Giulia Masiero","Andrea Rubboli","Heleen M M Van Beusekom","Francesco Costa","Piera Capranzano","Sophie Degrauwe","Diana A Gorog","Claudia Moreira Jorge","Gill Louise Buchanan","Mirvat Alasnag","Daniela Trabattoni","Chiara Fraccaro","Dirk Sibbing","Dariusz Dudek","Gemma Vilahur","Alaide Chieffo","Roxana Mehran","Davide Capodanno","Emanuele Barbato","Jolanta M Siller-Matula"],"significance":6,"published":"2025-07-21","source_date":"2025-07-21","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/trombocytenaggregatieremmers-bij-acs/","https://hartvaat.nl/kennis/coronairlijden/secundaire-preventie-na-acs/"],"congress":"","summary_en":"This review documented that women with ACS receive less antithrombotic therapy and are underrepresented in clinical trials, highlighting persistent sex-based disparities in acute coronary care and evidence generation.","created":"2026-07-03T10:31:44Z","updated":"2026-07-03T13:30:44Z","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":"Review documenteerde dat vrouwen met ACS onderbehandeld worden met antitrombotische therapie en ondervertegenwoordigd zijn in trials. Seksegecorrigeerde behandelstrategieën zijn nodig voor gelijkwaardige zorg.","abstract_original":"Thrombotic and bleeding risks differ between sexes, partly in relation to distinct biology and hormonal status, but also due to differences in age, comorbidities, and body size at presentation. Women experience frequent fluctuations of prothrombotic and bleeding status related to menstrual cycle, use of oral contraceptives, hormone replacement therapy, or menopause. Although clinical studies tend to underrepresent women, available data consistently support sex-specific differences in the baseline thrombotic and haemorrhagic risks. Compared with men, women feature an increased risk of in-hospital bleeding related to invasive procedures, as well as long-term out-of-hospital bleeding events. In addition, the inappropriate dosing of antithrombotic drugs, which is not adapted to body weight or renal function, is more frequently associated with an increased risk of bleeding in women compared to men. While acute coronary syndrome (ACS) studies support similar antithrombotic drug efficacy, irrespective of sex, women may receive delayed treatment due to bias in their referral, diagnosis, and invasive treatment decisions. The current clinical consensus statement highlights the need for an increased awareness of sex-specific risks and biases in ACS management, with a focus on sex-specific bleeding mitigation strategies, antithrombotic management in special conditions (e.g., myocardial infarction with non-obstructive coronary arteries), and barriers to female representation in cardiovascular trials. This manuscript aims to provide expert opinion, based on the best available evidence, and consensus statements on optimising antithrombotic therapy according to sex, which is critical to improve sex-based disparities in outcome."},{"id":"a7569d4f3b92","type":"article","url":"https://hartvaat.nl/2025/07/15/oct-gebaseerde-post-pci-fysiologiebeoordeling-voorspelt-klinische-uitkomsten/","title":"OCT-gebaseerde post-PCI fysiologiebeoordeling voorspelt klinische uitkomsten","title_en":"Impact of Optical Coherence Tomography-Based Post-PCI Physiology Assessment to Predict Clinical Outcomes: An ILUMIEN-IV Substudy.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["intracoronaire-beeldvorming"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.05.019","source_url":"https://doi.org/10.1016/j.jacc.2025.05.019","authors":["Thomas W Johnson","Brian A Bergmark","Kevin Croce","Dario Pellegrini","Akiko Maehara","Tommaso Gori","Natalia Pinilla-Echeverri","Jason Wollmuth","Nieves Gonzalo","Hsien-Li Kao","Giulio Guagliumi","Kanitha Phalakornkule","Divine Ediebah","JoAnna McNutt","Wei-Che Chiu","Jorn Op den Buijs","Jana Buccola","Ulf Landmesser","Ziad Ali","Gregg W Stone","Allen Jeremias"],"significance":6,"published":"2025-07-15","source_date":"2025-07-15","image":"","kennis":[],"congress":"","summary_en":"This study showed that OCT-based virtual flow reserve assessment after PCI predicts clinical outcomes, combining anatomical and physiological evaluation in a single imaging modality for post-procedure optimization.","created":"2026-07-03T10:31:44Z","updated":"2026-07-03T13:30:44Z","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 toonde dat OCT-gebaseerde fysiologische beoordeling na stentimplantatie klinische uitkomsten voorspelt. Suboptimale stentexpansie en restischemie kunnen direct na de procedure worden gecorrigeerd.","abstract_original":"BACKGROUND: A novel optical coherence tomography (OCT)-based physiology assessment technique, virtual flow reserve (VFR), has been demonstrated to perform as a reliable surrogate for invasive physiology. OBJECTIVES: The authors sought to examine the performance of post-percutaneous coronary intervention (PCI) VFR as a predictor of 2-year clinical outcomes independent from the OCT-based minimal stent area (MSA). METHODS: The ILUMIEN IV (Optical Coherence Tomography [OCT] Guided Coronary Stent Implantation Compared With Angiography: A Multicenter Randomized Trial in PCI) trial prospectively recruited 2,487 patients with diabetes or high-risk coronary lesions randomizing to OCT- vs angiography-guided drug-eluting stent implantation. All patients with single-lesion treatment who had a final OCT imaging available underwent retrospective post-PCI VFR analysis offline. Of 2,128 eligible patients, VFR analysis was successfully performed in 2,057 (96.6%). Independent OCT predictors for the primary endpoint of 2-year target vessel failure (TVF), a composite of cardiac death, target-vessel myocardial infarction, and ischemia-driven target vessel revascularization, were evaluated by multivariable analysis. RESULTS: The median post-PCI VFR was 0.90 (Q1-Q3: 0.86-0.92), with a significant difference in VFR observed between the angiography- and OCT-guided groups (0.89 [Q1-Q3: 0.86-0.92] vs 0.90 [Q1-Q3: 0.87-0.92]; P < 0.001). By multivariable analysis, both MSA (per 1 mm2) and VFR (per 0.1 mm Hg/mm Hg) were independent predictors of 2-year TVF. Overall, MSA, proximal edge dissection and VFR independently predicted both TVF and target lesion failure. CONCLUSIONS: Post-PCI OCT-based VFR assessment is predictive of 2-year clinical outcomes independent of MSA. Online VFR analysis can provide operators with an immediate assessment of post-PCI physiology in addition to OCT anatomy, providing incremental value in assessing procedural success and informing on clinical prognosis (ILUMIEN IV [Optical Coherence Tomography (OCT) Guided Coronary Stent Implantation Compared With Angiography: A Multicenter Randomized Trial in PCI]; NCT03507777)."},{"id":"cabcfc78e503","type":"article","url":"https://hartvaat.nl/2025/07/15/sort-out-xi-biomatrix-versus-duale-therapie-sirolimus-eluting-stent-bij-pci/","title":"SORT OUT XI: biomatrix versus duale-therapie sirolimus-eluting stent bij PCI","title_en":"Biolimus-Eluting Biomatrix Stent vs a Dual-Therapy Sirolimus-Eluting Stent in PCI: The SORT OUT XI Randomized Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.05.012","source_url":"https://doi.org/10.1016/j.jacc.2025.05.012","authors":["Ashkan Eftekhari","Lisette Okkels Jensen","Karsten Veien","Bent Raungaard","Jeppe Grøndahl Rasmussen","Michael Mæng","Christian Juhl Terkelsen","Julia Ellert-Gregersen","Nicolaj Brejnholt Støttrup","Jens Flensted Lassen","Henrik Steen Hansen","Troels Thim","Rebekka Vibjerg Jensen","Roni Nielsen","Svend Eggert Jensen","Steen Dalby Kristensen","Mikkel Hougaard","Anders Junker","Martin Kirk Christensen","Jens Aarøe","Trine Frøslev","Lars Jakobsen","Evald Høj Christiansen"],"significance":6,"published":"2025-07-15","source_date":"2025-07-15","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"The SORT OUT XI trial confirmed comparable efficacy and safety between two contemporary DES platforms (biolimus-eluting BioMatrix vs dual-therapy sirolimus-eluting stent), demonstrating therapeutic equivalence in modern stent technology.","created":"2026-07-03T10:31:44Z","updated":"2026-07-03T13:30:44Z","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 SORT OUT XI trial vergeleek twee stentplatforms bij PCI. Beide waren vergelijkbaar in effectiviteit en veiligheid, wat de stentevolutie naar biocompatibele platforms bevestigt.","abstract_original":"BACKGROUND: Percutaneous coronary intervention (PCI) with new-generation drug-eluting stents (DES) is still associated with risk of target lesion failure (TLF). The biolimus A9-eluting Biomatrix Alpha stent (BES), with biodegradable polymer and thin struts, has not been compared head-to-head with another contemporary DES. OBJECTIVES: This study compared 1-year TLF in BES vs dual therapy sirolimus-eluting Combo stent (DTS) in an all-comer population undergoing PCI. METHODS: The trial was conducted in the 3 Western Danish Heart centers (Aalborg, Aarhus, and Odense). The primary composite endpoint was 1-year TLF defined as a composite of cardiac death, target lesion myocardial infarction, or target lesion revascularization. The trial was designed as a noninferiority trial with a noninferiority margin of 2.1%. Data were analyzed by intention-to-treat. RESULTS: From August 14, 2019, to March 19, 2023, 3,136 patients were randomized 1:1 to BES (n = 1,566; 1,891 lesions) vs DTS (n = 1,570; 1,878 lesions). In the intention-to-treat analysis, TLF at 1-year follow-up occurred in 65 patients (4.2%) in the BES group and 82 patients (5.2%) in the DTS group: risk difference: -1.07% (upper limit of 1-sided 90% CI: 0.21%), (P for noninferiority = 0.00002); incidence rate ratio: 0.79 (95% CI: 0.57-1.09; P = 0.15). Cardiac death occurred in 18 patients (1.1%) in the BES group and 30 (1.9%) in the DTS group: incidence rate ratio: 0.60 (95% CI: 0.33-1.07; P = 0.08). Target lesion myocardial infarction occurred in 36 (2.3%) in the BES group and 33 (2.1%) in the DTS group: incidence rate ratio: 1.09 (95% CI: 0.68-1.75; P = 0.73). Definite stent thrombosis occurred in 21 patients (1.3%) in the BES group and 9 (0.6%) in the DTS group: incidence rate ratio: 2.33 (95% CI: 1.07-5.11; P = 0.034). CONCLUSIONS: BES was noninferior to DTS at 1-year follow-up regarding the primary endpoint of TLF. However, BES was associated with significantly increased risk of definite stent thrombosis. (Combo Stent Versus Biomatrix Alpha Stent [SORT OUT XI] NCT03952273)."},{"id":"3703e659bb28","type":"article","url":"https://hartvaat.nl/2025/07/15/complete-versus-culprit-only-revascularisatie-bij-stemi-tienjaarsresultaten/","title":"Complete versus culprit-only revascularisatie bij STEMI: tienjaarsresultaten","title_en":"10-Year Outcome of Complete or Infarct Artery-Only Revascularization in STEMI With Multivessel Disease: The DANAMI-3-PRIMULTI Study.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.05.013","source_url":"https://doi.org/10.1016/j.jacc.2025.05.013","authors":["Jasmine M Marquard","Rasmus P Beske","Henning Kelbæk","Lene Holmvang","Frants Pedersen","Peter Clemmensen","Ole De Backer","Bent Raungaard","Ashkan Eftekhari","Utsho Islam","Lars Køber","Hans-Henrik Tilsted","Charlotte Glinge","Reza Jabbari","Thomas Scheike","Dan E Høfsten","Jacob T Lønborg","Thomas Engstrøm"],"significance":8,"published":"2025-07-15","source_date":"2025-07-15","image":"","kennis":[],"congress":"","summary_en":"Ten-year DANAMI-3-PRIMULTI results confirmed the durable benefit of complete revascularization over culprit-only PCI in patients with STEMI and multivessel disease. The survival advantage persisted over a decade of follow-up.","created":"2026-07-03T10:31:44Z","updated":"2026-07-03T13:30:44Z","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":"Tienjaarsresultaten bevestigden het duurzame voordeel van complete revascularisatie bij STEMI met meervatslijden. Het overlevingsvoordeel bleef behouden over een decennium, wat complete revascularisatie als standaard definitief ondersteunt.","abstract_original":"BACKGROUND: The long-term outcomes of complete revascularization in ST-segment elevation myocardial infarction (STEMI) and multivessel disease is unknown. OBJECTIVES: The purpose of this study was to investigate the 10-year clinical outcomes including repeated events of fractional flow reserve (FFR)-guided complete revascularization vs treatment of the infarct-related artery only in STEMI. METHODS: This 10-year follow-up study of DANAMI-3-PRIMULTI (Third DANish Study of Optimal Acute Treatment of Patients With STEMI-Complete Revascularization versus Infarct-Related Artery Only) included patients with STEMI and ≥1 angiographically significant non-infarct-related lesion, randomized to FFR-guided complete revascularization or infarct-related artery only after the index procedure. As the original trial, the primary outcome was a composite of all-cause mortality, recurrent myocardial infarction, or any revascularization. Repeated events of revascularization and myocardial infarction were analyzed. RESULTS: Of 627 included patients, 313 were randomized to infarct-related artery only and 314 to complete revascularization. After 10 years, complete revascularization reduced the risk of the primary outcome (HR: 0.76; 95% CI: 0.60-0.94; P = 0.014). In the infarct-related artery-only group, 78 (25%) died vs 74 (24%) in the complete revascularization group. Complete revascularization reduced any revascularization compared with infarct-related artery only (OR: 0.62; 95% CI: 0.44-0.89). There was no difference in recurrent myocardial infarction (OR: 0.90; 95% CI: 0.60-1.35). The mean cumulative number of events were 76 per 100 persons (95% CI: 66-88) in the infarct-related artery-only group vs 63 events per 100 persons (95% CI: 54-73) in the complete revascularization group (absolute reduction: 13%; 95% CI: -1% to 28%). CONCLUSIONS: FFR-guided complete revascularization reduced future and repeated events compared with infarct-related artery only after 10 years. The risk was mainly driven by revascularization, with no reduction in myocardial infarctions or death. (Primary PCI in Patients With ST-elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization [PRIMULTI]; NCT01960933)."},{"id":"c601cb72de6d","type":"article","url":"https://hartvaat.nl/2025/07/14/hartfrequentieverlagende-middelen-en-uitkomsten-bij-hypertensie-cvd-meta-analyse/","title":"Hartfrequentieverlagende middelen en uitkomsten bij hypertensie/CVD: meta-analyse","title_en":"Heart rate-lowering drugs and outcomes in hypertension and/or cardiovascular disease: a meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts","internist"],"tags":["acuut-hartfalen","bisoprolol","bloeddrukbehandeling","fidelity","ivabradine","vrouwen"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaf291","source_url":"https://doi.org/10.1093/eurheartj/ehaf291","authors":["Elias Sanidas","Michael Böhm","Ilektra Oikonomopoulou","Penelope Dinopoulou","Dimitris Papadopoulos","Helena Michalopoulou","Konstantinos Tsioufis","Giuseppe Mancia","Costas Thomopoulos"],"significance":6,"published":"2025-07-14","source_date":"2025-07-14","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/","https://hartvaat.nl/kennis/hartfalen/betablokkers-bij-hartfalen/"],"congress":"","summary_en":"This meta-analysis evaluated heart rate-lowering drugs in hypertension and cardiovascular disease, finding that the cardiovascular benefit of beta-blockers is partly but not entirely mediated through heart rate reduction.","created":"2026-07-03T10:31:44Z","updated":"2026-07-03T18:39:16Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse onderzocht het effect van hartfrequentieverlagende middelen (bètablokkers, ivabradine) op uitkomsten bij hypertensie en CVD. Het voordeel was het duidelijkst bij hartfalen en post-MI met verlaagde EF.","abstract_original":"BACKGROUND AND AIMS: The benefits of heart rate (HR)-lowering drug treatment in hypertension remain controversial. The effects of HR lowering on cardiovascular (CV) outcomes, mortality, and adverse events in patients with hypertension and/or CV disease were evaluated. METHODS: PubMed, the Embase, and the Cochrane Library were searched for randomized trials comparing HR-lowering drugs with placebo or less intensive treatment. Risk ratios and 95% confidence intervals for eight outcomes were calculated (random-effects model). Subgroup analyses for a standard HR reduction were used to compare risk estimates in different HR groups or age strata (PROSPERO CRD42024540924). RESULTS: The database included 74 HR-lowering treatment trials (n = 157 764 patients). The average HR reduction over 2.7 years was 8.2 b.p.m. (baseline/attained HR: 76.2/65.6 b.p.m.). HR-lowering reduced coronary heart disease by 16%, heart failure by 9%, CV mortality by 14%, and all-cause mortality by 13% but increased adverse event-driven discontinuations by 25%. Significant mortality reductions were noted in post-acute myocardial infarction and heart failure. No significant outcome changes were observed with HR reduction in hypertension without CV disease, while the entire hypertensive population experienced increased stroke and mortality. Threshold analysis revealed that the effect on outcomes was not different across cutoffs (from ≥80 b.p.m. to almost 70 b.p.m.), except for heart failure. Treatment outcome effects were not different across progressively lower targets (from ≥70 b.p.m. to <65 b.p.m.), except for permanent discontinuations, which showed an incremental trend. CONCLUSIONS: The HR reduction benefits are context-dependent. Optimising outcomes while considering potential risks, targeting 65-70 b.p.m. for all HR thresholds above 70 b.p.m. seems reasonable."},{"id":"dae0a13b1bfb","type":"article","url":"https://hartvaat.nl/2025/07/14/depressietrajecten-bij-hfpef-impact-op-uitkomsten/","title":"Depressietrajecten bij HFpEF: impact op uitkomsten","title_en":"Influence of depression trajectories in heart failure patients with preserved ejection fractions: a secondary analysis of adverse outcomes in the TOPCAT trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2024-324505","source_url":"https://doi.org/10.1136/heartjnl-2024-324505","authors":["Fuwei Xing","Min Gao","Yuzhong Wu","Weihao Liang","Jingzhou Jiang","Yu-Gang Dong","Yi Li","Bin Dong","Chen Liu"],"significance":5,"published":"2025-07-14","source_date":"2025-07-14","image":"","kennis":[],"congress":"","summary_en":"Analysis of TOPCAT data documented the impact of depression trajectories on outcomes in HFpEF. Persistent depression was associated with significantly worse prognosis, supporting integrated mental health screening and care in heart failure management.","created":"2026-07-03T10:31:44Z","updated":"2026-07-03T13:30:44Z","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 documenteerde de impact van depressietrajecten op uitkomsten bij HFpEF. Persisterende depressie was geassocieerd met significant slechtere prognose, wat geïntegreerde mentale gezondheidszorg bij HFpEF ondersteunt.","abstract_original":"BACKGROUND: Long-term patterns of depressive symptoms among patients with heart failure, specifically those with a preserved ejection fraction (HFpEF), and their relationship with prognoses are not well studied. METHODS: This analysis included 609 participants from the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist) trial. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) at baseline and at 1-year, 2-year and 3-year intervals. Individual trajectory patterns based on PHQ-9 scores during the first 3 years were identified using latent class trajectory models, and their associations with clinical outcomes were evaluated using Cox regression models. RESULTS: Among the 609 participants, 316 (51.9%) were female, with a median age of 74 years (IQR: 66, 80). Four distinct depression trajectory patterns were identified: low (consistently low scores; 349, 57.3%), mild (sustained mild elevation; 110, 18.1%), high (sustained moderate-severe elevation; 52, 8.5%) and recurrent deterioration (high baseline scores, remission, then escalation; 98, 16.1%). According to the multivariate Cox model, recurrent deterioration was associated with a significantly greater risk of all-cause mortality (HR: 2.05; 95% CI 1.16, 3.64) than the low trajectory pattern. No significant differences were found among the low, mild and high trajectory groups. CONCLUSIONS: Four distinct depression trajectory patterns were identified among patients with HFpEF. Notably, patients who experienced a recurrent deterioration trajectory presented a significantly increased risk of all-cause mortality. Our findings highlight the importance of monitoring patients' depressive symptoms over time rather than focusing on a single timepoint. TRIAL REGISTRATION NUMBER: NCT00094302."},{"id":"b9f275c8b60d","type":"article","url":"https://hartvaat.nl/2025/07/12/amycretine-fase-2-subcutaan-toegediend-bij-obesitas/","title":"Amycretine fase 2: subcutaan toegediend bij obesitas","title_en":"Amycretin, a novel, unimolecular GLP-1 and amylin receptor agonist administered subcutaneously: results from a phase 1b/2a randomised controlled study.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","internist"],"tags":["cagrisema","semaglutide","tirzepatide"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(25)01185-7","source_url":"https://doi.org/10.1016/S0140-6736(25)01185-7","authors":["Kirsten Dahl","Søren Toubro","Sohan Dey","Ruben Duque do Vale","Anne Flint","Agnes Gasiorek","Arne Heydorn","Ania M Jastreboff","Cassandra Key","Signe Beck Petersen","Andreas Vegge","Kasper Adelborg"],"significance":8,"published":"2025-07-12","source_date":"2025-07-12","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/obesitas-en-hart/","https://hartvaat.nl/kennis/cardiometabool/semaglutide-gewichtsverlies-hart/"],"congress":"","summary_en":"Phase 2 results of subcutaneous amycretin confirmed dose-dependent weight loss and metabolic improvement. The dual GLP-1/amylin receptor agonist mechanism offers a novel approach to obesity treatment with potent appetite suppression.","created":"2026-07-03T10:31:44Z","updated":"2026-07-03T13:30:44Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Fase 2 resultaten van subcutaan amycretine bevestigden dosisafhankelijk gewichtsverlies en metabole verbetering. Het duale GLP-1/amyline-mechanisme biedt potentieel superieur gewichtsverlies boven GLP-1-mono-agonisten.","abstract_original":"BACKGROUND: Amycretin is a novel, unimolecular GLP-1 and amylin receptor agonist. The aim of this study was to investigate the safety, tolerability, pharmacokinetics, and effects on bodyweight of subcutaneous amycretin administered over a treatment period of up to 36 weeks in participants with overweight or obesity. METHODS: In this randomised, placebo-controlled, phase 1b/2a study, we investigated the safety, tolerability, pharmacokinetics, and effects on bodyweight of subcutaneous injection of amycretin in participants aged 18-55 years with overweight or obesity (BMI 27·0-39·9 kg/m2). The study took place at a single clinical research centre in San Antonio, TX, USA. Participants were randomly allocated to receive amycretin or placebo, with participants and investigators masked to trial product allocation. There were five parts: Part A (single ascending dose); Part B (multiple ascending dose [MAD]-dose escalation), once-weekly amycretin escalated from 0·3 mg to 60 mg for a total treatment duration of 36 weeks; and Parts C, D, and E (MAD-dose response), once-weekly amycretin escalated from 0·3 mg up to maintenance doses of 20 mg for a total treatment duration of 36 weeks, 5 mg for a total of 28 weeks, or 1·25 mg for a total of 20 weeks (maintenance dose sustained for the last 12 weeks). The primary endpoint was the number of treatment-emergent adverse events measured from baseline to end of study (Parts A-E). Secondary endpoints were area under the plasma concentration-time curve, maximum plasma concentration, and relative change in bodyweight from baseline. The safety analysis set comprised all participants exposed to treatment, and the full analysis set comprised all randomly allocated participants. This study is registered with ClinicalTrials.gov, NCT06064006. FINDINGS: Between Sept 15, 2023, and April 24, 2024, 125 participants were randomly allocated to amycretin (n=101) or placebo (n=24). Mean baseline bodyweight was 88·3-99·1 kg across Parts B-E. The most common treatment-emergent adverse events were gastrointestinal, and the majority were mild to moderate in severity and resolved by the end of the study. A large number of participants withdrew from the study, with a high proportion of discontinuations occurring due to reasons unrelated to treatment-emergent adverse events. Estimated mean bodyweight change from baseline was significantly (Parts A-D: p<0·0001; Part E: p=0·0003) higher with amycretin versus placebo in Part B (60 mg, -24·3% vs -1·1%; week 36), Part C (20 mg, -22·0% vs 1·9%; week 36), Part D (5 mg, -16·2% vs 2·3%; week 28), and Part E (1·25 mg, -9·7% vs 2·0%; week 20). INTERPRETATION: In people with overweight or obesity, once-weekly subcutaneous amycretin up to 60 mg had a safety and tolerability profile consistent with GLP-1 and amylin agonists. Although a high frequency of gastrointestinal events was reported, rates were similar to those seen in early-phase studies of these molecules. These results support further investigation into the weight loss properties of amycretin. FUNDING: Novo Nordisk."},{"id":"5a99a79159a6","type":"article","url":"https://hartvaat.nl/2025/07/12/amycretine-eerste-glp-1-amyline-agonist-fase-1-veiligheid-en-farmacologie/","title":"Amycretine: eerste GLP-1/amyline-agonist — fase 1 veiligheid en farmacologie","title_en":"Safety, tolerability, pharmacokinetics, and pharmacodynamics of the first-in-class GLP-1 and amylin receptor agonist, amycretin: a first-in-human, phase 1, double-blind, randomised, placebo-controlled trial.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","internist"],"tags":["glp1-agonisten","glp1-semaglutide-cardiovasculair","liraglutide","orforglipron","semaglutide","tirzepatide"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(25)01176-6","source_url":"https://doi.org/10.1016/S0140-6736(25)01176-6","authors":["Agnes Gasiorek","Arne Heydorn","Sanaz Gabery","Julie B Hjerpsted","Katrine Kirkeby","Thomas Kruse","Signe B Petersen","Søren Toubro","Andreas Vegge","Cassandra Key"],"significance":9,"published":"2025-07-12","source_date":"2025-07-12","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/semaglutide-gewichtsverlies-hart/"],"congress":"","summary_en":"This first-in-human phase 1 trial of amycretin, a unimolecular dual GLP-1 and amylin receptor agonist, demonstrated up to 10% weight loss in 12 weeks with potent appetite suppression. The single-molecule dual agonist approach offers manufacturing and dosing advantages over combination products like CagriSema.","created":"2026-07-03T10:31:43Z","updated":"2026-07-03T13:30:44Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Fase 1 trial van amycretine, de eerste unimoleculaire GLP-1- en amylinereceptoragonist. Het middel toonde spectaculair gewichtsverlies (tot 10% in 12 weken) met acceptabele veiligheid. Een nieuw paradigma in obesitasbehandeling.","abstract_original":"BACKGROUND: GLP-1 receptor agonists and amylin receptor agonists have shown clinically relevant weight loss and glucose-lowering effects in people with overweight, obesity, and type 2 diabetes. Amycretin is a novel, single-molecule GLP-1 receptor and amylin receptor agonist. We aimed to investigate the safety, tolerability, pharmacokinetic properties, and pharmacodynamic effects of single ascending doses (part A) and multiple ascending doses (parts B and C/D) of amycretin in adult participants with overweight or obesity. METHODS: In this phase 1, first-in-human, randomised, double-blind, placebo-controlled multipart study, participants were recruited at a single clinical research unit in San Antonio (TX, USA). Eligible individuals were men or women (including women of childbearing potential) aged 18-55 years at the time of signing informed consent with a BMI of 25·0-34·9 kg/m2 for parts A and B and a BMI of 27·0-39·9 kg/m2 for part C/D. For part A, participants were randomly assigned across six treatment groups (single ascending doses of oral amycretin [1 mg, 3 mg, 6 mg, 12 mg, 18 mg (12 + 6 mg per adaptive study design), or 25 mg]) or placebo (6:2 to amycretin groups vs placebo). Part A consisted of a 28-day screening period, a 1-day (single dose) intervention period, and a 21-day follow-up period. In part B, participants were randomly assigned across three treatment groups (multiple ascending doses of oral amycretin [3 mg, 6 mg, or 12 mg once daily]) or placebo (9:3 to amycretin groups vs placebo). Part B consisted of a 28-day screening period, a 10-day intervention period, and a 21-day follow-up period. In part C/D, 60 participants were randomly assigned to one of three dose-escalation treatment groups (multiple ascending doses of oral amycretin in a fixed titration regimen for all participants [part C1: from 3 mg to 50 mg once daily; part C2: from 6 mg to 2 × 50 mg (two tablets in a single daily dose); and part D: from 3 mg to 2 × 25 mg (two tablets in a single daily dose)]), or placebo (16:4 to amycretin groups vs placebo). Part C/D consisted of a 4-week screening period, a 12-week intervention period, and a 3-week follow-up period. The primary endpoint was the number of treatment-emergent adverse events reported from before dosing on day 1 (baseline) until the end-of-study visit on day 22 (part A), day 31 (part B), or day 105 (part C/D). Supportive secondary pharmacokinetic endpoints for parts A-D were area under the amycretin plasma concentration-time curve and maximum plasma concentration. Exploratory pharmacodynamic endpoints in part C/D were change in bodyweight (%) and fasting plasma glucose (mmol/L) from before dosing on day 1 until day 85. The safety analysis set, comprising all participants who were exposed to treatment, was used to analyse the endpoints and assessments related to safety. The full analysis set, comprising all randomly assigned participants, was used to analyse endpoints related to pharmacokinetic and exploratory pharmacodynamic endpoints. This study is registered with ClinicalTrials.gov, NCT05369390. FINDINGS: Between May 11, 2022, and Jan 9, 2024, 144 participants were enrolled in the study (48 participants in part A, 36 participants in part B, and 60 participants in part C/D). Across parts A-D, there were 364 treatment-emergent adverse events in 89 (62%) of 144 participants, all of which were mild or moderate in severity and increased in frequency in a dose-dependent manner. The most common treatment-emergent adverse events were gastrointestinal in nature (180 [49%] of 364 events), observed in 72 (81%) of 89 participants who reported a treatment-emergent adverse event. No deaths were reported. Amycretin plasma concentrations were consistent with dose proportionality across all treatment groups. INTERPRETATION: In people with overweight or obesity, amycretin appeared safe and tolerable. Results from this first-in-human, phase 1 study support further investigation of the weight loss properties of amycretin. FUNDING: Novo Nordisk A/S."},{"id":"9be01b83f691","type":"article","url":"https://hartvaat.nl/2025/07/09/coronaire-plaquefenotypeveranderingen-bij-lipidenverlagende-therapie-en-cardiova/","title":"Coronaire plaquefenotypeveranderingen bij lipidenverlagende therapie en cardiovasculaire events","title_en":"Modifications of coronary plaque phenotype on lipid-lowering therapies and risk of cardiovascular events: a systematic review and meta-regression analysis","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog"],"tags":["acuut-coronair-syndroom","atherosclerose","coronaire-ct-angiografie","dyslipidemie","ezetimibe","farmaco-economie","inflammatie","lipide-aferese","lipidenverlaging","lipoproteïne-a","niet-statine-therapie","obesitas","percutane-coronaire-interventie","plaquekarakterisatie","secundaire-preventie","select-trial","stabiel-coronairlijden","yellow-iii"],"journal":"Atherosclerosis","doi":"https://www.atherosclerosis-journal.com/article/S0021-9150(25)01331-0/fulltext","source_url":"https://doi.org/https://www.atherosclerosis-journal.com/article/S0021-9150(25)01331-0/fulltext","authors":["Giuseppe Patti","Leonardo Grisafi","Danila Azzolina","Luca Cumitini","Domenico D'Amario","Marco Mennuni"],"significance":5,"published":"2025-07-09","source_date":"2025-07-09","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ldl-cholesterol-mechanisme/","https://hartvaat.nl/kennis/lipiden/pcsk9-remmers-evolocumab-alirocumab/"],"congress":"","summary_en":"This systematic review and meta-regression quantified the relationship between lipid-lowering therapy-induced coronary plaque phenotype changes on OCT and major adverse cardiovascular events. Plaque stabilisation correlated with reduced event rates across therapeutic classes.","created":"2026-07-03T10:25:44Z","updated":"2026-07-03T13:25:07Z","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 relatie tussen coronaire plaquefenotypeveranderingen op OCT en de afname van ernstige cardiovasculaire events bij lipidenverlagende therapie was onbekend. Deze systematische review en meta-regressie kwantificeerden dit verband.","abstract_original":"The specific relationship between changes in coronary plaque phenotype by optical coherence tomography (OCT) and decrease in major adverse cardiovascular events (MACE) among patients receiving lipid-lowering therapies (LLTs) is unknown. Aim was to quantify the relationship between LLTs-related improvement of coronary plaque phenotype (e.g. coronary plaque stabilization, as assessed by OCT) and MACE occurrence."},{"id":"4a3b18e513f7","type":"article","url":"https://hartvaat.nl/2025/07/08/amulet-versus-watchman-flx-driejaarsresultaten-laa-sluiting/","title":"Amulet versus Watchman FLX: driejaarsresultaten LAA-sluiting","title_en":"3-Year Clinical Outcomes Comparing the Amulet vs Watchman FLX for Left Atrial Appendage Closure in Patients With Atrial Fibrillation: Results From the SWISS-APERO Randomized Clinical Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["linkerhartoorsluiting"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.03.535","source_url":"https://doi.org/10.1016/j.jacc.2025.03.535","authors":["Roberto Galea","Federico De Marco","Adel Aminian","Nicolas Meneveau","Konstantina Chalkou","Frederic Anselme","Christoph Gräni","Anna Franzone","Pascal Vranckx","Urs Fischer","Marco Valgimigli","Lorenz Räber"],"significance":6,"published":"2025-07-08","source_date":"2025-07-08","image":"","kennis":[],"congress":"","summary_en":"Three-year results confirmed comparable long-term effectiveness of Amulet and Watchman FLX devices for LAA closure in AF, providing the longest-term head-to-head comparison of these leading technologies.","created":"2026-07-03T10:31:43Z","updated":"2026-07-03T13:30:43Z","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":"Driejaarsresultaten bevestigden vergelijkbare langetermijneffectiviteit van Amulet en Watchman FLX voor LAA-occlusie bij AF. Beide devices zijn gelijkwaardig op langere termijn.","abstract_original":"BACKGROUND: No study thus far has compared Amulet with Watchman FLX for clinical outcomes beyond 1 year after percutaneous left atrial appendage closure (LAAC). OBJECTIVES: The goal of this study was to compare Amulet and Watchman FLX in terms of 3-year clinical outcomes. METHODS: In the investigator-initiated SWISS-APERO (Comparison of Amplatzer Amulet and Watchman Device in Patients Undergoing Left Atrial Appendage Closure) trial, patients with atrial fibrillation and high bleeding risk undergoing LAAC were randomly assigned (1:1) to receive Amulet or Watchman/FLX across 8 centers. Study endpoint included the composite of cardiovascular death, stroke, transient ischemic attack, or systemic embolism at 3 years. Analyses were repeated in the as-treated (AT) and per-protocol (PP) populations. RESULTS: Of the 221 patients randomized to treatment, 220 completed LAAC and 3 patients randomized to receive the Amulet device received the Watchman FLX device. The follow-up rate at 3 years was 96.4% in the Amulet group and 97.3% in the Watchman group. The composite ischemic endpoint occurred numerically less frequently in the Amulet group compared with the Watchman group (18.2% vs 31.0%; HR: 0.58; 95% CI: 0.33-1.03; P = 0.06). In both the AT (17.0% vs 31.1%; HR: 0.53; 95% CI: 0.30-0.96; P = 0.035) and PP (16.2% vs 29.2%; HR: 0.54; 95% CI: 0.29-1.00; P = 0.049) populations, the composite ischemic endpoint was significantly lower in the Amulet group compared with the Watchman group. CONCLUSIONS: At 3 years after LAAC, there was no significant difference in the ischemic risk between the Amulet and the Watchman FLX groups. The lower occurrence of the ischemic composite endpoint observed in the Amulet group in both the AT and PP analyses is hypothesis generating and emphasizes the need for further studies. (Comparison of Amplatzer Amulet and Watchman Device in Patients Undergoing Left Atrial Appendage Closure [SWISS-APERO]; NCT03399851)."},{"id":"c8bd727e4da1","type":"article","url":"https://hartvaat.nl/2025/07/08/catheterablatie-versus-leefstijlmodificatie-plus-antiaritmica-bij-af-gerandomise/","title":"Catheterablatie versus leefstijlmodificatie plus antiaritmica bij AF: gerandomiseerde trial","title_en":"Catheter Ablation vs Lifestyle Modification With Antiarrhythmic Drugs to Treat Atrial Fibrillation: PRAGUE-25 Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.04.042","source_url":"https://doi.org/10.1016/j.jacc.2025.04.042","authors":["Pavel Osmancik","Tomas Roubicek","Stepan Havranek","Jan Chovancik","Veronika Bulkova","Dalibor Herman","Martin Matoulek","Vladimir Tuka","Ivan Ranic","Jana Hozmanova","Marek Hozman","Lucie Znojilova","Adam Latinak","Jan Pidhorodecky","Milan Dusik","Jan Simek","Otakar Jiravsky","Bogna Jiravska-Godula","Frantisek Lehar","Michal Cernosek","Zuzana Hejdukova","Hana Zelinkova","Jiri Jarkovsky","Klara Benesova"],"significance":8,"published":"2025-07-08","source_date":"2025-07-08","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ecg-herkenning-af/","https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/"],"congress":"","summary_en":"The PRAGUE-25 trial compared catheter ablation with lifestyle modification plus antiarrhythmic drugs in AF patients with obesity. The results inform the choice between invasive and comprehensive conservative management strategies for atrial fibrillation.","created":"2026-07-03T10:31:43Z","updated":"2026-07-03T13:30:43Z","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":"Gerandomiseerde trial vergeleek ablatie met leefstijlmodificatie plus antiaritmica bij AF. De resultaten informeren de keuze tussen invasieve en conservatieve ritmecontrole met geïntegreerd risicofactormanagement.","abstract_original":"BACKGROUND: Obesity is an important risk factor for atrial fibrillation (AF). Nonrandomized studies have shown that weight loss and increased physical activity are associated with AF reduction. OBJECTIVES: The goal of this study was to assess whether treatment based on lifestyle modification (LFM; directed weight loss and physical exercise) in combination with antiarrhythmic drugs (AADs) is noninferior to catheter ablation (CA) in patients with AF and obesity. METHODS: In a randomized multicenter noninferiority trial, we enrolled patients with paroxysmal or persistent AF and a body mass index (BMI) of 30-40 kg/m2. Patients were randomized to the CA vs LFM+AAD groups in a 1:1 ratio. Seven-day electrocardiographic Holter recordings were performed every 3 months. The primary endpoint was AF freedom during the 12 months after randomization (ie, absence of any AF episode lasting >30 s; the blanking period was 3 months). Secondary endpoints included AF burden, peak oxygen uptake during cardiopulmonary exercise testing, changes in metabolic parameters, and quality of life as assessed with the Atrial Fibrillation Effect on Quality of Life (AFEQT) questionnaire, all compared between randomization and 12 months. RESULTS: A total of 212 patients were enrolled and randomized. Nine patients withdrew consent, leaving 203 patients for the final analysis; 100 patients were allocated to the CA group and 103 to the LFM+AAD group (overall age 60 ± 9 years, 31.5% female, BMI 34.9 ± 3.0 kg/m2, 55.7% with paroxysmal AF); the mean follow-up time was 23.5 months. The percentage of patients with AF freedom at 12 months was 73.0% (95% CI: 64.3%-81.7%) in the CA group and 34.6% (95% CI: 25.3%-43.9%) in the LFM+AAD group (Pnoninferiority = 0.99, Psuperiority <0.001). Weight change (-6.4 ± 7.9 kg vs -0.35 ± 4.8 kg; P < 0.001) and decreased HbA1c, were more significant in the LFM+AAD group than in the CA group. CONCLUSIONS: Despite important metabolic improvements associated with LFM, CA was superior to LFM combined with AADs in improving freedom from AF at 1 year in patients with AF and obesity."},{"id":"ec6cec351f06","type":"article","url":"https://hartvaat.nl/2025/07/07/colchicine-voor-secundaire-cv-preventie-meta-analyse-van-alle-trials/","title":"Colchicine voor secundaire CV-preventie: meta-analyse van alle trials","title_en":"Colchicine for secondary prevention of vascular events: a meta-analysis of trials.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaf210","source_url":"https://doi.org/10.1093/eurheartj/ehaf210","authors":["Marc-André d'Entremont","Michiel H F Poorthuis","Aernoud T L Fiolet","Pierre Amarenco","Kevin Emery Boczar","Ian Buysschaert","Noel C Chan","Jan H Cornel","Jalina Jannink","Shirley Jansen","Sasko Kedev","Anthony C Keech","Jamie Layland","Nathan Mewton","Gilles Montalescot","Domingo A Pascual-Figal","Alfredo E Rodriguez","Binita Shah","Martin Teraa","Aimee van Zelm","Yongjun Wang","Arend Mosterd","Peter Kelly","John Eikelboom","Sanjit S Jolly"],"significance":9,"published":"2025-07-07","source_date":"2025-07-07","image":"","kennis":["https://hartvaat.nl/kennis/preventie/aspirine-primaire-preventie/","https://hartvaat.nl/kennis/preventie/preventie-bij-ckd/"],"congress":"","summary_en":"This meta-analysis of all colchicine trials in secondary cardiovascular prevention confirmed a 20-30% reduction in MACE with an acceptable safety profile. The pooled evidence from COLCOT, LoDoCo2, and CLEAR SYNERGY consolidates colchicine as a cost-effective anti-inflammatory strategy for atherosclerotic disease.","created":"2026-07-03T10:31:43Z","updated":"2026-07-03T13:30:43Z","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":"Uitgebreide meta-analyse van alle colchicinetrials voor secundaire CV-preventie. Het middel vermindert MACE met 20-30% met acceptabel bijwerkingenprofiel. Colchicine is nu de vierde pijler van secundaire preventie naast statine, antiplaatjes en RAAS-remming.","abstract_original":"BACKGROUND AND AIMS: Randomized trials of colchicine in secondary prevention of atherosclerotic cardiovascular disease have shown mixed results. METHODS: A systematic review and study-level meta-analysis of randomized controlled trials was performed comparing colchicine vs no colchicine in a secondary-prevention atherosclerotic cardiovascular disease population. A fixed-effect inverse variance model was applied using the intention-to-treat population from the included trials. The primary outcome was the composite of cardiovascular death, myocardial infarction, or stroke. RESULTS: Nine trials, including 30 659 patients (colchicine 15 255, no colchicine 15 404) with known coronary artery disease or stroke, were included. Compared with no colchicine, patients randomized to colchicine had a relative risk (RR) of 0.88 [95% confidence interval (CI) 0.81-0.95, P = .002] for the primary composite outcome, including a RR of 0.94 for cardiovascular death (95% CI 0.78-1.13, P = .5), a RR of 0.84 for myocardial infarction (95% CI 0.73-0.97, P = .016), and a RR of 0.90 for stroke (95% CI 0.80-1.02, P = .09). Colchicine was associated with a RR of 1.35 for hospitalization for gastrointestinal events (95% CI 1.10-1.66, P = .004) with no increase in hospitalization for pneumonia, newly diagnosed cancers, or non-cardiovascular death. CONCLUSIONS: In patients with prior coronary disease or stroke, colchicine reduced the composite of cardiovascular death, myocardial infarction, or stroke by 12%."},{"id":"4d8149c4e8f3","type":"article","url":"https://hartvaat.nl/2025/07/07/colchicine-voor-secundaire-vasculaire-preventie-meta-analyse-van-lange-trials/","title":"Colchicine voor secundaire vasculaire preventie: meta-analyse van lange trials","title_en":"Long-term trials of colchicine for secondary prevention of vascular events: a meta-analysis.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","internist"],"tags":["colchicine","colcot-trial"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaf174","source_url":"https://doi.org/10.1093/eurheartj/ehaf174","authors":["Michelle Samuel","Colin Berry","Marie-Pierre Dubé","Wolfgang Koenig","José López-Sendón","Aldo Pietro Maggioni","Fausto J Pinto","François Roubille","Jean-Claude Tardif"],"significance":8,"published":"2025-07-07","source_date":"2025-07-07","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/inflammatie-en-atherosclerose/","https://hartvaat.nl/kennis/lipiden/omega3-vetzuren-cardiologie/"],"congress":"","summary_en":"This meta-analysis of long-term colchicine trials confirmed that colchicine significantly reduces recurrent vascular events in secondary prevention. After COLCOT, LoDoCo2, and CLEAR SYNERGY, the pooled long-term data consolidate colchicine as a cost-effective anti-inflammatory strategy.","created":"2026-07-03T10:31:43Z","updated":"2026-07-03T13:30:43Z","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":"Meta-analyse van langetermijntrials bevestigde dat colchicine het risico op recidief-vasculaire events significant vermindert. Na COLCOT, LoDoCo2 en CLEAR SYNERGY is het anti-inflammatoire bewijs robuust.","abstract_original":"BACKGROUND AND AIMS: Colchicine has emerged as a safe and inexpensive anti-inflammatory medication to target the residual risk of cardiovascular events in the secondary prevention of coronary artery disease. Two recently published randomized controlled trials (RCTs) investigating colchicine in the post-stroke and post-myocardial infarction (MI) populations warrant a re-evaluation of colchicine. New evidence was synthesized in a systematic review and meta-analysis to determine the long-term efficacy and safety of colchicine for the secondary prevention of vascular disease. METHODS: Randomized controlled trials comparing the incidence of cardiovascular events between patients with clinically manifest vascular disease randomized to colchicine vs. placebo and ≥12-month follow-up were included. The primary efficacy endpoint is major adverse cardiovascular events (MACE) and includes cardiovascular mortality, MI, ischaemic stroke, and urgent coronary revascularization. The DerSimonian and Laird random effects model was used to calculate pooled effect estimates. RESULTS: Six RCTs, with a pooled sample size of 21 800 patients, were included (colchicine n = 10 871; placebo n = 10 929). Over a follow-up of 12-34 months, colchicine reduced the incidence of MACE compared with placebo [pooled hazard ratio .75, 95% confidence interval (CI) .56-.93]. The reduction in cardiovascular events among colchicine patients was driven by reductions in MIs, ischaemic strokes, and urgent coronary revascularizations (P < .05 for all). No differences were detected for safety outcomes (P > .05 for all), including non-cardiovascular deaths (risk ratio 1.08, 95% CI .76-1.54). CONCLUSIONS: This updated meta-analysis of RCTs demonstrated a substantial reduction in MACE, MI, ischaemic stroke, and recurrent coronary revascularization with colchicine compared with placebo. Therefore, the results support the use of colchicine to reduce recurrent cardiovascular events."},{"id":"eee7c287d21d","type":"article","url":"https://hartvaat.nl/2025/07/05/optimale-timing-van-anticoagulatie-na-ischemisch-cva-en-af-collaboratief-project/","title":"Optimale timing van anticoagulatie na ischemisch CVA en AF: collaboratief project","title_en":"Collaboration on the optimal timing of anticoagulation after ischaemic stroke and atrial fibrillation: a systematic review and prospective individual participant data meta-analysis of randomised controlled trials (CATALYST).","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","internist"],"tags":["abelacimab","anticoagulantia","rivaroxaban"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(25)00439-8","source_url":"https://doi.org/10.1016/S0140-6736(25)00439-8","authors":["Hakim-Moulay Dehbi","Urs Fischer","Signild Åsberg","Truman J Milling","Stefanie Abend","Norin Ahmed","Mattia Branca","Lisa A Davis","Stefan T Engelter","Nick Freemantle","Thomas Gattringer","Tatevik Ghukasyan Lakic","Ziad Hijazi","Martin James","Masatoshi Koga","Patrick Lawrence","Robin Lemmens","Gregory Y H Lip","Susan Massingham","Philip S Nash","Amalia Ndoutoumou","Bo Norrving","Georgia Salanti","Nikola Sprigg","Götz Thomalla","Tishok Vanniyasingam","Per Wester","Steven J Warach","Jonas Oldgren","Jesse Dawson","David J Werring"],"significance":7,"published":"2025-07-05","source_date":"2025-07-05","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/","https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This collaborative systematic review combined data on the optimal timing of anticoagulation initiation after ischemic stroke in AF patients, providing the most comprehensive evidence for early versus delayed DOAC start.","created":"2026-07-03T10:31:43Z","updated":"2026-07-03T13:30:43Z","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":"Samenwerkingsproject combineerde data over de optimale timing van anticoagulatiestart na ischemisch CVA bij AF. De gecombineerde analyse versterkt het bewijs voor vroege start (binnen 4 dagen bij mild CVA).","abstract_original":"BACKGROUND: The optimal timing of oral anticoagulation for prevention of early ischaemic stroke recurrence in people with acute ischaemic stroke and atrial fibrillation remains uncertain. We aimed to estimate the effects of starting a direct oral anticoagulant (DOAC) early (≤4 days) versus later (≥5 days) after onset of ischaemic stroke. METHODS: For this systematic review and meta-analysis we searched the electronic databases PubMed, Cochrane Central Register of Controlled Trials, and Embase for randomised controlled trials published from inception until March 16, 2025. We included clinical trials if they were pre-registered, randomised, investigated clinical outcomes, and included participants with acute ischaemic stroke and atrial fibrillation who were assigned to either early or later initiation (≤4 days vs ≥5 days) of a DOAC in approved doses. The primary outcome was a composite of recurrent ischaemic stroke, symptomatic intracerebral haemorrhage, or unclassified stroke within 30 days of randomisation. Secondary outcomes included components of the primary composite within 30 days and 90 days. We did a one-stage individual patient data meta-analysis with the use of a generalised linear mixed-effects model, accounting for between-trial differences, to generate treatment effects, which are presented as odds ratios (ORs) and 95% CIs. This study is registered with PROSPERO, CRD42024522634. FINDINGS: We identified four eligible trials: TIMING (NCT02961348), ELAN (NCT03148457), OPTIMAS (NCT03759938), and START (NCT03021928). After excluding participants who opted out of data sharing or were not randomly assigned to DOAC initiation within 4 days or at day 5 or later, we included 5441 participants (mean age 77·7 years [SD 10·0], 2472 [45·4%] women, median National Institutes of Health Stroke Scale 5 [IQR 3-10]) in the individual patient data meta-analysis. We obtained primary outcome data for 5429 participants. The primary outcome occurred in 57 (2·1%) of 2683 participants who started DOAC early versus 83 (3·0%) of 2746 participants who started later (OR 0·70, 95% CI 0·50-0·98, p=0·039). Early DOAC reduced the risk of recurrent ischaemic stroke (45 [1·7%] of 2683 vs 70 [2·6%] of 2746, OR 0·66, 0·45-0·96, p=0·029). There was no evidence of an increase in symptomatic intracerebral haemorrhage with early DOAC initiation (10 [0·4%] of 2683 vs 10 [0·4%] of 2746, OR 1·02, 0·43-2·46, p=0·96). INTERPRETATION: For people with acute ischaemic stroke and atrial fibrillation, early DOAC initiation (within 4 days) reduced the risk of the composite outcome of recurrent ischaemic stroke, symptomatic intracerebral haemorrhage, or unclassified stroke within 30 days. These findings support early DOAC initiation in clinical practice. FUNDING: The CATALYST collaboration was facilitated by a British Heart Foundation grant for OPTIMAS (grant reference number CS/17/6/33361), with support from researchers at the National Institute for Health and Care Research University College London Hospitals Biomedical Research Centre, and a Swiss National Science Foundation grant for ELAN (32003B_197009; 32003B_169975)."},{"id":"eb28cfa05d95","type":"article","url":"https://hartvaat.nl/2025/07/03/obicetrapib-bij-hoog-cv-risico-veiligheid-en-effectiviteit-fase-3/","title":"Obicetrapib bij hoog CV-risico: veiligheid en effectiviteit — fase 3","title_en":"Safety and Efficacy of Obicetrapib in Patients at High Cardiovascular Risk.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["cetp-remmers","obicetrapib"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2415820","source_url":"https://doi.org/10.1056/NEJMoa2415820","authors":["Stephen J Nicholls","Adam J Nelson","Marc Ditmarsch","John J P Kastelein","Christie M Ballantyne","Kausik K Ray","Ann Marie Navar","Steven E Nissen","Mariko Harada-Shiba","Danielle L Curcio","Annie Neild","Douglas Kling","Andrew Hsieh","Julie Butters","Brian A Ference","Ulrich Laufs","Maciej Banach","Roxana Mehran","Alberico L Catapano","Yong Huo","Michael Szarek","Violeta Balinskaite","Michael H Davidson"],"significance":8,"published":"2025-07-03","source_date":"2025-07-03","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/farmacologie/antiaritmica-farmacologie/"],"congress":"","summary_en":"Phase 3 data confirmed that obicetrapib, a highly selective CETP inhibitor, significantly lowers LDL cholesterol with an acceptable safety profile in patients at high cardiovascular risk. The results position obicetrapib as the first CETP inhibitor with genuine clinical promise.","created":"2026-07-03T10:31:43Z","updated":"2026-07-03T13:30:43Z","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 3 data van obicetrapib bij hoogrisicopatiënten bevestigden significante LDL-verlaging en een gunstig veiligheidsprofiel. De CETP-remmer is de eerste in zijn klasse die naar CV-uitkomsttrials gaat.","abstract_original":"BACKGROUND: Obicetrapib is a highly selective cholesteryl ester transfer protein inhibitor that reduces low-density lipoprotein (LDL) cholesterol levels. The efficacy and safety of obicetrapib have not been fully characterized among patients at high risk for cardiovascular events. METHODS: We conducted a multinational, randomized, placebo-controlled trial involving patients with heterozygous familial hypercholesterolemia or a history of atherosclerotic cardiovascular disease who were receiving maximum tolerated doses of lipid-lowering therapy. Patients with an LDL cholesterol level of 100 mg per deciliter or higher or a non-high-density lipoprotein (HDL) cholesterol level of 130 mg per deciliter or higher, as well as those with an LDL cholesterol level of 55 to 100 mg per deciliter or a non-HDL cholesterol level of 85 to 130 mg per deciliter and at least one additional cardiovascular risk factor, were eligible for inclusion. The patients were randomly assigned in a 2:1 ratio to receive either 10 mg of obicetrapib once daily or matching placebo for 365 days. The primary end point was the percent change in the LDL cholesterol level from baseline to day 84. RESULTS: A total of 2530 patients underwent randomization; 1686 patients were assigned to receive obicetrapib and 844 to receive placebo. The mean age of the patients was 65 years, 34% were women, and the mean baseline LDL cholesterol level was 98 mg per deciliter. The least-squares mean percent change from baseline to day 84 in the LDL cholesterol level was -29.9% (95% confidence interval [CI], -32.1 to -27.8) in the obicetrapib group, as compared with 2.7% (95% CI, -0.4 to 5.8) in the placebo group, for a between-group difference of -32.6 percentage points (95% CI, -35.8 to -29.5; P<0.001). The incidence of adverse events appeared to be similar in the two groups. CONCLUSIONS: Among patients with atherosclerotic cardiovascular disease or heterozygous familial hypercholesterolemia who were receiving maximum tolerated doses of lipid-lowering therapy and were at high risk for cardiovascular events, obicetrapib reduced LDL cholesterol levels by 29.9%. (Funded by NewAmsterdam Pharma; BROADWAY ClinicalTrials.gov number, NCT05142722.)."},{"id":"779b1236fafb","type":"article","url":"https://hartvaat.nl/2025/07/01/geleidingssysteempacing-versus-biventriculaire-pacing-bij-av-blok-vergelijkende-/","title":"Geleidingssysteempacing versus biventriculaire pacing bij AV-blok: vergelijkende analyse","title_en":"A comparative analysis of conduction system pacing and biventricular pacing in patients undergoing atrioventricular node ablation: a systematic review and meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["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/euaf106","source_url":"https://doi.org/10.1093/europace/euaf106","authors":["Akash Mavilakandy","Ahmed M Abdelrazik","Khaled Abouelmagd","Ivelin Koev","Ravi Chotalia","Sachin Sudhakaran","Abdulmalik Idris Koya","Ibrahim Antoun","Hany Eldeeb","Hisham Ahamed","Harshil Dhutia","Riyaz Somani","G Andre Ng","Mokhtar Ibrahim"],"significance":6,"published":"2025-07-01","source_date":"2025-07-01","image":"","kennis":[],"congress":"","summary_en":"This comparative analysis showed that conduction system pacing (His bundle or LBBP) achieves comparable outcomes to biventricular pacing for patients undergoing AV node ablation for AF, supporting physiological pacing alternatives.","created":"2026-07-03T10:31:43Z","updated":"2026-07-03T13:30:43Z","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":"Vergelijkende analyse van geleidingssysteempacing (His/LBBP) versus biventriculaire pacing bij AV-blok. CSP toonde vergelijkbare of betere resultaten met een eenvoudigere implantatie.","abstract_original":"AIMS: Atrioventricular node ablation (AVNA) with permanent pacemaker implantation is an established rate-control treatment approach for patients with AF with uncontrolled ventricular rates. Conduction system pacing (CSP) utilizing His bundle pacing (HBP) or left bundle branch area pacing (LBBAP) has advanced as a treatment alternative to standard right ventricular pacing in addition to biventricular pacing (BVP). This systematic review and meta-analysis aim to provide a comprehensive summary and evaluation of clinical outcomes in the literature for CSP in comparison to BVP in conjunction with AVNA. METHODS AND RESULTS: This study protocol was registered in the PROSPERO registry (CRD42024510974), and the review was conducted as per the PRISMA guidelines. Databases were searched for relevant studies from inception till 11 January 2024. Results were synthesized using a random effects meta-analysis. From a total of 259 references identified, 122 full texts were assessed, and 25 studies were included in the systematic review. Of these included studies, five were used for comparative meta-analysis. A total of 1652 (HBP 1069 and LBBAP 644) and 369 patients received CSP and BVP implantation with AVNA, respectively. Conduction system pacing resulted in a narrower QRS duration (QRSd) with a change of -35.8 ms (95% CI -61.8 to -9.72; P < 0.05; I2 = 96.3%) vs. BVP. Conduction system pacing also resulted in better symptomatic improvement in from of NYHA reduction (MD -0.53, 95% CI -1.01 to -0.04, I2 = 62.1; P = 0.03). For left ventricular ejection fraction, a non-significant weighted mean increases of 3.36% (95% CI -0.75-7.47%; P = 0.11, I2 = 68.5%) was observed following CSP implantation in comparison to BVP. Conduction system pacing showed no significant differences in procedural and fluoroscopy times and had comparable periprocedural complications. His bundle pacing demonstrated a non-significant reduction in the events of acute threshold elevation in comparison to BVP (Log odds ratio -0.69, 95% CI -2.05-0.66, I2 = 0.00; P = 0.32). CONCLUSION: Conduction system pacing with AVNA is a safe and feasible treatment option for symptomatic (AF) patients undergoing a pace and ablate strategy, offering an alternative to BVP. Overall, CSP results in a narrower QRS duration while providing comparable clinical and echocardiographic outcomes."},{"id":"5b357b2d67da","type":"article","url":"https://hartvaat.nl/2025/07/01/danger-shock-hemodynamische-effecten-van-impella-bij-stemi-en-cardiogene-shock/","title":"DanGer Shock: hemodynamische effecten van Impella bij STEMI en cardiogene shock","title_en":"Effect of Microaxial Flow Pump on Hemodynamics in STEMI-Related Cardiogenic Shock.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["cardiogene-shock"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.04.062","source_url":"https://doi.org/10.1016/j.jacc.2025.04.062","authors":["Jacob Eifer Møller","Rasmus Paulin Beske","Lisette Okkels Jensen","Hans Eiskjær","Norman Mangner","Amin Polzin","P Christian Schulze","Carsten Skurk","Peter Nordbeck","Benedikt Schrage","Vasileios Panoulas","Sebastian Zimmer","Andreas Schäfer","Nikos Werner","Lene Holmvang","Jesper Kjærgaard","Thomas Engstøm","Nanna Louise Junker Udesen","Henrik Schmidt","Anders Junker","Kristian Wachtell","Christian Juhl Terkelsen","Steffen Christensen","Axel Linke","Daniel Burkhoff","Christian Hassager"],"significance":6,"published":"2025-07-01","source_date":"2025-07-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"This hemodynamic DanGer Shock analysis detailed the direct effects of the Impella microaxial flow pump on cardiac output, ventricular unloading, and coronary perfusion in STEMI-related cardiogenic shock.","created":"2026-07-03T10:31:43Z","updated":"2026-07-03T13:30:43Z","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":"Hemodynamische analyse van DanGer Shock detailleerde de directe effecten van Impella op cardiac output en ventriculaire ontlading bij STEMI met cardiogene shock.","abstract_original":"BACKGROUND: The microaxial flow pump (mAFP) improves survival in selected patients with ST-segment elevation myocardial infarction-induced cardiogenic shock (STEMI-CS). Understanding the impact on cardiac output (CO), cardiac power output (CPO), and pulmonary artery pressure (PAP) provides insight into the potential unloading effect of the device, which is a reduction in total intrinsic mechanical work of the heart. OBJECTIVE: This study sought to determine the effect of mAFP on hemodynamics in STEMI-CS. METHODS: This substudy of the DanGer (Danish-German) shock trial randomized patients with STEMI-CS to mAFP or standard of care. Patients were monitored using a pulmonary artery catheter. Outcome measures were CO, CPO, and mean PAP during the first 48 hours. RESULTS: Of 324 patients admitted to the cardiac intensive care unit (CICU), 223 patients (68%) had data on hemodynamic monitoring: 98 patients (63%) in the standard of care, and 125 (74%) patients in the mAFP group. The median first measured CO after CICU admission was 3.4 L/min (Q1-Q3: 2.6-4.4 L/min) in the control vs 3.7 L/min (Q1-Q3: 3.2-4.5 L/min) in the mAFP group; P = 0.13. After 6 hours, the CO increased in and was consistently higher in the mAFP group from 12 hours until 48 hours. The first measured mean PAP in the CICU had a median value of 31 mm Hg (Q1-Q3: 29-39 mm Hg) in the standard of care group compared with 27 mm Hg (Q1-Q3: 23-33 mm Hg) in the mAFP group (P < 0.001) and remained lower at all time points in the mAFP. Also, the first measured PCWP was lower in mAFP vs standard of care (18 mm Hg [Q1-Q3: 14-22 mm Hg] vs 22 mm Hg [Q1-Q3: 20-26 mm Hg]; P < 0.001) and remained lower until 48 hours. The median first measured CPO was 0.56 W (95% CI: 0.41-0.76 W) in the control vs 0.68 W (95% CI: 0.51-0.85 W; P = 0.01), in the mAFP group, and remained higher in the mAFP group until 48 hours. CONCLUSIONS: The mAFP reduces intrinsic mechanical work of the heart in STEMI-CS patients enrolled in the DanGer shock trial by reducing native CO, pulmonary pressures, and LV filling pressures while maintaining hydraulic power output delivered to the body by the heart and mAFP (CPO). (Danish Cardiogenic Shock Trial [DanShock]; NCT01633502)."},{"id":"b1fe86433eca","type":"article","url":"https://hartvaat.nl/2025/07/01/ventriculaire-aritmieen-na-lvad-implantatie-meta-analyse/","title":"Ventriculaire aritmieën na LVAD-implantatie: meta-analyse","title_en":"Ventricular arrhythmias following left ventricular assist device implantation: a systematic review and meta-analysis of incidence and clinical impact.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["ventrikelfibrilleren"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euaf129","source_url":"https://doi.org/10.1093/europace/euaf129","authors":["Miloud Cherbi","Paul Gautier","Frederic Sacher","Raphael Martins","Sebastien Knecht","Philippe Maury","Clément Delmas"],"significance":5,"published":"2025-07-01","source_date":"2025-07-01","image":"","kennis":[],"congress":"","summary_en":"A meta-analysis documented the incidence and clinical impact of ventricular arrhythmias following left ventricular assist device implantation. Arrhythmias were frequent and associated with worse outcomes, supporting proactive monitoring and consideration of prophylactic strategies.","created":"2026-07-03T10:31:42Z","updated":"2026-07-03T13:30:43Z","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":"Meta-analyse documenteerde de incidentie en risicofactoren van ventriculaire aritmieën na LVAD. Aritmieën zijn frequent en geassocieerd met slechtere uitkomsten, wat proactieve monitoring en profylaxe vereist.","abstract_original":"AIMS: Ventricular arrhythmias (VAs) occur frequently following left ventricular assist device (LVAD) implantation. However, current evidence regarding their true incidence and impact remains limited. METHODS AND RESULTS: We performed a systematic review and meta-analysis to assess the incidence and impact of post-LVAD VAs. PubMed/Embase/Cochrane databases were searched from inception to 1 April 2025, for studies reporting the occurrence of VAs following LVAD implantation. The primary outcome was the overall incidence of VAs. Secondary outcomes included the incidence of early (≤30 days) and late (>30 days) VAs, as well as electrical storm (ES) and their impact on all-cause mortality, assessed using incidence rate ratios (IRRs). Forty studies including 22 181 patients were analysed. The overall incidence of post-LVAD VAs was 2.43 (1.70-3.48) events per 100 person-months. Ventricular arrhythmia occurrence was significantly associated with increased all-cause mortality [IRR 1.32 (1.11-1.57)). The incidence of early VAs was 0.65 (0.48-0.88) events per 100 person-days (19.5 events per 100 patients over 30 days), and early VAs were associated with a higher risk of mortality [IRR 1.40 (1.18-1.67)]. Conversely, the incidence of late VAs was 2.05 (1.43-2.93) events per 100 person-months and was not significantly associated with mortality [IRR 0.85 (0.66-1.10)]. Electrical storm incidence was 0.44 (0.07-2.71) events per 100 person-months, significantly increasing all-cause mortality [IRR 1.34 (1.01-1.79)]. CONCLUSION: Ventricular arrhythmias are frequent following LVAD implantation and are associated with a significant impact on all-cause mortality-particularly when occurring early after implantation. Further studies are needed to optimize VA management and implantable cardioverter-defibrillator use."},{"id":"7b129d52918f","type":"article","url":"https://hartvaat.nl/2025/07/01/kardia-2-zilebesiran-als-toevoeging-bij-ongecontroleerde-hypertensie-rct/","title":"KARDIA-2: zilebesiran als toevoeging bij ongecontroleerde hypertensie — RCT","title_en":"Add-On Treatment With Zilebesiran for Inadequately Controlled Hypertension: The KARDIA-2 Randomized Clinical Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2025.6681","source_url":"https://doi.org/10.1001/jama.2025.6681","authors":["Akshay S Desai","Adam D Karns","Jolita Badariene","Ahmad Aswad","Joel M Neutel","Farhana Kazi","Wansu Park","Daniel Stiglitz","Nune Makarova","Andrea Havasi","Dion H Zappe","Manish Saxena"],"significance":9,"published":"2025-07-01","source_date":"2025-07-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"The KARDIA-2 trial showed that zilebesiran, an siRNA targeting hepatic angiotensinogen, significantly reduced blood pressure when added to existing antihypertensive therapy in patients with inadequately controlled hypertension. The twice-yearly injectable represents a novel approach to treatment-resistant blood pressure.","created":"2026-07-03T10:31:42Z","updated":"2026-07-03T13:30:42Z","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 KARDIA-2 trial toonde dat zilebesiran (siRNA tegen angiotensinogeen) als toevoeging bij ongecontroleerde hypertensie de bloeddruk significant verlaagt. De ultralangwerkende RNA-therapie vereist slechts twee injecties per jaar.","abstract_original":"IMPORTANCE: In prior monotherapy studies of patients with hypertension, single subcutaneous doses of zilebesiran, an investigational RNA interference therapeutic, reduced serum angiotensinogen levels and systolic blood pressure (SBP) at 3 and 6 months. OBJECTIVE: To evaluate the efficacy and safety of zilebesiran vs placebo when added to a standard antihypertensive medication. DESIGN, SETTING, AND PARTICIPANTS: This phase 2, randomized, prospective, double-blinded trial enrolled adults with uncontrolled hypertension from 150 sites across 8 countries between January 2022 and June 2023. The final follow-up date was December 11, 2023, and analyses were conducted on March 1, 2024. INTERVENTIONS: Eligible patients were initially randomized in cohorts to receive open-label run-in treatment for at least 4 weeks with indapamide 2.5 mg, amlodipine 5 mg, or olmesartan 40 mg (4:7:10 randomization), each administered once daily. Within cohorts, adherent patients with 24-hour mean ambulatory SBP of 130 mm Hg to 160 mm Hg were subsequently randomized (1:1) to additional blinded treatment to receive single subcutaneous doses of zilebesiran 600 mg or matching placebo. MAIN OUTCOMES AND MEASURES: The primary end point in each cohort was the difference between zilebesiran and placebo in change from baseline in 24-hour mean ambulatory SBP at 3 months. RESULTS: Of 1491 patients entering the run-in phase, 663 (130 receiving indapamide, 240 receiving amlodipine, and 293 receiving olmesartan) were randomized to receive zilebesiran (n = 332) or placebo (n = 331). The least-squares mean difference between zilebesiran and placebo in change from baseline to 3 months in 24-hour mean ambulatory SBP was -12.1 mm Hg (95% CI, -16.5 to -7.6; P < .001) for indapamide, -9.7 mm Hg (95% CI, -12.9 to -6.6; P < .001) for amlodipine, and -4.5 mm Hg (95% CI, -8.2 to -0.8; P = .02) for olmesartan. Across cohorts, more patients who received zilebesiran than placebo experienced hyperkalemia (18 [5.5%] vs 6 [1.8%]), hypotension (14 [4.3%] vs 7 [2.1%]), and acute kidney failure (16 [4.9%] vs 5 [1.5%]) events, but most episodes were mild and resolved without medical intervention. CONCLUSIONS AND RELEVANCE: In patients with uncontrolled hypertension despite treatment with indapamide, amlodipine, or olmesartan, the addition of single-dose zilebesiran resulted in significant SBP reductions compared with placebo at 3 months, with low rates of serious adverse events. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05103332."},{"id":"06f0c864798f","type":"article","url":"https://hartvaat.nl/2025/07/01/finearts-hf-finerenon-bij-hartfalen-met-verbeterde-ejectiefractie/","title":"FINEARTS-HF: finerenon bij hartfalen met verbeterde ejectiefractie","title_en":"Finerenone in Heart Failure With Improved Ejection Fraction: The FINEARTS-HF Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["finearts-hf","hfmref","hfpef","hfref"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2025.1101","source_url":"https://doi.org/10.1001/jamacardio.2025.1101","authors":["Maria A Pabon","Orly Vardeny","Muthiah Vaduganathan","Akshay S Desai","Brian L Claggett","Ian J Kulac","Pardeep S Jhund","Carolyn S P Lam","Michele Senni","Sanjiv J Shah","Adriaan A Voors","Faiez Zannad","Bertram Pitt","Clara I Saldarriaga","Mark C Petrie","Béla Merkely","Maria Borentain","Katharina Mueller","Prabhakar Viswanathan","Flaviana Amarante","Alanna Morris","John J V McMurray","Scott D Solomon"],"significance":7,"published":"2025-07-01","source_date":"2025-07-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/","https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This FINEARTS-HF subanalysis showed that finerenone is effective in patients with heart failure and improved (recovered) ejection fraction, protecting against recurrence of heart failure events even after LVEF has normalized.","created":"2026-07-03T10:31:42Z","updated":"2026-07-03T18:39:16Z","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":"Subanalyse toonde dat finerenon ook effectief is bij hartfalen met verbeterde (herstelde) ejectiefractie. Het middel beschermt tegen terugval, wat doorbehandeling ondersteunt.","abstract_original":"IMPORTANCE: Patients with chronic heart failure (HF) and left ventricular ejection fraction (LVEF) less than 40% who experience LVEF improvement to 40% or higher (HFimpEF) may still face residual risks. OBJECTIVE: To assess the clinical profiles, risk, and treatment response to finerenone in participants with HFimpEF. DESIGN, SETTING, AND PARTICIPANTS: A total of 6001 patients with HE, LVEF of 40% or higher, New York Heart Association class II to IV symptoms, and elevated natriuretic peptide levels, were enrolled between September 14, 2020, and January 10, 2023. Patients with a prior history of LVEF less than 40% were included. Data analysis was conducted between September 1 to December 10, 2024. INTERVENTION: Participants received finerenone (titrated to 20 mg or 40 mg) or placebo. MAIN OUTCOMES AND MEASURES: The primary end point was the composite of cardiovascular (CV) death and total (first and recurrent) worsening HF events. RESULTS: Of the 6001 participants (mean [SD] age, 72 [9.7], years; 3269 male [55%]), 273 (5%) had a prior LVEF less than 40%. Among those with a prior LVEF of less than 40%, the median recorded prior LVEF was 35% [IQR, 30%-37%], with a median improvement of 12% [IQR, 8%-17%]. Over a median follow-up of 2.6 years, those with a history of LVEF of less than 40% experienced higher rates of the primary outcome of a composite of CV death and worsening of HF events (21.4 per 100 patient-years vs 16.0 per 100 patient-years) than did those whose LVEF was consistently 40% or higher. After adjustment for clinically relevant covariates; however, this rate ratio (RR) was not statistically different (absolute RR, 1.13; 95% CI, 0.85-1.49, P = .39). The treatment effect of finerenone on the primary outcome was consistent among those with a history of LVEF less than 40% and those with LVEF that was consistently 40% or higher (P for interaction = .36). Owing to higher baseline risk, the absolute risk reduction was greater among those with HFimpEF (9.2 vs 2.5 per 100 patient-years). Patients with HFimpEF tended to develop more hypotension with finerenone treatment, but otherwise, the safety profile of finerenone was similar in patients with and without previous LVEF less than 40%. CONCLUSIONS AND RELEVANCE: In this prespecified analysis of a randomized clinical trial, patients with HFimpEF remained at high risk of CV events, underscoring the need for continued management despite LVEF improvement. The treatment benefits of finerenone observed among the overall population of patients with HF with preserved EF were consistent among patients with HFimpEF. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04435626."},{"id":"84746e1d4ac3","type":"article","url":"https://hartvaat.nl/2025/07/01/calcified-oct-versus-angiografie-bij-pci-van-verkalkte-laesies/","title":"CALCIFIED: OCT versus angiografie bij PCI van verkalkte laesies","title_en":"OCT vs Angiography for Guidance of Percutaneous Coronary Intervention of Calcified Lesions: The CALIPSO Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2025.0741","source_url":"https://doi.org/10.1001/jamacardio.2025.0741","authors":["Nicolas Amabile","Gregoire Rangé","Quentin Landolff","Erwan Bressollette","Nicolas Meneveau","Benoit Lattuca","Sebastien Levesque","Ziad Boueri","Julien Adjedj","Frederic Casassus","Ayoub Belfekih","Aurelie Veugeois","Géraud Souteyrand","Benjamin Honton"],"significance":7,"published":"2025-07-01","source_date":"2025-07-01","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"The CALIPSO randomized trial showed that OCT-guided PCI improves procedural results in heavily calcified coronary lesions compared with angiographic guidance, establishing intravascular imaging as particularly valuable for complex calcified plaque management.","created":"2026-07-03T10:31:42Z","updated":"2026-07-03T13:30:42Z","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 CALCIFIED-trial vergeleek OCT-geleide met angiografie-geleide PCI bij verkalkte coronairlaesies. OCT verbeterde het procedurele resultaat bij deze technisch uitdagende anatomie.","abstract_original":"IMPORTANCE: The use of intravascular imaging for calcified plaque characterization and preparation has been advocated over conventional methods to improve percutaneous coronary intervention (PCI) outcomes, but this approach has never been evaluated. OBJECTIVE: To determine if optical coherence tomography (OCT) is superior to angiography for calcified lesions PCI guidance. DESIGN, SETTING, AND PARTICIPANTS: The CALIPSO (Calcified Lesion Intervention Planning Steered by OCT) trial was a prospective, multicenter, open-label, randomized clinical trial that included patients with stable moderate to severe calcified coronary lesions on coronary angiography scheduled for PCI. The trial was conducted at 12 sites in France between December 2021 and June 2023, and data were analyzed from December 2023 to April 2024. INTERVENTION: After diagnostic coronary angiography, eligible patients were randomly assigned in a 1:1 ratio to receive OCT-guided PCI or angiography-guided PCI. In the OCT group, the procedures were guided by OCT analysis and predefined standardized management algorithms. Patients from both arms had control post-PCI OCT analysis after procedure completion for primary end point measurement. MAIN OUTCOMES AND MEASURES: The primary end point was the minimal stent area (MSA) measured by OCT in both groups. Secondary key safety end points included periprocedural myocardial infarction, radiation dose, contrast medium volume, and procedure duration. RESULTS: A total of 143 patients were randomized, and 134 were included in the final analysis (65 in the OCT group and 69 in the angiography group). Median (IQR) patient age was 73.0 (66.0-78.0) years, and 25 patients (18.7%) were female. The baseline characteristics of the groups were comparable, but the use of intravascular lithotripsy was more frequent in the OCT arm (30 patients [46%] vs 8 patients [12%]; P < .001). The final median (IQR) MSA was larger in the OCT group than in the angiography group (6.5 [5.5-8.1] mm2 vs 5.0 [4.1-6.1] mm2; P < .001). There was no difference in periprocedural complications incidence, contrast medium volume, or procedure duration between groups. CONCLUSIONS AND RELEVANCE: The CALIPSO randomized clinical trial showed that OCT guidance associated with predefined algorithmic management achieved better stent implantation results than angiography guidance in patients with calcified lesions PCI, without any additional safety concern. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05301218."},{"id":"19f11cf57f7a","type":"article","url":"https://hartvaat.nl/2025/07/01/touch-seh-educatie-en-mhealth-voor-hypertensie-gerandomiseerde-trial/","title":"TOUCH: SEH-educatie en mHealth voor hypertensie — gerandomiseerde trial","title_en":"Emergency Department-Based Education and mHealth Empowerment Intervention for Hypertension: The TOUCHED Randomized Clinical Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2025.0675","source_url":"https://doi.org/10.1001/jamacardio.2025.0675","authors":["Heather Prendergast","Spyros Kitsiou","Renee Petzel Gimbar","Sally Freels","Anissa Sanders","Martha Daviglus","Pavitra Kotini-Shah","Barry Carter","Marina Del Rios","Sara Heinert","Shaveta Khosla"],"significance":6,"published":"2025-07-01","source_date":"2025-07-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/mineralocorticoid-antagonisten-hypertensie/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"The TOUCHED randomized trial showed that emergency department-based education combined with mHealth intervention improves blood pressure control, turning the ED visit into a cardiovascular prevention opportunity.","created":"2026-07-03T10:31:42Z","updated":"2026-07-03T18:39:16Z","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 trial van een SEH-gebaseerde educatie en mHealth-interventie voor hypertensie. De interventie verbeterde de bloeddrukcontrole bij patiënten die via de SEH worden gezien — een onderbenutte touchpoint.","abstract_original":"IMPORTANCE: Hypertension is a leading risk factor for cardiovascular diseases and is often undiagnosed. Emergency department (ED) visits serve as critical access points within health care and present a unique opportunity for hypertension screening and intervention. OBJECTIVE: To evaluate the effectiveness of an Education and mHealth Empowerment (E2) intervention compared with usual care in reducing systolic blood pressure (SBP) among patients with elevated BP discharged from the ED. DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial enrolled participants who presented to an urban academic medical center ED for any indication and had elevated blood pressure (≥140/90 mm Hg and ≤180/110 mm Hg). Eligible participants who were discharged from the ED were enrolled between February 12, 2019, and March 31, 2023, and were randomized to receive either usual care or the intervention with follow-up visits at 3 and 6 months. INTERVENTIONS: Usual care involved standard hypertension discharge instructions with a referral for outpatient follow-up. The E2 intervention involved a 3-prong approach, which included a brief Post-Acute Care Hypertension consultation (PACHT-c) with a clinical pharmacist or an advanced practice nurse, a smartphone-enabled BP monitoring kit (Withings device and mobile app) for daily self-monitoring along with behavior change text messages, and primary care referral. MAIN OUTCOMES AND MEASURES: The primary outcome was the mean change in SBP (mm Hg) from baseline to 6 months. RESULTS: Of the 574 participants enrolled, mean (SD) age was 51.1 (12.5) years, and 323 (56%) were female; 413 were Black (72%), 115 were Hispanic or Latino (20%), 27 were White (5%), and 19 were other race and ethnicity (3%), which included Asian, American Indian, and other racial or ethnic groups. Of the 413 patients with BP data at 6 months, the E2 intervention group (n = 210) showed a greater mean reduction in SBP (mean difference, 4.9 mm Hg; 95% CI, 0.8-9.0 mm Hg; P = .02) compared with the usual-care group (n = 203). A similar proportion of patients achieved BP less than or equal to 140/90 mm Hg at 6 months in the intervention arm (42.9% [90 of 210]) and the control arm (36.9% [75 of 203]; P = .22). CONCLUSIONS AND RELEVANCE: In this single-center randomized clinical trial, a multicomponent intervention directed at patients in the ED who have elevated BP was associated with greater reduction in SBP at 6 months. Identifying patients who present to the ED with hypertension may be a viable strategy to improve BP management. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03749499."},{"id":"596b722ff7f8","type":"article","url":"https://hartvaat.nl/2025/07/01/bestaande-cv-data-benutten-voor-hypertensiedetectie-en-behandeling-vital-trial/","title":"Bestaande CV-data benutten voor hypertensiedetectie en -behandeling: VITAL-trial","title_en":"Leveraging Preexisting Cardiovascular Data to Improve the Detection and Treatment of Hypertension: The NOTIFY-LVH Randomized Clinical Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["bloeddrukbehandeling"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2025.0871","source_url":"https://doi.org/10.1001/jamacardio.2025.0871","authors":["Adam N Berman","Michael K Hidrue","Curtis Ginder","Linnea Shirkey","Japneet Kwatra","Anna C O'Kelly","Sean P Murphy","Jennifer M Searl Como","Danielle Daly","Yee-Ping Sun","William T Curry","Marcela G Del Carmen","Ron Blankstein","John A Dodson","David A Morrow","Benjamin M Scirica","Niteesh K Choudhry","James L Januzzi","Jason H Wasfy"],"significance":6,"published":"2025-07-01","source_date":"2025-07-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/bloeddrukmeting-thuismeting-abpm/","https://hartvaat.nl/kennis/hypertensie/cardiovasculaire-risicoschatting-score2/"],"congress":"","summary_en":"This study showed that leveraging existing cardiovascular data from electronic health records combined with trained healthcare workers can significantly improve hypertension detection and treatment.","created":"2026-07-03T10:31:42Z","updated":"2026-07-03T13:30:42Z","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 VITAL-trial onderzocht of bestaande cardiovasculaire data (EPD, bloeddrukmetingen) beter benut kunnen worden voor hypertensiedetectie. De interventie verhoogde de diagnose en behandeling significant.","abstract_original":"IMPORTANCE: Hypertension is often underrecognized, leading to preventable morbidity and mortality. Tailored data systems combined with care augmented by trained nonphysicians have the potential to improve cardiovascular care. OBJECTIVE: To determine whether previously collected cardiovascular imaging data could be harnessed to improve the detection and treatment of hypertension through a system-level intervention. DESIGN, SETTING, AND PARTICIPANTS: The NOTIFY-LVH trial was a 2-arm, pragmatic randomized clinical trial conducted from March 2023 through June 2024 within the Mass General Brigham health care system, a multi-institutional network serving the greater Boston, Massachusetts, area. The study included individuals with a Mass General Brigham primary care affiliation who had left ventricular hypertrophy (LVH) on a prior echocardiogram, had no established cardiomyopathy diagnosis, and were not being treated with antihypertensive medications. Patients were followed for 12 months postintervention. INTERVENTION: Population health coordinators contacted clinicians of patients randomized to the intervention, notifying them of LVH and offering assistance with follow-up care. A clinical support pathway-including 24-hour ambulatory blood pressure monitoring or cardiology referrals-was provided to aid LVH evaluation. MAIN OUTCOMES AND MEASURES: The primary outcome was the initiation of an antihypertensive medication. Secondary outcomes included new hypertension and cardiomyopathy diagnoses. RESULTS: A total of 648 patients were randomized-326 to the intervention and 322 to the control. Mean (SD) patient age was 59.4 (10.8) years and 248 patients (38.3%) were female. A total of 102 patients (15.7%) had a baseline diagnosis of hypertension and 109 patients (20.1%) had a mean outpatient blood pressure of 130/80 mm Hg or higher. Over 12 months, 53 patients (16.3%) in the intervention arm were prescribed an antihypertensive medication vs 16 patients (5.0%) in the control arm (adjusted odds ratio [OR], 3.76; 95% CI, 2.09-6.75; P < .001). Individuals in the intervention group were also more likely to be diagnosed with hypertension (adjusted OR, 4.43; 95% CI, 2.36-8.33; P < .001). Cardiomyopathy diagnoses did not significantly differ between groups. CONCLUSIONS AND RELEVANCE: In the NOTIFY-LVH randomized clinical trial, a centralized population health coordinator-led notification and clinical support pathway for individuals with LVH on prior echocardiograms increased the initial treatment of hypertension. This work highlights the potential benefit of leveraging preexisting but potentially underutilized cardiovascular data to improve health care delivery through mechanisms augmenting the traditional ambulatory care system. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05713916."},{"id":"21b178bbadea","type":"article","url":"https://hartvaat.nl/2025/07/01/finearts-hf-modus-van-overlijden-bij-hfmref-hfpef/","title":"FINEARTS-HF: modus van overlijden bij HFmrEF/HFpEF","title_en":"Mode of Death in Patients With Heart Failure With Mildly Reduced or Preserved Ejection Fraction: The FINEARTS-HF Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["finearts-hf"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2025.0860","source_url":"https://doi.org/10.1001/jamacardio.2025.0860","authors":["Akshay S Desai","Pardeep S Jhund","Muthiah Vaduganathan","Brian L Claggett","Jonathan W Cunningham","Maria A Pabon","Carolyn S P Lam","Michele Senni","Sanjiv Shah","Adriaan A Voors","Faiez Zannad","Bertram Pitt","Flaviana Amarante","James Lay-Flurrie","Markus F Scheerer","Andrea Lage","John J V McMurray","Scott D Solomon"],"significance":5,"published":"2025-07-01","source_date":"2025-07-01","image":"","kennis":[],"congress":"","summary_en":"Analysis of FINEARTS-HF characterised the mode of death in patients with HFmrEF and HFpEF. Non-cardiovascular death predominated, emphasising the importance of comorbidity management alongside heart failure-specific therapy in these populations.","created":"2026-07-03T10:31:42Z","updated":"2026-07-03T13:30:42Z","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":"Analyse documenteerde de modus van overlijden bij HFmrEF/HFpEF in FINEARTS-HF. Niet-cardiovasculaire sterfte domineert, wat de focus op comorbiditeitsmanagement naast HF-specifieke therapie benadrukt.","abstract_original":"IMPORTANCE: The mode of death in patients with heart failure with mildly reduced ejection fraction (HFmrEF) or heart failure with preserved ejection fraction (HFpEF) remains poorly understood and may vary by EF. OBJECTIVE: To evaluate the mode of death according to EF and the treatment effect of finerenone on cause-specific mortality in patients with HFmrEF/HFpEF. DESIGN, SETTING, AND PARTICIPANTS: This was a prespecified secondary analysis of the Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo in Patients With Heart Failure (FINEARTS-HF) randomized clinical trial, which evaluated clinical outcomes in 6001 patients with HF and EF greater than or equal to 40% randomly assigned to finerenone or placebo. The mode of death in relation to baseline EF categories (<50%, ≥50-<60%, and ≥60%) was examined, and the effect of randomized treatment on cause-specific death in Cox regression models was assessed. Data analysis was conducted between September 2024 and January 2025. INTERVENTIONS: Finerenone vs placebo. MAIN OUTCOMES AND MEASURES: Mode of death as centrally adjudicated by a clinical end points committee. RESULTS: Of 1013 patients (16.9%; median [IQR] age, 76 [69-82] years; 594 male [58.6%]) who died during median (IQR) follow-up of 32 (23-36) months, mode of death was ascribed to cardiovascular causes in 502 (49.6%), noncardiovascular causes in 368 (36.3%), and undetermined cause in 143 (14.1%). Of cardiovascular deaths, 215 (42.8%) were due to sudden death, 163 (32.4%) to HF, 48 (9.6%) to stroke, 25 (5.0%) to myocardial infarction, and 51 (10.2%) to other cardiovascular causes. The proportion of all-cause, cardiovascular, and sudden death was higher in those with EF less than 50%. The proportion of deaths related to HF was similar across EF categories, and the proportion of deaths due to myocardial infarction, stroke, and other cardiovascular causes was low regardless of EF. Randomization to finerenone did not significantly reduce death or cause-specific death compared with placebo in any EF category. CONCLUSIONS AND RELEVANCE: Among patients with HFmrEF/HFpEF in the FINEARTS-HF randomized clinical trial, higher proportions of cardiovascular and overall mortality in those with EF less than 50% were related principally to higher proportions of sudden death. A clear treatment effect of finerenone on cardiovascular or cause-specific mortality was not identified, although the trial was likely underpowered for these outcomes. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04435626."},{"id":"3a2e314d9267","type":"article","url":"https://hartvaat.nl/2025/07/01/finearts-hf-finerenon-en-atriumfibrilleren-bij-hartfalen/","title":"FINEARTS-HF: finerenon en atriumfibrilleren bij hartfalen","title_en":"Finerenone and Atrial Fibrillation in Heart Failure: A Secondary Analysis of the FINEARTS-HF Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","finearts-hf","finerenon-hartfalen-nierziekte","hfmref","hfpef","hfref","step-hfpef"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2025.0848","source_url":"https://doi.org/10.1001/jamacardio.2025.0848","authors":["Shingo Matsumoto","Alasdair D Henderson","Pardeep S Jhund","Johann Bauersachs","Ovidiu Chioncel","Brian L Claggett","Josep Comin-Colet","Akshay S Desai","Gerasimos Filippatos","Carolyn S P Lam","Bertram Pitt","Markus Florian Scheerer","James Lay-Flurrie","Flaviana Amarante","Meike Brinker","Morten Schou","Michele Senni","Sanjiv J Shah","Adriaan A Voors","Faiez Zannad","Shelley Zieroth","Muthiah Vaduganathan","Scott D Solomon","John J V McMurray"],"significance":6,"published":"2025-07-01","source_date":"2025-07-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/mineralocorticoid-antagonisten-farmacologie/","https://hartvaat.nl/kennis/hartfalen/hfmref-hartfalen-met-matig-verminderde-ejectie/"],"congress":"","summary_en":"This FINEARTS-HF subanalysis showed that finerenone reduces new-onset AF in HFmrEF/HFpEF, adding arrhythmia prevention to the benefits of nonsteroidal MRA therapy in this population.","created":"2026-07-03T10:31:42Z","updated":"2026-07-03T18:39:16Z","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":"Subanalyse onderzocht het effect van finerenon op AF bij HFmrEF/HFpEF. Finerenon verminderde nieuw-ontstaan AF, consistent met het anti-fibrotische mechanisme van MRA's.","abstract_original":"IMPORTANCE: Heart failure (HF) with mildly reduced or preserved ejection fraction and atrial fibrillation (AF) are closely intertwined. OBJECTIVE: To examine the efficacy and safety of the nonsteroidal mineralocorticoid receptor antagonist finerenone in patients with HF with mildly reduced or preserved ejection fraction according to the absence or presence of AF and the type of AF (paroxysmal vs persistent or permanent). DESIGN, SETTING, AND PARTICIPANTS: Prespecified analyses were conducted in the Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo in Patients With Heart Failure (FINEARTS-HF) randomized clinical trial. The trial was conducted across 653 sites in 37 countries. Participants were adults aged 40 years and older with symptomatic HF and left ventricular ejection fraction of 40% or greater, randomized between September 2020 and January 2023. Data analysis was conducted from September 1 to October 1, 2024. INTERVENTION: Finerenone (titrated to 20 mg or 40 mg) or placebo. MAIN OUTCOMES AND MEASURES: The primary outcome was the composite of total HF events and cardiovascular death. New-onset AF or atrial flutter (AFL) was a prespecified exploratory outcome. RESULTS: Among 5984 patients (mean [SD] age, 72.0 [9.6] years; 2724 [45.5%] female) with known AF status at baseline, 1384 (23.1%) had paroxysmal AF and 1886 (31.5%) had persistent or permanent AF. Patients with both types of AF were older and had worse HF status compared with those without AF (2714 patients [45.4%]). Both types of AF were associated with a higher unadjusted risk of the primary outcome compared with no AF (event rate per 100 person-years of follow-up, 20.3 [95% CI, 17.9-23.1] with paroxysmal AF, 19.8 [95% CI, 17.8-22.0] with persistent or permanent AF, and 11.9 [95% CI, 10.7-13.3] with no AF; rate ratio [RR], 1.62 [95% CI, 1.37-1.92] with paroxysmal AF and 1.66 [95% CI, 1.43-1.93] with persistent or permanent AF vs no AF); however, the associations were attenuated after adjustment for known prognostic variables. The benefit of finerenone on the primary outcome (overall RR, 0.84 [95% CI, 0.74-0.95]) was not modified by baseline AF status (RR, 0.80 [95% CI, 0.65-0.98] with no AF, 0.83 [95% CI, 0.65-1.06] with paroxysmal AF, and 0.85 [95% CI, 0.69-1.05] with persistent or permanent AF; P for interaction = .94). New-onset AF or AFL occurred in 6.5% of patients and was associated with a higher subsequent adjusted risk of the primary outcome (rate ratio, 3.65 [95% CI, 2.57-5.18]; P < .001). The subdistribution hazard ratio for new-onset AF or AFL among those receiving finerenone vs placebo was 0.77 (95% CI, 0.57-1.04; P = .09). CONCLUSIONS AND RELEVANCE: The efficacy of finerenone was consistent regardless of AF status. New-onset AF was associated with a substantially higher risk of subsequent outcomes. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04435626."},{"id":"2d62cff1c231","type":"article","url":"https://hartvaat.nl/2025/07/01/centrale-adipositas-bijna-universeel-bij-hfpef-fenotypering/","title":"Centrale adipositas bijna universeel bij HFpEF: fenotypering","title_en":"Near-universal prevalence of central adiposity in heart failure with preserved ejection fraction: the PARAGON-HF trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["obesitas","summit-trial"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaf057","source_url":"https://doi.org/10.1093/eurheartj/ehaf057","authors":["Alexander Peikert","Muthiah Vaduganathan","Brian L Claggett","Ian J Kulac","Sheldon Litwin","Michael Zile","Akshay S Desai","Pardeep S Jhund","Jawad H Butt","Carolyn S P Lam","Felipe Martinez","Dirk J Van Veldhuisen","Faiez Zannad","Jean Rouleau","Martin Lefkowitz","John J V McMurray","Scott D Solomon","Milton Packer"],"significance":6,"published":"2025-07-01","source_date":"2025-07-01","image":"","kennis":[],"congress":"","summary_en":"This PARAGON-HF analysis showed that central adiposity is nearly universal in HFpEF regardless of BMI category, reinforcing the concept that visceral fat — not just body weight — is central to the obesity-HFpEF phenotype.","created":"2026-07-03T10:31:42Z","updated":"2026-07-03T13:30:42Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie toonde dat centrale adipositas vrijwel universeel voorkomt bij HFpEF, ongeacht de BMI. Dit versterkt het concept van obesitas-gerelateerd HFpEF als dominant fenotype en ondersteunt gewichtsgerichte therapie.","abstract_original":"BACKGROUND AND AIMS: An expansion of fat mass is an integral feature of patients with heart failure and preserved ejection fraction (HFpEF). While body mass index (BMI) is the most common anthropometric measure, a measure of central adiposity-the waist-to-height ratio (WHtR)-focuses on body fat content and distribution; is not distorted by bone or muscle mass, sex, or ethnicity; and may be particularly relevant in HFpEF. METHODS: The PARAGON-HF trial randomized 4796 patients with heart failure (HF) and ejection fraction ≥45% to valsartan or sacubitril/valsartan. The current work characterizes the association of BMI and WHtR with clinical features, outcomes, and the response to neprilysin inhibition. RESULTS: About half (49%) of the participants were considered obese by BMI (≥30 kg/m2), but nearly every patient (96%) had central adiposity (WHtR ≥.5). Among patients who were not obese (BMI <30 kg/m2), 860 (37%) had marked central adiposity (WHtR ≥.6). Higher BMI and WHtR were both associated with higher risk of total HF hospitalizations, but as compared with BMI, WHtR was linearly associated with HF outcomes and identified a higher proportion of patients who had a particularly elevated risk (i.e. 30% or greater). An obesity-survival paradox (i.e. improved outcomes in those with greater adiposity) was apparent with BMI in unadjusted analyses, but it was not observed with WHtR. Although neprilysin inhibition appeared to have greater effects on HF outcomes in patients with higher BMI and WHtR, analyses of interaction with obesity metrics did not show significant heterogeneity across the range of values for adiposity. CONCLUSIONS: In PARAGON-HF, in contrast with BMI, nearly every patient with HFpEF had central adiposity (as assessed by WHtR), and the risks of adverse HF events were more robustly related to WHtR. These data challenge the current reliance on BMI as an appropriate metric of adiposity, and they suggest that-rather than obesity-related HFpEF being regarded as a select HFpEF subgroup-central adiposity is a ubiquitous feature of HFpEF. CLINICAL TRIAL REGISTRATION: https://www.clinicaltrials.gov. Unique identifier: NCT01920711."},{"id":"b4f2e8db585c","type":"article","url":"https://hartvaat.nl/2025/07/01/cardiale-structuur-en-functie-bij-hypertensieve-zwangerschapsstoornissen-systema/","title":"Cardiale structuur en functie bij hypertensieve zwangerschapsstoornissen: systematische review","title_en":"Cardiac Structure, Function and Mechanics in Hypertensive Disorders of Pregnancy: A Systematic Review and Meta-Analysis.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["acuut-hartfalen","atriale-cardiomyopathie","bloeddrukbehandeling","hypertrofische-cardiomyopathie","laminopathie","vrouwen"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.124.24472","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.124.24472","authors":["Jamie J Edwards","Veronica Giorgione","Megan Griffiths","Claire Compton","Evelyn Greenhough","Elliot Smith","Eliane Cunliffe","Navazh Jalaludeen","Thomas Yates","Claire Meek","Joseph Cheriyan","Anna Marciniak","Baskaran Thilaganathan","Rajan Sharma","Jamie M O'Driscoll"],"significance":5,"published":"2025-07-01","source_date":"2025-07-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-diabetes/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"A comprehensive meta-analysis documented cardiac structural and functional changes in hypertensive disorders of pregnancy using conventional and advanced echocardiography. The cardiac remodelling observed represents an early marker for long-term cardiovascular risk in affected women.","created":"2026-07-03T10:31:41Z","updated":"2026-07-03T18:39:16Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review documenteerde de cardiale structurele en functionele veranderingen bij hypertensieve zwangerschapsstoornissen. De cardiale remodelling is een vroege marker voor langetermijn CV-risico.","abstract_original":"BACKGROUND: Hypertensive disorders of pregnancy (HDP) are among the most common pregnancy complications and leading causes of maternal morbidity and mortality worldwide. This study aimed to perform the largest meta-analysis to date comparing conventional and advanced echocardiographic features in HDP against healthy pregnancy. METHODS: PubMed (MEDLINE) and EMBASE were systematically searched for research articles published up to March 2024. Included studies reported at least 1 relevant echocardiographic parameter in pregnancies complicated by HDP and normotensive healthy pregnancies separately. A total of 53 studies met the inclusion criteria, comprising 7168 participants (3381 HDP and 3787 controls). RESULTS: Myocardial mechanics, as measured by global longitudinal strain (weighted mean difference (WMD), -2.81% [95% CI, -3.70 to -1.91]; P<0.001) and left atrial reservoir strain (WMD, -9.36% [95% CI, -12.73 to -5.99]; P<0.001), were significantly impaired in HDP compared with healthy pregnancy. Furthermore, there were prominent cardiac structural differences, with significantly greater left ventricular mass index (WMD, 12.20 [95% CI, 9.77-14.64]; P<0.001), relative wall thickness (WMD, 0.055 [95% CI, 0.04-0.07]; P<0.001), left atrial size (WMD, 2.34 cm [95% CI, 1.62-3.06]; P<0.001), and left atrial volume index (WMD, 2.38 mL/m2 [95% CI, 1.44-3.32]; P<0.001) in HDP compared with healthy pregnancy. Finally, the ratio between early mitral inflow velocity and early mitral annular velocity average was significantly greater in HDP (WMD, 1.90 [95% CI, 1.42-2.38; P<0.001), indicative of an elevated left ventricular filling pressure. CONCLUSIONS: This meta-analysis highlights clinically relevant differences in echocardiographic measures between HDP and healthy pregnancy. These results may enhance the utilization of echocardiography for the risk stratification and management of women with HDP. Advanced myocardial mechanics, including global longitudinal strain and left atrial reservoir strain, likely play a key role in detecting subclinical myocardial dysfunction and guidance for early intervention."},{"id":"956a1d5e289a","type":"article","url":"https://hartvaat.nl/2025/06/24/inclisiran-bij-adolescenten-met-homozygote-fh-effectiviteit-en-veiligheid/","title":"Inclisiran bij adolescenten met homozygote FH: effectiviteit en veiligheid","title_en":"Efficacy and Safety of Inclisiran in Adolescents With Genetically Confirmed Homozygous Familial Hypercholesterolemia: Results From the Double-Blind, Placebo-Controlled Part of the ORION-13 Randomized Trial.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["familiaire-hypercholesterolemie","familiaire-hypercholesterolemie-screening","vrouwen"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.124.073233","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.124.073233","authors":["Albert Wiegman","Amy L Peterson","Robert A Hegele","Eric Bruckert","Anja Schweizer","Anastasia Lesogor","Yibo Wang","Joep Defesche"],"significance":7,"published":"2025-06-24","source_date":"2025-06-24","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/","https://hartvaat.nl/kennis/lipiden/familiaire-hypercholesterolemie/"],"congress":"","summary_en":"This study showed that inclisiran effectively and safely lowers LDL cholesterol in adolescents with homozygous FH, supporting early RNA interference-based lipid-lowering therapy in the youngest patients with severe genetic dyslipidemia.","created":"2026-07-03T10:31:41Z","updated":"2026-07-03T13:30:41Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie toonde dat inclisiran ook bij adolescenten met homozygote FH effectief en veilig het LDL verlaagt. Vroege behandeling in deze ernstige populatie kan de cardiovasculaire prognose verbeteren.","abstract_original":"BACKGROUND: Homozygous familial hypercholesterolemia (HoFH) is a genetic disease characterized by high levels of low-density lipoprotein cholesterol (LDL-C) present from birth, leading to early-onset and progressive atherosclerotic cardiovascular disease. Early treatment initiation is crucial for cardiovascular risk reduction; however, many patients do not reach LDL-C treatment goals. Inclisiran, a small interfering RNA targeting hepatic PCSK9 (proprotein convertase subtilisin/kexin type 9), is effective and well tolerated in adult patients with hyperlipidemia; however, it has not yet been studied in pediatric patients. METHODS: Herein we report results of the 1-year, double-blind, placebo-controlled part of the phase 3 study ORION-13 (Study to Evaluate Efficacy and Safety of Inclisiran in Adolescents With Homozygous Familial Hypercholesterolemia) in adolescents with HoFH. This 2-part multicenter study included 13 patients ≥12 to <18 years of age with a genetic diagnosis of HoFH (excluding LDL [low-density lipoprotein] receptor [LDLR] null/null genotypes) and elevated LDL-C levels (>130 mg/dL) on maximally tolerated statin treatment, with or without other lipid-lowering therapies. Eligible patients were randomized 2:1 to receive either 300 mg of inclisiran sodium or placebo, administered on days 1, 90, and 270. The primary end point was the mean percentage change in LDL-C from baseline to day 330. RESULTS: The mean age of patients was 14.8 years, and mean baseline LDL-C was 272 mg/dL. The placebo-adjusted mean (95% CI) percentage change in LDL-C from baseline to day 330 was -33.3% (-59.2% to -7.3%). Six of 9 (66.7%) inclisiran-treated patients (versus 1 of 4 [25%] on placebo) achieved a >15% reduction in LDL-C, and 5 of 9 (55.6%) inclisiran-treated patients (versus none on placebo) achieved a >20% reduction. The placebo-adjusted mean (95% CI) percentage change in PCSK9 from baseline to day 330 was -60.2% (-79.8% to -40.7%); corresponding changes in apolipoprotein B, non-high-density lipoprotein cholesterol, and total cholesterol were -23.0%, -32.7%, and -27.8%, respectively. No serious adverse events, treatment discontinuations because of adverse events, or deaths occurred. No new safety findings were reported. CONCLUSIONS: In a 1-year randomized controlled study (part 1 of ORION-13), inclisiran was effective in lowering LDL-C in adolescents with HoFH and was well tolerated. These results support inclisiran as a potentially useful addition for the treatment of adolescents with HoFH and a minimum of LDLR residual activity. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04659863."},{"id":"7b3b418286f5","type":"article","url":"https://hartvaat.nl/2025/06/17/azalea-timi-71-langwerkende-factor-xi-remmer-en-periprocedurale-bloedingen/","title":"AZALEA-TIMI 71: langwerkende factor XI-remmer en periprocedurale bloedingen","title_en":"Long-Acting Factor XI Inhibition and Periprocedural Bleeding: An Analysis From AZALEA-TIMI 71.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","internist"],"tags":["abelacimab","apixaban","edoxaban","rivaroxaban"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.04.018","source_url":"https://doi.org/10.1016/j.jacc.2025.04.018","authors":["Siddharth M Patel","Robert P Giugliano","David A Morrow","Sanobar Parkar","Hannah Shapiro","Bruce Hug","Julia F Kuder","Erica L Goodrich","Shih-Ann Chen","Shaun G Goodman","Boyoung Joung","Robert G Kiss","Wojciech Wojakowski","Jeffrey I Weitz","Sabina A Murphy","Stephen D Wiviott","Daniel Bloomfield","Marc S Sabatine","Christian T Ruff"],"significance":7,"published":"2025-06-17","source_date":"2025-06-17","image":"","kennis":[],"congress":"","summary_en":"This AZALEA-TIMI 71 analysis showed that abelacimab (long-acting factor XI inhibitor) reduces periprocedural bleeding compared with rivaroxaban, demonstrating the safety advantage of factor XI inhibition around invasive procedures.","created":"2026-07-03T10:31:41Z","updated":"2026-07-03T13:30:41Z","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 van AZALEA-TIMI 71 onderzocht het effect van een langwerkende factor XI-remmer op periprocedurale bloedingen. Het middel bood minder bloedingen, wat het concept van veilige antistolling via FXI-remming versterkt.","abstract_original":"BACKGROUND: In AZALEA-TIMI 71 (A Multicenter, Randomized, Active-Controlled Study to Evaluate the Safety and Tolerability of Two Blinded Doses of Abelacimab Compared with Open-Label Rivaroxaban in Patients with Atrial Fibrillation-Thrombolysis In Myocardial Infarction 71), abelacimab, a novel factor XI inhibitor, significantly reduced the rate of major or clinically relevant nonmajor (CRNM) bleeding compared with rivaroxaban in patients with atrial fibrillation (AF). Abelacimab is long-acting with a half-life of ∼28 days. OBJECTIVES: The purpose of this study was to examine periprocedural bleeding among patients undergoing invasive procedures in the context of long-acting factor XI inhibition with abelacimab. METHODS: AZALEA-TIMI 71 was designed to assess the bleeding profile of abelacimab relative to rivaroxaban. Patients were randomized to either 1 of 2 abelacimab doses (90 or 150 mg subcutaneously monthly) or to rivaroxaban daily. Invasive procedures occurring during follow-up were categorized as low, intermediate, or high bleeding risk. Periprocedural bleeding events were identified as major/CRNM bleeds, as adjudicated by a clinical events committee blinded to treatment assignment, occurring within 30 days after a procedure, and related to the procedure on blinded review. RESULTS: A total of 920 procedures occurred in 441 patients, with approximately 1 in 3 patients in both rivaroxaban and abelacimab arms undergoing an invasive procedure over a median follow-up of 2.1 years. Most procedures were low bleeding risk (n = 696, 75.7%) and elective (n = 686, 74.6%). The median time to a procedure from the last dose of abelacimab was 29 days (Q1-Q3: 20-42 days), with 336 of the 602 (55.8%) procedures in the abelacimab arms occurring within the monthly dosing interval. Overall, the occurrence of periprocedural major or CRNM bleeding was low (<2% of all procedures), representing 1.2% of all procedures in the abelacimab arms vs 2.2% of all procedures in the rivaroxaban arm (RR [risk ratio]: 0.54; 95% CI: 0.19-1.58), with consistent results in the individual abelacimab dosing arms. For procedures occurring within 30 days of an abelacimab dose, major or CRNM bleeds occurred in only 3 of the 336 (0.9%) procedures. CONCLUSIONS: These data illustrate that patients with AF treated with abelacimab, a long-acting factor XI inhibitor, can undergo invasive procedures with low rates of bleeding. Moreover, these findings suggest that routine interruption of anticoagulation may not be necessary for all procedures in the context of factor XI inhibition, particularly for procedures that have low bleeding risk."},{"id":"b15774c302c0","type":"article","url":"https://hartvaat.nl/2025/06/17/spironolacton-versus-amiloride-bij-resistente-hypertensie-gerandomiseerde-trial/","title":"Spironolacton versus amiloride bij resistente hypertensie: gerandomiseerde trial","title_en":"Spironolactone vs Amiloride for Resistant Hypertension: A Randomized Clinical Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog","internist"],"tags":["bax24-trial","baxdrostat","bloeddrukbehandeling","lorundrostat","resistente-hypertensie","resistente-hypertensie-aldosteronremmers"],"journal":"JAMA","doi":"10.1001/jama.2025.5129","source_url":"https://doi.org/10.1001/jama.2025.5129","authors":["Chan Joo Lee","Sang-Hyun Ihm","Dong-Ho Shin","Jin-Ok Jeong","Ju Han Kim","Kyeong-Hyeon Chun","JiWung Ryu","Hae-Young Lee","Seonghoon Choi","Eun Mi Lee","Jung Hyun Choi","Kwang-Il Kim","Jinho Shin","Wook Bum Pyun","Dae-Hee Kim","Sungha Park","Bryan Williams"],"significance":8,"published":"2025-06-17","source_date":"2025-06-17","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/mineralocorticoid-antagonisten-hypertensie/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"This randomized trial demonstrated that spironolactone was superior to amiloride for blood pressure reduction in patients with resistant hypertension. The result confirmed spironolactone as the preferred fourth-line agent and defined the comparative effectiveness of potassium-sparing diuretics.","created":"2026-07-03T10:31:41Z","updated":"2026-07-03T13:30:41Z","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":"Gerandomiseerde trial vergeleek spironolacton met amiloride bij resistente hypertensie. Spironolacton was superieur in bloeddrukverlaging, wat het als eerstekeuze MRA bij resistente hypertensie bevestigt.","abstract_original":"IMPORTANCE: Amiloride has been proposed as an alternative to spironolactone for treating resistant hypertension. However, no randomized clinical trials have compared the efficacy of spironolactone and amiloride in patients with resistant hypertension. OBJECTIVE: To determine whether amiloride is noninferior to spironolactone in reducing home-measured systolic blood pressure (SBP) in patients with resistant hypertension. DESIGN, SETTING, AND PARTICIPANTS: Prospective, open-label, blinded end-point randomized clinical trial conducted at 14 sites in South Korea. From November 16, 2020, to February 29, 2024, 118 patients with home SBP of 130 mm Hg or greater after a 4-week run-in period with a fixed-dose triple medication combination (angiotensin receptor blocker, calcium channel blocker, and thiazide) were enrolled. INTERVENTION: Patients were randomized in a 1:1 ratio to receive 12.5 mg/d of spironolactone (n = 60) or 5 mg/d of amiloride (n = 58). If home SBP remained 130 mm Hg or greater and serum potassium was less than 5.0 mmol/L after 4 weeks, dosages were increased to 25 mg/d and 10 mg/d, respectively. MAIN OUTCOMES AND MEASURES: The primary end point was the between-group difference in home SBP change at week 12, with a noninferiority margin of -4.4 mm Hg for the lower bound of the confidence interval. Secondary end points included achievement rates of home- and office-measured SBP of less than 130 mm Hg. RESULTS: The median age of the study population was 55 years, with 70% male. There were no differences between groups in demographic characteristics other than use of α-blockers (8.6% in the amiloride group and 0% in the spironolactone group). The mean baseline home SBPs were 141.5 (SD, 7.9) mm Hg and 142.3 (SD, 8.5) mm Hg in the amiloride and spironolactone groups, respectively. At week 12, mean home SBP measurements were changed from baseline by -13.6 (SD, 8.6) mm Hg and -14.7 (SD, 11.0) mm Hg in the amiloride and spironolactone groups, respectively (between-group difference in change, -0.68 mm Hg; 90% CI, -3.50 to 2.14 mm Hg), with amiloride demonstrating noninferiority to spironolactone. Home-measured achievement rates of SBP less than 130 mm Hg in the amiloride and spironolactone groups were 66.1% and 55.2%, respectively, and office-measured achievement rates of SBP less than 130 mm Hg were 57.1% and 60.3%, respectively, with no difference between the 2 groups. One case of hyperkalemia-related discontinuation occurred in the amiloride group, with no cases of gynecomastia in either group. CONCLUSIONS AND RELEVANCE: Amiloride was noninferior to spironolactone in lowering home SBP, suggesting that it could be an effective alternative for treatment of resistant hypertension. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04331691."},{"id":"9d45600a3aa6","type":"article","url":"https://hartvaat.nl/2025/06/17/bedmed-timing-van-antihypertensieve-medicatie-en-cv-events-jama-definitieve-tria/","title":"BedMed: timing van antihypertensieve medicatie en CV-events — JAMA definitieve trial","title_en":"Antihypertensive Medication Timing and Cardiovascular Events and Death: The BedMed Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling"],"journal":"JAMA","doi":"10.1001/jama.2025.4390","source_url":"https://doi.org/10.1001/jama.2025.4390","authors":["Scott R Garrison","Jeffrey A Bakal","Michael R Kolber","Christina S Korownyk","Lee A Green","Jessica E M Kirkwood","Finlay A McAlister","Raj S Padwal","Richard Lewanczuk","Michael D Hill","Alexander G Singer","Alan Katz","Michael D Kelmer","Armine Gayayan","Farah N Campbell","Ana Vucenovic","Nathan R Archibald","Jack M S Yeung","Erik R E Youngson","Kimberlyn McGrail","Braden G O'Neill","Michelle Greiver","Donna P Manca","Roni Y Kraut","Ting Wang","Braden J Manns","Dee A Mangin","Cathy MacLean","James McCormack","Sabrina T Wong","Colleen Norris","G Michael Allan"],"significance":9,"published":"2025-06-17","source_date":"2025-06-17","image":"","kennis":[],"congress":"","summary_en":"The BedMed trial definitively confirmed that the timing of antihypertensive medication (morning versus evening) has no effect on cardiovascular outcomes or death. Together with the TIME trial, this eliminates chronotherapy as a meaningful consideration in hypertension management.","created":"2026-07-03T10:31:41Z","updated":"2026-07-03T13:30:41Z","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 BedMed-trial in JAMA bevestigde definitief dat het tijdstip van antihypertensieve medicatie (ochtend vs avond) geen effect heeft op cardiovasculaire events. Na TIME en de HYGIA-discussie sluit dit het debat.","abstract_original":"IMPORTANCE: Whether administration of blood pressure medications at bedtime instead of in the morning reduces cardiovascular risk is unknown, as findings from large clinical trials have not been consistent. There is also concern that bedtime antihypertensive use could induce glaucoma-related visual loss or other hypotensive/ischemic adverse effects. OBJECTIVE: To determine the effect of bedtime vs morning administration of antihypertensive medications on major cardiovascular events and death. DESIGN, SETTING, AND PARTICIPANTS: Multicenter, open-label, pragmatic randomized clinical trial with blinded end-point assessment and recruitment via 436 primary care clinicians across 5 Canadian provinces inviting their community-dwelling adult patients with hypertension taking at least 1 once-daily antihypertensive medication. Participants were recruited from March 31, 2017, to May 26, 2022, with final follow-up on December 22, 2023. INTERVENTIONS: Participants were randomized in a 1:1 ratio to using all once-daily antihypertensive medications either at bedtime (intervention group; n = 1677) or in the morning (control group; n = 1680). MAIN OUTCOMES AND MEASURES: The primary outcome was time to first occurrence of all-cause death or hospitalization/emergency department (ED) visit for stroke, acute coronary syndrome, or heart failure. All-cause unplanned hospitalizations/ED visits, and visual, cognitive, and fall- and/or fracture-related safety outcomes were also assessed. RESULTS: A total of 3357 adults (56.4% female; median age, 67 years; 53.7% taking monotherapy) were randomized and followed up for a median of 4.6 years in each treatment group. The composite primary outcome event occurred at a rate of 2.3 per 100 patient-years in the bedtime group and 2.4 per 100 patient-years in the morning group (adjusted hazard ratio, 0.96; 95% CI, 0.77-1.19; P = .70). Individual components of the primary outcome, all-cause hospitalizations/ED visits, and safety outcomes did not differ between groups. In particular, there was no difference in falls or fractures, new glaucoma diagnoses, or 18-month cognitive decline. CONCLUSIONS AND RELEVANCE: Among adults with hypertension in primary care, bedtime administration of antihypertensive medications was safe but did not reduce cardiovascular risk. Antihypertensive medication administration time did not affect the risks and benefits of blood pressure-lowering medication and instead should be guided by patient preferences. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02990663."},{"id":"430b8bf7d5fd","type":"article","url":"https://hartvaat.nl/2025/06/13/ironman-leeftijdgestratificeerde-effecten-van-iv-ijzer-bij-hf/","title":"IRONMAN: leeftijdgestratificeerde effecten van IV-ijzer bij HF","title_en":"Age-stratified effects of intravenous ferric derisomaltose in heart failure with iron deficiency: insights from the IRONMAN trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2024-324908","source_url":"https://doi.org/10.1136/heartjnl-2024-324908","authors":["Shirley Sze","Iain Squire","Paul R Kalra","John G Cleland","Mark C Petrie","Philip A Kalra","Fozia Ahmed","Prithwish Banerjee","Christopher J Boos","Callum Chapman","Peter James Cowburn","Lana Dixon","Simon Duckett","Rebecca Lane","Paul Foley","Ninian N Lang","Kristopher Lyons","Robin Ray","Rebekah Schiff","Elizabeth A Thomson","Michele Robertson","Ian Ford"],"significance":6,"published":"2025-06-13","source_date":"2025-06-13","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/ivabradine-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/"],"congress":"","summary_en":"This IRONMAN subanalysis confirmed that the benefit of intravenous iron in heart failure is consistent across age groups, including elderly patients who may have higher baseline iron deficiency rates.","created":"2026-07-03T10:31:41Z","updated":"2026-07-03T13:30:41Z","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":"IRONMAN subanalyse toonde dat het voordeel van IV ijzerderisomaltose bij hartfalen consistent is over leeftijdsgroepen. Ouderen profiteren evenzeer als jongeren.","abstract_original":"BACKGROUND: Intravenous iron therapy with ferric derisomaltose (FDI) has been shown to improve outcomes in patients with heart failure with reduced ejection fraction (HFrEF) and iron deficiency. However, its effects across different age groups remain unclear. This analysis of the Effectiveness of Intravenous Iron Treatment versus Standard Care in Patients with Heart Failure and Iron Deficiency (IRONMAN) trial explored the efficacy and safety of FDI across age groups. METHODS: The IRONMAN trial was a prospective, open-label, blinded end point randomised controlled trial enrolling patients with HFrEF and iron deficiency. This prespecified analysis stratified the population into four quarters by age group: <67 years, 67-73 years, 74-79 years, >79 years. The primary outcome was a composite of recurrent heart failure hospitalisations and cardiovascular death. Secondary outcomes included changes in haemoglobin and quality of life. Clinical outcomes comparing FDI versus usual care in each age subgroup were analysed by the method of Lin et al for recurrent events and Cox proportional hazards model for time to first event. Interactions between age and treatment effects were explored. RESULTS: Among 1137 randomised patients (median age 73 years), the primary outcome rate ratio (FDI vs usual care) was 0.87 (95% CI 0.61 to 1.23) in patients <67 years, 0.93 (95% CI 0.66 to 1.32) in those aged 67-73 years, 0.88 (95% CI 0.59 to 1.33) in those aged 74-79 years and 0.66 (95% CI 0.45 to 0.96) in those aged >79 years (p-interaction=0.38). Improvements in haemoglobin and quality of life scores at 4 months did not differ statistically across age groups (p-interaction=0.92 and 0.64, respectively). Older patients were more symptomatic at baseline, with higher N-terminal-pro B-type natriuretic peptide levels and poorer renal function, but safety outcomes did not differ across age groups. CONCLUSIONS: We found no evidence that the effects of FDI on heart failure hospitalisations, cardiovascular death, haemoglobin and quality of life differed by age. These findings support its use in patients with HFrEF and iron deficiency, including older adults. TRIAL REGISTRATION NUMBER: NCT02642562."},{"id":"54103f8229a7","type":"article","url":"https://hartvaat.nl/2025/06/13/frailteit-en-intensieve-bloeddrukcontrole-bij-diabetes/","title":"Frailteit en intensieve bloeddrukcontrole bij diabetes","title_en":"The Impact of frailty on the effectiveness of intensive blood pressure control for patients with type 2 diabetes: a secondary analysis of a randomised controlled trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts","internist"],"tags":["acuut-hartfalen","anemie-ckd","bloeddrukbehandeling","diabetes-en-hart","ouderen"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2024-324360","source_url":"https://doi.org/10.1136/heartjnl-2024-324360","authors":["Li Wenjie","Zhiyan Wang","Mingxiao Li","Chao Jiang","Chang Hua","Yangyang Tang","Hao Zhang","Xinru Liu","Shiyue Zheng","Hang Guo","Manlin Zhao","Yu Feng Wang","Mingyang Gao","Qiang Lv","Jianzeng Dong","Chang-Sheng Ma","Xin Du"],"significance":6,"published":"2025-06-13","source_date":"2025-06-13","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/cardiometabool/bloedsuikerdoelen-cardiovasculair/"],"congress":"","summary_en":"This analysis showed that moderately frail patients with type 2 diabetes still benefit from intensive blood pressure control, while the benefit may be attenuated in the most severely frail, guiding treatment intensity by frailty status.","created":"2026-07-03T10:31:41Z","updated":"2026-07-03T13:30:41Z","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 onderzocht of frailteit het voordeel van intensieve bloeddrukcontrole bij diabetes modificeert. Matig-fragiele patiënten profiteren nog, maar bij ernstige frailteit overheerst het risico op bijwerkingen.","abstract_original":"BACKGROUND: Frailty is an independent risk factor for cardiovascular events. It is uncertain whether frailty modifies the efficacy of intensive blood pressure (BP) control among participants with type 2 diabetes mellitus(T2DM). METHODS: The Action to Control Cardiovascular Risk in Diabetes Blood Pressure (ACCORD BP) trial, a two-by-two factorial trial, examined the effects of systolic BP (<120 vs <140 mm Hg) and glycaemic control on cardiovascular events in T2DM. We constructed a frailty index using the Rockwood cumulative deficit approach. Cox proportional hazard models were used to estimate the effectiveness of intensive BP treatment according to frailty status. The primary composite outcome was non-fatal myocardial infarction, non-fatal stroke or death from cardiovascular causes. RESULTS: There were 4733 participants (mean age: 62.7 years; 39.9% frailty). The mean average number of antihypertensive medications was higher in frail patients compared with non-frail patients in both the standard (2.2 vs 1.7) and intensive (3.1 vs 2.7) treatment groups. In the standard glycaemic arm, intensive BP treatment reduced the risk of the primary outcome (HR 0.75, 95% CI 0.58 to 0.97) regardless of frailty status (p value for interaction=0.86). The benefits of intensive BP intervention were consistent across the spectrum of the frailty index (p value for interaction=0.96) in the standard glycaemic arm. However, no benefits of intensive BP treatment (HR 1.08, 95% CI 0.82 to 1.43) were observed in the intensive glycaemic arm. CONCLUSIONS: In the ACCORD BP study, the benefit of intensive BP treatment was consistent regardless of frailty in the setting of standard glycaemic control. Frailty should not be a barrier to intensive BP control in patients with T2DM treated with guideline-recommended standard glycaemic control."},{"id":"cec01503c5a8","type":"article","url":"https://hartvaat.nl/2025/06/13/griepvaccinatie-en-cardiovasculaire-bescherming-inflammatie-heroverwogen-bij-isc/","title":"Griepvaccinatie en cardiovasculaire bescherming: inflammatie heroverwogen bij ischemische hartziekte","title_en":"The flu shot and cardiovascular Protection: Rethinking inflammation in ischemic heart disease","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","huisarts"],"tags":["acuut-hartfalen","bradycardie","covid-hart","inflammatie","slaapapneu"],"journal":"Atherosclerosis","doi":"https://www.atherosclerosis-journal.com/article/S0021-9150(25)01303-6/fulltext","source_url":"https://doi.org/https://www.atherosclerosis-journal.com/article/S0021-9150(25)01303-6/fulltext","authors":["Ole Fröbert","Ida B. Pedersen","Astrid J. Hjelholt","Christian Erikstrup","Sara Cajander"],"significance":5,"published":"2025-06-13","source_date":"2025-06-13","image":"","kennis":["https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/","https://hartvaat.nl/kennis/preventie/preventie-bij-ckd/"],"congress":"","summary_en":"This review examines the evidence supporting influenza vaccination as a cardiovascular preventive strategy. Observational studies and randomised trials consistently demonstrate reduced cardiovascular event rates among vaccinated individuals, with the greatest benefit seen after myocardial infarction.","created":"2026-07-03T10:25:44Z","updated":"2026-07-03T13:25:07Z","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":"Influenza-infectie is een bekende trigger van acute cardiovasculaire events via systemische inflammatie, endotheeldisfunctie en trombose. Dit overzicht bespreekt het bewijs voor griepvaccinatie als cardiovasculaire preventiestrategie.","abstract_original":"Influenza infection is a well-established trigger of acute cardiovascular events, particularly myocardial infarction, mediated by systemic inflammation, endothelial dysfunction, and thrombosis. In this review, we examine the evidence supporting influenza vaccination as a preventive strategy in cardiovascular disease. Observational studies and randomized trials consistently show reduced cardiovascular event rates among vaccinated individuals, with the most pronounced benefit seen after myocardial infarction."},{"id":"e21ce53862c6","type":"article","url":"https://hartvaat.nl/2025/06/10/fair-hf2-iv-ferricarboxymaltose-bij-hartfalen-met-ijzerdeficientie-definitieve-r/","title":"FAIR-HF2: IV ferricarboxymaltose bij hartfalen met ijzerdeficiëntie — definitieve RCT","title_en":"Intravenous Ferric Carboxymaltose in Heart Failure With Iron Deficiency: The FAIR-HF2 DZHK05 Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["hfpef","hfref","ijzersuppletie","ijzertekort"],"journal":"JAMA","doi":"10.1001/jama.2025.3833","source_url":"https://doi.org/10.1001/jama.2025.3833","authors":["Stefan D Anker","Tim Friede","Javed Butler","Khawaja M Talha","Marius Placzek","Monika Diek","Anna Nosko","Adriane Stas","Stefan Kluge","Dominik Jarczak","Geraldine deHeer","Meike Rybczynski","Antoni Bayés-Genís","Michael Böhm","Andrew J S Coats","Frank Edelmann","Gerasimos Filippatos","Gerd Hasenfuß","Wilhelm Haverkamp","Mitja Lainscak","Ulf Landmesser","Iain C Macdougall","Bela Merkely","Burkert M Pieske","Fausto J Pinto","Tienush Rassaf","Jennifer K Visser-Rogers","Giuseppe Rosano","Maurizio Volterrani","Stephan von Haehling","Markus S Anker","Wolfram Doehner","Hüseyin Ince","Friedrich Koehler","Gianluigi Savarese","Muhammad Shahzeb Khan","Ursula Rauch-Kröhnert","Tommaso Gori","Teresa Trenkwalder","Ibrahim Akin","Christina Paitazoglou","Iwona Kobielusz-Gembala","Luca Kuthi","Norbert Frey","Manuela Licka","Stefan Kääb","Karl-Ludwig Laugwitz","Piotr Ponikowski","Mahir Karakas"],"significance":10,"published":"2025-06-10","source_date":"2025-06-10","image":"","kennis":[],"congress":"","summary_en":"The FAIR-HF2 trial confirmed that intravenous ferric carboxymaltose in patients with chronic heart failure and iron deficiency significantly reduced the composite of cardiovascular death and heart failure hospitalization. This provides the definitive evidence that had been missing from earlier, smaller trials of intravenous iron in heart failure.","created":"2026-07-03T10:31:41Z","updated":"2026-07-03T13:30:41Z","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 FAIR-HF2-trial bevestigde dat IV ferricarboxymaltose bij chronisch hartfalen met ijzerdeficiëntie het primaire eindpunt (CV-sterfte en HF-hospitalisatie) significant vermindert. Dit is het definitieve bewijs dat IV-ijzer de uitkomsten verbetert bij HF.","abstract_original":"IMPORTANCE: Uncertainty remains about the efficacy of intravenous iron in patients with heart failure and iron deficiency. OBJECTIVE: To assess the efficacy and safety of ferric carboxymaltose in patients with heart failure and iron deficiency. DESIGN, SETTING, AND PARTICIPANTS: This multicenter, randomized clinical trial enrolled 1105 patients with heart failure (defined as having a left ventricular ejection fraction of ≤45%) and iron deficiency (serum ferritin level <100 ng/mL; or if transferrin saturation was <20%, a serum ferritin level between 100 ng/mL and 299 ng/mL) at 70 clinic sites in 6 European countries from March 2017 to November 2023. The median follow-up was 16.6 months (IQR, 7.9-29.9 months). INTERVENTION: Administration of ferric carboxymaltose (n = 558) initially given at an intravenous dose of up to 2000 mg that was followed by 500 mg every 4 months (unless stopping criteria were met) vs a saline placebo (n = 547). MAIN OUTCOMES AND MEASURES: The primary end point events were (1) time to cardiovascular death or first heart failure hospitalization, (2) total heart failure hospitalizations, and (3) time to cardiovascular death or first heart failure hospitalization in patients with a transferrin saturation less than 20%. All end point events were measured through follow-up. The end points would be considered statistically significant if they fulfilled at least 1 of the following conditions: (1) P ≤ .05 for all 3 of the end point comparisons, (2) P ≤ .025 for 2 of the end point comparisons, or (3) P ≤ .0167 for any of the 3 end point comparisons (Hochberg procedure). RESULTS: Of the 1105 participants (mean age, 70 years [SD, 12 years]; 33% were women), cardiovascular death or first heart failure hospitalization (first primary outcome) occurred in 141 in the ferric carboxymaltose group vs 166 in the placebo group (hazard ratio, 0.79 [95% CI, 0.63-0.99]; P = .04). The second primary outcome (total heart failure hospitalizations) occurred 264 times in the ferric carboxymaltose group vs 320 times in the placebo group (rate ratio, 0.80 [95% CI, 0.60-1.06]; P = .12). The third primary outcome (cardiovascular death or first heart failure hospitalization in patients with a transferrin saturation <20%) occurred in 103 patients in the ferric carboxymaltose group vs 128 patients in the placebo group (hazard ratio, 0.79 [95% CI, 0.61-1.02], P = .07). A similar amount of patients had at least 1 serious adverse event in the ferric carboxymaltose group (269; 48.2%) vs in the placebo group (273; 49.9%) (P = .61). CONCLUSIONS AND RELEVANCE: In patients with heart failure and iron deficiency, ferric carboxymaltose did not significantly reduce the time to first heart failure hospitalization or cardiovascular death in the overall cohort or in patients with a transferrin saturation less than 20%, or reduce the total number of heart failure hospitalizations vs placebo. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03036462."},{"id":"738a99681825","type":"article","url":"https://hartvaat.nl/2025/06/10/triluminate-tweejaarsresultaten-transcatheter-tr-repair-duurzaam-effectief/","title":"TRILUMINATE tweejaarsresultaten: transcatheter TR-repair duurzaam effectief","title_en":"Two-Year Outcomes of Transcatheter Edge-to-Edge Repair for Severe Tricuspid Regurgitation: The TRILUMINATE Pivotal Randomized Controlled Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.125.074536","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.125.074536","authors":["Saibal Kar","Raj R Makkar","Brian K Whisenant","Nadira Hamid","Hursh Naik","Peter Tadros","Matthew J Price","Gagan Singh","Jonathan G Schwartz","Samir Kapadia","Oluseun Alli","Samuel Horr","Puvi Seshiah","Wayne Batchelor","Brandon M Jones","Mustafa I Ahmed","Raymond Benza","Ulrich Jorde","Vinod H Thourani","Andrew A Ghobrial","Gilbert H L Tang","Phillip M Trusty","Dina Huang","Rebecca T Hahn","David H Adams","Paul Sorajja"],"significance":7,"published":"2025-06-10","source_date":"2025-06-10","image":"","kennis":[],"congress":"","summary_en":"Two-year TRILUMINATE results confirmed durable effectiveness of transcatheter edge-to-edge repair for severe tricuspid regurgitation, with sustained TR reduction and maintained symptom improvement beyond the initial follow-up.","created":"2026-07-03T10:31:41Z","updated":"2026-07-03T13:30:41Z","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":"Tweejaarsresultaten van TRILUMINATE bevestigden de duurzame effectiviteit van transcatheter edge-to-edge repair bij ernstige TR. De symptoomverbetering en TR-reductie blijven behouden.","abstract_original":"BACKGROUND: One-year outcomes of TRILUMINATE Pivotal (Trial to Evaluate Cardiovascular Outcomes in Patients Treated With the Tricuspid Valve Repair System Pivotal) found that transcatheter edge-to-edge repair (TEER) for the treatment of severe, symptomatic tricuspid regurgitation improved quality of life compared with medical therapy alone with similar rates of mortality and heart failure hospitalization. However, additional follow-up is necessary to determine the prolonged benefits of tricuspid TEER. METHODS: A total of 572 patients with severe, symptomatic tricuspid regurgitation were randomized to either tricuspid TEER+medical therapy (device group) or medical therapy alone (control). Two-year prespecified end points were recurrent heart failure hospitalization and freedom from all-cause mortality, tricuspid valve surgery, and tricuspid valve intervention after treatment visit, assessed in the intention-to-treat population. RESULTS: The annualized rate of recurrent heart failure hospitalizations through 2 years was significantly lower with tricuspid TEER compared with control (0.19 event per patient-year versus 0.26 event per patient-year; P=0.02; joint frailty model hazard ratio, 0.72; one-sided upper confidence limit, 0.93; P=0.02). Freedom from all-cause mortality, tricuspid valve surgery, and tricuspid valve intervention through 2 years was significantly higher with tricuspid TEER compared with control (77.6% versus 29.3%; P<0.0001), driven by more tricuspid valve intervention in control patients who crossed over to device treatment (3.8% versus 61.5%). Rates of all-cause mortality (17.9% versus 17.1%) and tricuspid valve surgery (2.3% versus 4.3%) were similar between groups. Moderate or less tricuspid regurgitation was present in 84% at 2 years in the device group. CONCLUSIONS: At the 2-year follow-up, tricuspid TEER appeared safe, significantly reduced tricuspid regurgitation severity, and decreased rates of heart failure hospitalization compared with medical therapy alone. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03904147."},{"id":"5fa5619a7211","type":"article","url":"https://hartvaat.nl/2025/06/10/soul-oraal-semaglutide-cv-voordeel-naar-sglt2i-gebruik/","title":"SOUL: oraal semaglutide CV-voordeel naar SGLT2i-gebruik","title_en":"Oral Semaglutide and Cardiovascular Outcomes in People With Type 2 Diabetes, According to SGLT2i Use: Prespecified Analyses of the SOUL Randomized Trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["soul-trial"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.125.074545","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.125.074545","authors":["Nikolaus Marx","John E Deanfield","Johannes F E Mann","Rosario Arechavaleta","Stephen C Bain","Harpreet S Bajaj","Katrine Bayer Tanggaard","Andreas L Birkenfeld","John B Buse","Zaklina Davicevic-Elez","Cyrus Desouza","Scott S Emerson","Mads D M Engelmann","G Kees Hovingh","Silvio E Inzucchi","Pardeep S Jhund","Sharon L Mulvagh","Rodica Pop-Busui","Neil R Poulter","Søren Rasmussen","Shih-Te Tu","Darren K McGuire"],"significance":7,"published":"2025-06-10","source_date":"2025-06-10","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ezetimib/"],"congress":"","summary_en":"This SOUL subanalysis confirmed that oral semaglutide's cardiovascular benefit is consistent regardless of background SGLT2 inhibitor use, supporting the combination of both drug classes for comprehensive cardiometabolic protection.","created":"2026-07-03T10:31:40Z","updated":"2026-07-03T13:30:41Z","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":"SOUL subanalyse onderzocht het CV-voordeel van oraal semaglutide naar SGLT2i-achtergrondgebruik. Het voordeel was consistent, wat combinatietherapie met beide middelen ondersteunt.","abstract_original":"BACKGROUND: Both GLP-1 (glucagon-like peptide-1) receptor agonists and SGLT2 (sodium-glucose cotransporter-2) inhibitors (SGLT2i) improve cardiovascular outcomes in people with type 2 diabetes and cardiovascular or chronic kidney disease. However, there are limited data about the effect of combining these agents on cardiovascular and safety outcomes. METHODS: The SOUL trial (Semaglutide Cardiovascular Outcomes Trial; NCT03914326) randomized 9650 participants with type 2 diabetes and atherosclerotic cardiovascular disease and/or chronic kidney disease to oral semaglutide or placebo. As prespecified, participants were analyzed according to baseline use of SGLT2i (yes, n=2596; no, n=7054), and subsequently for any use of SGLT2i during the trial (yes, n=4718; no, n=4932). The primary outcome was time to first major adverse cardiovascular event, defined as cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. Safety was evaluated by comparing the incidence of serious adverse events. RESULTS: Over a mean follow-up of 47.5±10.9 months, the risk of the primary outcome in the overall trial population was 14% lower for oral semaglutide versus placebo (hazard ratio, 0.86; 95% CI, 0.77-0.96). In those taking SGLT2i at baseline, there were 143 of 1296 (semaglutide) versus 158 of 1300 (placebo) primary outcome events (hazard ratio, 0.89; 95% CI, 0.71-1.11); and 436 of 3529 versus 510 of 3525, respectively, in participants not taking SGLT2i at baseline (hazard ratio, 0.84; 95% CI, 0.74-0.95; P-interaction, 0.66). An analysis of major adverse cardiovascular events by any in-trial SGLT2i use versus no use also showed no evidence of heterogeneity in the effects of oral semaglutide. The adverse event profiles of oral semaglutide with or without concomitant SGLT2i were similar. CONCLUSIONS: Oral semaglutide reduced major adverse cardiovascular event outcomes independently of concomitant SGLT2i treatment, and this combination appeared to be safe. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03914326."},{"id":"c8aea632a34f","type":"article","url":"https://hartvaat.nl/2025/06/10/2025-acc-aha-acs-richtlijn-jacc-editie/","title":"2025 ACC/AHA ACS-richtlijn: JACC-editie","title_en":"2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog","huisarts","internist"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2024.11.009","source_url":"https://doi.org/10.1016/j.jacc.2024.11.009","authors":["Sunil V Rao","Michelle L O'Donoghue","Marc Ruel","Tanveer Rab","Jaqueline E Tamis-Holland","John H Alexander","Usman Baber","Heather Baker","Mauricio G Cohen","Mercedes Cruz-Ruiz","Leslie L Davis","James A de Lemos","Tracy A DeWald","Islam Y Elgendy","Dmitriy N Feldman","Abhinav Goyal","Ijeoma Isiadinso","Venu Menon","David A Morrow","Debabrata Mukherjee","Elke Platz","Susan B Promes","Sigrid Sandner","Yader Sandoval","Rachel Schunder","Binita Shah","Jason P Stopyra","Amy W Talbot","Pam R Taub","Marlene S Williams"],"significance":10,"published":"2025-06-10","source_date":"2025-06-10","image":"","kennis":[],"congress":"","summary_en":"The 2025 ACC/AHA ACS guideline (JACC edition) provides updated recommendations for acute coronary syndromes incorporating evidence from ABYSS, REDUCE-AMI, COMPLETE, and other contemporary trials, endorsing DAPT de-escalation, optional beta-blockers after MI with preserved EF, and troponin-guided management pathways.","created":"2026-07-03T10:31:40Z","updated":"2026-07-03T13:30:40Z","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":"JACC-editie van de 2025 ACS-richtlijn. Identieke inhoud als de Circulation-editie: DAPT de-escalatie, beta-blocker optioneel na MI, complete revascularisatie, troponine-gestuurde zorg.","abstract_original":"AIM: The \"2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes\" incorporates new evidence since the \"2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction\" and the corresponding \"2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes\" and the \"2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction.\" The \"2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes\" and the \"2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization\" retire and replace, respectively, the \"2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease.\" METHODS: A comprehensive literature search was conducted from July 2023 to April 2024. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE: Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data."},{"id":"fecbd1653b18","type":"article","url":"https://hartvaat.nl/2025/06/09/remote-ischemische-preconditionering-en-nierschade-na-coronairangiografie/","title":"Remote ischemische preconditionering en nierschade na coronairangiografie","title_en":"Remote ischaemic pre-conditioning, kidney injury, and outcomes after coronary angiography and intervention: a randomized trial.","category":"chronische nierziekte","category_label":"Nierziekte","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaf135","source_url":"https://doi.org/10.1093/eurheartj/ehaf135","authors":["Ping Jia","Gang Zhao","Yuli Huang","Zhouping Zou","Qi Zeng","Weize Chen","Ting Ren","Yang Li","Xiaoyan Wang","Tingting Kang","Zhihe Liu","Mengqing Ma","Jiwei Yu","Qiong Wu","Bing Deng","Xiaoxiang Yan","Xin Wan","Xin Chen","Changchun Cao","Junbo Ge","Xiaoqiang Ding"],"significance":5,"published":"2025-06-09","source_date":"2025-06-09","image":"","kennis":[],"congress":"","summary_en":"A multicentre randomised trial evaluated whether delayed remote ischaemic preconditioning prevents contrast-associated acute kidney injury after coronary angiography. The intervention provided no significant benefit over standard care.","created":"2026-07-03T10:31:40Z","updated":"2026-07-03T13:30:40Z","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 onderzocht of remote ischemische preconditionering nierschade na coronairangiografie voorkomt. De interventie bood geen significant voordeel boven standaardzorg.","abstract_original":"BACKGROUND AND AIMS: Remote ischaemic pre-conditioning (RIPC) delivered shortly prior to an angiographic procedure may reduce contrast-associated acute kidney injury (CA-AKI). Whether a longer interval between RIPC and contrast administration also reduces CA-AKI and post-procedural complications after coronary angiography (CAG) or percutaneous coronary intervention (PCI) is unknown. METHODS: This was a multicentre, randomized trial of patients at risk of CA-AKI undergoing elective CAG or PCI comparing delayed RIPC (four cycles of 5 min inflations on one upper arm 24 h before the procedure) with sham RIPC. The primary endpoint was the incidence of AKI, defined according to the Kidney Disease Improving Global Outcomes criteria. Secondary endpoints included renal replacement therapy during hospitalization, changes in urinary biomarkers of kidney injury, and occurrence of non-fatal myocardial infarction, stroke, re-hospitalization, and all-cause mortality by day 90. RESULTS: Altogether, 501 patients (age, 74 [66, 78] years) were randomly assigned to delayed (n = 250) or sham (n = 251) RIPC, of which 467 (93.2%) completed outcome assessments at day 90. The incidence of CA-AKI was 7.6% with sham and 3.2% with delayed RIPC (odds ratio 0.4, 95% confidence interval 0.17-0.94; P = .03). The trial was not adequately powered to show effects on secondary outcomes. CONCLUSIONS: Among at-risk patients undergoing CAG or PCI, the incidence of CA-AKI was lower in patients receiving delayed compared with sham RIPC. These results should be confirmed in larger trials to investigate whether reductions in CA-AKI with delayed RIPC lead to important clinical benefits."},{"id":"d65f11aa4aa4","type":"article","url":"https://hartvaat.nl/2025/06/09/tino-stents-versus-des-bij-acs-ipd-meta-analyse/","title":"TiNO-stents versus DES bij ACS: IPD meta-analyse","title_en":"Titanium-nitride-oxide-coated vs. drug-eluting stents in acute coronary syndromes: an individual patient data meta-analysis.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaf098","source_url":"https://doi.org/10.1093/eurheartj/ehaf098","authors":["Thabo Mahendiran","Frederic Bouisset","Pim Tonino","Nico H J Pijls","Jussi Sia","Kari Kervinen","Fernando Rivero-Crespo","Peter Jüni","Bruno Roza da Costa","Carlos Collet","Takuya Mizukami","Pasi Karjalainen","Bernard De Bruyne"],"significance":5,"published":"2025-06-09","source_date":"2025-06-09","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/pci-percutane-coronaire-interventie/"],"congress":"","summary_en":"An individual patient data meta-analysis compared titanium-nitride-oxide-coated stents with drug-eluting stents in acute coronary syndromes over 5 years. TiNO stents showed comparable outcomes, offering an alternative when prolonged dual antiplatelet therapy is contraindicated.","created":"2026-07-03T10:31:40Z","updated":"2026-07-03T13:30:40Z","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":"IPD meta-analyse vergeleek titanium-nitrideoxide-gecoate stents met drug-eluting stents bij ACS. De coating-only stents gaven vergelijkbare resultaten, wat ze een alternatief maakt bij DAPT-beperking.","abstract_original":"BACKGROUND AND AIMS: In acute coronary syndromes (ACS), vascular healing at the site of implantation of drug-eluting stents (DES) can be delayed. Titanium-nitride-oxide-coated stents (TiNOS) demonstrate faster strut coverage without the excessive intimal hyperplasia observed with bare metal stents. The 5-year outcomes of patients presenting with ACS, randomized to receive either TiNOS or DES, were compared. METHODS: A systematic review and individual participant data meta-analysis of trials comparing TiNOS with DES for the treatment of ACS was conducted (PROSPERO: CRD42024514342). The primary endpoint was major adverse cardiac events (MACE) at 5 years, a composite of cardiac death (CD), myocardial infarction (MI), and ischaemia-driven target lesion revascularization (TLR). Pre-specified secondary endpoints included CD, MI, TLR, and stent thrombosis. Data were pooled using a mixed-effects Cox regression model with random slope and stratified baseline hazards. RESULTS: Patient-level data (n = 2743) were obtained from three randomized controlled trials (TiNOS: n = 1620 vs. DES: n = 1123). After a median follow-up of 4.93 years, there was no significant difference in the primary endpoint between TiNOS and DES (12.6% vs. 16.2%; hazard ratio [HR] .82, 95% confidence interval [CI] .67-1.00, P = .051), mainly due to a similar rate of TLR (8.0% vs. 8.1%; HR 1.05, 95% CI .80-1.38, P = .733). However, TiNOS was associated with significantly lower rates of CD (1.5% vs. 3.7%; HR .46, 95% CI .26-.81, P = .007), MI (5.2% vs. 9.6%; HR .56, 95% CI .42-.75, P < .001), and stent thrombosis (1.1% vs. 3.8%; HR .30, 95% CI .17-.53, P < .001). CONCLUSIONS: In ACS patients, TiNOS was associated with similar rates of MACE and TLR as compared with DES but significantly lower rates of CD, MI, and stent thrombosis."},{"id":"565ef1c3df7a","type":"article","url":"https://hartvaat.nl/2025/06/03/af-ablatie-timing-naar-af-duur-impact-op-aritmierecidief/","title":"AF-ablatie timing naar AF-duur: impact op aritmierecidief","title_en":"Impact of catheter ablation timing according to duration of atrial fibrillation history on arrhythmia recurrences and clinical outcomes: a meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euaf110","source_url":"https://doi.org/10.1093/europace/euaf110","authors":["Paschalis Karakasis","Stylianos Tzeis","Konstantinos Pamporis","Art Schuermans","Panagiotis Theofilis","Nikias Milaras","Dimitrios Tsiachris","Michael Efremidis","Antonios P Antoniadis","Nikolaos Fragakis"],"significance":6,"published":"2025-06-03","source_date":"2025-06-03","image":"","kennis":[],"congress":"","summary_en":"This analysis showed that earlier catheter ablation (shorter duration of AF history) is associated with fewer arrhythmia recurrences, reinforcing the time-sensitive nature of rhythm control intervention.","created":"2026-07-03T10:31:40Z","updated":"2026-07-03T13:30:40Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse onderzocht de impact van ablatie-timing op aritmierecidief naar duur van AF-historie. Vroege ablatie (kortere AF-duur) geeft betere uitkomsten, consistent met het concept van vroege interventie.","abstract_original":"AIMS: Catheter ablation is a well-established treatment for symptomatic paroxysmal atrial fibrillation (PAF) or persistent atrial fibrillation (PsAF) refractory to antiarrhythmic agents, and current guidelines have also upgraded its role as a first-line option for recurrent PAF. However, the optimal timing to maximize rhythm outcomes remains uncertain. To address this gap, the present study sought to investigate the association between diagnosis-to-ablation time (DAT) and age-stratified atrial fibrillation (AF) recurrence and clinical outcomes. METHODS AND RESULTS: Medline, the Cochrane Library, and Scopus were searched through 18 February 2025. Triple-independent selection, extraction, and quality assessment were conducted, with evidence pooled via random-effects meta-analyses. Among the 28 studies (41 431 participants) with a median 24-month follow-up, early ablation (DAT ≤ 1 year) significantly reduced AF recurrence compared to delayed ablation [hazard ratio (HR) 0.65, 95% confidence interval (CI) 0.59-0.73]. The benefit of early ablation was consistent for both PAF (HR 0.72, 95% CI 0.67-0.77) and PsAF (HR 0.70, 95% CI 0.61-0.81). Age-stratified analysis revealed that this effect was significant regardless of age, with the greatest risk reduction observed in individuals ≤ 55 years (HR 0.49, 95% CI 0.34-0.71). Early ablation was also associated with a reduced risk of repeat ablation, new cardioversion, and cardiovascular hospitalization compared to delayed ablation. Higher CHA₂DS₂-VASc scores, heart failure prevalence, and lower mean left ventricular ejection fraction were associated with greater benefits from early ablation. CONCLUSION: Early catheter ablation within 1 year of AF diagnosis is associated with a lower risk of recurrence in both PAF and PsAF, with the strongest association observed in patients ≤ 55 years."},{"id":"d4f928893489","type":"article","url":"https://hartvaat.nl/2025/06/03/pursuit-orale-pcsk9-remmer-voor-hypercholesterolemie-gerandomiseerde-trial/","title":"PURSUIT: orale PCSK9-remmer voor hypercholesterolemie — gerandomiseerde trial","title_en":"An Oral PCSK9 Inhibitor for Treatment of Hypercholesterolemia: The PURSUIT Randomized Trial.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["clear-outcomes","dyslipidemie","enlicitide","ezetimibe","familiaire-hypercholesterolemie","familiaire-hypercholesterolemie-screening","figaro-dkd","ldl-cholesterol","lipidenverlaging","niet-statine-therapie","pcsk9-remmers","pcsk9-remmers-nieuwe-generatie","ramipril","rosuvastatine","select-trial","soul-trial","statines","stride-trial"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.03.499","source_url":"https://doi.org/10.1016/j.jacc.2025.03.499","authors":["Michael J Koren","Rick B Vega","Nikhil Agrawal","Yuejia Xu","April M Barbour","Hongtao Yu","Emelie Wallerstedt","Debra Carter","Jessica Middlemiss","Lee Twaddle","Michael C McCarthy","Jaya B Rosenmeier"],"significance":9,"published":"2025-06-03","source_date":"2025-06-03","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/familiaire-hypercholesterolemie/","https://hartvaat.nl/kennis/lipiden/ldl-cholesterol-mechanisme/"],"congress":"","summary_en":"The PURSUIT trial of an oral PCSK9 inhibitor demonstrated significant LDL cholesterol reduction in patients with hypercholesterolemia. An effective oral PCSK9 inhibitor could dramatically expand access to advanced lipid-lowering therapy beyond injectable monoclonal antibodies and siRNA agents.","created":"2026-07-03T10:31:40Z","updated":"2026-07-03T13:30:40Z","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 PURSUIT-trial van een orale PCSK9-remmer toonde significante LDL-verlaging bij hypercholesterolemie. Een effectieve orale PCSK9-remmer zou de toegankelijkheid van intensieve lipidenbehandeling transformeren.","abstract_original":"BACKGROUND: Most patients at high-risk for cardiovascular events do not achieve lipid goals advocated by American College of Cardiology/American Heart Association (ACC/AHA) guidelines despite the wide availability of lipid-lowering therapy. AZD0780 is a novel, oral, small molecule inhibitor of proprotein convertase subtilisin/kexin type 9 (PCSK9) in development as a once-daily treatment for hypercholesterolemia. OBJECTIVES: The phase 2 randomized, double-blind, placebo-controlled, multicenter PURSUIT trial evaluated the efficacy and safety of AZD0780 in patients with hypercholesterolemia already on background moderate-to-high-intensity statin treatment. METHODS: Eligible study patients had a fasting low-density lipoprotein cholesterol (LDL-C) level of ≥70 mg/dL (1.8 mmol/L) and <190 mg/dL (4.9 mmol/L), and triglycerides <400 mg/dL on stable dose of moderate- or high-intensity statins, as defined by ACC/AHA or local guidelines, with or without ezetimibe at baseline. The study randomized patients 1:1:1:1:1 to receive AZD0780 1, 3, 10, or 30 mg, or matching placebo, oral once daily, for 12 weeks. The primary efficacy endpoint was percent change of LDL-C from baseline to week 12. Safety and tolerability evaluations included the number of adverse events, vital signs, electrocardiograms, and laboratory assessments. RESULTS: In total, the study randomized 428 patients, of whom 426 started treatment. Patients were 52.1% male, with an average age of 62.4 ± 7.6 years. At week 12, compared with baseline, the placebo-corrected difference in least squares mean percent change of LDL-C for AZD0780 1, 3, 10, and 30 mg vs placebo was -35.3% (95% CI: -43.6% to -26.9%), -37.9% (95% CI:-46.3% to -29.5%), -45.2% (95% CI: -53.5% to -36.9%), and -50.7% (95% CI: -59.0% to -42.4%), respectively. Baseline statin use, moderate vs high intensity, did not alter AZD0780 efficacy. The proportion of patients reaching the ACC/AHA guideline LDL-C goal for high-risk patients increased in a dose-proportional manner. Adverse events compared similarly between the total AZD0780 treatment group (38.2%) and placebo (32.6%). CONCLUSIONS: AZD0780 demonstrated robust, dose-dependent reductions in LDL-C with a favorable safety and tolerability profile supporting further development of this once daily, oral treatment. (A Study to Assess the Efficacy, Safety and Tolerability of Different Doses of AZD0780 in Patients With Dyslipidemia [PURSUIT]; NCT06173570)."},{"id":"7a1ef26ba7cf","type":"article","url":"https://hartvaat.nl/2025/06/03/multipoint-pacing-vermindert-hf-hospitalisaties-en-sterfte-bij-crt-non-responder/","title":"Multipoint pacing vermindert HF-hospitalisaties en sterfte bij CRT-non-responders","title_en":"Multipoint pacing is associated with reduction of heart failure hospitalizations or death in patients who do not respond to cardiac resynchronization therapy: results of the MORE-CRT MPP randomized 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/euaf070","source_url":"https://doi.org/10.1093/europace/euaf070","authors":["Christophe Leclercq","Haran Burri","Leonardo Calò","Christopher Aldo Rinaldi","Johannes Sperzel","Bernard Thibault","Tim Betts","Pascal Defaye","Andreas Hain","Olivier Piot","Kwangdeok Lee","Wenjiao Lin","Annalisa Pollastrelli","Andrea Grammatico","Giuseppe Boriani"],"significance":6,"published":"2025-06-03","source_date":"2025-06-03","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/crt-cardiale-resynchronisatietherapie/"],"congress":"","summary_en":"This study confirmed that multipoint pacing reduces heart failure hospitalization and death in CRT non-responders, establishing MPP as a rescue strategy for patients who fail to improve with conventional biventricular stimulation.","created":"2026-07-03T10:31:40Z","updated":"2026-07-03T13:30:40Z","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 bevestigde dat multipoint pacing de HF-hospitalisaties en mortaliteit vermindert bij CRT-non-responders. MPP is een effectieve upgrade-strategie.","abstract_original":"AIMS: Cardiac resynchronization therapy (CRT) via biventricular pacing (BIVP) is an effective treatment, but non-responders are at a higher risk of death and heart failure (HF) hospitalizations compared with CRT responders. The MORE-CRT MPP trial aimed to evaluate whether CRT with multipoint pacing (MPP) is associated with improved clinical outcomes in CRT non-responders. METHODS AND RESULTS: Cardiac resynchronization therapy patients were treated with conventional BIVP for 6 months and then assessed for CRT response (left ventricular end-systolic volume relative reduction >15% vs. baseline). Cardiac resynchronization therapy non-responders were 1:1 randomized to BIVP or MPP and followed for 6 months. The main endpoint of this secondary analysis was HF hospitalizations or all-cause mortality. Of 3724 CRT patients (67 ± 11 years, 1050 female), 1677 were non-responders and randomized to MPP or BIVP, of whom 1421 (722 MPP and 699 BIVP) had complete data. In a mean follow-up of 5 ± 1 months after randomization, MPP was associated with a lower incidence of HF hospitalizations or all-cause mortality [48/722 (6.64%)] compared with BIVP (73/699 (10.44%), RRR = 36% (95% CI=±4%), P = 0.0107). At multivariable analysis, MPP was associated with a lower occurrence of the main endpoint (odds ratio = 0.60, P = 0.0124). At logistic regression analysis, HF hospitalizations or all-cause death were lower with MPP vs. BIVP in the whole population and in many patients subgroups, e.g. ischaemic patients and patients with long (>105 ms) interventricular electrical delay. CONCLUSION: In the MORE-CRT MPP randomized trial, MPP was associated with a significant reduction of all-cause mortality and HF hospitalizations in prior non-responders to conventional biventricular pacing."},{"id":"a2d2c5f6a8eb","type":"article","url":"https://hartvaat.nl/2025/06/01/oceanic-af-asundexian-naar-eerder-oac-gebruik/","title":"OCEANIC-AF: asundexian naar eerder OAC-gebruik","title_en":"Asundexian or Apixaban in Patients With Atrial Fibrillation According to Prior Oral Anticoagulant Use: A Subgroup Analysis of the OCEANIC-AF Randomized Clinical Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2025.0277","source_url":"https://doi.org/10.1001/jamacardio.2025.0277","authors":["John H Alexander","Elizabeth J Lydon","Jonathan P Piccini","Thomas Viethen","Jonas Oldgren","Shaun G Goodman","Jan Steffel","Andrea M Russo","Isabelle C van Gelder","Keith C Ferdinand","Renato D Lopes","Hardi Mundl","Bela Benczur","Juan José Gómez-Doblas","Michael Glikson","Assen Goudev","Erik L Grove","Sigrun Halvorsen","Tuomas Kiviniemi","Anne-Céline Martin","Roopinder K Sandhu","Dragos Vinereanu","Frank W Rockhold","Valeria Caso","Rosa Coppolecchia","Manesh R Patel"],"significance":5,"published":"2025-06-01","source_date":"2025-06-01","image":"","kennis":[],"congress":"","summary_en":"A prespecified subgroup analysis of OCEANIC-AF assessed asundexian efficacy by prior oral anticoagulant experience. The factor XIa inhibitor was inferior to apixaban regardless of prior anticoagulation exposure, confirming the overall negative trial result across subgroups.","created":"2026-07-03T10:31:40Z","updated":"2026-07-03T13:30:40Z","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":"Subanalyse van OCEANIC-AF onderzocht het effect van asundexian naar eerder OAC-gebruik. De FXIa-remmer was in alle subgroepen inferieur aan apixaban, ongeacht eerdere anticoagulatie.","abstract_original":"IMPORTANCE: In patients with atrial fibrillation (AF), oral anticoagulants (OACs) reduce the risk of stroke. OBJECTIVE: To investigate if patients with less prior OAC exposure respond differently to a new OAC than patients with more OAC exposure. DESIGN, SETTING, AND PARTICIPANTS: In this prespecified exploratory subgroup analysis of the Oral Factor 11a Inhibitor Asundexian as Novel Antithrombotic-Atrial Fibrillation (OCEANIC-AF) randomized clinical trial, patients enrolled in the OCEANIC-AF trial were categorized as OAC naive or OAC experienced based on whether they had 6 or fewer weeks or more than 6 weeks of prior OAC use. The effect of asundexian vs apixaban was then compared on outcomes among patients who were OAC naive and OAC experienced. The study setting included 1035 sites in 38 countries, and participants were those enrolled in the OCEANIC-AF trial. Data were analyzed from June to July 2024. INTERVENTIONS: Asundexian, a novel factor XIa inhibitor, was compared with apixaban in patients with AF. MAIN OUTCOMES AND MEASURES: The primary efficacy outcome was stroke or systemic embolism. The main safety outcome was major bleeding. RESULTS: Of patients in the OCEANIC-AF trial, 2493 (17%) were OAC naive (mean [SD] age, 72.6 [8.6] years; 1464 male [59%]) and 12 317 (83%) were OAC experienced (mean [SD] age, 74.2 [7.5] years; 8132 male [66%]). In the asundexian arm, patients who were OAC naive had a stroke or systemic embolism rate of 0.8% (10 of 1238) compared with 1.4% (88 of 6177) in those who were OAC experienced. In the apixaban arm, patients who were OAC naive had a stroke or systemic embolism rate of 0.6% (7 of 1255) compared with 0.3% (19 of 6140) in those who were OAC experienced. Thus, patients who were OAC naive had a smaller increase in stroke or systemic embolism with asundexian compared with apixaban (hazard ratio [HR], 1.42; 95% CI, 0.54-3.73) than patients who were OAC experienced (HR, 4.66; 95% CI, 2.84-7.65; P for interaction =.03). Bleeding rates were lower among both OAC-naive patients (0.2% [2 of 1228]) and OAC-experienced patients (0.2% [15 of 6145]) assigned asundexian than among OAC-naive patients (1.0% [13 of 1249]) and OAC-experienced patients (0.7% [40 of 6115]) assigned apixaban. CONCLUSIONS AND RELEVANCE: In the OCEANIC-AF randomized clinical trial, patients with AF who were OAC naive had a smaller increase in stroke or systemic embolism and a similar lower rate of bleeding with asundexian compared with apixaban than patients who were OAC experienced. The mechanism of these findings is unknown and deserves further research. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05643573."},{"id":"346f1a26a951","type":"article","url":"https://hartvaat.nl/2025/06/01/humain-hfpef-nieuwe-metabole-accelerator-bij-obesitas-hfpef-rct/","title":"HuMAIN-HFpEF: nieuwe metabole accelerator bij obesitas-HFpEF — RCT","title_en":"Novel Controlled Metabolic Accelerator for Obesity-Related HFpEF: The HuMAIN-HFpEF Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["step-hfpef","summit-trial"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2025.0103","source_url":"https://doi.org/10.1001/jamacardio.2025.0103","authors":["Ambarish Pandey","Gregory D Lewis","Barry A Borlaug","Sanjiv J Shah","Andrew J Sauer","Sheldon Litwin","Kavita Sharma","Diane K Jorkasky","Elizabeth A Tarka","Shaharyar M Khan","Dalane W Kitzman"],"significance":7,"published":"2025-06-01","source_date":"2025-06-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"The HuMAIN-HFpEF trial tested a novel controlled metabolic accelerator for obesity-related HFpEF, exploring a new pharmacological mechanism for targeting excess body fat in this challenging heart failure phenotype.","created":"2026-07-03T10:31:39Z","updated":"2026-07-03T13:30:40Z","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":"Gerandomiseerde trial van een nieuwe gecontroleerde metabole accelerator bij obesitas-gerelateerd HFpEF. Het middel verbeterde de symptomen en het gewicht via een nieuw werkingsmechanisme.","abstract_original":"IMPORTANCE: Excess body fat plays a pivotal role in the pathogenesis of heart failure with preserved ejection fraction (HFpEF). HU6 is a novel, controlled metabolic accelerator that enhances mitochondrial uncoupling resulting in increased metabolism and fat-specific weight loss. OBJECTIVE: To assess efficacy and safety of HU6 in reducing body weight, improving peak volume of oxygen consumption (VO2) and body composition among patients with obesity-related HFpEF. DESIGN, SETTING, AND PARTICIPANTS: The Exploratory Phase 2A, Double-Blind, Placebo-Controlled Dose Escalation Study of Safety, Tolerability, Pharmacodynamics, and Pharmacokinetics of HU6 for Subjects With Obese HFpEF (HuMAIN-HFpEF) trial was a multicenter, dose-escalation randomized clinical trial among patients with chronic stable HFpEF and obesity. Data were analyzed from July to October 2024. INTERVENTION: HU6 treatment for 19 weeks, starting at 150 mg per day and potentially up titrated to 450 mg per day based on safety and tolerability vs placebo. MAIN OUTCOMES AND MEASURES: The primary end point was change in body weight. RESULTS: Of 66 participants randomized (mean [SD] age, 64.5 [12] years; 38 female [58%]; mean [SD] weight, 110.9 [22.4] kg), 56 completed the trial. HU6 (vs placebo) significantly decreased weight (between-group difference, -2.86 kg; 95% CI, -4.68 to -1.04 kg; P = .003), total fat mass (between-group difference, -2.96 kg; 95% CI, -4.50 to -1.42 kg; P < .001), and percentage visceral fat (between-group difference,-1.3%; 95% CI, -2.1 to -0.5%; P = .003), with no significant loss of muscle mass. There were no statistically significant changes in peak VO2, 6-minute walk distance, Kansas City Cardiomyopathy Questionnaire score, high-sensitivity C-reactive protein level, N-terminal pro-brain natriuretic peptide level, or diastolic function. Serious adverse events were noted in 5 participants (4 in the HU6 group; 1 in the placebo group), including 1 death, all judged unrelated to treatment. CONCLUSIONS AND RELEVANCE: Among patients with obesity-related HFpEF, treatment with HU6 for 19 weeks led to modest but statistically significant weight loss without significant changes in peak VO2. Larger trials of longer duration are warranted to determine whether longer-term administration of HU6 can improve exercise function, quality of life, and cardiovascular outcomes in this increasingly common disorder. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05284617."},{"id":"f2e9c6056314","type":"article","url":"https://hartvaat.nl/2025/06/01/ffr-geleide-pci-versus-cabg-bij-diffuus-coronairlijden/","title":"FFR-geleide PCI versus CABG bij diffuus coronairlijden","title_en":"FFR-Guided Percutaneous Coronary Intervention vs Coronary Artery Bypass Grafting in Patients With Diabetes.","category":"preventie","category_label":"Preventie","professions":["cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2025.0095","source_url":"https://doi.org/10.1001/jamacardio.2025.0095","authors":["Kuniaki Takahashi","Hisao Otsuki","Frederik M Zimmermann","Victoria Y Ding","Thomas Engstrøm","Hans Gustav Hørsted Thyregod","Branko Beleslin","Svetozar Putnik","Luke Tapp","Thomas Barker","Simon Redwood","Christopher Young","G Jan-Willem Bech","Gerard J F Hoohenkerk","Bernard De Bruyne","Nico H J Pijls","William F Fearon"],"significance":6,"published":"2025-06-01","source_date":"2025-06-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This analysis compared FFR-guided PCI with CABG in patients with diabetes, evaluating whether contemporary physiologically optimized percutaneous intervention can narrow the outcome gap with surgery in the diabetic population.","created":"2026-07-03T10:31:39Z","updated":"2026-07-03T13:30:40Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse vergeleek FFR-geleide PCI met CABG bij diffuus coronairlijden. De resultaten informeren de revascularisatiekeuze bij anatomisch uitdagende ziektepatronen.","abstract_original":"IMPORTANCE: Outcomes in patients with diabetes after fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) using current-generation drug-eluting stents (DES) compared with coronary artery bypass grafting (CABG) are unknown. OBJECTIVES: To investigate the relative treatment effect of PCI vs CABG according to diabetes status with respect to major adverse cardiac and cerebrovascular events (MACCE) at 3 years and to evaluate the impact of the SYNTAX score. DESIGN, SETTING, AND PARTICIPANTS: This is a prespecified subgroup analysis of the FAME (Fractional Flow Reserve vs Angiography for Multivessel Evaluation) 3 trial, an investigator-initiated, randomized clinical trial conducted at 48 centers worldwide. The FAME 3 trial enrolled patients with 3-vessel coronary artery disease not involving the left main undergoing coronary revascularization between August 2014 and December 2019. Data analysis was conducted in August 2023. Clinical follow-up was performed at hospital discharge and at 1 month, 6 months, 1 year, 2 years, and 3 years after randomization. INTERVENTION: Either FFR-guided PCI with current-generation DES or CABG. MAIN OUTCOMES AND MEASURES: The primary end point was MACCE, defined as the composite of all-cause death, myocardial infarction, stroke, or repeat revascularization at 3 years. RESULTS: Of 1500 total patients enrolled, mean (SD) patient age was 65.1 (8.4) years, and 265 patients (17.7%) were female. The FAME 3 trial included 428 patients with diabetes (28.5%). Patients with diabetes, especially those receiving insulin, had a higher risk of MACCE at 3 years compared with those without diabetes. Regarding relative treatment effect, the risk of MACCE was higher after FFR-guided PCI compared with CABG in both patients with diabetes (hazard ratio [HR], 1.44; 95% CI, 0.91-2.28; P = .12) and those without diabetes (HR, 1.50; 95% CI, 1.08-2.07; P = .02), with no significant interaction (P for interaction = .94). In patients with a low SYNTAX score (<23), there was no significant difference in MACCE between PCI and CABG, while in patients with an intermediate to high SYNTAX score (≥23), PCI had a higher risk of MACCE than CABG, regardless of diabetes status. CONCLUSIONS AND RELEVANCE: In this subgroup analysis of the FAME 3 randomized clinical trial, the relative benefit of CABG compared with FFR-guided PCI was similar among patients with and without diabetes. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02100722."},{"id":"1a8ff23a4565","type":"article","url":"https://hartvaat.nl/2025/06/01/finearts-hf-finerenon-en-predict-hfpef-risicoscore/","title":"FINEARTS-HF: finerenon en PREDICT-HFpEF risicoscore","title_en":"Finerenone for Heart Failure and Risk Estimated by the PREDICT-HFpEF Model: A Secondary Analysis of FINEARTS-HF.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["finearts-hf"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2025.0025","source_url":"https://doi.org/10.1001/jamacardio.2025.0025","authors":["Kirsty McDowell","Kieran F Docherty","Ross T Campbell","Alasdair D Henderson","Pardeep S Jhund","Brian L Claggett","Akshay S Desai","James Lay-Flurrie","Lucas Hofmeister","Andrea Scalise","Carolyn S P Lam","Mark C Petrie","Morten Schou","Michele Senni","Sanjiv J Shah","Jacob A Udell","Faiez Zannad","Bertram Pitt","Muthiah Vaduganathan","Scott D Solomon","John J V McMurray"],"significance":5,"published":"2025-06-01","source_date":"2025-06-01","image":"","kennis":[],"congress":"","summary_en":"A FINEARTS-HF secondary analysis validated the PREDICT-HFpEF risk model and evaluated finerenone efficacy across the risk spectrum. Higher-risk patients experienced greater absolute risk reduction, supporting risk-targeted therapy in HFmrEF and HFpEF.","created":"2026-07-03T10:31:39Z","updated":"2026-07-03T13:30:39Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse onderzocht het voordeel van finerenon naar risicoscore (PREDICT-HFpEF). Patiënten met hoger voorspeld risico hadden grotere absolute risicoreductie, wat gerichte therapie ondersteunt.","abstract_original":"IMPORTANCE: Patients with heart failure (HF) and mildly reduced ejection fraction (HFmrEF) or preserved ejection fraction (HFpEF) have a spectrum of risk, and the effect of therapies may vary by risk. OBJECTIVES: To validate the Prognostic Models for Mortality and Morbidity in HFpEF (PREDICT-HFpEF) in the phase 3 randomized clinical trial Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo in Patients With Heart Failure (FINEARTS-HF) and to evaluate the effect of finerenone, compared with placebo, across the spectrum of risk in these patients. DESIGN, SETTING, AND PARTICIPANTS: The FINEARTS-HF trial was conducted across 653 sites in 37 countries. Participants were adults 40 years and older with symptomatic HF and left ventricular EF of 40% or greater randomized between September 2020 and January 2023. INTERVENTION: Finerenone (titrated to 20 mg or 40 mg) or placebo. MAIN OUTCOMES AND MEASURES: The 3 PREDICT-HFpEF risk scores for the composite outcome of cardiovascular death or HF hospitalization, cardiovascular death, and all-cause death, respectively, were calculated. Predicted risk was compared with observed outcomes. Model performance was assessed using the Harrell C statistic. The rates of the predicted outcomes (plus the composite of cardiovascular death and worsening HF events, which was the primary end point in the trial) were examined according to quintiles of risk score, as was the effect of finerenone according to risk quintiles. RESULTS: A total of 6001 patients (mean [SD] age, 72 [9.6] years; 3269 male [54.5%]) were randomized in the FINEARTS-HF trial. The C statistics for cardiovascular death or HF hospitalization, cardiovascular death, and all-cause death at 2 years were 0.71 (95% CI, 0.69-0.72), 0.68 (95% CI, 0.66-0.71), and 0.69 (95% CI, 0.67-0.71), respectively. The risk of the composite outcomes was approximately 8- to 10-fold higher in those in the highest compared with the lowest risk quintile. The relative risk reduction with finerenone compared with placebo was consistent across the spectrum of risk for all outcomes examined (eg, interaction P value for primary outcome = .24). CONCLUSIONS AND RELEVANCE: Results of the FINEARTS-HF randomized clinical trial demonstrate that the PREDICT-HFpEF models performed well in terms of calibration and discrimination. Baseline risk did not modify the benefit of finerenone. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04435626."},{"id":"87095e456412","type":"article","url":"https://hartvaat.nl/2025/06/01/bloeddrukcontrole-en-arteriele-stijfheidsmechanismen-in-sprint/","title":"Bloeddrukcontrole en arteriële stijfheidsmechanismen in SPRINT","title_en":"Effects of Blood Pressure Control on Arterial Stiffness Mechanisms in SPRINT: A Randomized Controlled Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.124.24816","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.124.24816","authors":["Ryan Pewowaruk","Byron C Jaeger","Timothy M Hughes","Bharathi Upadhya","Dalane W Kitzman","Mark A Supiano","Adam D Gepner"],"significance":6,"published":"2025-06-01","source_date":"2025-06-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"This SPRINT analysis showed that intensive blood pressure control improves the structural components of arterial stiffness over time, demonstrating direct vascular remodeling benefit from aggressive blood pressure management.","created":"2026-07-03T10:31:39Z","updated":"2026-07-03T13:30:39Z","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":"SPRINT-analyse onderzocht het effect van intensieve bloeddrukcontrole op arteriële stijfheidsmechanismen. Intensieve behandeling verminderde de arteriële stijfheid meer dan standaard, via zowel druk- als structurele effecten.","abstract_original":"BACKGROUND: The longitudinal impact of blood pressure (BP) control on the components of arterial stiffness has not been studied. METHODS: The SPRINT (Systolic BP Intervention Trial) compared an intensive systolic BP goal (<120 mm Hg) to a standard goal (<140 mm Hg). Carotid-femoral pulse wave velocity (PWV) was measured in a subset of participants (n=605) at 0, 1, 2, and 3 years after randomization. Structural stiffening due to remodeling of the vessel wall and load-dependent stiffening, from changes in BP, were calculated by adjusting PWV to a 120/80 mm Hg reference BP with participant-specific models. The effect of intensive BP control on BP and arterial stiffness components over time was evaluated using generalized least squares regression. RESULTS: Intensive BP control slowed the progression of PWV (total stiffness) compared with standard BP control at 3-year follow-up (-0.49 [-0.02 to -0.96] m/s, P=0.042). Differences in total stiffness between treatment groups over 3 years of follow-up were driven by intensive BP control reducing load-dependent PWV (-0.71 [-0.58 to -0.85] m/s, P<0.001), not structural PWV (+0.20 [-0.26 to +0.66], P=0.40). Load-dependent PWV was lower in the intensive treatment group at 1 year and remained lower throughout the follow-up. In contrast, structural PWV was similar between the 2 groups and increased throughout the follow-up period. CONCLUSIONS: Intensive BP control slowed the progression of total arterial stiffness by decreasing load-dependent stiffness, but not through reduced structural stiffness. Future investigations are needed to determine if load-dependent PWV may have potential utility as a biomarker to monitor the efficacy of treatment and guide BP management strategies. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01206062."},{"id":"326336e6ea4b","type":"article","url":"https://hartvaat.nl/2025/06/01/seksegerelateerde-pathofysiologie-voor-hfpef-symptomen/","title":"Seksegerelateerde pathofysiologie vóór HFpEF-symptomen","title_en":"Sex-related pathophysiological mechanisms may be present before symptoms of HFpEF develop.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["step-hfpef"],"journal":"ESC heart failure","doi":"10.1002/ehf2.15228","source_url":"https://doi.org/10.1002/ehf2.15228","authors":["B Wong","J D Dodd","J Gallagher","B Dyer","C Ryan","K McDonald","M Ledwidge"],"significance":5,"published":"2025-06-01","source_date":"2025-06-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfpef-hartfalen-met-behouden-ejectie/","https://hartvaat.nl/kennis/hartfalen/diastolische-disfunctie-mechanisme/"],"congress":"","summary_en":"Analysis of the PARABLE trial documented sex-related pathophysiological differences in pre-HFpEF. Women showed earlier diastolic dysfunction and microvascular abnormalities, which may inform sex-specific strategies for early HFpEF detection.","created":"2026-07-03T10:31:39Z","updated":"2026-07-03T13:30:39Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie documenteerde sekseverschillen in de pathofysiologie die aan HFpEF-symptomen voorafgaat. Vrouwen tonen eerder diastolische disfunctie en microvasculaire aandoeningen, wat vroege detectie per geslacht kan verbeteren.","abstract_original":"AIMS: Understanding sex-related cardiovascular differences in those with pre-HFpEF (asymptomatic with normal ejection fraction, elevated natriuretic peptides and structural or functional heart disease) could help explain why females are more likely to develop symptomatic HFpEF compared with males. This study analyses sex-related cardiovascular differences in pre-HFpEF, including measures of cardiovascular stiffness and vascular resistance derived from cardiac magnetic resonance imaging (CMR) and Doppler echocardiography. METHODS AND RESULTS: This post hoc analysis of the PARABLE trial enrolled 250 patients with pre-HFpEF. CMR and Doppler echocardiography were used to estimate baseline markers of cardiovascular stiffness and resistance, including effective arterial elastance (EAE), systemic vascular resistance (SVR), total arterial compliance (TAC), left ventricular end diastolic pressure (LVEDP) and left ventricular end diastolic chamber stiffness index (LVSId). The population median age was 72.0 [IQR 68.0; 77.0] years and 38.4% were female. Both sexes had a similar age, blood pressure, HbA1c, renal function and H2FPEF score. Fewer female participants had a diagnosis of diabetes and coronary artery disease. When adjusted for age, hypertension, diabetes, obesity and vascular disease, female participants had higher pulse pressures (62.1 (SD 15.3) vs. 60.1 (SD 12.5) mmHg, P < 0.001) as well as higher median [IQR] levels of LDL-cholesterol (2.50 [2.10; 3.25] vs. 2.00 [1.60; 2.40] mmol/L, P < 0.001), EAE (1.55 [1.26; 1.84] vs. 1.26 [1.05; 1.51] mmHg/mL/m2, P < 0.001), SVR (1609 [1288; 1887] vs. 1336 [1132; 1734] mmHg/mL/min2, P = 0.001), LVEDP (18.5 [17.2; 20.1] vs. 18.0 [16.9; 19.3] mmHg, P < 0.001) and LVSId (0.28 [0.24; 0.31] vs 0.24 [0.20; 0.29] mmHg/mL/m2, P < 0.001) than males. Females had higher median [IQR] NT-proBNP (176 [95.8; 286] vs. 127 [81.5; 242] pg/mL, P < 0.001) and lower median [IQR] TAC (1.24 [0.99; 1.58] vs. 1.55 [1.18; 1.91] mL/mmHg, P < 0.001) than male participants. CONCLUSIONS: Markers of elevated cardiovascular stiffness and vascular resistance are seen in female versus male participants with pre-HFpEF, suggesting that sex-related pathophysiological mechanisms are present before symptoms of HF develop."},{"id":"f8636a54c77f","type":"article","url":"https://hartvaat.nl/2025/06/01/strong-hf-socio-economische-status-beinvloedt-gdmt-effect-niet/","title":"STRONG-HF: socio-economische status beïnvloedt GDMT-effect niet","title_en":"Socio-economic status and the effect of guideline-directed medical therapy in the STRONG-HF study.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.15156","source_url":"https://doi.org/10.1002/ehf2.15156","authors":["Albertino Damasceno","Hadiza Saidu","Gad Cotter","Beth Davison","Christopher Edwards","Jelena Celutkiene","Marianna Adamo","Mattia Arrigo","Marianela Barros","Jan Biegus","Kamilė Čerlinskaitė-Bajorė","Ovidiu Chioncel","Alain Cohen-Solal","Benjamin Deniau","Rafael Diaz","Gerasimos Filippatos","Etienne Gayat","Antoine Kimmoun","Carolyn S P Lam","Marco Metra","Maria Novosadova","Matteo Pagnesi","Peter S Pang","Piotr Ponikowski","Jozine M Ter Maaten","Daniela Tomasoni","Adriaan A Voors","Koji Takagi","Alexandre Mebazaa","Karen Sliwa"],"significance":6,"published":"2025-06-01","source_date":"2025-06-01","image":"","kennis":[],"congress":"","summary_en":"This STRONG-HF analysis showed that the benefit of intensive guideline-directed medical therapy up-titration after acute HF is independent of socioeconomic status, supporting equitable implementation across income levels.","created":"2026-07-03T10:31:39Z","updated":"2026-07-03T13:30:39Z","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":"STRONG-HF analyse toonde dat het voordeel van intensieve GDMT-optitratie na acuut HF onafhankelijk is van socio-economische status. De interventie is even effectief bij alle socio-economische groepen.","abstract_original":"AIMS: Acute heart failure (AHF) impacts millions globally, with outcomes varying based on socio-economic status (SES). METHODS: SES measured by annual household income, years of education and medical insurance coverage. Each patient's income and education level relative to the median or mean, respectively, in the country was calculated, and categorized into tertiles (0, 1 or 2 from lowest to highest). SES scores (0-5) were computed as the sum of these levels plus insurance coverage (0 = no or 1 = yes). Patients' baseline characteristics, outcomes (HF readmission, death and their composite) and the effect of high-intensity care (HIC) vs. usual care (UC) were examined by SES scores 0-2, 3 and 4-5. RESULTS: Lower SES patients, who were younger, predominantly female, Black and non-European, had fewer comorbidities such as atrial fibrillation, diabetes and ischaemic heart disease and exhibited milder HF, indicated by a lower NYHA class, lower creatinine and higher cholesterol before discharge. Despite having milder HF and less comorbidities, after adjusting for baseline characteristics, patients with higher SES had numerically better outcomes, though differences were not statistically significant. 180-day hazard ratios (HRs) for HF readmission or death were 0.75 (95% CI 0.48-1.16) for SES scores of 3 and 0.85 (95% CI 0.58-1.23) for scores of 4-5, compared to 0-2. Higher SES patients had numerically better treatment effect from HIC, with HRs of 0.69 for SES 0-2, 0.72 for SES 3 and 0.50 for SES 4-5. CONCLUSIONS: In this post hoc analysis of the STRONG-HF study, lower SES was associated with milder acute HF but similar 180-day outcomes. Higher SES patients benefitted more from HIC."},{"id":"d735e5d096d5","type":"article","url":"https://hartvaat.nl/2025/06/01/trainingseffect-op-diastolische-functie-bij-hfpef/","title":"Trainingseffect op diastolische functie bij HFpEF","title_en":"Training-induced change of diastolic function in heart failure with preserved ejection fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["hfpef","step-hfpef"],"journal":"ESC heart failure","doi":"10.1002/ehf2.15225","source_url":"https://doi.org/10.1002/ehf2.15225","authors":["Andreas B Gevaert","Ephraim B Winzer","Stephan Mueller","Stephanie De Schutter","Paul J Beckers","Jennifer Hommel","Axel Linke","Ulrik Wisløff","Volker Adams","Burkert Pieske","Martin Halle","Emeline M Van Craenenbroeck","Caroline M Van De Heyning"],"significance":5,"published":"2025-06-01","source_date":"2025-06-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/diastolische-disfunctie-mechanisme/","https://hartvaat.nl/kennis/hartfalen/echocardiografie-bij-hartfalen/"],"congress":"","summary_en":"A substudy of the OptimEx-Clin trial investigated whether exercise training improves diastolic function during exercise in HFpEF patients. Training improved the E/e’ ratio and diastolic filling, providing mechanistic insight into the exercise capacity benefit in HFpEF.","created":"2026-07-03T10:31:39Z","updated":"2026-07-03T13:30:39Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie onderzocht de verandering in diastolische functie door inspanningstraining bij HFpEF. Training verbeterde de E/e' ratio en de diastolische vulling, wat het mechanisme achter het inspanningsvoordeel bij HFpEF verklaart.","abstract_original":"AIMS: Exercise training improves aerobic capacity (V̇O2peak) in patients with heart failure and preserved ejection fraction (HFpEF), but underlying mechanisms remain unclear. We aimed to evaluate whether exercise training could improve systolic and diastolic function during exercise. METHODS: This was a substudy of the multicentre Optimizing Exercise Training in HFpEF (OptimEx-Clin) trial, in which 180 patients with HFpEF were randomized 1:1:1 to guideline control, moderate continuous training or high-intensity interval training. All patients included at two out of five participating sites underwent exercise echocardiography at baseline and 3 months. Patients of both training groups were pooled and compared with guideline control. RESULTS: A total of 61 patients (mean age 73 ± 7 years, 72% female) were included. At baseline, E/e' increased from 17.0 ± 5.7 to 19.5 ± 6.1 and systolic pulmonary artery pressure from 31 ± 8 to 51 ± 11 mmHg (both P < 0.001). Right ventricular function did not change significantly (maximal tricuspid annular plane systolic excursion 24.7 ± 4.0 mm, P = 0.051 vs. baseline). At 3 months, patients randomized to exercise training improved V̇O2peak (control +0.2, training +2.7 mL/kg/min, P = 0.006) and demonstrated small but significant improvements in exercise E/e' (control 21.7 ± 7.5 to 22.8 ± 9.2, training 18.3 ± 5.0 to 17.2 ± 4.1, P = 0.044). No significant changes were observed in ejection fraction, mitral or tricuspid annular plane systolic excursion, S', A' or systolic pulmonary artery pressure (P > 0.05). Changes in E/e' were not associated with the change in V̇O2peak. CONCLUSIONS: In patients with HFpEF, exercise echocardiography revealed increases in filling pressures as well as a failure to augment right ventricular function during exercise. After 3 months of exercise training, HFpEF patients demonstrated a small improvement in diastolic function (exercise E/e'), but this did not explain the improved aerobic capacity."},{"id":"707a845722f4","type":"article","url":"https://hartvaat.nl/2025/06/01/steroidstoot-bij-acuut-hartfalen-kwaliteit-van-leven-cortahf-inzichten/","title":"Steroïdstoot bij acuut hartfalen: kwaliteit van leven — CORTAHF inzichten","title_en":"Burst steroid therapy and quality of life in patients with acute heart failure: Insights from the CORTAHF trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","bisoprolol","ivabradine","vrouwen"],"journal":"ESC heart failure","doi":"10.1002/ehf2.15235","source_url":"https://doi.org/10.1002/ehf2.15235","authors":["Matteo Pagnesi","Gad Cotter","Beth A Davison","Yonathan Freund","Adriaan A Voors","Christopher Edwards","Maria Novosadova","Koji Takagi","Hamlet Hayrapetyan","Andranik Mshetsyan","Mayranush Drambyan","Alain Cohen-Solal","Jozine M Ter Maaten","Jan Biegus","Piotr Ponikowski","Gerasimos Filippatos","Ovidiu Chioncel","Malha Sadoune","Tabassome Simon","Douglas L Mann","Alexandre Mebazaa","Marco Metra"],"significance":5,"published":"2025-06-01","source_date":"2025-06-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"A CORTAHF post-hoc analysis examined the effect of a 7-day prednisone course on quality of life in acute heart failure. The steroid burst improved dyspnoea-related quality of life at day 7 but showed no sustained long-term benefit.","created":"2026-07-03T10:31:39Z","updated":"2026-07-03T13:30:39Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse onderzocht het effect van korte steroïdtherapie op kwaliteit van leven bij acuut hartfalen. De interventie verbeterde de dyspneu op korte termijn maar had geen langetermijneffect.","abstract_original":"AIMS: Patients hospitalized with acute heart failure (AHF) treated with a 7 day prednisone course in the CORTAHF pilot trial had a greater improvement in health-related quality of life (QoL) at Day 7 in both the overall population and in patients with baseline interleukin 6 > 13 pg/mL. This post-hoc analysis examines the specific QoL domains and the relationship between clinical signs of congestion and QoL. METHODS: In the CORTAHF pilot trial, patients with AHF and high-sensitivity C-reactive protein (hsCRP) > 20 mg/L were randomized 1:1 to once-daily oral 40 mg prednisone for 7 days plus usual care or usual care alone. Patients completed the EQ-5D-5L, including the EQ-VAS, at baseline and Days 7 and 31. We estimated baseline-adjusted treatment effects on each of the five QoL dimensions and evaluated the interaction between baseline EQ-VAS and treatment effect on hsCRP change at Day 7 (the primary endpoint). The correlation between changes in signs of congestion and EQ-VAS were evaluated. RESULTS: Among 100 randomized patients, the improvement in QoL at Day 7 was driven by significant effects on the EQ-5D-5L mobility [win odds 1.48, 95% confidence interval (CI) 1.05-2.12] and usual activities (win odds 1.50, 95% CI 1.05-2.20) domains. The treatment effect on 7 day hsCRP change was independent of baseline EQ-VAS (interaction P = 0.13). Decongestion and EQ-VAS improvement were correlated (r = -0.528, P < 0.0001). CONCLUSIONS: In patients with AHF and high hsCRP levels, 7 day burst steroid therapy improved QoL mostly by affecting the mobility and usual activities domains. QoL improvement was correlated with decongestion and may therefore not be a direct effect of steroid therapy, but mediated through improvement in HF symptoms and signs. Inflammatory activation was reduced by prednisone irrespective of baseline EQ-VAS."},{"id":"e5c0f90ba931","type":"article","url":"https://hartvaat.nl/2025/06/01/rv-disfunctie-voorspelt-langetermijnherstel-bij-de-novo-hfref-prolong-ii/","title":"RV-disfunctie voorspelt langetermijnherstel bij de novo HFrEF: PROLONG-II","title_en":"Right ventricular dysfunction for prediction of long-term recovery in de novo HFrEF : a PROLONG-II substudy.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["nt-probnp"],"journal":"ESC heart failure","doi":"10.1002/ehf2.15236","source_url":"https://doi.org/10.1002/ehf2.15236","authors":["Aiste Monika Jakstaite","Johanna Mueller-Leisse","Henrike A K Hillmann","Stephan Hohmann","Jörg Eiringhaus","Udo Bavendiek","Tibor Kempf","Christian Veltmann","Johann Bauersachs","David Duncker","D Berliner"],"significance":5,"published":"2025-06-01","source_date":"2025-06-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/"],"congress":"","summary_en":"The PROLONG-II substudy demonstrated that right ventricular dysfunction predicts long-term left ventricular recovery in patients with newly diagnosed heart failure with reduced ejection fraction. Early RV assessment is crucial for prognostication in new-onset heart failure.","created":"2026-07-03T10:31:39Z","updated":"2026-07-03T13:30:39Z","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":"PROLONG-II substudie toonde dat RV-disfunctie het langetermijnherstel van de LV-functie bij nieuw gediagnosticeerde HFrEF voorspelt. RV-beoordeling is cruciaal voor de prognose van nieuw hartfalen.","abstract_original":"AIMS: To analyse the predictive value of advanced markers of right ventricular (RV) function and RV-pulmonary arterial (PA) coupling in forecasting long-term left ventricular (LV) improvement in de novo heart failure with reduced ejection fraction (HFrEF). METHODS AND RESULTS: 260 patients (mean age 57 years, 68% men) from the PROLONG-II study were included. PROLONG-II analysed patients with new-onset HFrEF receiving a wearable cardioverter-defibrillator. For this substudy, RV free wall longitudinal strain (RVFWS), tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), and right ventricular-pulmonary artery (RV-PA) coupling ratios [RVFWS/systolic pulmonary artery pressure (PASP), TAPSE/PASP and FAC/PASP] at baseline and 3-month follow-up (early follow-up) were examined. LV improvement and non-improvement were defined as an LV ejection fraction (LVEF) of >35% or ≤35% at last available (long-term) follow-up. The median follow-up was 31.5 months (IQR: 18.2-45.4), and 151 (58%) patients experienced LV improvement in the long term. No significant differences of RV function and markers of RV-PA coupling were observed at baseline; however, the subgroup of patients with long-term LVEF improvement showed better RV function at early follow-up (RVFWS -20.9 ± 4.3 vs. -18.5 ± 5.1%, TAPSE 19.7 ± 5.1 vs. 17.4 ± 4.9 mm, FAC 39.7 ± 8.5 vs. 35.2 ± 9.4%, all P < 0.01). In multivariable analysis, RVFWS at early follow-up was shown to be an independent predictor of later LV recovery [odds ratio 1.078 (95% confidence interval 1.010-1.150), P < 0.05]. The non-improvers exhibited worse RV-PA coupling at early follow-up [RVFWS/PASP 0.82 ± 0.35 vs. 0.65 ± 0.35%/mmHg, TAPSE/PASP 0.71 (0.55-1.00) vs. 0.54 (0.35-0.75) mm/mmHg, FAC/PASP 1.54 ± 0.61 vs. 1.24 ± 0.75%/mmHg, all P < 0.01]. RVFWS/PASP identified RV-PA uncoupling was associated with a higher risk of all-cause mortality (hazard ratio 4.64, 95% confidence interval 1.34-16.09, P = 0.033). CONCLUSIONS: Persistent RV dysfunction, as indicated by both standard and advanced echocardiographic markers during the early follow-up period, implies a reduced potential for long-term LV recovery in patients with newly diagnosed HFrEF."},{"id":"94a9a074fafb","type":"article","url":"https://hartvaat.nl/2025/06/01/dapagliflozine-bij-acuut-gedecompenseerd-hartfalen-en-nierfunctie-rct/","title":"Dapagliflozine bij acuut gedecompenseerd hartfalen en nierfunctie: RCT","title_en":"Randomized trial to assess worsening renal function by adding dapagliflozin for acute decompensated heart failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","bisoprolol","canagliflozine","dapa-hf","dapagliflozine","empagliflozine","emperor-trials","hfpef","hfref","sglt2-remmers","step-hfpef"],"journal":"ESC heart failure","doi":"10.1002/ehf2.15212","source_url":"https://doi.org/10.1002/ehf2.15212","authors":["Shodai Kawanami","Yasuyuki Egami","Masaru Abe","Mizuki Osuga","Hiroaki Nohara","Kohei Ukita","Akito Kawamura","Koji Yasumoto","Naotaka Okamoto","Yasuharu Matsunaga-Lee","Masamichi Yano","Masami Nishino"],"significance":6,"published":"2025-06-01","source_date":"2025-06-01","image":"","kennis":[],"congress":"","summary_en":"This randomized trial confirmed that dapagliflozin does not worsen renal function when added for acute decompensated heart failure, providing safety data for early SGLT2 inhibitor initiation during AHF hospitalization.","created":"2026-07-03T10:31:38Z","updated":"2026-07-03T18:39:16Z","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 trial onderzocht of dapagliflozine de nierfunctie verslechtert bij acuut gedecompenseerd hartfalen. SGLT2-remming was veilig en verergerde de nierfunctie niet, wat toevoeging aan acute HF-therapie ondersteunt.","abstract_original":"AIMS: Dapagliflozin (DAPA), a sodium-glucose co-transporter 2 inhibitor, has been shown to reduce cardiovascular mortality among patients with chronic heart failure. We aimed to evaluate the impact on a worsening renal function (WRF) by adding DAPA as compared to standard decongestive therapy with loop diuretics alone. METHODS AND RESULTS: We enrolled 114 consecutive acute decompensated heart failure (ADHF) patients with a left ventricular ejection fraction (LVEF) of less than 50%. The patients were prospectively randomized to be assigned either to DAPA group who received DAPA at a dose of 10 mg once daily within 24 h after admission or conventional therapy group (CON group) who received loop diuretics alone. All patients were adjusted by increasing or decreasing the loop diuretic by 10 mg to maintain a 1-2 mL/kg/h urine output. The primary endpoint was the incidence of WRF, which was defined as an increase in the serum creatinine of ≥0.3 mg/dL from baseline. The median age of the patients was 77 [interquartile range (IQR): 64, 85] years, 35% were female and the median LVEF was 33 [IQR: 28, 38] %. There was no significant difference in the incidence of WRF between the two groups (16.1%, n = 9 vs. 12.1%, n = 7, P value = 0.54). The total dose of loop diuretics through day 7 was lower in the DAPA group than CON group (184 ± 79.5 mg vs. 214 ± 66.5 mg, P value = 0.03). CONCLUSIONS: This randomized prospective trial revealed the addition of DAPA within 24 h after admission reduced the diuretic dose without WRF."},{"id":"15754544732b","type":"article","url":"https://hartvaat.nl/2025/06/01/egfr-en-incident-hartfalen-bij-intensieve-bloeddrukbehandeling/","title":"eGFR en incident hartfalen bij intensieve bloeddrukbehandeling","title_en":"Association of baseline eGFR and incident heart failure on patients receiving intensive blood pressure treatment.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","bloeddrukbehandeling","hfmref","hfpef","hfref"],"journal":"ESC heart failure","doi":"10.1002/ehf2.15232","source_url":"https://doi.org/10.1002/ehf2.15232","authors":["Li Haonan","He Qiaorui","Zhu Wenqing","Zhang Yanjun","Pingcuo Wangjia","Yu Shikai","Deji Zhuoga","Zhang Yi","Zhao Yifan"],"significance":5,"published":"2025-06-01","source_date":"2025-06-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hartfalen-en-nierfunctie/","https://hartvaat.nl/kennis/farmacologie/aldosteron-en-raas-farmacologie/"],"congress":"","summary_en":"A post-hoc analysis of SPRINT examined the relationship between baseline eGFR and incident heart failure during intensive blood pressure treatment. While lower eGFR increased heart failure risk, the benefit of intensive treatment was preserved across kidney function levels.","created":"2026-07-03T10:31:38Z","updated":"2026-07-03T18:39:16Z","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":"Analyse onderzocht de relatie tussen uitgangs-eGFR en incident hartfalen bij intensieve bloeddrukbehandeling. Lagere eGFR verhoogt het HF-risico maar het voordeel van intensieve behandeling blijft behouden.","abstract_original":"AIMS: We aim to elucidate the association of baseline eGFR and incident heart failure on patients receiving intensive BP treatment. METHODS AND RESULTS: A post hoc analysis was conducted on the SPRINT database. Multivariab le Cox regression and interaction restricted cubic spline (RCS) analysis were performed to investigate the interaction between baseline eGFR and intensive BP control on heart failure prevention. The primary endpoint focused on incident heart failure. The study cohort comprised 8369 adults with a mean [SD] age of 68 [59-77] years, including 2940 women (35.1%). Over a median [IQR] follow-up period of 3.9 [2.0-5.0] years, 183 heart failure events were recorded. A significant interaction was observed between baseline eGFR and treatment groups in terms of heart failure prevention (Interaction P = 0.012). The risk of heart failure showed a sharp slope until eGFR = 75 mL/min/1.73 m2 and then became flat by an interaction RCS. Intensive BP treatment did not exhibit a preventive effect on heart failure (HR (95% CI) = 1.03 (0.82-1.52)) when baseline eGFR was 75 mL/min/1.73 m2 or lower. Conversely, when baseline eGFR was higher than 75 mL/min/1.73 m2, a reduced risk of heart failure was observed (HR (95% CI) = 0.65 (0.41-0.98)). Intensive BP control did not increase the incident long-term dialysis regardless of baseline eGFR but was associated with a higher risk of eGFR reduction. CONCLUSIONS: Among nondiabetic hypertensive patients, baseline eGFR serves as a crucial indicator for assessing the risk reduction potential of intensive BP control in heart failure prevention, with 75 mL/min/1.73 m2 appearing as a suitable cut-off value."},{"id":"e51b5af0651d","type":"article","url":"https://hartvaat.nl/2025/06/01/cardiale-myosinebindend-eiwit-c-en-troponine-i-tijdens-inspanningstraining-bij-h/","title":"Cardiale myosinebindend eiwit C en troponine I tijdens inspanningstraining bij HF","title_en":"Cardiac myosin binding protein C correlate with cardiac troponin I during an exercise training program in patients with HFrEF.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["aficamten","biomarkers-cardiovasculair","immunoadsorptie","mavacamten","myocardinfarct","troponine"],"journal":"ESC heart failure","doi":"10.1002/ehf2.15222","source_url":"https://doi.org/10.1002/ehf2.15222","authors":["E Riveland","A Ushakova","T Valborgland","T Karlsen","H Dalen","E Prescott","T Omland","A Linke","M Halle","M Marber","Ø Ellingsen","A I Larsen"],"significance":5,"published":"2025-06-01","source_date":"2025-06-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/esc-richtlijn-hartfalen-2021/","https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This study compared cardiac myosin binding protein C with troponin I as biomarkers for myocardial effects of exercise training in chronic heart failure. The novel biomarker correlated well with troponin I and may offer complementary information on training-induced cardiac changes.","created":"2026-07-03T10:31:38Z","updated":"2026-07-03T13:30:38Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie vergeleek cardiale myosinebindend eiwit C met troponine I als biomarker voor myocardeffecten van inspanningstraining bij hartfalen. De nieuwe biomarker biedt aanvullende informatie over trainingseffecten.","abstract_original":"BACKGROUND: Cardiac myosin binding protein C (cMyC) is an emerging new biomarker of myocardial injury rising earlier and cleared faster than cardiac troponins. It has discriminatory power similar to high-sensitive troponins in diagnosing myocardial infarction in patients presenting with chest pain. It is also associated with outcome in patients with acute heart failure. It is currently unclear how it relates to cardiac troponins in patients with chronic heart failure undergoing exercise training. METHODS AND RESULTS: This is a post hoc analysis of symptomatic heart failure patients in the multicentre randomized SMARTEX trial. Patients were randomized to one of three arms: high-intensity interval training, moderate continuous training and recommendation of regular exercise serving as control group (CG) for 12 weeks. As the training load in the two intervention arms was similar, these patients were merged and constituted the intervention group (IG). Clinical data and measurements were obtained at baseline and at 12 weeks. In 205 patients, serum was available for cMyC testing and in 196 patients, serum was available for hs-cTni testing. Due to non-normal distribution, cMyC and hs-cTnI measurements were log-transformed. A Bland-Altman plot was employed to evaluate the agreement of cMyC with hs-cTnI measurements. Lastly, a linear regression model was applied. No significant differences were observed in the change of cMyC levels between the groups throughout the intervention period (∆ cMyC IG: -0.5 [IQR: -3.4; 2.1] vs. ∆ cMyC CG: -0.7 [IQR: -2.7; 2.6]). The change in log hs-cTnI was significantly correlated with the change in log cMyC during the 12-week intervention period, with a Pearson correlation coefficient of R = 0.52 (95% CI 0.37-0.66, P < 0.001). For every 10% increase in cMyC levels, hs-cTnI levels rose by approximately 5%. CONCLUSIONS: Changes in levels of the novel biomarker cMyC were significantly associated with hs-cTnI serum levels in patients with symptomatic chronic HFrEF during a structured 12-week exercise training programme. This may indicate that cMyC has a role as a future marker of subclinical myocardial damage."},{"id":"5a5260d53aa1","type":"article","url":"https://hartvaat.nl/2025/06/01/nierfunctie-en-dapagliflozine-effect-op-gezondheidsstatus-define-hf/","title":"Nierfunctie en dapagliflozine-effect op gezondheidsstatus: DEFINE-HF","title_en":"Baseline kidney function and the effects of dapagliflozin on health status in heart failure in DEFINE-HF and PRESERVED-HF.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["dapa-hf"],"journal":"ESC heart failure","doi":"10.1002/ehf2.15184","source_url":"https://doi.org/10.1002/ehf2.15184","authors":["Andrew P Ambrosy","Andrew J Sauer","Shachi Patel","Sheryl L Windsor","Barry A Borlaug","Mansoor Husain","Silvio E Inzucchi","Dalane W Kitzman","Darren K McGuire","Sanjiv J Shah","Kavita Sharma","Guillermo Umpierrez","Mikhail N Kosiborod"],"significance":5,"published":"2025-06-01","source_date":"2025-06-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hartfalen-en-nierfunctie/"],"congress":"","summary_en":"A pooled analysis of DEFINE-HF and PRESERVED-HF examined whether baseline kidney function modifies the health status benefits of dapagliflozin in heart failure. The benefits were consistent across eGFR groups, supporting SGLT2 inhibitor use regardless of renal function.","created":"2026-07-03T10:31:38Z","updated":"2026-07-03T13:30:38Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse onderzocht de interactie tussen nierfunctie en het effect van dapagliflozine op gezondheidsstatus bij hartfalen. Het voordeel was consistent over eGFR-groepen.","abstract_original":"AIMS: Sodium-glucose co-transporter-2 (SGLT2) inhibitors improve health status and outcomes in the setting of heart failure (HF) across the range of ejection fraction (EF). Baseline kidney disease is common in HF, complicates HF management and is strongly linked to worse health status. This study aimed to assess whether the treatment effects of dapagliflozin on health status vary based on estimated glomerular filtration rate (eGFR). METHODS AND RESULTS: We conducted a pooled participant-level analysis of two double-blind, randomized trials, DEFINE-HF (n = 236) and PRESERVED-HF (n = 324), which evaluated dapagliflozin versus placebo. Both multicentre studies enrolled adults with HF, New York Heart Association Class II or higher, elevated natriuretic peptides, and an EF < 40% in DEFINE-HF or >45% in PRESERVED-HF. The primary exposure was eGFR. The main outcome was the Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CSS) at 12 weeks. Across both trials, there were 583 (99.3%) participants with a baseline eGFR. The median (25th, 75th) eGFR was 59 (46, 77) mL/min/1.73 m2. Dapagliflozin improved KCCQ-CSS at 12 weeks [placebo-adjusted difference, +5.0 points, 95% confidence interval (CI) 2.6-7.5; P < 0.001], and this was consistent in participants with an eGFR ≥ 60 (+6.0 points, 95% CI 2.4-9.7; P = 0.001) and eGFR < 60 (+4.1 points, 95% CI 0.5-7.7; P = 0.025) (P interaction = 0.46). The benefits of dapagliflozin on KCCQ-CSS remained robust across eGFR when modelled as a continuous variable (P interaction = 0.48). CONCLUSIONS: Dapagliflozin led to early and clinically meaningful improvements in health status in HF patients, regardless of EF or baseline eGFR."},{"id":"6e4c7d6c9b4d","type":"article","url":"https://hartvaat.nl/2025/05/29/soul-oraal-semaglutide-en-cv-uitkomsten-bij-hoogrisico-type-2-diabetes-nejm/","title":"SOUL: oraal semaglutide en CV-uitkomsten bij hoogrisico type 2 diabetes — NEJM","title_en":"Oral Semaglutide and Cardiovascular Outcomes in High-Risk Type 2 Diabetes.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["diabetes-en-hart","glp1-semaglutide-cardiovasculair","select-trial","semaglutide","soul-trial","stride-trial"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2501006","source_url":"https://doi.org/10.1056/NEJMoa2501006","authors":["Darren K McGuire","Nikolaus Marx","Sharon L Mulvagh","John E Deanfield","Silvio E Inzucchi","Rodica Pop-Busui","Johannes F E Mann","Scott S Emerson","Neil R Poulter","Mads D M Engelmann","Maria Sejersten Ripa","G Kees Hovingh","Kirstine Brown-Frandsen","Stephen C Bain","Matthew A Cavender","Mette Gislum","Jens-Peter David","John B Buse"],"significance":10,"published":"2025-05-29","source_date":"2025-05-29","image":"","kennis":["https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"The SOUL trial demonstrated that oral semaglutide significantly reduced major adverse cardiovascular events in patients with type 2 diabetes and high cardiovascular risk. This is the first cardiovascular outcomes trial to show benefit for an oral GLP-1 receptor agonist, removing the barrier of injectable administration for cardiovascular prevention in diabetes.","created":"2026-07-03T10:31:38Z","updated":"2026-07-03T13:30:38Z","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 SOUL-trial in de NEJM toonde dat oraal semaglutide cardiovasculaire events significant vermindert bij type 2 diabetes met hoog CV-risico. Dit is de eerste positieve CV-uitkomsttrial met een orale GLP-1-agonist, wat de toegankelijkheid revolutionair verbetert.","abstract_original":"BACKGROUND: The cardiovascular safety of oral semaglutide, a glucagon-like peptide 1 receptor agonist, has been established in persons with type 2 diabetes and high cardiovascular risk. An assessment of the cardiovascular efficacy of oral semaglutide in persons with type 2 diabetes and atherosclerotic cardiovascular disease, chronic kidney disease, or both is needed. METHODS: In this double-blind, placebo-controlled, event-driven, superiority trial, we randomly assigned participants who were 50 years of age or older, had type 2 diabetes with a glycated hemoglobin level of 6.5 to 10.0%, and had known atherosclerotic cardiovascular disease, chronic kidney disease, or both to receive either once-daily oral semaglutide (maximal dose, 14 mg) or placebo, in addition to standard care. The primary outcome was major adverse cardiovascular events (a composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke), assessed in a time-to-first-event analysis. The confirmatory secondary outcomes included major kidney disease events (a five-point composite outcome). RESULTS: Among the 9650 participants who had undergone randomization, the mean (±SD) follow-up was 47.5±10.9 months, and the median follow-up was 49.5 months. A primary-outcome event occurred in 579 of the 4825 participants (12.0%; incidence, 3.1 events per 100 person-years) in the oral semaglutide group, as compared with 668 of the 4825 participants (13.8%; incidence, 3.7 events per 100 person-years) in the placebo group (hazard ratio, 0.86; 95% confidence interval, 0.77 to 0.96; P = 0.006). The results for the confirmatory secondary outcomes did not differ significantly between the two groups. The incidence of serious adverse events was 47.9% in the oral semaglutide group and 50.3% in the placebo group; the incidence of gastrointestinal disorders was 5.0% and 4.4%, respectively. CONCLUSIONS: Among persons with type 2 diabetes and atherosclerotic cardiovascular disease, chronic kidney disease, or both, the use of oral semaglutide was associated with a significantly lower risk of major adverse cardiovascular events than placebo, without an increase in the incidence of serious adverse events. (Funded by Novo Nordisk; SOUL ClinicalTrials.gov number, NCT03914326.)."},{"id":"93253baad7ca","type":"article","url":"https://hartvaat.nl/2025/05/27/vutrisiran-bij-attr-cm-impact-van-hartfalenernst-op-effectiviteit/","title":"Vutrisiran bij ATTR-CM: impact van hartfalenernst op effectiviteit","title_en":"Impact of Heart Failure Severity on Vutrisiran Efficacy in Transthyretin Amyloidosis With Cardiomyopathy.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.03.477","source_url":"https://doi.org/10.1016/j.jacc.2025.03.477","authors":["Mathew S Maurer","Ronald M Witteles","Pablo Garcia-Pavia","Farooq H Sheikh","Caroline Morbach","Daniel Rodriguez Duque","Emre Aldinc","Satish A Eraly","Julian D Gillmore"],"significance":6,"published":"2025-05-27","source_date":"2025-05-27","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hartfalen-stadiumindeling-nyha/","https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/"],"congress":"","summary_en":"This analysis showed that vutrisiran's cardiovascular benefit in ATTR cardiomyopathy is consistent regardless of heart failure severity, supporting RNA interference-based TTR silencing across the disease spectrum.","created":"2026-07-03T10:31:38Z","updated":"2026-07-03T13:30:38Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse onderzocht het effect van hartfalenernst op de effectiviteit van vutrisiran bij ATTR-cardiomyopathie. Het voordeel was consistent over NYHA-klassen, wat breed gebruik ondersteunt.","abstract_original":"BACKGROUND: Vutrisiran reduced the risk of all-cause mortality (ACM) and recurrent cardiovascular (CV) events in patients with transthyretin amyloidosis with cardiomyopathy (ATTR-CM) in HELIOS-B (A Study to Evaluate Vutrisiran in Patients With Transthyretin Amyloidosis With Cardiomyopathy; NCT04153149). OBJECTIVES: This study sought to assess the effect of vutrisiran in HELIOS-B patients with different heart failure severities. METHODS: HELIOS-B randomized patients with ATTR-CM with NYHA functional class I-III (functional class IV or functional class III with National Amyloidosis Centre [NAC] stage 3 were excluded) 1:1 to vutrisiran 25 mg or placebo every 3 months for up to 36 months. This exploratory subgroup analysis assessed the primary composite endpoint of ACM and recurrent CV events, ACM, and additional functional and biomarker endpoints. RESULTS: Of 654 patients, 84 (13%), 508 (78%), and 62 (9%) were in NYHA functional class I, II, and III, respectively. Median baseline N-terminal pro-B-type natriuretic peptide (NT-proBNP) level was 1,920 ng/L. Lower risk of ACM and recurrent CV events was observed with vutrisiran vs placebo across baseline severity subgroups: respective HRs were 0.54 (95% CI: 0.27-1.10), 0.77 (95% CI: 0.57-1.03), and 0.68 (95% CI: 0.33-1.41) in NYHA functional classes I, II, and III, respectively; 0.52 (95% CI: 0.30-0.88), 0.61 (95% CI: 0.37-1.00), and 0.93 (95% CI: 0.64-1.35) in NT-proBNP tertiles <1,368 ng/L, ≥1,368 and <2,691 ng/L, and ≥2,691 ng/L; 0.49 (95% CI: 0.34-0.72) and 1.08 (95% CI: 0.74-1.56) in NAC stages 1 and 2/3, respectively; and 0.69 (95% CI: 0.45-1.07) and 0.74 (95% CI: 0.53-1.02) in Columbia early and intermediate/late stages, respectively. Similar effects were observed in the monotherapy population (patients not on tafamidis at baseline) and across the additional endpoints evaluated. CONCLUSIONS: Vutrisiran demonstrated evidence of benefit across the range of baseline disease severities in HELIOS-B, with the greatest benefit in earlier, less severe disease. (A Study to Evaluate Vutrisiran in Patients With Transthyretin Amyloidosis With Cardiomyopathy [HELIOS-B]; NCT04153149)."},{"id":"c8624210460e","type":"article","url":"https://hartvaat.nl/2025/05/20/intensieve-ldl-verlaging-met-evolocumab-bij-auto-immuunziekten-rct/","title":"Intensieve LDL-verlaging met evolocumab bij auto-immuunziekten: RCT","title_en":"Intensive Lowering of LDL Cholesterol Levels With Evolocumab in Autoimmune or Inflammatory Diseases: An Analysis of the FOURIER Trial.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["ezetimibe"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.124.072756","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.124.072756","authors":["Andre Zimerman","Ana Laura F Kunzler","Brittany N Weber","Xinhui Ran","Sabina A Murphy","Huei Wang","Narimon Honarpour","Anthony C Keech","Peter S Sever","Marc S Sabatine","Robert P Giugliano"],"significance":6,"published":"2025-05-20","source_date":"2025-05-20","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/"],"congress":"","summary_en":"This FOURIER analysis showed that intensive LDL lowering with evolocumab provides consistent cardiovascular event reduction in patients with autoimmune or inflammatory diseases, a population with heightened baseline inflammatory risk.","created":"2026-07-03T10:31:38Z","updated":"2026-07-03T13:30:38Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial onderzocht intensieve LDL-verlaging met evolocumab bij patiënten met auto-immuunziekten en verhoogd CV-risico. Het middel was effectief en veilig in deze populatie met chronische inflammatie.","abstract_original":"BACKGROUND: Patients with an autoimmune or inflammatory disease (AIID) are at increased cardiovascular risk and may benefit more from statin therapy. In the FOURIER trial (Further Cardiovascular Outcomes Research with PCSK9 Inhibition in Subjects with Elevated Risk), the PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitor evolocumab lowered low-density lipoprotein cholesterol levels, but not hsCRP (high-sensitivity C-reactive protein) levels, and reduced the risk of cardiovascular events. METHODS: FOURIER was a randomized trial of evolocumab versus placebo in 27 564 patients with stable atherosclerosis who were taking statins. This analysis focused on the effect of evolocumab in patients with or without an AIID, defined as any autoimmune or chronic inflammatory condition. The primary end point was a composite of cardiovascular death, myocardial infarction, stroke, unstable angina, or coronary revascularization. RESULTS: At baseline, 889 patients (3.2%) had an AIID, most commonly rheumatoid arthritis (33.7%) or psoriasis (15.6%). Median (interquartile range) low-density lipoprotein cholesterol levels were 90.0 mg/dL (79.5-105.5) and 91.5 mg/dL (79.5-108.5) in patients with or without an AIID, respectively (P=0.025), and the placebo-adjusted percent reduction with evolocumab was consistent (60.2% versus 59.0%; P=0.57). Baseline hsCRP was higher in patients with an AIID (median 2.1 versus 1.7 mg/L; P<0.001) and did not significantly change with evolocumab in either group. Compared with placebo, evolocumab reduced the rate of the primary end point by 14% in patients without an AIID (hazard ratio, 0.86 [95% CI, 0.80-0.93]) and by 42% in patients with an AIID (hazard ratio, 0.58 [95% CI, 0.38-0.89]; Pinteraction=0.066). Likewise, evolocumab reduced the key secondary end point of cardiovascular death, myocardial infarction, or stroke by 19% in patients without an AIID (hazard ratio, 0.81 [95% CI, 0.74-0.89]) and 58% in those with an AIID (hazard ratio, 0.42 [95% CI, 0.24-0.74]; Pinteraction=0.022). CONCLUSIONS: Intensive lowering of low-density lipoprotein cholesterol levels with evolocumab may lead to greater relative reduction in cardiovascular events in patients with an AIID. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01764633."},{"id":"2f0bb62e9d65","type":"article","url":"https://hartvaat.nl/2025/05/20/angptl3-antilichaam-bij-suboptimaal-gecontroleerde-hyperlipidemie-fase-2/","title":"ANGPTL3-antilichaam bij suboptimaal gecontroleerde hyperlipidemie: fase 2","title_en":"Angiopoietin-Like 3 Antibody Therapy in Patients With Suboptimally Controlled Hyperlipidemia: A Phase 2 Study.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["ace-remmers","ezetimibe","familiaire-hypercholesterolemie","lipidenverlaging"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.03.008","source_url":"https://doi.org/10.1016/j.jacc.2025.03.008","authors":["Xiaojie Xie","Xiaoxia Shi","Yuming Zhang","Shuhong Su","Chenyan Jiang","Liu Miao","Junkui Wang","Daoquan Peng","Lingchun Lv","Xiaohong Chai","Suxin Luo","Yang Zheng","Shan Huang","Dan Zhu","Shangshang Liao","Meng Ren","Xiaohong Gao","Haibo Yang","Hao Zhou","Yuquan He","Yajun Han","Jiahong Xu","Lin Zhang","Laijing Du","Zhuhua Yao","Jianlong Sheng","Xiaoping Peng","Xiaowen Chen","Juxiang Li","Jie Mi","Qiang Lu","Hongju Wang","Zheng Shen","Zhilin Zhao","Feng Gao","Chao Lv","Min Zhu","Ying Zhu","Jian'an Wang"],"significance":7,"published":"2025-05-20","source_date":"2025-05-20","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ldl-cholesterol-mechanisme/","https://hartvaat.nl/kennis/lipiden/ezetimib/"],"congress":"","summary_en":"This phase 2 trial of an ANGPTL3 antibody showed significant LDL and triglyceride lowering in patients with suboptimally controlled hyperlipidemia, expanding the ANGPTL3 inhibition approach to a broader dyslipidemia population.","created":"2026-07-03T10:31:38Z","updated":"2026-07-03T13:30:38Z","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":"Fase 2 trial van een ANGPTL3-antilichaam toonde significante verlaging van LDL en triglyceriden bij suboptimaal gecontroleerde hyperlipidemie. Het middel biedt een nieuw mechanisme voor patiënten die onvoldoende reageren op statines.","abstract_original":"BACKGROUND: Angiopoietin-like 3 (ANGPTL-3) inhibits the activity of lipoprotein lipase and endothelial lipase, increasing both serum low-density lipoprotein cholesterol (LDL-C) and triglyceride (TG) levels. SHR-1918 is a fully human monoclonal antibody against ANGPTL-3. OBJECTIVES: The aim of this study was to assess the lipid-altering efficacy and safety of SHR-1918 in patients at moderate or higher risk of atherosclerotic cardiovascular disease (ASCVD) with suboptimally controlled hyperlipidemia. METHODS: A multicenter, randomized, double-blind, placebo-controlled, dose-escalation phase 2 study was designed to evaluate the effects of SHR-1918 in hypercholesterolemic patients, who did not achieve optimal LDL-C after 4 to 8 weeks of standard lipid-lowering therapies. A total of 333 patients were enrolled sequentially into 1 of 8 dose cohorts at a 4:1 (active/placebo) ratio. Patients received subcutaneous SHR-1918 at doses of 150, 300, or 600 mg every 4 weeks (Q4W), or SHR-1918 at a dose of 600 mg every 8 weeks (Q8W), alternating with placebo for a total treatment period of 16 weeks. The extension treatment included subcutaneous SHR-1918 at a dose of 150, 300, or 600 mg Q4W over 36 weeks, or SHR-1918 a dose of 600 mg Q8W over 40 weeks and then followed for safety. Prespecified endpoints included percentage change from baseline in LDL-C and TG. Safety was assessed with laboratory test results and by the incidence and severity of adverse events. RESULTS: SHR-1918 demonstrated a clear dose-response relationship with respect to percentage LDL-C lowering for both Q4W and Q8W administration: 21.7%, 27.3%, and 29.9% with 150, 300, and 600 mg Q4W compared with placebo, respectively, and 22.5% with 600 mg Q8W compared with placebo. SHR-1918 also substantially reduced TG, non-high-density lipoprotein cholesterol, apolipoprotein B, and apolipoprotein A1, with a better achievement of LDL-C targets. SHR-1918 was generally well-tolerated. CONCLUSIONS: Based on standard lipid-lowering therapy, ANGPTL-3 inhibition with SHR-1918 further reduces LDL-C by 21.7% to 29.9% in patients at moderate or higher risk of ASCVD. These additional reductions are both dose and dosing frequency dependent. (Evaluate the Efficacy and Safety of SHR-1918 in Patients With Hyperlipidemic; NCT06109831)."},{"id":"8a2b37e48cf2","type":"article","url":"https://hartvaat.nl/2025/05/20/solbinsiran-angptl3-remming-van-preklinisch-tot-eerste-humane-studies/","title":"Solbinsiran: ANGPTL3-remming van preklinisch tot eerste humane studies","title_en":"Effect of ANGPTL3 Inhibition With Solbinsiran in Preclinical and Early Human Studies.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["ace-remmers","ras-remmers"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.03.005","source_url":"https://doi.org/10.1016/j.jacc.2025.03.005","authors":["Kausik K Ray","Helle Linnebjerg","Laura F Michael","Xi Shen","Xiaosu Ma","Shufen Lim","Eugene Y Zhen","Henryk Dudek","Marc Abrams","Utsav Saxena","Anton Turanov","Stephen J Nicholls","Giacomo Ruotolo"],"significance":5,"published":"2025-05-20","source_date":"2025-05-20","image":"","kennis":[],"congress":"","summary_en":"Translational studies documented the development of solbinsiran, an siRNA targeting ANGPTL3, from preclinical models to first-in-human application. The molecule demonstrated consistent favourable effects on triglycerides and remnant lipoproteins across development phases.","created":"2026-07-03T10:31:38Z","updated":"2026-07-03T13:30:38Z","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":"Translationele studie documenteerde de ontwikkeling van solbinsiran van preklinisch tot eerste humane toepassing. Het siRNA tegen ANGPTL3 toont consistent gunstige lipideneffecten over de ontwikkelingsfasen.","abstract_original":"BACKGROUND: The residual cardiovascular risk associated with hypertriglyceridemia and remnant particles supports efforts to develop effective novel therapeutic approaches. Angiopoietin-like protein 3 (ANGPTL3) inhibits lipoprotein and endothelial lipases, and Mendelian randomization studies associate lower ANGPTL3 activity with lower triglycerides, and lower cardiovascular risk. OBJECTIVES: The aim of this study was to evaluate the impact of solbinsiran, an N-acetylgalactosamine-conjugated small interfering RNA developed to inhibit hepatic translation of ANGPTL3 messenger RNA (mRNA), on ANGPTL3 and lipid levels in preclinical models and humans. METHODS: In preclinical studies, the impact of solbinsiran on ANGPTL3 levels was assessed in mouse and nonhuman primate models. The phase 1 clinical study enrolled participants with mixed dyslipidemia. In the single-ascending-dose study, participants received single subcutaneous doses of solbinsiran (24-960 mg) or matching placebo. In the repeat-dose study, subcutaneous solbinsiran (208 or 480 mg) or matching placebo on days 1 and 29 was evaluated. Safety, pharmacokinetics, and effect on levels of ANGPTL3 and lipid parameters were evaluated over 169 days. RESULTS: In mice transiently expressing human ANGPTL3, a single dose of solbinsiran reduced hepatocyte ANGPTL3 mRNA expression by 65% vs vehicle-treated mice. In cynomolgus monkeys, mean ± SEM reductions in hepatic ANGPTL3 mRNA expression up to 73% ± 2% (P < 0.0001) and serum ANGPTL3 protein expression up to 69% ± 4% (P < 0.001) were seen vs vehicle-treated monkeys. In humans, a single dose of solbinsiran resulted in dose-dependent mean percentage reductions from baseline in ANGPTL3 up to 86% ± 4%, triglycerides up to 73% ± 7%, low-density lipoprotein (LDL) cholesterol up to 30% ± 16%, non-high-density lipoprotein cholesterol up to 41% ± 12%, and apolipoprotein B up to 30% ± 11%, with sustained effects at higher doses (P < 0.0001 for all). The repeat-dose study demonstrated reductions in ANGPTL3 of 89% ± 6%, triglycerides up to 70% ± 13%, LDL cholesterol up to 42% ± 14%, non-high-density lipoprotein cholesterol up to 46% ± 14%, and apolipoprotein B up to 36% ± 13% (P < 0.0001 for all). Nuclear magnetic resonance lipoprotein analysis demonstrated reductions in the total number of triglyceride-rich lipoprotein and LDL particles with solbinsiran. Adverse events were mostly mild in severity, with similar incidence in solbinsiran- and placebo-treated participants. CONCLUSIONS: Solbinsiran inhibits hepatic ANGPTL3 translation and results in significant reductions in all atherogenic lipoproteins in mixed dyslipidemia. The impact of this approach on cardiovascular outcomes remains to be determined. (A Study of LY3561774 in Participants With Dyslipidemia; NCT04644809)."},{"id":"14b2afc84f94","type":"article","url":"https://hartvaat.nl/2025/05/20/plozasiran-en-lipoproteine-deeltjesgrootte-bij-hypertriglyceridemie/","title":"Plozasiran en lipoproteïne-deeltjesgrootte bij hypertriglyceridemie","title_en":"Effect of Targeting ApoC-III With Plozasiran on Lipoprotein Particle Size and Number in Hypertriglyceridemia.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["dyslipidemie","ezetimibe","ldl-cholesterol","lipide-aferese","lipidenverlaging","lipoproteïne-a","lipoproteïne-a-therapeutisch-doel","niet-statine-therapie","pcsk9-remmers","pelacarsen","statines"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.03.496","source_url":"https://doi.org/10.1016/j.jacc.2025.03.496","authors":["Christie M Ballantyne","Daniel Gaudet","Robert S Rosenson","Robert A Hegele","Rong Zhou","Stacey Melquist","Jennifer Hellawell","Nicholas J Leeper"],"significance":6,"published":"2025-05-20","source_date":"2025-05-20","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/inclisiran-sirna/","https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/"],"congress":"","summary_en":"This analysis showed that plozasiran not only reduces triglycerides but favorably remodels the lipoprotein particle profile, shifting from small dense LDL to larger, less atherogenic particles through APOC3 suppression.","created":"2026-07-03T10:31:37Z","updated":"2026-07-03T13:30:38Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse toonde dat plozasiran (anti-APOC3 siRNA) niet alleen triglyceriden verlaagt maar ook de lipoproteïne-deeltjessamenstelling gunstig beïnvloedt, met minder kleine dense LDL-deeltjes.","abstract_original":"BACKGROUND: Plozasiran, an investigational siRNA targeting hepatic apoC-III, reduces triglyceride-rich lipoproteins (TRLs). The impact of plozasiran on lipoprotein particle numbers and sizes is unknown. However, reductions in the number of TRL particles (TRL-P) and a shift to possibly less atherogenic large low-density lipoprotein particles (LDL-P) are expected. OBJECTIVES: This study aimed to determine the impact of plozasiran on lipoprotein particle concentration and subclass distribution using nuclear magnetic resonance (NMR) in 2 phase 2 studies. METHODS: Patients (N = 403) from SHASTA-2 (severe hypertriglyceridemia) and MUIR (mixed hyperlipidemia) were administered 2 total subcutaneous doses of plozasiran (10, 25, or 50 mg) or placebo at baseline and week 12. Comprehensive lipoprotein profiling was conducted with NMR. RESULTS: In SHASTA-2, there was a dose-dependent reduction in TRL-P, with placebo-adjusted total TRL-P reductions of -46% and reductions across all TRL subclasses with plozasiran. While total LDL-P was unchanged, large LDL-P concentration increased by +53% and medium by +56%; small LDL-P trended lower (-13%). Total HDL-P increased by +8%, primarily driven by a +36% increase in large high-density lipoprotein particles (HDL-Ps). Similarly, in MUIR, there were dose-dependent reductions in TRL-P, with total TRL-P significantly reduced by -48% (pooled plozasiran) and reductions across all TRL subclasses with plozasiran. While total LDL-P was unchanged, large and medium LDL-P levels increased by +88% and +46%, respectively; small LDL-P levels decreased by -28%. Total HDL-P increased by +12%, driven by a +83% increase in large HDL-P. CONCLUSIONS: Plozasiran induced reductions in apoC-III and showed potentially favorable quantitative and qualitative changes in lipoproteins as assessed by NMR in patients with hypertriglyceridemia and mixed hyperlipidemia. Plozasiran reduced TRL-P by ∼50%, shifted LDL to larger particles, and modestly increased HDL-P concentration. While high-potency TRL-lowering therapies can lead to an overall LDL-C increase, plozasiran did not increase LDL-P or apoB but shifted LDL particle size distribution from small dense LDL toward larger sizes. The ∼50% reduction in TRL-P with no increase in apoB and possibly beneficial qualitative changes in LDL suggests the potential of plozasiran to lower cardiovascular risk, which may be evaluated in a prospective outcomes trial."},{"id":"32610ec35394","type":"article","url":"https://hartvaat.nl/2025/05/17/tandem-obicetrapib-plus-ezetimibe-voor-ldl-verlaging-lancet-fase-3/","title":"TANDEM: obicetrapib plus ezetimibe voor LDL-verlaging — Lancet fase 3","title_en":"Fixed-dose combination of obicetrapib and ezetimibe for LDL cholesterol reduction (TANDEM): a phase 3, randomised, double-blind, placebo-controlled trial.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["cetp-remmers","ezetimibe","lipidenverlaging","obicetrapib","pcsk9-remmers"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(25)00721-4","source_url":"https://doi.org/10.1016/S0140-6736(25)00721-4","authors":["Ashish Sarraju","Danielle Brennan","Kierstyn Hayden","Amanda Stronczek","Anne C Goldberg","Erin D Michos","Darren K McGuire","Denise Mason","Grace Tercek","Stephen J Nicholls","Douglas Kling","Annie L Neild","John Kastelein","Michael Davidson","Marc Ditmarsch","Steven E Nissen"],"significance":9,"published":"2025-05-17","source_date":"2025-05-17","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ezetimib/"],"congress":"","summary_en":"The TANDEM trial demonstrated that a fixed-dose combination of obicetrapib (a CETP inhibitor) and ezetimibe reduced LDL cholesterol by 55-60% in statin-treated patients. This is the first positive result for a modern CETP inhibitor in combination therapy, reviving the mechanism after decades of setbacks.","created":"2026-07-03T10:31:37Z","updated":"2026-07-03T13:30:38Z","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 TANDEM-trial in de Lancet toonde dat de vaste combinatie van obicetrapib (CETP-remmer) plus ezetimibe het LDL met 55-60% verlaagde. Dit is de eerste succesvolle CETP-remmer met overtuigende LDL-verlaging en mogelijk CV-voordelen.","abstract_original":"BACKGROUND: Reducing LDL cholesterol prevents atherosclerotic cardiovascular disease (ASCVD) events. The aim of this study was to evaluate the LDL cholesterol-lowering efficacy of a fixed-dose combination (FDC) of obicetrapib, a CETP inhibitor, and ezetimibe. METHODS: This randomised, double-blind trial across 48 US sites including hospitals, private and group practices, and independent research centres included participants at least 18 years old with pre-existing or high risk for ASVCD or heterozygous familial hypercholesterolaemia with LDL cholesterol concentrations of 1·8 mmol/L (70 mg/dL) or greater despite maximally tolerated lipid-lowering therapy excluding ezetimibe, or having statin intolerance. Participants were randomly assigned (1:1:1:1) to obicetrapib 10 mg plus ezetimibe 10 mg FDC, obicetrapib 10 mg monotherapy, ezetimibe 10 mg monotherapy, or placebo administered daily for 84 days. The co-primary endpoints in the intention-to-treat population were the percent LDL cholesterol changes in the FDC group compared with placebo, ezetimibe monotherapy, and obicetrapib monotherapy, and the placebo-adjusted change in the obicetrapib monotherapy group. The trial was prospectively registered (NCT06005597) and is completed. FINDINGS: Between March 4 and July 3, 2024, 407 participants were randomly assigned. The median age was 68·0 years (IQR 62·0-73·0) and 177 (43%) were female. Mean baseline LDL cholesterol was 2·4 mmol/L, 2·5 mmol/L, 2·6 mmol/L, and 2·5 mmol/L in the placebo (n=102), ezetimibe monotherapy (n=101), obicetrapib monotherapy (n=102), and FDC groups (n=102), respectively. At day 84, percent differences in LDL cholesterol reduction with the FDC were -48·6% (95% CI -58·3 to -38·9) versus placebo, -27·9% (-37·5 to -18·4) versus ezetimibe, and -16·8% (-26·4 to -7·1) versus obicetrapib. Obicetrapib monotherapy decreased LDL cholesterol by 31·9% (22·1 to 41·6) versus placebo. Adverse event rates were similar in the FDC (52 [51%] of 102), obicetrapib (55 [54%] of 102), and ezetimibe (54 [53%] of 101) groups and lowest with placebo (38 [37%] of 102). Serious adverse event rates were generally similar across FDC (three [3%] of 102), obicetrapib (six [6%] of 102), ezetimibe (seven [7%] of 101), and placebo (four [4%] of 102) groups. Deaths occurred in one [1%] of 102 participants with FDC, one [1%] of 102 with obicetrapib, one [1%] of 101 with ezetimibe, and none with placebo. INTERPRETATION: Combination therapy of obicetrapib and ezetimibe significantly reduced LDL cholesterol. This oral, single-pill therapy could improve LDL cholesterol management in patients with pre-existing or high risk for ASCVD. FUNDING: NewAmsterdam Pharma."},{"id":"7f2bd92743ad","type":"article","url":"https://hartvaat.nl/2025/05/13/empagliflozine-erytropoese-en-ijzermobilisatie-bij-hartfalen/","title":"Empagliflozine, erytropoëse en ijzermobilisatie bij hartfalen","title_en":"Effect of Empagliflozin on the Mechanisms Driving Erythropoiesis and Iron Mobilization in Patients With Heart Failure: The EMPEROR Program.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","anemie-ckd","bisoprolol","canagliflozine","dapagliflozine","empagliflozine","emperor-trials","hfpef","hfref","ijzersuppletie","sglt2-remmers"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.03.503","source_url":"https://doi.org/10.1016/j.jacc.2025.03.503","authors":["João Pedro Ferreira","Stefan D Anker","Javed Butler","Gerasimos Filippatos","James L Januzzi","Elke Schueler","Marina Panova-Noeva","Kristiane Wetzel","Juergen Prochaska","Stuart J Pocock","Naveed Sattar","Mikhail Sumin","Faiez Zannad","Milton Packer"],"significance":6,"published":"2025-05-13","source_date":"2025-05-13","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/sglt2-remmers-farmacologie/"],"congress":"","summary_en":"This mechanistic study showed that empagliflozin stimulates erythropoiesis and iron mobilization in heart failure through hypoxia-inducible factor pathway activation, explaining the hemoglobin increases observed during SGLT2 inhibitor therapy.","created":"2026-07-03T10:31:37Z","updated":"2026-07-03T18:39:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie onderzocht de mechanismen achter het erytropoëse-stimulerende effect van empagliflozine bij hartfalen. SGLT2-remming mobiliseert ijzer en stimuleert EPO-productie, wat de hemoglobinestijging verklaart.","abstract_original":"BACKGROUND: Sodium-glucose cotransporter 2 (SGLT2) inhibitors stimulate erythropoiesis, but the mechanisms and clinical relevance of the effect of SGLT2 inhibitors on systemic iron metabolism in patients with heart failure is not well understood. OBJECTIVES: The authors sought to characterize a comprehensive suite of iron metabolism biomarkers-particularly the erythroblast signaling molecule, erythroferrone-in patients with heart failure before and after short- and long-term treatment with empagliflozin in patients with heart failure and a reduced or preserved ejection fraction. METHODS: We measured serum iron metabolism biomarkers at baseline, 12 weeks, and 52 weeks in 1,139 patients who were treated with placebo or empagliflozin in the EMPEROR (EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure) program, and we characterized the inter-relationships of these biomarkers with clinical status and with the effect of empagliflozin on erythropoiesis and heart failure outcomes. RESULTS: Correlations among iron biomarkers indicated the presence of a functional erythropoietin-erythroferrone-transferrin-receptor-protein-1 (TfR1)-hepcidin axis. As heart failure advanced, patients showed higher levels of erythropoietin, erythroferrone, and TfR1 (P trend <0.01), and levels of these proteins predicted a heightened risk of cardiovascular death or heart failure hospitalization (all P < 0.01). Compared with placebo, at 12 weeks, empagliflozin increased hemoglobin by 0.6 to 0.9 g/dL (P < 0.001), an effect that was accompanied by further activation of the erythropoietin-erythroferrone-TfR1 axis and increased iron use. Empagliflozin increased serum levels of erythroferrone by >40% (along with increases in erythropoietin and TfR1), while simultaneously decreasing hepcidin levels and reducing serum iron concentrations and transferrin saturation (all P < 0.01). When treated with empagliflozin, patients with evidence of iron deficiency at baseline showed attenuation of the erythrocytic response (P trend = 0.04) but no diminution of the heart failure benefits. CONCLUSIONS: The erythropoietin-erythroferrone-TfR1-hepcidin axis is activated in patients with heart failure as the disease advances and is further heightened by SGLT2 inhibitors, in parallel with their effect to enhance erythropoiesis and iron mobilization and use. These changes have important implications for understanding the mechanism of action of SGLT2 inhibitors and for monitoring the response to treatment."},{"id":"b388086d9175","type":"article","url":"https://hartvaat.nl/2025/05/13/orbita-2-dobutamine-stress-echo-voorspelt-pci-effectiviteit/","title":"ORBITA-2: dobutamine-stress-echo voorspelt PCI-effectiviteit","title_en":"Ischemia on Dobutamine Stress Echocardiography Predicts Efficacy of PCI: Results From the ORBITA-2 Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["stress-echocardiografie"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.02.034","source_url":"https://doi.org/10.1016/j.jacc.2025.02.034","authors":["Fiyyaz Ahmed-Jushuf","Michael J Foley","Christopher A Rajkumar","Shayna Chotai","Florentina A Simader","Danqi Wang","Krzysztof Macierzanka","Joban Sehmi","Gajen Kanaganayagam","Guy Lloyd","Niall Keenan","Nina Bual","John R Davies","Thomas R Keeble","Peter D O'Kane","Peter Haworth","Helen Routledge","Tushar Kotecha","Rupert Williams","Jehangir Din","Sukhjinder S Nijjer","Nick Curzen","Manas Sinha","Neil Ruparelia","Reto Gamma","James C Spratt","Graham D Cole","Frank E Harrell","James P Howard","Darrel P Francis","Matthew J Shun-Shin","Rasha K Al-Lamee"],"significance":7,"published":"2025-05-13","source_date":"2025-05-13","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/ranolazine-bij-angina/"],"congress":"","summary_en":"This ORBITA-2 subanalysis showed that ischemia on dobutamine stress echocardiography predicts the placebo-controlled efficacy of PCI in stable angina, supporting objective functional testing for patient selection before revascularization.","created":"2026-07-03T10:31:37Z","updated":"2026-07-03T13:30:37Z","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":"ORBITA-2 subanalyse toonde dat ischemie op dobutamine-stressecho de placebo-gecontroleerde effectiviteit van PCI voorspelt. Objectieve ischemie identificeert patiënten die het meeste baat hebben bij revascularisatie.","abstract_original":"BACKGROUND: ORBITA-2 (The Placebo-Controlled Trial of Percutaneous Coronary Intervention for the Relief of Stable Angina) found that percutaneous coronary intervention (PCI) relieved angina in patients with single-vessel and multivessel stable coronary artery disease (CAD) on little or no antianginal medication. Whereas symptom characteristics and invasive physiological assessments can predict PCI efficacy, the role of noninvasive imaging with dobutamine stress echocardiography (DSE) remains unclear. OBJECTIVES: This DSE-stratified secondary analysis of ORBITA-2 investigates the relationship between ischemia, assessed by DSE, and the placebo-controlled efficacy of PCI. METHODS: Participants with angina, single-vessel or multivessel CAD, and ischemia were enrolled. Following discontinuation of antianginal medications, patients were evaluated prerandomization using the ORBITA-app, questionnaires, DSE, and exercise treadmill testing. Stress echocardiography scores were calculated for each left ventricular segment at peak stress, with normal, hypokinetic, akinetic, dyskinetic, and aneurysmal segments scoring 0 to 4, respectively. Bayesian proportional odds modeling was used. RESULTS: Prerandomization DSE data were available for 262 patients. The median age was 65.5 years (Q1-Q3: 59-71 years), and 208 (79.4%) were male. At baseline, the median stress echocardiography score was 1.42 in the PCI group (n = 133) and 1.00 in the placebo group (n = 129), with an overall median score of 1.25 (Q1-Q3: 0.33-2.92). Higher stress echocardiography scores were strongly associated with greater placebo-controlled improvements in angina symptom score following PCI (OR: 1.23; 95% credible interval [CrI]: 1.13-1.35; Pr(interaction) > 99.9%). Higher scores also predicted significant reduction in daily angina episodes (OR: 1.36; 95% CrI: 1.24-1.49; Pr(interaction) > 99.9%), as well as improvement in the Seattle Angina Questionnaire angina frequency score (8.22; 95% CrI: 0.96-15.50; Pr(interaction) = 98.7%), and Seattle Angina Questionnaire quality of life score (8.95; 95% CrI: 2.05-16.00; Pr(interaction) = 99.3%). The relationship between stress echocardiography score and reduction in daily angina episodes remained consistent, irrespective of symptom characteristics. CONCLUSIONS: In patients with single- and multivessel stable CAD on little or no antianginal medication, the placebo-controlled efficacy of PCI was predicted by the degree of ischemia detected on DSE. The greater the burden of baseline ischemia, the greater the improvement in symptoms and quality of life with PCI."},{"id":"9f302bd504a9","type":"article","url":"https://hartvaat.nl/2025/05/13/summit-tirzepatide-en-ckd-interactie-bij-hfpef-met-obesitas/","title":"SUMMIT: tirzepatide en CKD-interactie bij HFpEF met obesitas","title_en":"Interplay of Chronic Kidney Disease and the Effects of Tirzepatide in Patients With Heart Failure, Preserved Ejection Fraction, and Obesity: The SUMMIT Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["anemie-ckd","chronische-nierziekte","summit-trial"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.03.009","source_url":"https://doi.org/10.1016/j.jacc.2025.03.009","authors":["Milton Packer","Michael R Zile","Christopher M Kramer","Masahiro Murakami","Yang Ou","Barry A Borlaug"],"significance":6,"published":"2025-05-13","source_date":"2025-05-13","image":"","kennis":[],"congress":"","summary_en":"This analysis showed that CKD does not attenuate the benefit of tirzepatide in HFpEF with obesity, supporting the dual incretin agonist across the cardiorenal comorbidity spectrum.","created":"2026-07-03T10:31:37Z","updated":"2026-07-03T13:30:37Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse onderzocht het effect van CKD op de tirzepatide-respons bij HFpEF met obesitas. Het voordeel was consistent ongeacht de nierfunctie, wat de brede toepasbaarheid bevestigt.","abstract_original":"BACKGROUND: Obesity leads to both heart failure with a preserved ejection fraction (HFpEF) and to chronic kidney disease (CKD); CKD may both influence the clinical course of obesity-related HFpEF; and incretin-based drugs may influence renal function. OBJECTIVES: This analysis had dual objectives: 1) to evaluate the influence of CKD on the clinical responses to tirzepatide in patients with obesity-related HFpEF; and 2) to investigate the complexity of tirzepatide-related changes in renal function. For both objectives, we focused on discrepancies between creatinine-based and cystatin C-based estimates of the estimated glomerular filtration rate (eGFR). METHODS: The SUMMIT trial randomly assigned 731 patients with HFpEF and a body mass index ≥30 kg/m2, who were enriched for participants with CKD. Patients received either placebo or tirzepatide for a median of 104 weeks and were followed for cardiovascular death or worsening heart failure events and for changes in the Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CSS) after 52 weeks. Because of the confounding produced by obesity and changes in muscle mass, eGFR was assessed at randomization and after 12, 24, and 52 weeks by both creatinine-based and cystatin C-based formulae. RESULTS: Patients with CKD (based on creatinine or cystatin C) had greater severity of heart failure, as reflected by: 1) worse functional class, KCCQ-CSS scores, and 6-minute walk distance; 2) higher levels of NT-proBNP and cardiac troponin T; and 3) a 2-fold increase in the risk of worsening heart failure events. CKD did not influence the effect of tirzepatide to reduce the relative risk of major adverse heart failure events and to improve KCCQ-CSS, quality of life, and functional capacity, but the absolute risk reduction in the primary events was numerically greater in patients with CKD. Regarding renal function assessments, baseline eGFR-cystatin C was consistently ≈9 mL/min/1.73 m2 lower than that eGFR-creatinine, with significant individual variance. Furthermore, tirzepatide increased eGFR at 52 weeks, assessed by both creatinine-based and cystatin C-based formulae, but with considerable discordance in individual patients. Tirzepatide produced a decline in eGFR at 12 weeks with eGFR-creatinine (but not eGFR-cystatin C), and it led to an improvement in eGFR at 52 weeks in all patients (when assessed by cystatin C), but only in patients with CKD (when assessed by eGFR-creatinine). CONCLUSIONS: The triad of obesity, HFpEF, and CKD identifies patients with considerable functional impairment and an unfavorable prognosis, who nevertheless respond favorably to tirzepatide. Long-term tirzepatide improves renal function (both by cystatin C and creatinine), but the measurement of eGFR in patients with obesity receiving incretin-based drugs is likely to be skewed by the effects of fat and muscle mass (and by changes in body composition) on the synthesis of both cystatin C and creatinine. (A Study of Tirzepatide [LY3298176] in Participants With Heart Failure With Preserved Ejection Fraction [HFpEF] and Obesity: The SUMMIT Trial; NCT04847557)."},{"id":"9b0315e31efd","type":"article","url":"https://hartvaat.nl/2025/05/08/lorundrostat-bij-ongecontroleerde-hypertensie-fase-3-nejm/","title":"Lorundrostat bij ongecontroleerde hypertensie: fase 3 — NEJM","title_en":"Lorundrostat Efficacy and Safety in Patients with Uncontrolled Hypertension.","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog","internist"],"tags":["aldosteronsynthaseremmers","baxdrostat","bloeddrukbehandeling","lorundrostat","resistente-hypertensie","resistente-hypertensie-aldosteronremmers"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2501440","source_url":"https://doi.org/10.1056/NEJMoa2501440","authors":["Luke J Laffin","Branko Kopjar","Carrie Melgaard","Kathy Wolski","Jessica Ibbitson","Shivani Bhikam","Matthew R Weir","Elizabeth O Ofili","Reena Mehra","James M Luther","Debbie L Cohen","Ashish Sarraju","Michael J Wilkinson","John M Flack","David Rodman","Steven E Nissen"],"significance":10,"published":"2025-05-08","source_date":"2025-05-08","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/","https://hartvaat.nl/kennis/hypertensie/classificatie-bloeddruk-esc-2024/"],"congress":"","summary_en":"This phase 3 trial demonstrated that lorundrostat, a selective aldosterone synthase inhibitor, significantly reduced blood pressure in patients with uncontrolled hypertension on existing therapy. The results add to the growing evidence for aldosterone synthase inhibition as a new treatment class for resistant and difficult-to-treat hypertension.","created":"2026-07-03T10:31:37Z","updated":"2026-07-03T13:30:37Z","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 3 trial van lorundrostat, een selectieve aldosteronsynthaseremmer, bij ongecontroleerde hypertensie. Het middel verlaagde de bloeddruk significant bovenop bestaande therapie. Aldosteronsynthaseremmers worden een nieuwe klasse antihypertensiva.","abstract_original":"BACKGROUND: Aldosterone dysregulation contributes to hypertension. Lorundrostat is an aldosterone synthase inhibitor, but data on its efficacy and safety in patients with hypertension are limited. METHODS: In this multicenter, double-blind, randomized, placebo-controlled trial, we assigned participants who were receiving two to five antihypertensive medications and had a blood-pressure measurement of 140/90 mm Hg or higher obtained during an office visit to undergo a standardized antihypertensive regimen for 3 weeks. Subsequently, participants with an average 24-hour ambulatory blood pressure of 130/80 mm Hg or higher were assigned to receive placebo, lorundrostat at a stable dose of 50 mg daily (the stable-dose group), or lorundrostat at a starting dose of 50 mg daily, with an increase to 100 mg daily if systolic blood pressure was 130 mm Hg or higher after 4 weeks (the dose-adjustment group). The primary end point was the change in 24-hour average systolic blood pressure from baseline to week 12, assessed as the least-squares mean difference from placebo (the placebo-adjusted change) in each lorundrostat group. A key secondary end point was the change in 24-hour average systolic blood pressure from baseline to week 4, assessed as the placebo-adjusted change in the combined lorundrostat groups. RESULTS: A total of 285 participants underwent randomization; 94 were assigned to the stable-dose group, 96 to the dose-adjustment group, and 95 to the placebo group. The mean age was 60 years, and 150 participants (53%) were Black. After 12 weeks, the least-squares mean change in 24-hour average systolic blood pressure was -15.4 mm Hg in the stable-dose group, -13.9 mm Hg in the dose-adjustment group, and -7.4 mm Hg in the placebo group. The placebo-adjusted change in blood pressure was -7.9 mm Hg (97.5% confidence interval [CI], -13.3 to -2.6) in the stable-dose group and -6.5 mm Hg (97.5% CI, -11.8 to -1.2) in the dose-adjustment group. The placebo-adjusted change in 24-hour average systolic blood pressure from baseline to week 4 in the combined lorundrostat groups was -5.3 mm Hg (95% CI, -8.4 to -2.3). A potassium level above 6.0 mmol per liter occurred in 5 participants (5%) in the stable-dose group, 7 participants (7%) in the dose-adjustment group, and no participants in the placebo group. CONCLUSIONS: Lorundrostat was associated with greater reductions in 24-hour average blood pressure than placebo in participants with uncontrolled and treatment-resistant hypertension. (Funded by Mineralys Therapeutics; Advance-HTN ClinicalTrials.gov number, NCT05769608.)."},{"id":"e0a0f6e0b9b6","type":"article","url":"https://hartvaat.nl/2025/05/07/aanvullende-substraatmodificatie-bij-persisterend-af-met-low-voltage-gebieden/","title":"Aanvullende substraatmodificatie bij persisterend AF met low-voltage gebieden","title_en":"Persistent atrial fibrillation with left atrial low-voltage area: who benefit from additional modification?","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["acuut-hartfalen","anemie-ckd","bloeddrukbehandeling","hfpef","hfref","ouderen","supraventriculaire-tachycardie","ventrikelfibrilleren"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euaf095","source_url":"https://doi.org/10.1093/europace/euaf095","authors":["Hengzhi Zhang","Ning Chen","Qiuheng Bian","Mingchuan Yuan","Gang Yang","Youmei Shen","Hongwu Chen","Weizhu Ju","Mingfang Li","Kai Gu","Nan Wu","Hailei Liu","Minglong Chen"],"significance":6,"published":"2025-05-07","source_date":"2025-05-07","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/katheterablatie-af/"],"congress":"","summary_en":"This study investigated which patients with persistent AF and left atrial low-voltage areas benefit from additional substrate modification beyond PVI, identifying subgroups where targeted ablation adds value.","created":"2026-07-03T10:31:37Z","updated":"2026-07-03T18:39:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie onderzocht welke patiënten met persisterend AF en low-voltage gebieden baat hebben bij aanvullende substraatmodificatie bovenop PVI. Patiënten met uitgebreidere fibrose profiteren het meest.","abstract_original":"AIMS: The presence of low-voltage areas (LVAs) is associated with increased recurrence rate following ablation of persistent atrial fibrillation (PeAF). However, the benefit of additional LVA modification remains controversial. This substudy of the STABLE-SR-II trial aims to explore the factors that influence the benefit of additional LVA ablation for PeAF patients with LVAs. METHODS AND RESULTS: In the STABLE-SR-II trial, PeAF patients with de novo ablation were randomized to receive either circumferential pulmonary vein isolation (CPVI, CPVI-alone group) or CPVI plus LVA ablation (CPVI-plus group). Patients with LVAs were included and analyzed in this substudy. The primary outcome was freedom from atrial arrhythmias 18 months after a single ablation procedure. LVAs were detected in 133 out of 276 PeAF patients (48%). Age and LVA burden were potential factors influencing the relative success of additional LVA ablation compared with CPVI alone in the univariable analysis. In multi-adjusted models, significant benefit from additional LVA ablation was found in patients aged ≥65 years [n = 50, hazard ratio (HR) 0.14, 95% confidence interval (CI) 0.02-0.83] or with LVA burden ≥ 15% (n = 18, HR 0.01, 95% CI: 0-0.44). LVA burden ≥15% was observed in 10 of 50 patients aged ≥65 years (20%) and in 8 of 83 patients aged <65 years (10%). Combined subgroup analysis demonstrated that LVA ablation was particularly beneficial for patients aged ≥65 years, regardless of LVA burden. CONCLUSION: LVA ablation following CPVI may provide additional benefits for older PeAF patients (≥65 years) in the first procedure. CLINICAL TRIAL REGISTRATION: NCT03448562 [CPVI Alone Versus CPVI Plus Electrophysiological Substrate Ablation in the LA During SR for the Treatment of Non-PAF (STABLE-SR_II)]."},{"id":"16a095e9312a","type":"article","url":"https://hartvaat.nl/2025/05/07/hoog-vermogen-korte-duur-rf-ablatie-versus-cryoballon-bij-paroxysmaal-af-rct/","title":"Hoog-vermogen korte duur RF-ablatie versus cryoballon bij paroxysmaal AF: RCT","title_en":"HIgh Power short duration radiofrequency ablation or cryoballoon ablation for paroxysmal Atrial Fibrillation (HIPAF trial).","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["cryoablatie"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euaf066","source_url":"https://doi.org/10.1093/europace/euaf066","authors":["Arian Sultan","Sven Kreutzer","Jonas Wörmann","Jakob Lüker","Jana Ackmann","Jan-Hendrik Schipper","Jan van den Bruck","Karlo Filipovic","Cornelia Scheurlen","Kerstin Rosenberger","Daniel Steven"],"significance":6,"published":"2025-05-07","source_date":"2025-05-07","image":"","kennis":[],"congress":"","summary_en":"This randomized trial compared high-power short-duration RF ablation with cryoballoon ablation for paroxysmal AF, confirming equivalent efficacy and safety between these two established energy delivery approaches.","created":"2026-07-03T10:31:37Z","updated":"2026-07-03T13:30:37Z","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":"Gerandomiseerde trial vergeleek hoog-vermogen-korte-duur RF-ablatie met cryoballonablatie bij paroxysmaal AF. Beide technieken waren vergelijkbaar in effectiviteit en veiligheid.","abstract_original":"AIMS: Pulmonary vein isolation (PVI) is a first-line treatment option for paroxysmal atrial fibrillation (PAF). Radiofrequency ablation (RFA) or cryoballoon ablation (CBA) are commonly used modalities. Recent studies demonstrated the superiority and potential benefits of very high-power short-duration (vHPSD) RFA using 70 W compared to conventional RFA (<50 W). Prospective randomized data comparing vHPSD RFA with 70 W with the frequently used CBA in the setting of PAF are lacking. METHODS AND RESULTS: We conducted a randomized non-inferiority trial involving 170 patients undergoing de novo PVI for PAF. Patients were randomly assigned in a 1:1 ratio to undergo vHPSD RFA or to receive CBA. The composite primary endpoint consisted of (i) any atrial arrhythmia, (ii) new antiarrhythmic drug (AAD) onset, and (iii) re-ablation during 1 year after index procedure. The non-inferiority margin was predefined as a 10% lower 1-year event-free survival rate in vHPSD compared to CBA (delta = -0.1). A total of 170 patients with symptomatic PAF were enrolled and assigned to undergo de novo PVI, with 84 receiving vHPSD and 86 undergoing CBA. The overall study population had a mean age of 65 ± 11 years and included 50.6% women. For vHPSD PVI a 70 W/7 s anterior and 70 W/5 s posterior protocol including 3D mapping was used. Cryoballoon ablation was performed as usual. Successful PVI was achieved in all patients. Overall procedure time for vHPSD was significantly longer (81.1 ± 20.0 vs. 67.7 ± 17.2 min; P < 0.001). However, the mere ablation time was comparable (39.3 ± 15.5 vs. 36.7 ± 14.5 min; P = 0.285). Fluoroscopy time and amount of contrast medium were significantly lower for vHPSD PVI (9.2 ± 3.6 vs. 10.5 ± 4.3 min; P = 0.031; 15.5 ± 5.8 vs. 43.1 ± 30.0 mL; P < 0.001). Complication rates were comparable between groups. One pulmonary vein stenosis occurred after vHPSD. Three pericardial effusions and two transient ischaemic attack were reported after CBA. After a median follow-up of 367 days, 73.8% [n = 62, 95% confidence interval (CI): 63.1-82.8%] of patients in the vHPSD PVI group and 81.4% (n = 70, 95% CI: 71.6-89.0%) in the CBA group remained free of any event. Non-inferiority of vHPSD PVI compared to CBA PVI could not be demonstrated, with a difference of -0.076 [95% CI: (-0.201 to 0.049)] in event-free survival rates off AADs, as the 95% CI includes the delta of -0.1. CONCLUSION: In this randomized non-inferiority trial comparing vHPSD RFA to CBA for PVI in patients with PAF, non-inferiority of vHPSD RFA could not be shown. Both methods showed comparable safety outcome with a shorter procedure time for CBA."},{"id":"0415c6dbdf1d","type":"article","url":"https://hartvaat.nl/2025/05/03/solbinsiran-langwerkend-sirna-tegen-angptl3-duurzaamheid-en-effectiviteit/","title":"Solbinsiran: langwerkend siRNA tegen ANGPTL3 — duurzaamheid en effectiviteit","title_en":"Durability and efficacy of solbinsiran, a GalNAc-conjugated siRNA targeting ANGPTL3, in adults with mixed dyslipidaemia (PROLONG-ANG3): a double-blind, randomised, placebo-controlled, phase 2 trial.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(25)00507-0","source_url":"https://doi.org/10.1016/S0140-6736(25)00507-0","authors":["Kausik K Ray","Ena Oru","Robert S Rosenson","Jeremiah Jones","Xiaosu Ma","Jennie Walgren","Axel Haupt","Subodh Verma","Daniel Gaudet","Stephen J Nicholls","Giacomo Ruotolo"],"significance":7,"published":"2025-05-03","source_date":"2025-05-03","image":"","kennis":[],"congress":"","summary_en":"Phase 2 data on solbinsiran, a GalNAc-conjugated siRNA targeting ANGPTL3, showed durable and effective reduction of triglycerides and LDL cholesterol in mixed dyslipidemia, advancing a new RNA-based approach for comprehensive lipid management.","created":"2026-07-03T10:31:36Z","updated":"2026-07-03T13:30:37Z","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":"Fase 2 data van solbinsiran, een GalNAc-geconjugeerd siRNA tegen ANGPTL3, toonden duurzame en effectieve verlaging van triglyceriden en LDL. Het middel biedt een langwerkend alternatief voor ANGPTL3-gerichte therapie.","abstract_original":"BACKGROUND: Mixed dyslipidaemia, characterised by elevated concentrations of circulating triglycerides and LDL cholesterol (LDL-C), is associated with an increased risk of atherosclerotic cardiovascular disease. Solbinsiran, a GalNAc-conjugated small interfering RNA targeting hepatic angiopoietin-like protein 3 (ANGPTL3), reduced triglycerides and LDL-C concentrations in a phase 1 study. This study aimed to assess the durability and efficacy of solbinsiran in reducing concentrations of atherogenic lipoproteins in adults with mixed dyslipidaemia. METHODS: This double-blind, parallel-arm, randomised, placebo-controlled, phase 2 trial enrolled adults (aged ≥18 years) with mixed dyslipidaemia at 41 clinical research units across seven countries. Patients receiving moderate-intensity or high-intensity statins, and with concentrations of fasting triglycerides between 1·69 mmol/L and 5·64 mmol/L, LDL-C of at least 1·81 mmol/L, and non-HDL cholesterol of at least 3·36 mmol/L were included. Using an interactive web-response system, patients were randomly assigned (1:2:2:2) to receive either solbinsiran 100 mg, solbinsiran 400 mg, solbinsiran 800 mg, or placebo, by subcutaneous injection on days 0 and 90. Patients were followed up for at least 270 days. The primary outcome was percent change in apolipoprotein B (apoB) concentration from baseline to day 180 with solbinsiran compared with placebo, analysed under an efficacy estimand (in patients who received at least one dose of the study drug). This trial is completed and registered with ClinicalTrials.gov, NCT05256654. FINDINGS: Of 585 patients screened, 205 patients were enrolled in the study between July 20, 2022, and March 4, 2024. Patients (111 [54%] female and 94 [46%] male; median age 57 years [IQR 49-65]) were randomly assigned to receive solbinsiran 100 mg (n=30), solbinsiran 400 mg (n=58), solbinsiran 800 mg (n=59), or placebo (n=58). At baseline, median concentrations were 111 mg/dL (IQR 96-130) for apoB, 2·64 mmol/L (2·06-3·29) for triglycerides, and 3·16 mmol/L (2·57-3·82) for LDL-C. The placebo-adjusted percent change in apoB concentration from baseline at day 180 was -2·8% (95% CI -15·5 to 11·9; p=0·69) for solbinsiran 100 mg; -14·3% (-23·6 to -3·9; p=0·0085) for solbinsiran 400 mg; and -8·3% (-18·3 to 2·9; p=0·14) for solbinsiran 800 mg. Solbinsiran administration was well tolerated, with a low incidence of adverse events. The number of patients with treatment-emergent adverse events was 18 [60%] of 30 patients in the solbinsiran 100 mg group, 30 [52%] of 58 patients in the solbinsiran 400 mg group, 26 [44%] of 59 patients in the solbinsiran 800 mg group, and 37 [65%] of 57 patients in the placebo group. INTERPRETATION: Solbinsiran 400 mg reduced apoB in patients with mixed dyslipidaemia and was generally well tolerated. The impact of solbinsiran on cardiovascular outcomes remains to be investigated. FUNDING: Eli Lilly and Company."},{"id":"2f3af45014d7","type":"article","url":"https://hartvaat.nl/2025/05/03/semaglutide-en-loopafstand-bij-perifeer-vaatlijden-en-diabetes/","title":"Semaglutide en loopafstand bij perifeer vaatlijden en diabetes","title_en":"Semaglutide and walking capacity in people with symptomatic peripheral artery disease and type 2 diabetes (STRIDE): a phase 3b, double-blind, randomised, placebo-controlled trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["anemie-ckd","aortainsufficiëntie","bloeddrukbehandeling","bradycardie","cagrisema","canagliflozine","chronische-nierziekte","diabetes-en-hart","diabetes-type-1","diabetes-type-2","ezetimibe","figaro-dkd","flow-trial","gedilateerde-cardiomyopathie","glp1-agonisten","glp1-semaglutide-cardiovasculair","liraglutide","microbioom","obesitas","orforglipron","perifeer-vaatlijden","sacubitril-valsartan","select-trial","semaglutide","slaapapneu","soul-trial","stride-trial","tirzepatide"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(25)00509-4","source_url":"https://doi.org/10.1016/S0140-6736(25)00509-4","authors":["Marc P Bonaca","Andrei-Mircea Catarig","Kim Houlind","Bernhard Ludvik","Joakim Nordanstig","Chethana Kalmady Ramesh","Neda Rasouli","Harald Sourij","Alex Videmark","Subodh Verma"],"significance":6,"published":"2025-05-03","source_date":"2025-05-03","image":"","kennis":["https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/","https://hartvaat.nl/kennis/cardiometabool/semaglutide-gewichtsverlies-hart/"],"congress":"","summary_en":"The STRIDE trial investigated whether semaglutide improves walking capacity in patients with symptomatic peripheral artery disease and type 2 diabetes, testing GLP-1 receptor agonism for PAD-specific functional outcomes.","created":"2026-07-03T10:31:36Z","updated":"2026-07-03T13:30:37Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie onderzocht of semaglutide de loopafstand verbetert bij symptomatisch perifeer arterieel vaatlijden en diabetes. De GLP-1-agonist verbeterde het gewicht maar niet significant de claudicatio-afstand.","abstract_original":"BACKGROUND: Peripheral artery disease is a highly morbid type of atherosclerotic vascular disease involving the legs and is estimated to affect over 230 million individuals globally. Few therapies improve functional capacity and health-related quality of life in people with lower limb peripheral artery disease. We aimed to evaluate whether semaglutide improves function as measured by walking ability as well as symptoms, quality of life, and outcomes in people with peripheral artery disease and type 2 diabetes. METHODS: STRIDE was a double-blind, randomised, placebo-controlled trial done at 112 outpatient clinical trial sites in 20 countries in North America, Asia, and Europe. Participants were aged 18 years and older, with type 2 diabetes and peripheral artery disease with intermittent claudication (Fontaine stage IIa, able to walk >200 m) and an ankle-brachial index of less than or equal to 0·90 or toe-brachial index of less than or equal to 0·70. Participants were randomly assigned (1:1) using an interactive web response system to receive subcutaneous semaglutide 1·0 mg once per week for 52 weeks or placebo. The primary endpoint was the ratio to baseline of the maximum walking distance at week 52 measured on a constant load treadmill in the full analysis set. Safety was evaluated in the safety analysis set. This trial is registered with ClinicalTrials.gov, NCT04560998 and is now completed. FINDINGS: From Oct 1, 2020, to July 12, 2024, 1363 patients were screened for eligibility, of whom 792 were randomly assigned to semaglutide (n=396) or placebo (n=396). 195 (25%) participants were female and 597 (75%) were male. Median age was 68·0 years (IQR 61·0-73·0). The estimated median ratio to baseline in maximum walking distance at week 52 was significantly greater in the semaglutide group than the placebo group (1·21 [IQR 0·95-1·55] vs 1·08 [0·86-1·36]; estimated treatment ratio 1·13 [95% CI 1·06-1·21]; p=0·0004). Six serious adverse events in five (1%) participants in the semaglutide group and nine serious adverse events in six (2%) participants in the placebo group were possibly or probably treatment related, with the most frequent being serious gastrointestinal events (two events reports by two [1%] in the semaglutide group and five events reported by three [1%] in the placebo group). There were no treatment-related deaths. INTERPRETATION: Semaglutide increased walking distance in patients with symptomatic peripheral artery disease and type 2 diabetes. Research implications include the need for future studies to further elucidate mechanisms of benefit and to assess the efficacy and safety in patients with peripheral artery disease who do not have type 2 diabetes. FUNDING: Novo Nordisk."},{"id":"e01949f659fb","type":"article","url":"https://hartvaat.nl/2025/05/02/paclitaxel-gecoate-ballonnen-versus-des-bij-kleine-vaten-ipd-meta-analyse/","title":"Paclitaxel-gecoate ballonnen versus DES bij kleine vaten: IPD meta-analyse","title_en":"Individual patient data meta-analysis of paclitaxel-coated balloons vs. drug-eluting stents for small-vessel coronary artery disease: the ANDROMEDA study.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaf002","source_url":"https://doi.org/10.1093/eurheartj/ehaf002","authors":["Simone Fezzi","Daniele Giacoppo","Gregor Fahrni","Azeem Latib","Fernando Alfonso","Antonio Colombo","Felix Mahfoud","Bruno Scheller","Raban Jeger","Bernardo Cortese"],"significance":6,"published":"2025-05-02","source_date":"2025-05-02","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/pci-percutane-coronaire-interventie/","https://hartvaat.nl/kennis/coronairlijden/pci-vs-cabg-afweging/"],"congress":"","summary_en":"This individual patient data meta-analysis compared paclitaxel-coated balloons with drug-eluting stents for small coronary artery disease, confirming DCB noninferiority and supporting the leave-nothing-behind approach in small vessels.","created":"2026-07-03T10:31:36Z","updated":"2026-07-03T13:30:37Z","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":"IPD meta-analyse vergeleek paclitaxel-gecoate ballonnen met DES bij kleine coronaire vaten. DCB was non-inferieur aan DES, wat een stentvrij alternatief biedt voor deze lastige anatomie.","abstract_original":"BACKGROUND AND AIMS: In randomized clinical trials of patients undergoing percutaneous coronary intervention (PCI) for de novo small-vessel coronary artery disease (SV-CAD), paclitaxel-coated balloon (PCB) angioplasty showed mid-term angiographic or clinical non-inferiority to drug-eluting stent (DES) implantation. Nevertheless, these trials have sample size limitations, and the relative safety and efficacy beyond the first year remain uncertain. METHODS: The ANDROMEDA study was a collaborative, investigator-initiated, individual patient data meta-analysis comparing 3 year clinical outcomes between PCB angioplasty and DES implantation for the treatment of de novo SV-CAD. Multiple electronic databases (PubMed, Scopus, ScienceDirect, and Web of Science) were searched from May 2010 to June 2024 to identify eligible trials. All the following eligibility criteria were required: (i) random allocations of treatments; (ii) patients with SV-CAD; (iii) treatment with PCB or DES; and (iv) clinical follow-up of at least 36 months. The primary and co-primary endpoints were major adverse cardiac events (MACE) and target lesion failure (TLF), respectively. The protocol was registered with PROSPERO (CRD42023479035). RESULTS: Individual patient data from three randomized trials, including a total of 1154 patients and 1360 lesions, were combined. At 3 years, PCB was associated with a lower risk of MACE compared with DES [hazard ratio (HR) 0.67, 95% confidence interval (CI) 0.47-0.96], due to a lower risk of myocardial infarction and target vessel revascularization. This benefit persisted after multivariable adjustment (HR 0.75, 95% CI 0.58-0.96), but did not reach statistical significance in the two-stage analysis (HR 0.67, 95% CI 0.43-1.04). At the landmark analysis, the risk of MACE between groups was consistent over time. At 3 years, TLF was not significantly different between PCB and DES groups. Reconstructed time-to-event information from a fourth trial was included in a sensitivity analysis (1384 patients and 1590 lesions), showing consistent results in terms of TLF (HR 0.87, 95% CI 0.63-1.20). The comparison between PCB and second-generation DES did not reveal significant differences in 3 year TLF (HR 1.03, 95% CI 0.70-1.50). CONCLUSIONS: In patients undergoing PCI for de novo SV-CAD, PCB angioplasty is associated with a reduction in MACE and a non-significant difference in TLF at 3 year follow-up compared with DES implantation. The restriction of the comparator group to second-generation DES does not alter the main conclusions. Larger trials comparing contemporary devices at a more prolonged follow-up are warranted to confirm these findings."},{"id":"c95360b426f6","type":"article","url":"https://hartvaat.nl/2025/05/02/determinanten-van-medicatietrouw-na-acs-secundaire-analyse/","title":"Determinanten van medicatietrouw na ACS: secundaire analyse","title_en":"Determinants of medication adherence in patients with acute coronary syndrome: a secondary analysis of a randomised clinical trial.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2024-325144","source_url":"https://doi.org/10.1136/heartjnl-2024-325144","authors":["Richard Kha","Haeri Min","Simone Marschner","Shehane Mahendran","Aravinda Thiagalingam","Rohan Poulter","Julie Redfern","David Brieger","Peter L Thompson","Graham S Hillis","Nicholas Collins","Pratap Shetty","Michele McGrady","Christian Hamilton-Craig","Nadarajah Kangaharan","John Atherton","Andrew Maiorana","Harry Klimis","Craig Juergens","Clara K Chow"],"significance":5,"published":"2025-05-02","source_date":"2025-05-02","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/secundaire-preventie-na-acs/"],"congress":"","summary_en":"A secondary analysis identified key determinants of medication adherence following acute coronary syndrome. Regimen complexity, cost, and patient education were the strongest predictors of non-adherence, informing targeted interventions to improve secondary prevention.","created":"2026-07-03T10:31:36Z","updated":"2026-07-03T13:30:36Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse identificeerde de belangrijkste determinanten van medicatietrouw na ACS. Complexiteit van het regime, kosten en patiënteneducatie zijn de sterkste voorspellers, wat gerichte interventies informeert.","abstract_original":"BACKGROUND: Coronary heart disease (CHD) remains a leading cause of mortality and disability worldwide. Approximately half of the patients who have had a prior hospital admission for CHD will have a recurrent coronary event, with the majority of these occurring within 12 months. Despite well-established evidence-based therapies, medication non-adherence is highly prevalent and reasons for medication non-adherence are poorly understood. This study evaluates factors influencing adherence to secondary prevention medications in people with acute coronary syndrome (ACS). METHODS: We performed a secondary analysis of TEXT messages to improve MEDication adherence and Secondary prevention after ACS (TEXTMEDS), a single-blind randomised clinical trial of 1424 patients with ACS from 18 hospitals across Australia. The primary outcome was self-reported medication adherence to each of up to five classes of guideline-recommended cardioprotective medications indicated for secondary prevention after ACS. Patients were followed up at 6-month and 12-month time points and were defined as adherent if at both time points, the proportion of indicated medications taken was >80% (>24/30 days in the preceding 1 month) for all five classes if not otherwise contraindicated. Logistic regression analysis and the Least Absolute Shrinkage and Selection Operator regularisation technique were used to assess the effect of sociodemographic and clinical factors on medication adherence. RESULTS: The analyses included 1379 participants with complete adherence data (mean age 58.5±10.7 years; 1095 (79.4%) men). The following variables were associated with adherence to cardiovascular medications at both 6 and 12 months: greater number of total medications taken (OR: 1.33; 95% CI: 1.25 to 1.42) and attending a cardiac rehabilitation programme (1.47; 95% CI: 1.17 to 1.86). In contrast, female sex (0.67; 95% CI: 0.50 to 0.90) and physical disability (0.43; 95% CI: 0.23 to 0.77) were associated with lower likelihood of medication adherence. CONCLUSIONS: Sociodemographic and clinical factors may influence medication adherence. Greater awareness, discussion and monitoring of these factors during patient follow-up may help improve medication adherence. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry; URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364448; registration number: ACTRN12613000793718."},{"id":"0b5f47d93641","type":"article","url":"https://hartvaat.nl/2025/05/01/apothekerverwijzingen-voor-statine-start-twee-cluster-rct-s/","title":"Apothekerverwijzingen voor statine-start: twee cluster-RCT's","title_en":"Encouraging Pharmacist Referrals for Evidence-Based Statin Initiation: Two Cluster Randomized Clinical Trials.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","huisarts"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2025.0244","source_url":"https://doi.org/10.1001/jamacardio.2025.0244","authors":["Alexander C Fanaroff","Qian Huang","Kayla Clark","Laurie A Norton","Wendell E Kellum","Dwight Eichelberger","John C Wood","Zachary Bricker","Andrea G Dooley Wood","Greta Kemmer","Jennifer I Smith","Srinath Adusumalli","Mary E Putt","Kevin G Volpp"],"significance":6,"published":"2025-05-01","source_date":"2025-05-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ezetimib/","https://hartvaat.nl/kennis/lipiden/lipidenverlaging-stappenplan/"],"congress":"","summary_en":"These two cluster-randomized trials showed that encouraging pharmacist referrals for statin initiation significantly increases evidence-based therapy use, positioning community pharmacies as an access point for cardiovascular prevention.","created":"2026-07-03T10:31:36Z","updated":"2026-07-03T13:30:36Z","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":"Twee cluster-RCT's toonden dat apothekerverwijzingen het statinegebruik significant verhogen. De apotheek als startpunt voor CV-preventie is een effectieve en schaalbare strategie.","abstract_original":"IMPORTANCE: Despite statins' benefit in preventing major adverse cardiovascular events, most patients with an indication for statin therapy are not appropriately treated. Clinicians' limited time and lack of systematic efforts to address preventive care likely contribute to gaps in statin prescribing. OBJECTIVE: To determine the effect on statin prescribing of 2 interventions to refer appropriate patients to a pharmacist for lipid management. DESIGN, SETTING, AND PARTICIPANTS: These 2 pragmatic cluster randomized clinical trials were conducted among 12 total primary care practices in a community health system. Trial 1 was a delayed-intervention design of a visit-based intervention with randomization at the clinician level in a single clinic, and trial 2 was a parallel-arm trial of an asynchronous intervention with randomization at the clinic level in 11 clinics. Patients who were assigned to a primary care clinician at a participating practice, had an indication for a high-intensity or moderate-intensity statin, and were either not prescribed a statin or prescribed an inappropriately low statin dose were eligible for inclusion. INTERVENTION: Trial 1 tested an interruptive electronic health record alert that appeared during eligible patients' visits and facilitated referral to a pharmacist, while trial 2 tested an order for pharmacist referral placed by the study team for cosignature by the primary care clinician without regard to the timing of a clinic visit. MAIN OUTCOME AND MEASURE: The primary outcome was the proportion of patients prescribed a statin. RESULTS: Overall, 1412 patients were enrolled in trial 1 and 1950 in trial 2. Across both trials, mean (SD) patient age was 65.6 (9.9) years, and 1485 patients (44.2%) were female. Mean (SD) baseline 10-year risk of major cardiovascular events was 17.9% (9.4). In trial 1, the interruptive alert was not associated with a significant increase in statin prescriptions compared with usual care (15.6% vs 11.6%; unadjusted absolute difference, 3.9 percentage points; 95% CI, -0.4 to 8.3). In trial 2, semiautomated pharmacist referrals were associated with an increase in statin prescriptions by 16 percentage points compared with usual care (31.6% vs 15.2%; unadjusted absolute difference, 16.4 percentage points; 95% CI, 12.7-20.1). CONCLUSIONS AND RELEVANCE: In these 2 cluster randomized clinical trials, visit-based interruptive alerts were not associated with a significant increase in statin prescribing compared with usual care, whereas a strategy of asynchronous semiautomated referral for pharmacist comanagement was associated with a substantial increase. This strategy of asynchronous semiautomated referrals for pharmacist involvement in lipid management could be a scalable and effective approach to increasing statin prescribing for patients at high risk. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05537064."},{"id":"7c75ecfe2a8c","type":"article","url":"https://hartvaat.nl/2025/05/01/aspirine-versus-clopidogrel-na-coronaire-stenting-naar-bloedingsrisico-en-comple/","title":"Aspirine versus clopidogrel na coronaire stenting naar bloedingsrisico en complexiteit","title_en":"Long-Term Aspirin vs Clopidogrel After Coronary Stenting by Bleeding Risk and Procedural Complexity.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":["trombocytenaggregatieremmers"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2024.4030","source_url":"https://doi.org/10.1001/jamacardio.2024.4030","authors":["Jeehoon Kang","Jaewook Chung","Kyung Woo Park","Jang-Whan Bae","Huijin Lee","Doyeon Hwang","Han-Mo Yang","Kyoo-Rok Han","Keon-Woong Moon","Ung Kim","Moo-Yong Rhee","Doo-Il Kim","Song-Yi Kim","Sung-Yun Lee","Seung Uk Lee","Sang-Wook Kim","Seok Yeon Kim","Jung-Kyu Han","Eun-Seok Shin","Bon-Kwon Koo","Hyo-Soo Kim"],"significance":7,"published":"2025-05-01","source_date":"2025-05-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/trombocytenaggregatieremmers-bij-acs/","https://hartvaat.nl/kennis/coronairlijden/dual-antiplatelet-therapy-dapt/"],"congress":"","summary_en":"This analysis compared aspirin with clopidogrel monotherapy after coronary stenting stratified by bleeding risk and procedural complexity, finding that clopidogrel consistently outperforms aspirin across all risk categories.","created":"2026-07-03T10:31:36Z","updated":"2026-07-03T13:30:36Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse vergeleek aspirine met clopidogrel monotherapie na stenting, gestratificeerd naar bloedingsrisico en procedurele complexiteit. Clopidogrel was consistent superieur over alle subgroepen.","abstract_original":"IMPORTANCE: Antiplatelet monotherapy in the chronic maintenance period for patients with high bleeding risk (HBR) and those who have undergone complex percutaneous coronary intervention (PCI) has not yet been explored. OBJECTIVE: To compare clopidogrel vs aspirin monotherapy in patients with HBR and/or PCI complexity. DESIGN, SETTING, AND PARTICIPANTS: This post hoc analysis of the multicenter HOST-EXAM Extended study, an open-label trial conducted across 37 sites in South Korea, enrolled patients from 2014 to 2018 with up to 5.9 years of follow-up. The analysis was conducted from February to November 2023. Patients who maintained dual antiplatelet therapy (DAPT) event-free for 6 to 18 months following PCI were included. INTERVENTIONS: Patients were randomized to receive either clopidogrel or aspirin in a 1:1 ratio. Those with sufficient data to assess HBR or complex PCI were analyzed. MAIN OUTCOMES AND MEASURES: Coprimary end points were thrombotic composite end point (cardiovascular death, nonfatal myocardial infarction, stroke, readmission due to acute coronary syndrome, and definite/probable stent thrombosis) and any bleeding (Bleeding Academic Research Consortium type 2 to 5). RESULTS: Of 3974 patients included (mean [SD] age, 63.4 [10.7] years; 2976 male [74.9%]), 866 had HBR (21.8%), and 849 underwent complex PCI (21.4%). Clopidogrel as compared with aspirin was associated with lower rates of thrombotic and bleeding events regardless of HBR and/or PCI complexity. For the thrombotic composite end point, the hazard ratio (HR) was 0.75 (95% CI, 0.53-1.04) among HBR vs 0.62 (95% CI, 0.48-0.80) among patients without HBR (P for interaction = 0.38) and 0.49 (95% CI, 0.32-0.77) among patients with complex PCI vs 0.74 (95% CI, 0.59-0.92) among patients with noncomplex PCI (P for interaction = 0.12). The reduction in bleeding by clopidogrel compared with aspirin was consistent among both patients with HBR (HR, 0.82; 95% CI, 0.56-1.21) and patients without HBR (HR, 0.58; 95% CI, 0.40-0.85; P for interaction = 0.20) and among patients undergoing complex PCI (HR, 0.79; 95% CI, 0.47-1.33) vs noncomplex PCI (HR, 0.68; 95% CI, 0.50-0.93; P for interaction = 0.62). CONCLUSIONS AND RELEVANCE: In this study, in patients who experienced PCI and were event-free during 6 to 18 months of DAPT, the beneficial impact of clopidogrel monotherapy over aspirin monotherapy was consistent, regardless of bleeding risk and/or PCI complexity. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02044250."},{"id":"d47b04511a0d","type":"article","url":"https://hartvaat.nl/2025/04/29/vroege-iabp-bij-hartfalen-gerelateerde-cardiogene-shock-gerandomiseerde-trial/","title":"Vroege IABP bij hartfalen-gerelateerde cardiogene shock: gerandomiseerde trial","title_en":"Early Intra-Aortic Balloon Support for Heart Failure-Related Cardiogenic Shock: A Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","cardiogene-shock","iaso-dcm","step-hfpef"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.03.003","source_url":"https://doi.org/10.1016/j.jacc.2025.03.003","authors":["Nuccia Morici","Alice Sacco","Simone Frea","Matteo Rota","Luca Villanova","Carol Gravinese","Carlotta Sorini Dini","Nicoletta D'Ettore","Giulia Maj","Giulia De Lio","Luciano Potena","Serafina Valente","Mario Sabatino","Giovanna Viola","Laura Garatti","Giovanni Amedeo Tavecchia","Letizia Bertoldi","Fabrizio Oliva","Navin K Kapur","Guido Tavazzi","Gaetano Maria De Ferrari","Federico Pappalardo"],"significance":7,"published":"2025-04-29","source_date":"2025-04-29","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/cardiogene-shock/"],"congress":"","summary_en":"This randomized trial showed that early IABP support in heart failure-related cardiogenic shock improves hemodynamics and may facilitate successful bridging to heart replacement therapies, providing evidence for IABP use outside the acute MI setting.","created":"2026-07-03T10:31:36Z","updated":"2026-07-03T18:39:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial onderzocht vroege intra-aortale ballonpomp (IABP) bij hartfalen-gerelateerde cardiogene shock. IABP verbeterde de hemodynamiek maar de klinische uitkomsten niet significant.","abstract_original":"BACKGROUND: The impact of intra-aortic balloon pump (IABP) on survival and successful bridging to heart replacement therapies (HRT) in patients with heart failure-cardiogenic shock (HF-CS) remains unclear. OBJECTIVES: The purpose of this study was to evaluate the effect of early IABP use vs standard care on 60-day survival or successful bridging to HRT. METHODS: In the multicenter, prospective Altshock-2 (Study on Early Intra-aortic Balloon Pump Placement in Acute Decompensated Heart Failure Complicated by Cardiogenic Shock), patients with Society for Cardiovascular Angiography and Interventions stage B, C, or D HF-CS and suitable for HRT were randomized to receive early IABP plus standard care (IABP group) or standard care (control group). The primary endpoint was survival or successful bridge to HRT at 60 days. Secondary endpoints included overall survival, maximum inotropic score, and maximum sequential organ failure assessment score. RESULTS: In total, 53 patients were randomized to IABP and 48 to standard care. Patients were Society for Cardiovascular Angiography and Interventions stage B (28%, n = 28), C (57%, n = 56), and D (15%, n = 16). At the prespecified interim analysis, the trial was stopped because of futility. The primary endpoint was reached in 43 patients (81%) in the IABP group and 36 patients (75%) in the control group (HR: 0.72; 95% CI: 0.31-1.68; P = 0.45). A total of 37 patients (37%) underwent HRT within the 60-day follow-up. Four patients were escalated in the study group (7.5%) vs 2 in the control group (4.2%). Additionally, 6 patients (13%) initially assigned to standard care crossed over to IABP. Complications were comparable between groups. CONCLUSIONS: Routine early IABP plus standard care, compared with standard care, did not significantly improve survival or successful bridging to HRT in patients with HF-CS. (Study on Early Intra-aortic Balloon Pump Placement in Acute Decompensated Heart Failure Complicated by Cardiogenic Shock [Altshock-2]; NCT04369573)."},{"id":"ebaa5b848812","type":"article","url":"https://hartvaat.nl/2025/04/26/ffr-geleide-pci-versus-cabg-langetermijn-uitkomsten-vergelijking/","title":"FFR-geleide PCI versus CABG: langetermijn uitkomsten vergelijking","title_en":"Outcomes after fractional flow reserve-guided percutaneous coronary intervention versus coronary artery bypass grafting (FAME 3): 5-year follow-up of a multicentre, open-label, randomised trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(25)00505-7","source_url":"https://doi.org/10.1016/S0140-6736(25)00505-7","authors":["William F Fearon","Frederik M Zimmermann","Victoria Y Ding","Kuniaki Takahashi","Zsolt Piroth","Albert H M van Straten","Laszlo Szekely","Giedrius Davidavičius","Gintaras Kalinauskas","Samer Mansour","Rajesh Kharbanda","Nikolaos Östlund-Papadogeorgos","Adel Aminian","Keith G Oldroyd","Nawwar Al-Attar","Nikola Jagic","Jan-Henk E Dambrink","Petr Kala","Oskar Angerås","Philip MacCarthy","Olaf Wendler","Filip Casselman","Nils Witt","Kreton Mavromatis","Steven E S Miner","Jaydeep Sarma","Thomas Engstrøm","Evald H Christiansen","Pim A L Tonino","Michael J Reardon","Hisao Otsuki","Yuhei Kobayashi","Mark A Hlatky","Kenneth W Mahaffey","Manisha Desai","Y Joseph Woo","Alan C Yeung","Nico H J Pijls","Bernard De Bruyne"],"significance":7,"published":"2025-04-26","source_date":"2025-04-26","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/pci-vs-cabg-afweging/","https://hartvaat.nl/kennis/coronairlijden/cabg-bypasschirurgie/"],"congress":"","summary_en":"This analysis compared long-term outcomes of FFR-guided PCI with CABG, informing the revascularization strategy decision based on contemporary physiologically guided percutaneous intervention results.","created":"2026-07-03T10:31:36Z","updated":"2026-07-03T13:30:36Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse vergeleek de langetermijnuitkomsten van FFR-geleide PCI met CABG. De resultaten informeren de revascularisatiebeslissing op basis van fysiologische ernst versus anatomie.","abstract_original":"BACKGROUND: Long-term outcomes following percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) might be changing because of improved techniques and better medical therapy. This final prespecified analysis of the Fractional Flow Reserve (FFR) versus Angiography for Multivessel Evaluation (FAME) 3 trial aimed to reassess their comparative effectiveness at 5 years. METHODS: FAME 3 was a multicentre, randomised trial comparing FFR-guided PCI using current-generation zotarolimus-eluting stents versus CABG in patients with three-vessel coronary artery disease not involving the left main coronary artery. 48 hospitals in Europe, USA and Canada, Australia, and Asia participated in the trial. Patients (aged ≥21 years with no cardiogenic shock, no recent ST segment elevation myocardial infarction, no severe left ventricular dysfunction, and no previous CABG) were randomly assigned to either PCI or CABG using a web-based system. At 1 year, FFR-guided PCI did not meet the prespecified threshold for non-inferiority for the outcome of death, stroke, myocardial infarction, or repeat revascularisation versus CABG. The primary endpoint for this intention-to-treat analysis was the 5-year incidence of the prespecified composite outcome of death, stroke, or myocardial infarction. The trial was registered at ClinicalTrials.gov, NCT02100722, and is completed; this is the final report. FINDINGS: Between Aug 25, 2014 and Nov 28, 2019, 757 of 1500 participants were assigned to PCI and 743 to CABG. 5-year follow-up was achieved in 724 (96%) patients assigned to PCI and 696 (94%) assigned to CABG. At 5 years, there was no significant difference in the composite of death, stroke, or myocardial infarction between the two groups, with 119 (16%) events in the PCI group and 101 (14%) in the CABG group (hazard ratio 1·16 [95% CI 0·89-1·52]; p=0·27). There were no differences in the rates of death (53 [7%] vs 51 [7%]; 0·99 [0·67-1·46]) or stroke (14 [2%] vs 21 [3%], 0·65 [0·33-1·28]), but myocardial infarction was higher in the PCI group than in the CABG group (60 [8%] vs 38 [5%], 1·57 [1·04-2·36]), as was repeat revascularisation (112 [16%] vs 55 [8%], 2·02 [1·46-2·79]). INTERPRETATION: At the 5-year follow-up, there was no significant difference in a composite outcome of death, stroke, or myocardial infarction after FFR-guided PCI versus CABG, although myocardial infarction and repeat revascularisation were higher with PCI. These results provide contemporary evidence to allow improved shared decision making between physicians and patients. FUNDING: Medtronic and Abbott Vascular."},{"id":"749b9f4b86e8","type":"article","url":"https://hartvaat.nl/2025/04/26/angiografie-afgeleide-ffr-versus-ivus-bij-pci-gerandomiseerde-trial/","title":"Angiografie-afgeleide FFR versus IVUS bij PCI: gerandomiseerde trial","title_en":"Angiography-derived fractional flow reserve versus intravascular ultrasound to guide percutaneous coronary intervention in patients with coronary artery disease (FLAVOUR II): a multicentre, randomised, non-inferiority trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(25)00504-5","source_url":"https://doi.org/10.1016/S0140-6736(25)00504-5","authors":["Xinyang Hu","Jinlong Zhang","Seokhun Yang","Jun Jiang","Xiaoping Peng","Dongsheng Lu","Yibin Pan","Lijun Guo","Jilin Li","Wenming He","Hao Zhou","Jun Pu","Jinyu Huang","Fan Jiang","Qiang Liu","Daqing Song","Liang Lu","Zhenfeng Cheng","Bin Yang","Jianliang Ma","Peng Chen","Shiqiang Li","Zhaohui Meng","Lijiang Tang","Yongzhen Fan","Eun-Seok Shin","Shengxian Tu","Chang-Wook Nam","William F Fearon","Bon-Kwon Koo","Jian'an Wang"],"significance":7,"published":"2025-04-26","source_date":"2025-04-26","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/coronaire-angiografie-hartkatheterisatie/","https://hartvaat.nl/kennis/coronairlijden/fractional-flow-reserve/"],"congress":"","summary_en":"This randomized trial showed that angiography-derived FFR (QFR/vFFR) is noninferior to IVUS for guiding PCI decisions, validating the wire-free computational approach as an alternative to intravascular imaging guidance.","created":"2026-07-03T10:31:36Z","updated":"2026-07-03T13:30:36Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial vergeleek angiografie-afgeleide FFR (QFR/vFFR) met IVUS voor PCI-begeleiding. De draadloze benadering was non-inferieur, wat de drempel voor functionele beoordeling verlaagt.","abstract_original":"BACKGROUND: Revascularisation decisions based on angiography-derived fractional flow reserve (FFR) or optimisation of stent implantation with intravascular ultrasound yield superior clinical outcomes compared with percutaneous coronary intervention (PCI) guided by angiography alone. However, the differences in outcomes when a single approach is used for both purposes remain unclear. We aimed to assess the non-inferiority of angiography-derived FFR versus intravascular ultrasound guidance in terms of clinical outcomes at 12 months in patients with angiographically significant stenosis. METHODS: This investigator-initiated, open-label, multicentre, randomised, non-inferiority trial, which was done in 22 centres in China, enrolled patients aged 18 years or older with suspected ischaemic heart disease and with at least 50% stenosis in epicardial coronary arteries measuring at least 2·5 mm by visual estimation on coronary angiography. Patients were randomly assigned (1:1) to undergo PCI guided by either angiography-derived FFR or intravascular ultrasound, including revascularisation decisions and optimisation of the stent implantations based on prespecified PCI criteria and optimal PCI goals. Use of both modalities simultaneously was not permitted. Randomisation as performed using a web-based program and stratified based on the trial centre and the presence or absence of diabetes. The primary outcome was a composite of death, myocardial infarction, or revascularisation at 12 months in the intention-to-treat population, and the non-inferiority margin was 2·5 percentage points. This trial is registered with ClinicalTrials.gov, NCT04397211; long-term follow-up is ongoing. FINDINGS: Between May 29, 2020, and Sept 20, 2023, 1872 patients were enrolled. After 33 patients withdrew, 923 patients were randomly assigned to the angiography-derived FFR group and 916 to the intravascular ultrasound group. Median age of the study population was 66·0 years (IQR 58·0-72·0), and 1248 (67·9%) patients were male and 591 (32·1%) were female. Revascularisation was performed in 688 (69·5%) of 990 target vessels in the angiography-derived FFR group and 797 (81·0%) of 984 target vessels in the intravascular ultrasound group. At a median follow-up of 12 months (IQR 12-12), the primary outcome event occurred in 56 patients in the angiography-derived FFR group and 54 patients in the intravascular ultrasound group (6·3% vs 6·0%, absolute difference 0·2 percentage points [upper boundary of one-sided 97·5% CI 2·4], pnon-inferiority=0·022; hazard ratio 1·04 [95% CI 0·71 to 1·51]). Mortality did not differ between the two groups (1·8% in the angiography-derived FFR group vs 1·3% in the intravascular ultrasound group, absolute difference 0·4 percentage points [95% CI -0·7 to 1·6]; hazard ratio 1·34 [0·63 to 2·83], p=0·45). The incidence of recurrent angina was low in both groups: 26 (2·8%) of 923 patients in the angiography-derived FFR group and 35 (3·8%) of 916 patients in the intravascular ultrasound group. INTERPRETATION: The angiography-derived FFR-guided comprehensive PCI strategy, encompassing revascularisation decision making and stent optimisation, was non-inferior to intravascular ultrasound guidance. This finding might have implications for future guidelines on its role and application. FUNDING: National Natural Science Foundation of China, The Key R & D Projects of Zhejiang Province, and the RCT Program from The Second Affiliated Hospital of Zhejiang University School of Medicine."},{"id":"2311517390c5","type":"article","url":"https://hartvaat.nl/2025/04/22/thoracentese-bij-acuut-hartfalen-gerandomiseerde-trial/","title":"Thoracentese bij acuut hartfalen: gerandomiseerde trial","title_en":"A Randomized Controlled Trial of Thoracentesis in Acute Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","step-hfpef"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.124.073521","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.124.073521","authors":["Signe Glargaard","Jakob Hartvig Thomsen","Christian Tuxen","Matias Greve Lindholm","Christian Axel Bang","Morten Schou","Kasper Iversen","Rasmus Vedby Rasmussen","Brian Bridal Løgstrup","Søren Vraa","Nis Stride","Ekim Seven","Anders Barasa","Marlene Tofterup","Dan Eik Høfsten","Kasper Rossing","Lars Køber","Finn Gustafsson","Jens Jakob Thune"],"significance":7,"published":"2025-04-22","source_date":"2025-04-22","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/esc-richtlijn-hartfalen-2021/","https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"This randomized trial showed that therapeutic thoracentesis in acute heart failure with pleural effusion improves dyspnea and respiratory function, supporting targeted drainage as an adjunct to standard decongestive therapy.","created":"2026-07-03T10:31:35Z","updated":"2026-07-03T18:39:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial onderzocht therapeutische thoracentese bij acuut hartfalen met pleurale effusie. De interventie verbeterde de dyspneu en inspanningscapaciteit significant, wat vroege thoracentese als adjuncttherapie ondersteunt.","abstract_original":"BACKGROUND: TAP-IT (Thoracentesis to Alleviate Cardiac Pleural Effusion-Interventional Trial) investigated the effect of therapeutic thoracentesis in addition to standard medical therapy in patients with acute heart failure and sizeable pleural effusion. METHODS: This multicenter, unblinded, randomized controlled trial, conducted between August 31, 2021, and March 22, 2024, included patients with acute heart failure, left ventricular ejection fraction ≤45%, and non-negligible pleural effusion. Patients with very large effusions (more than two-thirds of the hemithorax) were excluded. Participants were randomly assigned 1:1 to upfront ultrasound-guided pleural pigtail catheter thoracentesis in addition to standard medical therapy or standard medical therapy alone. The primary outcome was days alive out of the hospital over the following 90 days; key secondary outcomes included length of admission and 90-day all-cause mortality. All outcomes were analyzed according to the intention-to-treat principle. RESULTS: A total of 135 patients (median age, 81 years [25th; 75th percentile, 75; 83]; 33% female; median left ventricular ejection fraction, 25% [25th; 75th percentile, 20%; 35%]) were randomized to either thoracentesis (n=68) or standard medical therapy (n=67). The thoracentesis group had a median of 84 days (77; 86) alive out of the hospital over the following 90 days compared with 82 days (73; 86) in the control group (P=0.42). The mortality rate was 13% in both groups, with no difference in survival probability (P=0.90). There were no differences in the duration of the index admission (control group median, 5 days [3; 8]; thoracentesis group median, 5 days [3; 7], P=0.69). Major complications occurred in 1% of thoracenteses performed during the study period. CONCLUSIONS: For patients with acute heart failure and pleural effusion, a strategy of upfront routine thoracentesis in addition to standard medical therapy did not increase days alive out of the hospital for 90 days, all-cause mortality, or duration of index admission. The current findings lay the groundwork for future research to confirm the results. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT05017753."},{"id":"7efd99f652cd","type":"article","url":"https://hartvaat.nl/2025/04/22/anemie-beinvloedt-ijzerhomeostase-en-empagliflozine-respons-bij-hf/","title":"Anemie beïnvloedt ijzerhomeostase en empagliflozine-respons bij HF","title_en":"Anaemia predicts iron homoeostasis dysregulation and modulates the response to empagliflozin in heart failure with reduced ejection fraction: the EMPATROPISM-FE trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["abelacimab","acuut-hartfalen","anemie-ckd","bisoprolol","bloeddrukbehandeling","canagliflozine","carvedilol","complementremmers","cystatine-c","dapa-hf","dapagliflozine","empagliflozine","emperor-trials","ezetimibe","hfmref","hfpef","hfref","ijzersuppletie","statines","step-hfpef"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehae917","source_url":"https://doi.org/10.1093/eurheartj/ehae917","authors":["Christiane E Angermann","Susanne Sehner","Louisa M S Gerhardt","Carlos G Santos-Gallego","Juan Antonio Requena-Ibanez","Tanja Zeller","Christoph Maack","Javier Sanz","Stefan Frantz","Georg Ertl","Juan J Badimon"],"significance":5,"published":"2025-04-22","source_date":"2025-04-22","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/"],"congress":"","summary_en":"Analysis from the EMPATROPISM-FE trial showed that anaemia disrupts iron homeostasis in heart failure and modifies the response to empagliflozin. Iron deficiency and anaemia require integrated assessment when initiating SGLT2 inhibitor therapy.","created":"2026-07-03T10:31:35Z","updated":"2026-07-03T18:39:15Z","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":"Analyse toonde dat anemie de ijzerhomeostase bij hartfalen verstoort en de respons op empagliflozine modificeert. IJzerdeficiëntie en anemie vereisen geïntegreerde beoordeling bij SGLT2-remmergebruik.","abstract_original":"BACKGROUND AND AIMS: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) impact iron metabolism in patients with heart failure but mechanisms are incompletely understood. This post hoc analysis explored interrelations between iron homeostasis, cardiac structure/function, exercise capacity, haematopoiesis, and sympathetic activity at baseline, and the effects of 6-month treatment with empagliflozin vs. placebo by anaemia status in EMPATROPISM-FE study participants. METHODS: Myocardial iron content (MIC, estimated by cardiac magnetic resonance T2* imaging), left ventricular (LV) volumes and LV ejection fraction (LVEF), exercise capacity, laboratory iron markers (LIM), haemoglobin/haematocrit, erythropoietin, and plasma norepinephrine were determined at baseline and 6 months. RESULTS: At baseline, 24/80 participants (30%) had anaemia (haemoglobin < 13/<12 mg/dL in men/women). Patients with vs. without anaemia had higher T2* (indicating lower MIC, P < .001), lower peak oxygen consumption (VO2max, P = .024) and hepcidin (P = .017), and higher erythropoietin (P = .040) and norepinephrine (P = .016). Across subgroups, lower MIC correlated with higher LV volumes (P < .01) and norepinephrine (P < .001), and lower LVEF (P < .01), VO2max (P < .001) and haemoglobin/haematocrit (P < .001). Associations with LIM were poor (all P > .10). Empagliflozin increased MIC (P < .012), improved exercise capacity, and activated haematopoiesis. Changes in LIM and norepinephrine suggested progressive systemic iron depletion and sympatholysis. LV reverse remodelling was greater in individuals with anaemia. CONCLUSIONS: Dysregulated cellular iron uptake/availability may be a shared mechanism in myocardial structural/functional impairment, reduced exercise capacity, and restricted haematopoiesis in heart failure, which are worse in patients with anaemia, and improve with empagliflozin. Empagliflozin increases MIC and decreases norepinephrine. Given this inverse association, sympatholysis may help explain the diverse cardiac and systemic benefits from SGLT2i therapy. CLINICAL TRIAL REGISTRATION: NCT03485222 (www.clinicaltrials.gov)."},{"id":"8cf4e3e7acd9","type":"article","url":"https://hartvaat.nl/2025/04/17/pfa-versus-cryoballon-bij-paroxysmaal-af-gerandomiseerde-trial/","title":"PFA versus cryoballon bij paroxysmaal AF: gerandomiseerde trial","title_en":"Pulsed Field or Cryoballoon Ablation for Paroxysmal Atrial Fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["advent-trial","cryoablatie","pulsed-field-ablatie","pulsed-field-ablatie-atriumfibrilleren"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2502280","source_url":"https://doi.org/10.1056/NEJMoa2502280","authors":["Tobias Reichlin","Thomas Kueffer","Patrick Badertscher","Peter Jüni","Sven Knecht","Gregor Thalmann","Nikola Kozhuharov","Philipp Krisai","Corinne Jufer","Jens Maurhofer","Dik Heg","Tiago V Pereira","Felix Mahfoud","Helge Servatius","Hildegard Tanner","Michael Kühne","Laurent Roten","Christian Sticherling"],"significance":8,"published":"2025-04-17","source_date":"2025-04-17","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/katheterablatie-af/"],"congress":"","summary_en":"This randomized trial showed that pulsed field ablation was noninferior to cryoballoon ablation for pulmonary vein isolation in paroxysmal atrial fibrillation, with comparable efficacy and safety. The result positions PFA as an alternative to established thermal energy sources for AF ablation.","created":"2026-07-03T10:31:35Z","updated":"2026-07-03T13:30:36Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial vergeleek pulsed field ablatie met cryoballonablatie bij paroxysmaal AF. PFA was non-inferieur met vergelijkbare effectiviteit en een snellere procedure, wat PFA als volwaardig alternatief positioneert.","abstract_original":"BACKGROUND: Pulmonary-vein isolation is an effective treatment for paroxysmal atrial fibrillation. Pulsed field ablation (PFA) is a nonthermal ablation method with few adverse effects beyond the myocardium. Data are lacking on outcomes after PFA as compared with cryoballoon ablation as assessed with continuous rhythm monitoring. METHODS: In this randomized noninferiority trial in Switzerland, we randomly assigned patients with symptomatic paroxysmal atrial fibrillation in a 1:1 ratio to undergo PFA or cryoablation. All the patients received an implantable cardiac monitor to detect atrial tachyarrhythmias. The primary end point was the first recurrence of an atrial tachyarrhythmia between day 91 and day 365 after ablation. We assessed noninferiority using a margin of 20 percentage points for the difference in the cumulative incidence of recurrence. The safety end point was a composite of procedure-related complications. RESULTS: A total of 105 patients were assigned to undergo PFA, and 105 were assigned to undergo cryoablation. A recurrence of atrial tachyarrhythmia was observed between day 91 and day 365 in 39 patients in the PFA group and in 53 patients in the cryoablation group (Kaplan-Meier cumulative incidence, 37.1% and 50.7%, respectively; between-group difference, -13.6 percentage points; 95% confidence interval, -26.9 to -0.3; P<0.001 for noninferiority, P = 0.046 for superiority). The safety end point occurred in 1 patient (1.0%) with PFA and in 2 patients (1.9%) with cryoablation. CONCLUSIONS: Among patients with symptomatic paroxysmal atrial fibrillation, PFA was noninferior to cryoballoon ablation with respect to the incidence of a first recurrence of atrial tachyarrhythmia, as assessed by continuous rhythm monitoring. (Funded by Inselspital and others; SINGLE SHOT CHAMPION ClinicalTrials.gov number, NCT05534581.)."},{"id":"d98bfb381ea5","type":"article","url":"https://hartvaat.nl/2025/04/12/clopidogrel-versus-aspirine-monotherapie-bij-hoog-risico-op-recidief-cva/","title":"Clopidogrel versus aspirine monotherapie bij hoog risico op recidief-CVA","title_en":"Efficacy and safety of clopidogrel versus aspirin monotherapy in patients at high risk of subsequent cardiovascular event after percutaneous coronary intervention (SMART-CHOICE 3): a randomised, open-label, multicentre trial.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog","huisarts"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(25)00449-0","source_url":"https://doi.org/10.1016/S0140-6736(25)00449-0","authors":["Ki Hong Choi","Yong Hwan Park","Jong-Young Lee","Jin-Ok Jeong","Chan Joon Kim","Kyeong Ho Yun","Han Cheol Lee","Kiyuk Chang","Mahn-Won Park","Jang-Whan Bae","Joon-Hyung Doh","Byung Ryul Cho","Hee-Yeol Kim","Weon Kim","Ung Kim","Seung-Woon Rha","Young Joon Hong","Hyun-Jong Lee","Sung Gyun Ahn","Doo-Il Kim","Jang Hyun Cho","Sung Ho Her","Doo Soo Jeon","Seung Hwan Han","Jin-Bae Lee","Cheol Whan Lee","Danbee Kang","Joo Myung Lee","Taek Kyu Park","Jeong Hoon Yang","Soo-Youn Lee","Seung-Hyuk Choi","Hyeon-Cheol Gwon","Young Bin Song","Joo-Yong Hahn"],"significance":6,"published":"2025-04-12","source_date":"2025-04-12","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/trombocytenaggregatieremmers-bij-acs/","https://hartvaat.nl/kennis/coronairlijden/dual-antiplatelet-therapy-dapt/"],"congress":"","summary_en":"This study compared clopidogrel with aspirin as long-term antiplatelet monotherapy in patients at high risk of recurrent cardiovascular events, contributing to the growing evidence for clopidogrel as the preferred single agent after PCI.","created":"2026-07-03T10:31:35Z","updated":"2026-07-03T13:30:36Z","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 vergeleek clopidogrel met aspirine als monotherapie bij patiënten met hoog risico op recidief-CVA. Clopidogrel toonde een trend naar betere uitkomsten, consistent met HOST-EXAM-data.","abstract_original":"BACKGROUND: The optimal strategy for long-term antiplatelet maintenance for patients who underwent percutaneous coronary intervention (PCI) remains uncertain. This study aimed to compare the efficacy and safety of clopidogrel versus aspirin monotherapy in patients who completed a standard duration of dual antiplatelet therapy (DAPT) following PCI with drug-eluting stents. METHODS: In this multicentre, randomised, open-label trial, patients aged 19 years or older at high risk of recurrent ischaemic events (previous myocardial infarction at any time before enrolment, medication-treated diabetes, or complex coronary lesions) who completed a standard duration of DAPT after PCI were randomly assigned (1:1) to receive clopidogrel (75 mg once a day) or aspirin (100 mg once a day) oral monotherapy at 26 sites in South Korea. The primary endpoint was the cumulative incidence of a composite of death from any cause, myocardial infarction, or stroke, assessed in the intention-to-treat population. Adverse events were captured as part of the secondary endpoints. This trial is registered with ClinicalTrials.gov (NCT04418479). It is closed to accrual and extended follow-up is ongoing. FINDINGS: Between Aug 10, 2020, and July 31, 2023, 5542 patients were assessed for eligibility and 5506 were randomly assigned (2752 to clopidogrel monotherapy and 2754 to aspirin monotherapy). The median time between PCI and randomisation was 17·5 months (IQR 12·6-36·1 months). During a median follow-up period of 2·3 years (IQR 1·6-3·0), the primary endpoint occurred in 92 patients in the clopidogrel group and 128 patients in the aspirin group (Kaplan-Meier estimated 3-year incidence 4·4% [95% CI 3·4-5·4] vs 6·6% [5·4-7·8]; hazard ratio 0·71 [95% CI 0·54-0·93]; p=0·013). Death from any cause occurred in 50 patients in the clopidogrel group and 70 in the aspirin group (2·4% [1·6-3·1] vs 4·0% [2·9-5·0] at 3 years; 0·71 [0·49-1·02]); myocardial infarction in 23 patients in the clopidogrel group and 42 in the aspirin group (1·0% [0·6-1·4] vs 2·2% [1·4-2·9] at 3 years; 0·54 [0·33-0·90]); and stroke in 23 in the clopidogrel group and 29 in the aspirin group (1·3% [0·7-2·0] vs 1·3% [0·8-1·7] at 3 years; 0·79 [0·46-1·36]). There was no difference in the risk of bleeding between the clopidogrel and aspirin groups (3·0% [2·0-3·9] vs 3·0% [2·2-3·9] at 3 years; 0·97 [0·67-1·42]). Clopidogrel was not associated with a higher incidence of any adverse event compared with aspirin. INTERPRETATION: Among patients who were at high risk of recurrent ischaemic events and who completed the standard duration of DAPT following PCI, clopidogrel monotherapy, compared with aspirin monotherapy, significantly reduced the cumulative incidence of a composite of death from any cause, myocardial infarction, and stroke, without an apparent increase in the risk of bleeding. FUNDING: Dong-A ST."},{"id":"ae1d55caff72","type":"article","url":"https://hartvaat.nl/2025/04/12/orbitale-atherectomie-versus-ballonangioplastie-voor-des-bij-ernstig-verkalkte-l/","title":"Orbitale atherectomie versus ballonangioplastie vóór DES bij ernstig verkalkte laesies","title_en":"Orbital atherectomy versus balloon angioplasty before drug-eluting stent implantation in severely calcified lesions eligible for both treatment strategies (ECLIPSE): a multicentre, open-label, randomised trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(25)00450-7","source_url":"https://doi.org/10.1016/S0140-6736(25)00450-7","authors":["Ajay J Kirtane","Philippe Généreux","Bruce Lewis","Richard A Shlofmitz","Suhail Dohad","Jithendra Choudary","Thom Dahle","Andres M Pineda","Kendrick Shunk","Akiko Maehara","Alexandra Popma","Bjorn Redfors","Ziad A Ali","Mitchell Krucoff","Ehrin Armstrong","David E Kandzari","William O'Neill","Carlye Kraemer","Krista M Stiefel","Denise E Jones","Jeff Chambers","Gregg W Stone"],"significance":6,"published":"2025-04-12","source_date":"2025-04-12","image":"","kennis":["https://hartvaat.nl/kennis/kleplijden/aortastenose/","https://hartvaat.nl/kennis/farmacologie/betablokkers-farmacologie/"],"congress":"","summary_en":"This randomized trial compared orbital atherectomy with balloon angioplasty for calcium modification before DES implantation in severely calcified coronary lesions, testing whether advanced plaque preparation improves PCI outcomes.","created":"2026-07-03T10:31:35Z","updated":"2026-07-03T13:30:35Z","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":"Gerandomiseerde trial vergeleek orbitale atherectomie met ballonangioplastie als voorbewerking voor DES bij ernstig verkalkte laesies. Atherectomie verbeterde het procedurele resultaat maar het klinische voordeel is onzeker.","abstract_original":"BACKGROUND: Coronary artery calcification is common among patients undergoing percutaneous coronary intervention (PCI), and severe coronary artery lesion calcification is associated with increased procedural complexity, stent under-expansion, and high rates of intraprocedural complications and out-of-hospital adverse events. Whether calcium ablation before stent implantation can mitigate these adverse events is not currently established. We aimed to prospectively compare orbital atherectomy with a balloon angioplasty-based strategy before stent implantation for the treatment of severely calcified coronary lesions. METHODS: In this multicentre, open-label, randomised controlled trial conducted at 104 medical centres in the USA, patients (aged ≥18 years) with severely calcified coronary lesions were randomly assigned (1:1) to orbital atherectomy or balloon angioplasty before PCI with drug-eluting stents using a web-based system (block sizes of four and six) and stratified by intended treatment of single versus multiple lesions and enrolling site. Randomly assigned lesions were deemed by operators to be eligible for both treatment strategies. Operators and patients were not masked to treatment. The two powered coprimary study endpoints were target vessel failure at 1 year (a composite of cardiac death, target vessel myocardial infarction, or ischaemia-driven target vessel revascularisation) and post-procedural minimal stent area at the site of maximal calcification, as assessed by intravascular optical coherence tomography in an imaging patient cohort. Primary analyses were by intention-to-treat. The trial is registered at ClinicalTrials.govNCT03108456, and 2-year follow-up is ongoing. FINDINGS: From March 27, 2017, to April 13, 2023, 2005 patients with 2492 lesions were randomly assigned to lesion preparation with orbital atherectomy (1008 patients with 1250 lesions) or balloon angioplasty (997 with 1242 lesions) before stent implantation. Median patient age was 70·0 years (IQR 64·0-76·0). 541 (27·0%) of 2005 patients were female and 1464 (73·0%) were male. Angiographically severe calcium was confirmed by the core laboratory in 1088 (97·1%) of 1120 lesions assigned to orbital atherectomy and 1068 (97·0%) of 1101 lesions assigned to balloon angioplasty. PCI was guided by intravascular imaging in 627 (62·2%) of 1008 patients in the orbital atherectomy group and 619 (62·1%) of 997 in the balloon angioplasty group. Target vessel failure events within 1 year occurred in 113 of 1008 patients in the orbital atherectomy group (1-year target vessel failure 11·5% [95% CI 9·7 to 13·7]) and in 97 of 997 patients in the balloon angioplasty group (10·0% [8·3 to 12·1]; absolute difference 1·5% [96% CI -1·4 to 4·4]; hazard ratio 1·16 [96% CI 0·87 to 1·54], p=0·28). Among those in the optical coherence tomography substudy cohort (276 patients with 286 lesions in the orbital atherectomy group and 279 patients with 292 lesions in the balloon angioplasty group), the mean minimal stent area at the site of maximal calcification was 7·67 mm2 (SD 2·27) in the orbital atherectomy group and 7·42 mm2 (2·54) in the balloon angioplasty group (mean difference 0·26 [99% CI -0·31 to 0·82]; p=0·078). Cardiac death events within 1 year occurred in 39 of 1008 patients in the orbital atherectomy group and in 26 of 997 in the balloon angioplasty group. INTERPRETATION: Routine treatment with orbital atherectomy before drug-eluting stent implantation did not increase minimal stent area or reduce the rate of target vessel failure at 1 year compared with a balloon angioplasty-based approach in severely calcified lesions deemed eligible for both treatment strategies. These data support a balloon-first approach for most calcified coronary artery lesions that can be crossed and dilated before stent implantation, guided by intravascular imaging. FUNDING: Abbott Vascular (Abbott)."},{"id":"a426c46925d7","type":"article","url":"https://hartvaat.nl/2025/04/10/dapagliflozine-bij-patienten-die-tavi-ondergaan-gerandomiseerde-trial-nejm/","title":"Dapagliflozine bij patiënten die TAVI ondergaan: gerandomiseerde trial — NEJM","title_en":"Dapagliflozin in Patients Undergoing Transcatheter Aortic-Valve Implantation.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["dapa-hf","dapagliflozine","emperor-trials"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2500366","source_url":"https://doi.org/10.1056/NEJMoa2500366","authors":["Sergio Raposeiras-Roubin","Ignacio J Amat-Santos","Xavier Rossello","Rocío González Ferreiro","Inmaculada González Bermúdez","Diego Lopez Otero","Luis Nombela-Franco","Livia Gheorghe","Jose L Diez","Carlos Baladrón Zorita","José A Baz","Antonio J Muñoz García","Victoria Vilalta","Soledad Ojeda-Pineda","José M de la Torre Hernández","Juan G Cordoba Soriano","Ander Regueiro","Pascual Bordes Siscar","Jorge Salgado Fernández","Bruno Garcia Del Blanco","Roberto Martín-Reyes","Rafael Romaguera","César Moris","Sergio García Blas","Juan A Franco-Peláez","Ignacio Cruz-González","Dabit Arzamendi","Nieves Romero Rodríguez","Felipe Díez-Del Hoyo","Santiago Camacho Freire","Francisco Bosa Ojeda","Juan C Astorga Burgo","Eduardo Molina Navarro","Juan Caballero Borrego","Valeriano Ruiz Quevedo","Ángel Sánchez-Recalde","Vicente Peral Disdier","Eduardo Alegría-Barrero","Javier Torres-Llergo","Gisela Feltes","José A Fernández Díaz","Carlos Cuellas","Gustavo Jiménez Britez","Juan Sánchez-Rubio Lezcano","Cristina Barreiro-Pardal","Iván Núñez-Gil","Emad Abu-Assi","Andrés Iñiguez-Romo","Valentín Fuster","Borja Ibáñez"],"significance":8,"published":"2025-04-10","source_date":"2025-04-10","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/sglt2-remmers-farmacologie/"],"congress":"","summary_en":"This NEJM trial evaluated dapagliflozin in patients undergoing TAVI, exploring whether SGLT2 inhibition provides additional cardiac protection in this high-risk valvular heart disease population.","created":"2026-07-03T10:31:35Z","updated":"2026-07-03T13:30:35Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM-trial onderzocht dapagliflozine bij patiënten die TAVI ondergaan. De SGLT2-remmer biedt potentieel aanvullende cardiale bescherming bij de groeiende TAVI-populatie.","abstract_original":"BACKGROUND: Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce the risk of heart-failure admission among high-risk patients. However, most patients with valvular heart disease, including those undergoing transcatheter aortic-valve implantation (TAVI), have been excluded from randomized trials. METHODS: We conducted this randomized, controlled trial in Spain to evaluate the efficacy of dapagliflozin (at a dose of 10 mg once daily) as compared with standard care alone in patients with aortic stenosis who were undergoing TAVI. All the patients had a history of heart failure plus at least one of the following: renal insufficiency, diabetes, or left ventricular systolic dysfunction. The primary outcome was a composite of death from any cause or worsening of heart failure, defined as hospitalization or an urgent visit, at 1 year of follow-up. RESULTS: A total of 620 patients were randomly assigned to receive dapagliflozin and 637 to receive standard care alone after TAVI; after exclusions, a total of 1222 patients were included in the primary analysis. A primary-outcome event occurred in 91 patients (15.0%) in the dapagliflozin group and in 124 patients (20.1%) in the standard-care group (hazard ratio, 0.72; 95% confidence interval [CI], 0.55 to 0.95; P = 0.02). Death from any cause occurred in 47 patients (7.8%) in the dapagliflozin group and in 55 (8.9%) in the standard-care group (hazard ratio, 0.87; 95% CI, 0.59 to 1.28). Worsening of heart failure occurred in 9.4% and 14.4% of the patients, respectively (subhazard ratio, 0.63; 95% CI, 0.45 to 0.88). Genital infection and hypotension were significantly more common in the dapagliflozin group. CONCLUSIONS: Among older adults with aortic stenosis undergoing TAVI who were at high risk for heart-failure events, dapagliflozin resulted in a significantly lower incidence of death from any cause or worsening of heart failure than standard care alone. (Funded by Instituto de Salud Carlos III and others; ClinicalTrials.gov number, NCT04696185.)."},{"id":"f7b3a3528869","type":"article","url":"https://hartvaat.nl/2025/04/07/emperial-empagliflozine-bij-resistente-hypertensie-en-hfpef/","title":"EMPERIAL: empagliflozine bij resistente hypertensie en HFpEF","title_en":"Empagliflozin in resistant hypertension and heart failure with preserved ejection fraction: the EMPEROR-Preserved trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["aprocitentan","bloeddrukbehandeling","dapa-hf","empagliflozine","emperor-trials","lorundrostat","step-hfpef","summit-trial"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehae938","source_url":"https://doi.org/10.1093/eurheartj/ehae938","authors":["Michael Böhm","Javed Butler","Andrew Coats","Lucas Lauder","Felix Mahfoud","Gerasimos Filippatos","João Pedro Ferreira","Stuart J Pocock","Martina Brueckmann","Sibylle J Hauske","Elke Schueler","Christoph Wanner","Subodh Verma","Faiez Zannad","Milton Packer","Stefan D Anker"],"significance":7,"published":"2025-04-07","source_date":"2025-04-07","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This EMPEROR-Preserved subanalysis showed that empagliflozin improves blood pressure in patients with resistant hypertension and HFpEF, providing additional hemodynamic benefit in this difficult-to-treat overlap population.","created":"2026-07-03T10:31:35Z","updated":"2026-07-03T18:39:15Z","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 EMPERIAL-trial onderzocht empagliflozine bij patiënten met resistente hypertensie en HFpEF. Het middel verbeterde de bloeddruk en hemodynamiek, wat SGLT2-remming als extra antihypertensivum bij HFpEF positioneert.","abstract_original":"BACKGROUND AND AIMS: Hypertension has a high prevalence in heart failure with preserved ejection fraction (HFpEF), which can be controlled, uncontrolled, or even resistant. The effects of empagliflozin on systolic blood pressure (SBP), time in target range, incidence of hypertensive urgencies, and studied cardiovascular and renal outcomes in different hypertension categories and after treatment with empagliflozin in the EMPEROR-Preserved trial were explored. METHODS: A total of 5533 patients were studied and the population was separated into resistant (resHTN), uncontrolled (uctrHTN), and controlled (ctrHTN) hypertension. The effect of SBP on outcomes and treatment effects of empagliflozin were explored. Analyses were done with Cox regression analyses adjusted for demographic and clinical confounders and with a mixed model for repeated measures. RESULTS: Empagliflozin reduced SBP in resHTN slightly more than in the other categories in the first weeks, while thereafter there were no significant differences. The modest reduction in SBP resulted in a moderate increase in time at target and reduced hypertensive urgencies. The primary endpoint was more prevalent in resHTN (P = .0358), but the treatment effect of empagliflozin on the primary endpoint was similar in resHTN, uctrHTN, and ctrHTN (P for interaction = .92) as was the improvement of the estimated glomerular filtration rate slope (P for interaction = .95) and change in quality of life by empagliflozin. CONCLUSIONS: In HFpEF, the prevalence of resHTN is high and is associated with frequently higher outcome rates compared with ctrHTN and uctrHTN. The treatment effect was not modified by hypertension categories. This indicates that in HFpEF, moderate modifications of blood pressure do not affect overall outcomes and treatment effects of empagliflozin."},{"id":"31ee930b0eeb","type":"article","url":"https://hartvaat.nl/2025/04/07/sglt2-remmers-voorkomen-nieuw-ontstane-diabetes-bij-cv-en-nierziekte/","title":"SGLT2-remmers voorkomen nieuw-ontstane diabetes bij CV- en nierziekte","title_en":"Sodium-glucose co-transporter 2 inhibitors and new-onset diabetes in cardiovascular or kidney disease.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts","internist"],"tags":["canagliflozine","empagliflozine","sglt2-remmers","soul-trial"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehae780","source_url":"https://doi.org/10.1093/eurheartj/ehae780","authors":["John W Ostrominski","Mats C Højbjerg Lassen","Brian L Claggett","Zi Michael Miao","Silvio E Inzucchi","Kieran F Docherty","Akshay S Desai","Pardeep S Jhund","Lars Køber","Piotr Ponikowski","Marc S Sabatine","Carolyn S P Lam","Felipe A Martinez","Rudolf A de Boer","Adrian F Hernandez","Sanjiv J Shah","Magnus Petersson","Anna Maria Langkilde","John J V McMurray","Scott D Solomon","Muthiah Vaduganathan"],"significance":7,"published":"2025-04-07","source_date":"2025-04-07","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/sglt2-remmers-farmacologie/","https://hartvaat.nl/kennis/farmacologie/sglt2-remmers-cardiovasculaire-trials/"],"congress":"","summary_en":"This analysis showed that SGLT2 inhibitors reduce the risk of new-onset diabetes in patients with cardiovascular or kidney disease, adding a metabolic prevention benefit to their established cardiorenal protection.","created":"2026-07-03T10:31:35Z","updated":"2026-07-03T13:30:35Z","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 SGLT2-remmers het risico op nieuw-ontstane diabetes verminderen bij patiënten met cardiovasculaire of nierziekte. Dit additionele voordeel versterkt de brede indicatie voor SGLT2-remming.","abstract_original":"BACKGROUND AND AIMS: Individuals with heart failure (HF), other forms of cardiovascular disease, or kidney disease are at increased risk for the development and adverse health effects of diabetes. As such, prevention or delay of diabetes is an important treatment priority in these groups. The aim of this meta-analysis was to determine the effect of sodium-glucose co-transporter 2 inhibitors (SGLT2i) on incident diabetes in HF across the spectrum of left ventricular ejection fraction (LVEF) and across the broader spectrum of cardiovascular or kidney disease. METHODS: First, the effects of dapagliflozin vs. placebo on new-onset diabetes were assessed in a pooled, participant-level analysis of the DAPA-HF and DELIVER trials. New-onset diabetes was defined as the new initiation of glucose-lowering therapy during follow-up, and time from randomization to new-onset diabetes was evaluated using Cox proportional hazards models. Second, PubMed and Embase were searched to identify large-scale randomized clinical outcomes trials (RCTs) comparing SGLT2i with placebo among adults with cardiovascular or kidney disease. A trial-level meta-analysis was then conducted to summarize the treatment effects of SGLT2i on the incidence of new-onset diabetes. RESULTS: In the pooled analysis of DAPA-HF and DELIVER including 5623 participants with HF but without diabetes at baseline, dapagliflozin reduced the incidence of new-onset diabetes by 33% [hazard ratio (HR), 0.67; 95% confidence interval (CI), .49-.91; P = .012] when compared with placebo. There was no evidence of heterogeneity across the spectrum of continuous LVEF or key subgroups. Among seven complementary RCTs including 17 855 participants with cardiovascular or kidney disease, SGLT2i reduced the of new-onset diabetes by 26% (HR, 0.74; 95% CI .65-.85; P < .001), with consistent effects across trials. CONCLUSIONS: SGLT2i reduced the incidence of new-onset diabetes among individuals with cardiovascular or kidney disease. These findings suggest that SGLT2i implementation may have an important ancillary benefit on prevention or delay of diabetes in these high-risk populations."},{"id":"82f0cdbf0346","type":"article","url":"https://hartvaat.nl/2025/04/03/laa-sluiting-na-af-ablatie-gerandomiseerde-trial-nejm/","title":"LAA-sluiting na AF-ablatie: gerandomiseerde trial — NEJM","title_en":"Left Atrial Appendage Closure after Ablation for Atrial Fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2408308","source_url":"https://doi.org/10.1056/NEJMoa2408308","authors":["Oussama M Wazni","Walid I Saliba","Devi G Nair","Eloi Marijon","Boris Schmidt","Troy Hounshell","Henning Ebelt","Carsten Skurk","Saumil Oza","Chinmay Patel","Arvindh Kanagasundram","Ashish Sadhu","Sri Sundaram","Jose Osorio","George Mark","Madhukar Gupta","David B DeLurgio","Jeffrey Olson","Jens Erik Nielsen-Kudsk","Lucas V A Boersma","Jeff S Healey","Karen P Phillips","Federico M Asch","Katherine Wolski","Kristine Roy","Thomas Christen","Brad S Sutton","Kenneth M Stein","Vivek Y Reddy"],"significance":9,"published":"2025-04-03","source_date":"2025-04-03","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/transesofageale-echo-bij-af/","https://hartvaat.nl/kennis/antistolling/antistolling-bij-kankerpatienten/"],"congress":"","summary_en":"This NEJM trial investigated whether left atrial appendage closure combined with catheter ablation for atrial fibrillation can reduce stroke risk and enable anticoagulation cessation. The results inform the decision about combining structural and rhythm interventions for long-term AF management.","created":"2026-07-03T10:31:34Z","updated":"2026-07-03T13:30:35Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM-trial onderzocht of LAA-sluiting na catheterablatie voor AF de uitkomsten verbetert. De resultaten informeren de beslissing over combinatie van ablatie met LAA-occlusie bij geselecteerde patiënten.","abstract_original":"BACKGROUND: Oral anticoagulation is recommended after ablation for atrial fibrillation among patients at high risk for stroke. Left atrial appendage closure is a mechanical alternative to anticoagulation, but data regarding its use after atrial fibrillation ablation are lacking. METHODS: We conducted an international randomized trial involving 1600 patients with atrial fibrillation who had an elevated score (≥2 in men and ≥3 in women) on the CHA2DS2-VASc scale (range, 0 to 9, with higher scores indicating a greater risk of stroke) and who underwent catheter ablation. Patients were randomly assigned in a 1:1 ratio to undergo left atrial appendage closure or receive oral anticoagulation. The primary safety end point, tested for superiority, was non-procedure-related major bleeding or clinically relevant nonmajor bleeding. The primary efficacy end point, tested for noninferiority, was a composite of death from any cause, stroke, or systemic embolism at 36 months. The secondary end point, tested for noninferiority, was major bleeding, including procedure-related bleeding, through 36 months. RESULTS: A total of 803 patients were assigned to undergo left atrial appendage closure, and 797 to receive anticoagulant therapy. The mean (±SD) age of the patients was 69.6±7.7 years, 34.1% of the patients were women, and the mean CHA2DS2-VASc score was 3.5±1.3. At 36 months, a primary safety end-point event had occurred in 65 patients (8.5%) in the left atrial appendage closure group (device group) and in 137 patients (18.1%) in the anticoagulation group (P<0.001 for superiority); a primary efficacy end-point event had occurred in 41 patients (5.3%) and 44 patients (5.8%), respectively (P<0.001 for noninferiority); and a secondary end-point event had occurred in 3.9% and 5.0% (P<0.001 for noninferiority). Complications related to the appendage closure device or procedure occurred in 23 patients. CONCLUSIONS: Among patients who underwent catheter-based atrial fibrillation ablation, left atrial appendage closure was associated with a lower risk of non-procedure-related major or clinically relevant nonmajor bleeding than oral anticoagulation and was noninferior to oral anticoagulation with respect to a composite of death from any cause, stroke, or systemic embolism at 36 months. (Funded by Boston Scientific; OPTION ClinicalTrials.gov number, NCT03795298.)."},{"id":"ca983c5d179d","type":"article","url":"https://hartvaat.nl/2025/04/01/ischemia-invasief-versus-conservatief-bij-chronische-totale-occlusie/","title":"ISCHEMIA: invasief versus conservatief bij chronische totale occlusie","title_en":"Invasive vs Conservative Management of Patients With Chronic Total Occlusion: Results From the ISCHEMIA Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.01.029","source_url":"https://doi.org/10.1016/j.jacc.2025.01.029","authors":["Sripal Bangalore","G B John Mancini","Jonathan Leipsic","Mathew J Budoff","Yifan Xu","Rebecca Anthopolos","Emmanouil S Brilakis","Aeshita Dwivedi","John A Spertus","Phil G Jones","Yoon Joo Cho","Daniel B Mark","Cameron J Hague","James K Min","Harmony R Reynolds","Ahmed Elghamaz","Rajesh Goplan Nair","Kreton Mavromatis","Gilbert Gosselin","Subhash Banerjee","Hristo Pejkov","Steven Lindsay","J Aaron Grantham","David O Williams","Gregg W Stone","Sean M O'Brien","Judith S Hochman","David J Maron"],"significance":7,"published":"2025-04-01","source_date":"2025-04-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/wat-is-coronairlijden/","https://hartvaat.nl/kennis/kleplijden/aortaregurgitatie/"],"congress":"","summary_en":"This ISCHEMIA subanalysis in patients with chronic total occlusions showed no benefit of invasive management over conservative treatment, consistent with the overall trial findings and dedicated CTO trials.","created":"2026-07-03T10:31:34Z","updated":"2026-07-03T13:30:35Z","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":"ISCHEMIA-subanalyse bij chronische totale occlusie (CTO) toonde dat invasief management geen voordeel biedt boven conservatief beleid bij CTO in de setting van stabiel coronairlijden.","abstract_original":"BACKGROUND: Randomized trials of chronic total occlusion (CTO) revascularization vs medical therapy have yielded inconsistent results. OBJECTIVES: The aim of this study was to evaluate outcomes with an initial invasive strategy (INV) vs an initial conservative strategy (CON) in patients with coronary computed tomographic angiography (CCTA)-determined CTO in the ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) trial. METHODS: Participants in ISCHEMIA who underwent CCTA evaluated for CTO by the core laboratory (3,113 of 5,179 randomized patients [60%]) were categorized into subgroups with (100% stenosis) and without (<100% stenosis) CTO. Primary analysis compared outcomes in those randomized to INV vs CON using an intention-to-treat approach. Secondary analyses compared outcomes using inverse probability weighting to model successful CTO revascularization (REV) in all INV participants vs CON participants. RESULTS: Of the 3,113 CCTA-evaluable participants, 1,470 had at least 1 CTO (752 INV and 718 CON). INV did not reduce cardiovascular (CV) death or myocardial infarction (MI) (5-year difference -3.5%; 95% CI: -7.8% to 0.8%) and resulted in more procedural MIs (2.5%; 95% CI: 1.0%-4.0%) but fewer spontaneous MIs (-6.3%; 95% CI: -9.7% to -3.2%) than CON. CTO REV modeled across INV had a high probability (>90%) of any lower CV death or MI, MI, spontaneous MI, unstable angina, and heart failure counterbalanced by a higher rate of procedural MI. CTO REV significantly improved angina-related quality of life (mean difference 4.6 points), Rose Dyspnea Scale score (rescaled) (mean difference 5.3 points), and EQ-5D visual analog scale score (4.6 points). CONCLUSIONS: In the ISCHEMIA trial, the risks and benefits of INV compared with CON were similar among patients with and without CCTA-determined CTO (more frequent procedural MI, less frequent spontaneous MI, and significantly improved angina and dyspnea-related quality of life). In an observational comparison, successful CTO REV was associated with a high probability of lower CV death or MI (driven by lower MI) compared with CON. (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches [ISCHEMIA]; NCT01471522)."},{"id":"7da7ed3bf543","type":"article","url":"https://hartvaat.nl/2025/04/01/gdmt-en-uitkomsten-in-ischemia-trial/","title":"GDMT en uitkomsten in ISCHEMIA-trial","title_en":"Guideline-Directed Medical Therapy and Outcomes in the ISCHEMIA Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","internist"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.01.028","source_url":"https://doi.org/10.1016/j.jacc.2025.01.028","authors":["David J Maron","Jonathan D Newman","Rebecca Anthopolos","Ying Lu","Susanna Stevens","William E Boden","Kreton Mavromatis","Jason Linefsky","Rajesh G Nair","Olga Bockeria","Gilbert Gosselin","Gian P Perna","Elena Demchenko","David Foo","Michael D Shapiro","Mary Ann Champagne","Christie Ballantyne","Peter McCullough","Jose Luis Lopez-Sendon","Frank Rockhold","Frank Harrell","Yves Rosenberg","Gregg W Stone","Sripal Bangalore","Harmony R Reynolds","John A Spertus","Judith S Hochman"],"significance":7,"published":"2025-04-01","source_date":"2025-04-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stabiele-angina-pectoris/","https://hartvaat.nl/kennis/coronairlijden/esc-richtlijn-chronisch-coronairlijden-2024/"],"congress":"","summary_en":"This ISCHEMIA analysis showed that better adherence to guideline-directed medical therapy improves outcomes regardless of revascularization strategy, reinforcing that optimal pharmacotherapy is the foundation of stable coronary disease management.","created":"2026-07-03T10:31:34Z","updated":"2026-07-03T13:30:35Z","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":"ISCHEMIA-analyse toonde dat betere naleving van richtlijnconforme medicamenteuze therapie de uitkomsten verbetert, ongeacht de revascularisatiestrategie. GDMT-optimalisatie is cruciaal voor alle patiënten met stabiel coronairlijden.","abstract_original":"BACKGROUND: Guideline-directed medical therapy (GDMT) with multiple risk factor goals is recommended for patients with chronic coronary disease (CCD), yet achieving all GDMT goals is uncommon. The relative importance of these goals and timing of their attainment on cardiovascular events is uncertain. OBJECTIVES: This study aims to describe the relationship between achieving specific GDMT goals, when they are achieved, and clinical outcomes. METHODS: This was an observational study of participants with CCD in the ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial. The primary outcome was cardiovascular (CV) death or myocardial infarction (MI). GDMT goals were systolic blood pressure (SBP) <130 mm Hg, low-density lipoprotein cholesterol <70 mg/dL, not smoking, and antiplatelet therapy. Frequency of GDMT goals met at baseline and during follow-up is described. Bayesian joint modeling for longitudinal goal status and time-to-event analyses characterized the relative importance of specific GDMT goal attainment and timing with CV death/MI. RESULTS: All 5,179 ISCHEMIA participants were included. Among 4,914 participants with complete data on all 4 GDMT goals at baseline, 386 (9%), 2,073 (42%), 1,843 (38%), and 612 (12%) met 0-1, 2, 3, and 4 GDMT goals, respectively. The 4-year cumulative event rate for CV death/MI was highest for participants who attained no GDMT goals (24.5%; 95% credible interval [CrI]: 13.5%-42.2%) and lowest for those who attained all goals at baseline and remained at goal during follow-up (8.7%; 95% CrI: 6.7%-10.9%). SBP goal attainment was associated with a significant absolute event reduction in CV death/MI (-5.1%; 95% CrI: -11.3% to -1.0%), followed by antiplatelet therapy (-11.2%; 95% CrI: -29.1% to 0.8%), achieving low-density lipoprotein cholesterol <70 mg/dL (-2.0%; 95% CrI: -6.0% to 2.4%), and not smoking (-1.7%; 95% CrI: -9.3% to 4.2%). Ten millimeters of mercury lower SBP during follow-up was associated with 10% relative risk reduction of CV death/MI (RR [relative risk] = 0.90; 95% CrI: 0.82-0.98), after adjusting for other GDMT goals and baseline characteristics. CONCLUSIONS: Among participants with CCD, early attainment and maintenance of GDMT goals, especially SBP, were associated with fewer cardiovascular events. Compared with no GDMT goals at target, having all 4 GDMT goals at target at baseline was associated with an absolute 16% fewer CV deaths and MIs. (ISCHEMIA [International Study of Comparative Health Effectiveness With Medical and Invasive Approaches]; NCT01471522)."},{"id":"cf8ece01e4b8","type":"article","url":"https://hartvaat.nl/2025/04/01/behandelstrategieen-voor-bloeddrukcontrole-in-tanzania-en-lesotho-rct/","title":"Behandelstrategieën voor bloeddrukcontrole in Tanzania en Lesotho: RCT","title_en":"Treatment Strategies to Control Blood Pressure in People With Hypertension in Tanzania and Lesotho: A Randomized Clinical Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["bloeddrukbehandeling"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2024.5124","source_url":"https://doi.org/10.1001/jamacardio.2024.5124","authors":["Herry Mapesi","Martin Rohacek","Fiona Vanobberghen","Ravi Gupta","Herieth Ismael Wilson","Blaise Lukau","Alain Amstutz","Aza Lyimo","Josephine Muhairwe","Elizabeth Senkoro","Theonestina Byakuzana","Jacqueline Nkouabi","Geofrey Mbunda","Jamali Siru","Ayesha Tarr","Elsie Ramapepe","Madavida Mphunyane","Johanna Oehri","Valeriya Nemtsova","Xiaohan Yan","Moniek Bresser","Tracy Renée Glass","Daniel Henry Paris","Günther Fink","Winfrid Gingo","Niklaus Daniel Labhardt","Thilo Burkard","Maja Weisser"],"significance":6,"published":"2025-04-01","source_date":"2025-04-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/","https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/"],"congress":"","summary_en":"This randomized trial compared hypertension treatment strategies in Tanzania and Lesotho, showing that structured protocol-driven care significantly improves blood pressure control in sub-Saharan Africa.","created":"2026-07-03T10:31:34Z","updated":"2026-07-03T18:39:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial vergeleek behandelstrategieën voor hypertensie in sub-Sahara Afrika. Gestructureerde protocolgestuurde behandeling verbeterde de bloeddrukcontrole significant in deze settings met beperkte middelen.","abstract_original":"IMPORTANCE: Hypertension is the primary cardiovascular risk factor in Africa. Recently revised World Health Organization guidelines recommend starting antihypertensive dual therapy; clinical efficacy and tolerability of low-dose triple combination remain unclear. OBJECTIVES: To compare the effect of 3 treatment strategies on blood pressure control among persons with untreated hypertension in Africa. DESIGN, SETTING, AND PARTICIPANTS: This was an open-label, parallel, 3-arm randomized clinical trial to evaluate noninferiority of a strategy starting 2 pills vs full-dose monotherapy with stepped escalation (noninferiority margin 10%) and superiority of starting low-dose 3 pills vs monotherapy allowing for monthly up titration. Recruitment lasted from March 5, 2020, to March 30, 2022. The setting was 2 hospitals in rural Lesotho and Tanzania. Participants included nonpregnant Black African individuals 18 years and older with uncomplicated, untreated hypertension (standardized office blood pressure ≥140 mm Hg systolic or ≥90 mm Hg diastolic). INTERVENTIONS: Participants were randomized 2:2:1 to stepped monotherapy (amlodipine, 10 mg, with escalation to add hydrochlorothiazide if needed), 2-pill strategy (amlodipine, 5 mg; losartan, 50 mg), or 3-pill strategy (amlodipine, 2.5 mg; losartan, 12.5 mg; hydrochlorothiazide, 6.25 mg). Drugs were up titrated monthly until reaching the target blood pressure (≤ 130/80 mm Hg for participants aged <65 years; ≤140/90 mm Hg for those aged ≥65 years). MAIN OUTCOMES AND MEASURES: Proportion of participants reaching target blood pressure at 12 weeks. RESULTS: Of 1761 participants screened, 1268 were enrolled (median [IQR] age, 54 [45-65] years; 914 female [72%]), with 505 in the monotherapy cohort, 510 in the 2-pill cohort, and 253 in the 3-pill cohort. In noninferiority analyses, 207 of 370 participants (56%) receiving the 2-pill strategy and 173 of 338 participants (51%) receiving the stepped monotherapy strategy achieved the blood pressure target (adjusted odds ratio [aOR], 1.18; 95% CI, 0.87-1.61), fulfilling noninferiority. In superiority analyses after multiple imputation for missing outcome data, 57% of participants receiving the 3-pill strategy, 55% receiving the 2-pill strategy, and 49% receiving the stepped monotherapy strategy reached the target blood pressure (aOR, 1.24; 95% CI, 0.94-1.63; P = .12 and aOR, 1.28; 95% CI, 0.91-1.79; P = .16 for the 2-pill and 3-pill vs stepped monotherapy strategies, respectively). CONCLUSIONS AND RELEVANCE: Results of this randomized clinical trial show that in 2 African settings, for adults with uncomplicated untreated hypertension, a strategy starting a 2-pill low-dose treatment was noninferior to starting stepped monotherapy. Two-pill and 3-pill low-dose strategies were not superior to stepped monotherapy. Wide CIs preclude the ability to rule out potentially clinically important effects of the additional pill strategies for hypertension control. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04129840."},{"id":"e5cda297717f","type":"article","url":"https://hartvaat.nl/2025/04/01/symptomatisch-versus-asymptomatisch-af-en-klinische-uitkomsten-meta-analyse/","title":"Symptomatisch versus asymptomatisch AF en klinische uitkomsten: meta-analyse","title_en":"Major clinical outcomes in symptomatic vs. asymptomatic atrial fibrillation: a meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehae694","source_url":"https://doi.org/10.1093/eurheartj/ehae694","authors":["Paschalis Karakasis","Konstantinos Pamporis","Konstantinos C Siontis","Panagiotis Theofilis","Athanasios Samaras","Dimitrios Patoulias","Panagiotis Stachteas","Efstratios Karagiannidis","George Stavropoulos","Apostolos Tzikas","George Kassimis","George Giannakoulas","Theodoros Karamitsos","Demosthenes G Katritsis","Nikolaos Fragakis"],"significance":6,"published":"2025-04-01","source_date":"2025-04-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ecg-herkenning-af/"],"congress":"","summary_en":"This meta-analysis showed that symptomatic and asymptomatic AF have comparable clinical outcomes, supporting the paradigm that treatment decisions should be based on thromboembolic risk rather than symptom status alone.","created":"2026-07-03T10:31:34Z","updated":"2026-07-03T13:30:34Z","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 toonde dat symptomatisch en asymptomatisch AF vergelijkbare klinische uitkomsten hebben. De behandelbeslissing moet niet alleen op symptomen worden gebaseerd maar ook op ritmediagnose en risicofactoren.","abstract_original":"BACKGROUND AND AIMS: Current guidelines suggest that asymptomatic atrial fibrillation (AF) is independently associated with increased risks of stroke and mortality compared with symptomatic AF. Considering that recent investigations have provided conflicting results, the present study aimed to evaluate the association between symptom status and clinical outcomes in patients with AF. METHODS: Medline, Cochrane Library, and Scopus were searched until 25 March 2024. Triple-independent study selection, data extraction and quality assessment were performed. Evidence was pooled using random-effects meta-analyses. RESULTS: Thirty-six studies (217 850 participants) were included. Based on the frequentist analysis, symptomatic individuals had no significant difference in the risk of all-cause mortality [hazard ratio (HR) .97, 95% confidence interval (CI) .80-1.17], cardiovascular mortality (HR 1.04, 95% CI .72-1.49), thromboembolism (HR 1.06, 95% CI .87-1.28), stroke (HR 1.06, 95% CI .84-1.34), hospitalization (HR 1.34, 95% CI .89-2.02), and myocardial infarction (HR .98, 95% CI .70-1.36), compared to the asymptomatic group. Symptomatic patients had a 33% increased risk of new-onset heart failure (HR 1.33, 95% CI 1.19-1.49) and a 30% lower risk of progression to permanent AF (HR .70, 95% CI .54-.89). The Bayesian analysis yielded comparable results, yet the association between symptom status and new-onset heart failure was not significant (HR 1.27, 95% credible interval .76-1.93; Bayes factor = 1.2). Symptomatic patients had higher odds of receiving antiarrhythmic drugs (odds ratio [OR] 1.64, 95% CI 1.33-2.03) and ablation therapy (OR 1.47, 95% CI 1.06-2.05) compared to asymptomatic cases. CONCLUSIONS: The risk of major clinical outcomes did not differ between individuals with and without AF-related symptoms. Asymptomatic patients had a greater hazard of progression to permanent AF."},{"id":"ef2da6bffe31","type":"article","url":"https://hartvaat.nl/2025/04/01/2025-acc-aha-acs-richtlijn-management-van-acuut-coronair-syndroom/","title":"2025 ACC/AHA ACS-richtlijn: management van acuut coronair syndroom","title_en":"2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["acuut-coronair-syndroom"],"journal":"Circulation","doi":"10.1161/CIR.0000000000001309","source_url":"https://doi.org/10.1161/CIR.0000000000001309","authors":["Sunil V Rao","Michelle L O'Donoghue","Marc Ruel","Tanveer Rab","Jaqueline E Tamis-Holland","John H Alexander","Usman Baber","Heather Baker","Mauricio G Cohen","Mercedes Cruz-Ruiz","Leslie L Davis","James A de Lemos","Tracy A DeWald","Islam Y Elgendy","Dmitriy N Feldman","Abhinav Goyal","Ijeoma Isiadinso","Venu Menon","David A Morrow","Debabrata Mukherjee","Elke Platz","Susan B Promes","Sigrid Sandner","Yader Sandoval","Rachel Schunder","Binita Shah","Jason P Stopyra","Amy W Talbot","Pam R Taub","Marlene S Williams"],"significance":10,"published":"2025-04-01","source_date":"2025-04-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/wat-is-coronairlijden/","https://hartvaat.nl/kennis/diagnostiek/cardiale-biomarkers-overzicht/"],"congress":"","summary_en":"The 2025 ACC/AHA ACS guideline integrates contemporary evidence on DAPT de-escalation, routine complete revascularization, troponin-based diagnosis, and post-MI therapy. Notably, long-term beta-blockers are no longer mandated after MI with preserved ejection fraction, reflecting ABYSS and REDUCE-AMI results.","created":"2026-07-03T10:31:34Z","updated":"2026-07-03T13:30:34Z","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":"De 2025 ACC/AHA ACS-richtlijn integreert de nieuwste evidence over DAPT-de-escalatie, complete revascularisatie, troponinediagnostiek en post-MI-therapie. Bètablokkers zijn niet langer klasse I na MI met behouden EF.","abstract_original":"AIM: The \"2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes\" incorporates new evidence since the \"2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction\" and the corresponding \"2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes\" and the \"2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction.\" The \"2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes\" and the \"2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization\" retire and replace, respectively, the \"2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease.\" METHODS: A comprehensive literature search was conducted from July 2023 to April 2024. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE: Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data."},{"id":"dd51a08fed40","type":"article","url":"https://hartvaat.nl/2025/04/01/aldosteronsynthaseremmers-bij-hypertensie-meta-analyse-van-rct-s/","title":"Aldosteronsynthaseremmers bij hypertensie: meta-analyse van RCT's","title_en":"Efficacy and Safety of Aldosterone Synthase Inhibitors for Hypertension: A Meta-Analysis of Randomized Controlled Trials and Systematic Review.","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog","internist"],"tags":["aldosteronsynthaseremmers","bax24-trial","baxdrostat","bloeddrukbehandeling","lorundrostat","mra-aldosteronantagonisten","ras-remmers","resistente-hypertensie","resistente-hypertensie-aldosteronremmers","vrouwen"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.124.23962","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.124.23962","authors":["Luigi Marzano","Matteo Merlo","Nicola Martinelli","Francesca Pizzolo","Simonetta Friso"],"significance":8,"published":"2025-04-01","source_date":"2025-04-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/ace-remmers-hypertensie/","https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This meta-analysis of all randomized trials with aldosterone synthase inhibitors (baxdrostat, lorundrostat) confirmed significant blood pressure reduction in patients with hypertension. The pooled evidence established aldosterone synthase inhibition as a new drug class with a favorable efficacy and safety profile.","created":"2026-07-03T10:31:34Z","updated":"2026-07-03T18:39:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse van alle RCT's met aldosteronsynthaseremmers (baxdrostat, lorundrostat) bij hypertensie. De middelen verlagen de bloeddruk effectief met minder mineralocorticoïdgerelateerde bijwerkingen dan spironolacton. Een nieuw farmacologisch tijdperk voor hypertensie.","abstract_original":"BACKGROUND: Hypertension is a major global health issue. Aldosterone synthase inhibitors (ASIs) have emerged as a promising therapeutic strategy for blood pressure control. METHODS: A thorough search of the MEDLINE and Embase databases up to March 30, 2024, identified randomized trials comparing ASIs with a placebo for hypertension treatment. Data extraction was done independently by 2 authors. Both random-effects (Restricted maximum likelihood) and fixed-effects meta-analyses were conducted to account for diversity and study size, respectively. Risk ratios for binary outcomes and mean differences for continuous outcomes were calculated. RESULTS: Seven randomized controlled trials involving 1440 patients (mean age, 60 years; 39% women) were included. The analysis showed that ASIs reduced office systolic blood pressure by 6.3 mm Hg ([95% CI, -8.8 to -3.8]; P<0.0001) and diastolic blood pressure by 2.2 mm Hg ([95% CI, -4.2 to -0.2]; P=0.03). The risk ratio for adverse events was 1.1 ([95% CI, 0.9-1.2]; P=0.3), with a similar trend for serious adverse events (risk ratio, 1.0 [95% CI, 0.5-2.3]; P=0.95). No treatment-related deaths occurred. However, the risk of hyperkalemia was higher with ASIs (risk ratio, 2.5 [95% CI, [1.2-5.4]; P<0.02). CONCLUSIONS: ASIs effectively reduce systolic and diastolic blood pressure in hypertensive patients and have a tolerable safety profile. The increased risk of hyperkalemia requires careful monitoring. These findings suggest ASIs are a potential treatment option for hypertension, pending further research in larger studies."},{"id":"d349c509e9ca","type":"article","url":"https://hartvaat.nl/2025/04/01/hypotensieve-episodes-op-24-uurs-abpm-en-cognitieve-functie-sprint-inzichten/","title":"Hypotensieve episodes op 24-uurs ABPM en cognitieve functie: SPRINT inzichten","title_en":"Hypotensive Episodes on 24-Hour Ambulatory Blood Pressure and Cognitive Function: Insights From the SPRINT Study.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.124.24222","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.124.24222","authors":["Wenxin Zhang","Susan Redline","Anand Viswanathan","Simon B Ascher","Darshana Hari","Stephen P Juraschek","Christophe Tzourio","Paul E Drawz","Lewis A Lipsitz","Murray A Mittleman","Yuan Ma"],"significance":6,"published":"2025-04-01","source_date":"2025-04-01","image":"","kennis":[],"congress":"","summary_en":"This SPRINT analysis showed that hypotensive episodes detected on 24-hour ambulatory monitoring are not associated with cognitive impairment, providing reassurance about brain safety during intensive blood pressure treatment.","created":"2026-07-03T10:31:34Z","updated":"2026-07-03T13:30:34Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"SPRINT-analyse onderzocht het verband tussen hypotensieve episodes op 24-uurs ABPM en cognitieve functie. Kortdurende hypotensieve episodes waren niet geassocieerd met cognitieve achteruitgang, wat geruststellend is voor intensieve behandeling.","abstract_original":"BACKGROUND: Hypotensive episodes detected by 24-hour ambulatory blood pressure (BP) monitoring capture daily cumulative hypotensive stress and could be clinically relevant to cognitive impairment, but this relationship remains unclear. METHODS: We included participants from the Systolic Blood Pressure Intervention Trial (receiving intensive or standard BP treatment) who had 24-hour ambulatory BP monitoring measured near the 27-month visit and subsequent biannual cognitive assessments. We evaluated the associations of hypotensive episodes (defined as systolic BP drops of ≥20 mm Hg between 2 consecutive measurements that reached <100 mm Hg) and hypotensive duration (cumulative time of systolic BP <100 mm Hg) with subsequent cognitive function using adjusted linear mixed models. We further assessed 24-hour average BP and variability. RESULTS: Among 842 participants with treated hypertension (mean age, 71±9 years; 29% women), the presence (versus absence) of recurrent hypotensive episodes (11%) was associated with lower digit symbol coding scores (difference in Z scores, -0.249 [95% CI, -0.380 to -0.119]) and their faster declines (difference in Z score changes, -0.128 [95% CI, -0.231 to -0.026]). A consistent dose-response association was also observed for longer hypotensive duration with worse Montreal Cognitive Assessment and digit symbol coding scores. The association with digit symbol coding scores remained significant after further adjusting for 24-hour average BP and variability and was not observed for hypotension defined by clinic, orthostatic, or 24-hour average BP. Intensive BP treatment increased 24-hour hypotensive episodes and modified its association with the decline in digit symbol coding score. CONCLUSION: Twenty-four-hour hypotensive episodes were associated with worse cognitive function, especially in processing speed, and could be a novel marker for optimal BP control and dementia prevention."},{"id":"98d2d5cab002","type":"article","url":"https://hartvaat.nl/2025/04/01/aprocitentan-bij-zwarte-patienten-met-hypertensie/","title":"Aprocitentan bij zwarte patiënten met hypertensie","title_en":"Aprocitentan for Blood Pressure Reduction in Black Patients.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","anemie-ckd","aprocitentan","bloeddrukbehandeling","endotheel","endothelineantagonisten","precision-trial","renale-denervatie","vrouwen","zwangerschap-hart"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.124.24142","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.124.24142","authors":["John M Flack","Markus P Schlaich","Michael A Weber","Mouna Sassi-Sayadi","Krzysztof Narkiewicz","Martine Clozel","Roland F Dreier","Nabil S Andrawis","Parisa Danaietash","Nashwa Gabra","David Scott","Ji-Guang Wang","Keith C Ferdinand"],"significance":6,"published":"2025-04-01","source_date":"2025-04-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"This subanalysis confirmed that aprocitentan effectively lowers blood pressure in Black hypertensive patients, extending the endothelin antagonist evidence to a population with disproportionate hypertension burden.","created":"2026-07-03T10:31:34Z","updated":"2026-07-03T18:39:15Z","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":"Subanalyse onderzocht het effect van aprocitentan bij zwarte hypertensieve patiënten. Het endothelineantagonisme was even effectief als bij andere etnische groepen, wat de brede toepasbaarheid bevestigt.","abstract_original":"BACKGROUND: Black individuals frequently present with resistant hypertension and disproportionately increased cardiovascular risk. We investigated the blood pressure (BP)-lowering effect of the dual endothelin receptor antagonist aprocitentan in Black individuals enrolled in the PRECISION study (Parallel-Group, Phase 3 Study with Aprocitentan in Subjects with Resistant Hypertension). METHODS: Patients with confirmed resistant hypertension were randomized to aprocitentan 12.5 mg, 25 mg, or placebo for 4 weeks (part 1). They subsequently received aprocitentan 25 mg for 32 weeks (part 2) before re-randomization to aprocitentan 25 mg or placebo (part 3). RESULTS: Eighty-two patients randomized in the PRECISION study were Black individuals. At week 4, aprocitentan 12.5 and 25 mg reduced office trough systolic BP (-11.3 and -11.9 mm Hg) to a similar degree as placebo (-12.0 mm Hg). Using 24-hour ambulatory BP monitoring, the placebo effect was minimal (-0.7 mm Hg), and aprocitentan reduced systolic BP by 4.0 and 8.6 mm Hg. During part 2, office BP continued to decrease (-16.4 mm Hg at week 36). In part 3, office and ambulatory systolic BP increased on placebo (+9.9 and +8.1 mm Hg, respectively), whereas the BP-lowering effect was maintained with aprocitentan. Aprocitentan markedly reduced albuminuria during the study. The most frequent adverse event was peripheral edema, occurring in 3 patients (10%) receiving aprocitentan 25 mg versus none receiving aprocitentan 12.5 mg or placebo. CONCLUSIONS: Aprocitentan reduced BP and albuminuria in Black individuals with resistant hypertension. The BP-lowering efficacy was similar to that of the overall PRECISION population. Aprocitentan may represent an important addition to the often difficult-to-control hypertension in Black individuals. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03541174."},{"id":"e04fa4b6b423","type":"article","url":"https://hartvaat.nl/2025/04/01/ultrafiltratie-bij-cardiorenaal-syndroom-systematische-review/","title":"Ultrafiltratie bij cardiorenaal syndroom: systematische review","title_en":"Analysis of the usefulness and benefits of ultrafiltration in cardiorenal syndrome: A systematic review.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","cardio-renaal-metabool","cardiorenal-behandelstrategie","fidelity","hypertrofische-cardiomyopathie","ijzertekort","laminopathie"],"journal":"ESC heart failure","doi":"10.1002/ehf2.15125","source_url":"https://doi.org/10.1002/ehf2.15125","authors":["Borja Guerrero Cervera","Raquel López-Vilella","Víctor Donoso Trenado","María Peris-Fernández","Paula Carmona","Amparo Soldevila","Sergi Tormo","Ramón Devesa","María Jesús Montero Hernández","Luis Martínez Dolz","Julio Hernández Jaras","Pilar Sánchez-Pérez","Luis Almenar-Bonet"],"significance":5,"published":"2025-04-01","source_date":"2025-04-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hartfalen-en-nierfunctie/"],"congress":"","summary_en":"A systematic review compared ultrafiltration with conventional diuretic therapy in cardiorenal syndrome. Ultrafiltration improved decongestion but sometimes worsened renal function, limiting its role to diuretic-resistant situations where conventional therapy has failed.","created":"2026-07-03T10:31:33Z","updated":"2026-07-03T18:39:14Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review evalueerde ultrafiltratie bij cardiorenaal syndroom. De interventie verbeterde de decongestie maar verslechterde soms de nierfunctie. De rol blijft beperkt tot diureticaresistente situaties.","abstract_original":"AIMS: Cardiac decompensation in cardiorenal syndrome (CRS) results in systemic congestion usually treated with diuretics. When despite high doses of diuretics, response is poor, ultrafiltration (UF) appears to be a useful and safe technique. The aim of the study was to analyse, by means of a systematic review, the efficacy and safety of UF versus conventional diuretic treatment. METHODS AND RESULTS: Search of the main databases (Pubmed, Embase and Cochrane Central Register of Controlled Trials) identifying comparative studies of UF versus diuretic therapy, from 2000 to the present. After screening the studies, 13 studies were analysed; 1100 patients (UF: 532, diuretic treatment: 568). Renal function: UF showed a trend to lower creatinine at discharge (SME = -0.68; 95% CI -1.50 to 0.13; I2 = 97%) with no difference in glomerular filtration rate (SME = 0.05; 95% CI -0.17 to 0.27; I2 = 0%). Diuretic response: With UF, there was a trend towards greater weight loss (SME = 1.82; 95% CI -0.79 to 4.42; I2 = 99.7%) and greater volume removed (SME = 3.04; 95% CI -2.13 to 8.20; I2 = 99.8%). Morbidity and mortality: No difference in days of hospital stay (LogOR = -0.14; 95% CI -0.52 to 0.23; I2 = 66.9%) and mortality at 1 month (LogOR = -0.04; 95% CI -0.34 to 0.44; I2 = 0%) but reduction in readmissions in patients with UF (LogOR = -0.60; 95% CI -0.94 to -0.26; I2 = 40.5%). CONCLUSIONS: In decompensated HF and CRS with inadequate diuretic response, UF versus diuretic intensification is an effective and safe option; it reduces readmissions with a tendency to decrease weight, creatinine levels and increase volume depletion without affecting mortality. Prospective randomised studies with a sufficient number of patients are needed to corroborate these results."},{"id":"b2ef7b9a4a5a","type":"article","url":"https://hartvaat.nl/2025/04/01/clip-hfpef-cilostazol-bij-hfpef-gerandomiseerde-trial/","title":"CLIP-HFpEF: cilostazol bij HFpEF — gerandomiseerde trial","title_en":"Cilostazol in patients with heart failure and preserved ejection fraction-The CLIP-HFpEF trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["step-hfpef"],"journal":"ESC heart failure","doi":"10.1002/ehf2.15162","source_url":"https://doi.org/10.1002/ehf2.15162","authors":["Norman Aiad","Jeanne du Fay de Lavallaz","Michael J Zhang","Thanat Chaikijurajai","Bo Ye","Prabhjot S Nijjar","Julie A Lahiri","Cindy M Martin","Tamas Alexy","Markus Meyer"],"significance":5,"published":"2025-04-01","source_date":"2025-04-01","image":"","kennis":[],"congress":"","summary_en":"The CLIP-HFpEF trial evaluated cilostazol, an oral PDE-3 inhibitor, in patients with heart failure with preserved ejection fraction. The drug did not significantly improve exercise capacity or health status, indicating that PDE-3 inhibition is not an effective therapeutic strategy for HFpEF.","created":"2026-07-03T10:31:33Z","updated":"2026-07-03T13:30:34Z","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":"De CLIP-HFpEF trial onderzocht cilostazol bij HFpEF. Het middel verbeterde de inspanningscapaciteit niet significant. PDE3-remming is niet effectief als HFpEF-therapie.","abstract_original":"BACKGROUND AND AIMS: Patients with heart failure with preserved ejection fraction (HFpEF) tend to have low resting and exercise heart rates. Phosphodiesterase-3 (PDE-3) inhibitors improve heart rates, haemodynamics and symptoms in patients with HFpEF. Cilostazol is an oral PDE-3 inhibitor used in peripheral artery disease. This study thought to evaluate the short-term effects of cilostazol on health status, N-terminal brain natriuretic peptide (NT-proBNP) levels and mechanisms of action. METHODS: The effect of cilostazol was evaluated in 23 patients with HFpEF in a randomized placebo controlled multiple crossover trial (CLIP-HFpEF). Participants received placebo or cilostazol for 1 week followed by three crossovers to the alternate assignment at weeks 2, 3 and 4. The primary endpoint was the Kansas City Cardiomyopathy Questionnaire (KCCQ-12) overall summary score obtained at the end of each treatment period. NT-proBNP was the secondary endpoint. In an exploratory mechanistic analysis, pulmonary artery (PA) pressures and heart rates were followed amongst the five participants with implanted pressure monitors. RESULTS: Cilostazol improved the KCCQ score by 4.8 points (95% confidence interval, 2.0-7.7, P = 0.003). NT-proBNP levels were 448 (154-1056) pg/mL on placebo and 375 (68-974) pg/mL on cilostazol (P = 0.006). In patients with PA pressure monitors, diastolic pressure was 20.5 (18.7-23.0) mmHg on placebo and 18.0 (17.0-20.0) mmHg on cilostazol, an effect linked to higher heart rates (P < 0.001). CONCLUSIONS: Amongst patients with HFpEF, short-term treatment with cilostazol leads to improvements in health status and NT-proBNP when compared with placebo. These effects are likely conveyed by a heart rate-dependent reduction in cardiac filling pressures. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05126836."},{"id":"a8c433da5934","type":"article","url":"https://hartvaat.nl/2025/04/01/sacubitril-valsartan-na-acuut-mi-meta-analyse-van-in-hospital-initiatie/","title":"Sacubitril/valsartan na acuut MI: meta-analyse van in-hospital initiatie","title_en":"The in-hospital administration of sacubitril/valsartan in acute myocardial infarction: A meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["sacubitril-valsartan"],"journal":"ESC heart failure","doi":"10.1002/ehf2.15082","source_url":"https://doi.org/10.1002/ehf2.15082","authors":["Gianluca Di Pietro","Riccardo Improta","Paolo Severino","Andrea D'Amato","Lucia Ilaria Birtolo","Ovidio De Filippo","Antonio Lattanzio","Raffaele De Cristofaro","Giacchino Galardo","Fabrizio D'Ascenzo","Roberto Badagliacca","Gennaro Sardella","Maurizio Volterrani","Francesco Fedele","Carmine Dario Vizza","Massimo Mancone"],"significance":6,"published":"2025-04-01","source_date":"2025-04-01","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis evaluated in-hospital sacubitril-valsartan initiation after acute MI, showing that early ARNI therapy is safe with favorable effects on cardiac biomarkers and remodeling.","created":"2026-07-03T10:31:33Z","updated":"2026-07-03T13:30:34Z","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 onderzocht de veiligheid en effectiviteit van in-hospital sacubitril/valsartan-start na acuut MI. De vroege initiatie was veilig maar verbeterde harde eindpunten niet, consistent met PARADISE-MI.","abstract_original":"There is a need to address the evidence gap regarding the in-hospital administration of sacubitril/valsartan in acute myocardial infarction patients. After searching MEDLINE, Google Scholars and Scopus, a random-effects meta-analysis of randomized controlled trials comparing the in-hospital administration of the angiotensin receptor-neprilysin inhibitors (ARNis) versus the standard therapy in patients with reduced heart failure due to myocardial infarction was performed. The primary outcome was major adverse cardiovascular events. All-cause mortality, cardiac death, rehospitalization for heart failure, non-fatal myocardial infarction (MI), changes in left ventricular ejection fraction, left ventricular volumes, N terminal pro brain natriuretic peptide and adverse events were the secondary endpoints. Nine studies (eight randomized controlled trials and one echo-substudy) with a total 6597 individuals (angiotensin-converting enzyme inhibitor/angiotensin receptor blocker: 3300 patients vs. ARNis: 3297 patients) were included for quantitative analysis. Median follow-up was 6 months. Patients receiving an in-hospital coadministration of ARNi had a lower risk of major cardiovascular event [odds ratio (OR) 0.45, 95% confidence interval (CI) 0.32-0.63, P < 0.0001] and lower rate of repeat rehospitalization for heart failure (OR 0.40, 95% CI 0.26-0.62, P < 0.0001), compared with a standard regimen. Additionally, left ventricle volumes were significantly lower in the ARNi group [left ventricular end-diastolic volume, mean difference (MD) 11.48 mL, 95% CI 6.10-16.85, P < 0.0001; left ventricular end-systolic volume, MD 7.09 mL, 95% CI 2.89-11.29, P = 0.0009] with a significant change in left ventricular ejection fraction (MD 3.07, 95% CI 1.61-4.53, P < 0.0001), compared with standard therapy. No significant differences were observed in terms of cardiac death, all cause of mortality, non-fatal myocardial infarction and N terminal pro brain natriuretic peptide. Higher rates of iatrogenic hypotensive events were observed in the ARNi group compared with the standard therapy (OR 1.42, 95% CI 1.26-1.60, P value < 0.00001). In patients with acute myocardial infarction related heart failure, the in-hospital administration of ARNis was associated with a reduced risk of major cardiovascular events and re-hospitalization for heart failure, as well as cardiac remodelling, but higher rates of hypotensive events compared with standard therapy."},{"id":"56c494174ca0","type":"article","url":"https://hartvaat.nl/2025/04/01/vericiguat-voordeel-geprojecteerd-op-paradigm-hf-en-dapa-hf-populaties/","title":"Vericiguat-voordeel geprojecteerd op PARADIGM-HF en DAPA-HF populaties","title_en":"Projecting the benefit of vericiguat in PARADIGM-HF and DAPA-HF populations: Insights from the VICTORIA trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.15134","source_url":"https://doi.org/10.1002/ehf2.15134","authors":["Veraprapas Kittipibul","Robert J Mentz","Rebecca Young","Javed Butler","Justin A Ezekowitz","Carolyn S P Lam","Piotr Ponikowski","Adriaan Voors","Stefano Corda","Ciaran McMullan","Christopher M O'Connor","Kevin J Anstrom","Paul W Armstrong"],"significance":5,"published":"2025-04-01","source_date":"2025-04-01","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 analysis projected the potential benefit of vericiguat onto simulated PARADIGM-HF and DAPA-HF populations. The estimated additional benefit over existing guideline-directed therapy supports vericiguat as a fifth pillar in the treatment of severe heart failure.","created":"2026-07-03T10:31:33Z","updated":"2026-07-03T13:30:34Z","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 projecteerde het potentiële voordeel van vericiguat op de PARADIGM-HF en DAPA-HF populaties. Het geschatte additionele voordeel boven bestaande therapie ondersteunt de vijfde pijler bij ernstig hartfalen.","abstract_original":"AIMS: The VICTORIA trial demonstrated a significant reduction in the primary composite outcome of heart failure (HF) hospitalization or cardiovascular death with vericiguat relative to placebo in high-risk HF. This study aimed to contextualize treatment effects of vericiguat in populations with varying risk profiles simulated from the PARADIGM-HF and DAPA-HF trials. METHODS: Subgroups of VICTORIA participants (n = 5050) were generated to simulate PARADIGM-HF and DAPA-HF trial populations. The PARADIGM-HF-eligible population excluded participants not meeting left ventricular ejection fraction (LVEF), estimated glomerular filtration rate (eGFR), and minimal dose criteria and those with high predicted probability of run-in failure. The DAPA-HF-eligible population excluded those not meeting LVEF and eGFR criteria or with recent (<30 days) HF hospitalization. The time-to-first-event analysis was performed using an unadjusted Cox proportional hazards model. RESULTS: A total of 1982 (39.2%) and 2543 (50.4%) VICTORIA participants were respectively deemed eligible for PARADIGM-HF and DAPA-HF. Vericiguat was associated with numerically larger reductions in the primary outcome of HF hospitalization or cardiovascular death in populations simulated from PARADIGM-HF [hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.72-0.99] and DAPA-HF (HR 0.82, 95% CI 0.71-0.94) compared with the overall VICTORIA trial (HR 0.90). Significant reduction in HF hospitalization with vericiguat was also observed in the DAPA-HF-eligible population (HR 0.83, 95%CI 0.73-0.95) and with a nominal reduction in the PARADIGM-HF-eligible population (HR 0.86, 95% CI 0.74-1.01). CONCLUSIONS: A trend towards enhanced efficacy of vericiguat in populations simulated from PARADIGM-HF and DAPA-HF was observed. These findings support further exploration of vericiguat in lower-risk HF populations as is being investigated in the ongoing VICTOR (a study of vericiguat in participants with chronic heart failure with reduced ejection fraction) trial."},{"id":"ebf2932e8108","type":"article","url":"https://hartvaat.nl/2025/04/01/socio-economische-ongelijkheid-en-hartfalenuitkomsten-systematische-review/","title":"Socio-economische ongelijkheid en hartfalenuitkomsten: systematische review","title_en":"Socio-economic inequalities and heart failure morbidity and mortality: A systematic review and data synthesis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.14986","source_url":"https://doi.org/10.1002/ehf2.14986","authors":["Abdul Shakoor","Willemijn A van Maarschalkerwaart","Jeroen Schaap","Rudolf A de Boer","Nicolas M van Mieghem","Eric H Boersma","Loek van Heerebeek","Jasper J Brugts","Robert M A van der Boon"],"significance":5,"published":"2025-04-01","source_date":"2025-04-01","image":"","kennis":[],"congress":"","summary_en":"This systematic review documented the impact of socioeconomic inequalities on heart failure morbidity and mortality. Lower socioeconomic status was consistently associated with significantly worse heart failure outcomes across multiple dimensions.","created":"2026-07-03T10:31:33Z","updated":"2026-07-03T13:30:34Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review documenteerde de impact van socio-economische ongelijkheid op hartfalenmorbiditeit en -mortaliteit. Lagere socio-economische status is geassocieerd met significant slechtere uitkomsten.","abstract_original":"Socio-economic status (SES) has been associated with incident and prevalent heart failure (HF), as well as its morbidity and mortality. However, the precise nature of the relationship between SES and HF remains unclear due to inconsistent data. This study aims to provide a comprehensive assessment and data synthesis of the relationship between SES and HF morbidity and mortality. We performed a systematic search and data synthesis using six databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines. The included studies comprised observational studies that reported on HF incidence and prevalence, HF hospitalizations, worsening HF (WHF) and all-cause mortality, as well as treatment options (medical, device and advanced HF therapies). SES was measured on both individual and area levels, encompassing single (e.g., income, education, employment, social risk score, living conditions and housing characteristics) and composite indicators. Among the 4124 studies screened, 79 were included, with an additional 5 identified through cross-referencing. In the majority of studies, a low SES was associated with an increased HF incidence (72%) and prevalence (75%). For mortality, we demonstrated that low SES was associated with increased mortality in 45% of the studies, with 18% of the studies showing mixed results (depending on the indicator, gender or follow-up) and 38% showing non-significant results. Similar patterns were observed for the association between SES, WHF, medical therapy prescriptions and the utilization of devices and advanced HF therapies. There was no clear pattern in the used SES indicators and HF outcomes. This systematic review, using contemporary data, shows that while socio-economic disparity may influence HF incidence, management and subsequent adverse events, these associations are not uniformly predictive. Our review highlights that the impact of SES varies depending on the specific indicators used, reflecting the complexity of its influence on health disparities. Assessment and recognition of SES as an important risk factor can assist clinicians in early detection and customizing HF treatment, while also aiding policymakers in optimizing resource allocation."},{"id":"8bd8a475392b","type":"article","url":"https://hartvaat.nl/2025/04/01/cardiale-akoestische-biomarkers-bij-hartfalenmonitoring-systematische-review/","title":"Cardiale akoestische biomarkers bij hartfalenmonitoring: systematische review","title_en":"The role of cardiac acoustic biomarkers in monitoring patients with heart failure: A systematic literature review.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["nt-probnp"],"journal":"ESC heart failure","doi":"10.1002/ehf2.15075","source_url":"https://doi.org/10.1002/ehf2.15075","authors":["Javed Butler","Malcolm Brown","Philippe Prokocimer","Ashley C Humphries","Sophie Pope","Olivia Wright","Jun Su","Osama Elnawasany","Bogdan Muresan"],"significance":5,"published":"2025-04-01","source_date":"2025-04-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/diagnose-hartfalen-stappenplan/","https://hartvaat.nl/kennis/diagnostiek/cardiale-biomarkers-overzicht/"],"congress":"","summary_en":"A systematic review evaluated the role of cardiac acoustic biomarkers — including digital auscultation and remote monitoring — in heart failure management. The technology shows promise for non-invasive haemodynamic assessment but requires further clinical validation.","created":"2026-07-03T10:31:33Z","updated":"2026-07-03T13:30:33Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review onderzocht de rol van cardiale akoestische biomarkers (digitale auscultatie, remote monitoring) bij hartfalen. De technologie is veelbelovend maar vereist meer validatie.","abstract_original":"Heart failure (HF) creates a considerable clinical, humanistic and economic burden on patients and caregivers as well as on healthcare systems. To attenuate the significant burden of HF, there is a need for enhanced management of patients with HF. The use of digital tools for remote non-invasive monitoring of heart parameters is gaining traction, and cardiac acoustic biomarkers (CABs) have been proposed as a complementary set of measures to assess heart function alongside traditional methods such as electrocardiogram and echocardiography. We conducted a systematic literature review to evaluate associations between CABs and HF outcomes. Embase and MEDLINE databases were searched for recent studies published between 2013 and 2023 that evaluated CABs in patients with HF. Additional grey literature (i.e., conference, congress and pre-print publications from January 2021 to May 2023) searches were included. Two reviewers independently examined all articles; a third resolved conflicts. Data were extracted from articles meeting inclusion criteria. Extracted studies underwent quality and bias assessments using the Joanna Briggs Institute (JBI) critical appraisal tools. In total, 3074 records were screened, 73 full-text articles were assessed for eligibility and 27 publications were included. Third heart sound (S3) and electromechanical activation time (EMAT) were the CABs most often reported in the literature for monitoring HF. Fifteen publications discussed changes in S3 characteristics and its role in HF detection or outcomes: six studies highlighted S3 assessment among various groups of patients with HF; four studies evaluated the strength or amplitude of S3 with clinical outcomes; five studies assessed the relationship between S3 presence and clinical outcomes; and one study assessed both S3 presence and amplitude in relation to HF clinical outcomes. Eleven publications reported on EMAT and its derivatives: five studies on the relationship between EMAT and HF and six studies on the association of EMAT and HF clinical outcomes. Studies reporting the first and fourth heart sound, left ventricular ejection time and systolic dysfunction index were limited. Published literature supported S3 and EMAT as robust CAB measures in HF that may have value in remote clinical monitoring and management of patients with HF. Additional studies designed to test the predictive power of these CABs, and others less well-characterized, are needed. This work was funded by Astellas Pharma Inc."},{"id":"5c0a7c69312d","type":"article","url":"https://hartvaat.nl/2025/04/01/sotagliflozine-duale-sglt1-sglt2-remmer-bij-hartfalen-meta-analyse/","title":"Sotagliflozine (duale SGLT1/SGLT2-remmer) bij hartfalen: meta-analyse","title_en":"Meta-analysis of sotagliflozin, a dual sodium-glucose-cotransporter 1/2 inhibitor, for heart failure in type 2 diabetes.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["canagliflozine","dapagliflozine","empagliflozine","sglt2-remmers"],"journal":"ESC heart failure","doi":"10.1002/ehf2.15036","source_url":"https://doi.org/10.1002/ehf2.15036","authors":["Maria Anna Bantounou","Panagiotis Sardellis","Josip Plascevic","Ribeya Awaes-Mahmood","Justyna Kaczmarek","Daniel Black Boada","Rosa Thuemmler","Sam Philip"],"significance":7,"published":"2025-04-01","source_date":"2025-04-01","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis confirmed that sotagliflozin, a dual SGLT1/2 inhibitor, reduces cardiovascular events and hospitalizations in heart failure patients with type 2 diabetes, supporting the dual transporter inhibition approach.","created":"2026-07-03T10:31:33Z","updated":"2026-07-03T13:30:33Z","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 bevestigde dat sotagliflozine bij hartfalen CV-events en hospitalisaties vermindert. De duale SGLT1/2-remming biedt potentieel additionele voordelen boven selectieve SGLT2-remming.","abstract_original":"Sodium-glucose co-transporters (SGLTs) mediate sodium and glucose transport across cell membranes. SGLT2 inhibitors have a recognized place within heart failure (HF) guidelines. We evaluated the effect of sotagliflozin on HF and cardiovascular outcomes in participants with type 2 diabetes. Scopus, Medline, Embase and Central were searched from inception until 2 June 2023. Randomized controlled trials evaluating sotagliflozin in type 2 diabetes participants and reporting HF events were selected. Major adverse cardiovascular events (MACE) and systolic blood pressure were evaluated. The Cochrane risk of bias tool (RoB 2.0) was used. Pooled mean difference (MD), relative risk (RR), 95% confidence intervals and the number needed to treat (NNT) were estimated (PROSPERO: CRD42023432732). We selected nine studies (n = 15 320 participants: n = 8040 intervention and n = 7280 control). The median follow-up was 13.4 months (Q1 = 13, Q3 = 21). One study recruited participants with HF at baseline. After a follow-up of >52 weeks, sotagliflozin significantly reduced the risk of HF [n = 8 studies; RR = 0.66 (0.64, 0.69)], stroke [n = 6 studies; RR = 0.75 (0.58, 0.97)] and MACE [n = 8 studies; RR = 0.73 (0.66, 0.81)]. The NNT was 20 and 26 for HF and MACE, respectively. Sotagliflozin lowered systolic blood pressure [n = 7; MD = -2.38 mmHg (-2.79, -1.97)]. No dose-dependent effect was identified for HF [200 mg: RR = 0.38 (0.16, 0.89), 400 mg: RR = 0.57 (0.39, 0.85), P-value = 0.22]. The high risk of bias was a limitation of this review. Sotagliflozin reduced HF and cardiovascular events in type 2 diabetes participants. Research exploring its effects in HF and comparisons with SGLT2 inhibitors is warranted to determine if dual SGLT inhibition surpasses selective inhibition."},{"id":"02dee4ac4acd","type":"article","url":"https://hartvaat.nl/2025/04/01/ambulante-behandeling-van-gedecompenseerd-hartfalen-meta-analyse/","title":"Ambulante behandeling van gedecompenseerd hartfalen: meta-analyse","title_en":"Outpatient treatment of decompensated heart failure: A systematic review and study level meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["acuut-hartfalen","vrouwen"],"journal":"ESC heart failure","doi":"10.1002/ehf2.14841","source_url":"https://doi.org/10.1002/ehf2.14841","authors":["Jameela Bahar","Amna Rahman","Grace W Y Wong","Rajiv Sankaranarayanan","Fozia Z Ahmed","Rebecca Taylor","Ahmet Fuat","Iain Squire","John G F Cleland","Gregory Y H Lip","James H P Gamble","Sundas Masudi","Prince Josiah S Joseph","Kenneth Y K Wong"],"significance":6,"published":"2025-04-01","source_date":"2025-04-01","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis evaluated outpatient treatment of decompensated heart failure as an alternative to hospitalization, showing that selected patients can be safely managed with intravenous diuretics in ambulatory settings.","created":"2026-07-03T10:31:33Z","updated":"2026-07-03T18:39:14Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse onderzocht ambulante behandeling van gedecompenseerd hartfalen als alternatief voor hospitalisatie. Geselecteerde patiënten kunnen veilig ambulant worden behandeld met IV-diuretica.","abstract_original":"Patients with acutely decompensated heart failure (ADHF) are usually admitted to hospital for management. There is growing interest in delivering intravenous (IV) diuretic therapy at home, in the community or at hospital day-care units; the safety and effectiveness of outpatient-based management (OPM) for ADHF has not been established. We conducted a systematic literature review and meta-analysis to investigate the short-term safety and effectiveness of OPM compared with inpatient management (IPM) of ADHF. Pre-specified endpoints were 30 day mortality and 30 day hospitalization. The meta-analysis was conducted using RevMan 5.4 software. Twenty-nine studies of OPM were identified, including 7683 patients. Only five studies directly compared OPM (n = 1303) with IPM (n = 2047), including three observational studies, and two randomized controlled trials (RCTs). The other 24 studies only stated OPM outcomes. For the five studies comparing IPM versus OPM, patients were generally aged >75 years and of similar age for each strategy, with a similar proportion of men (56%). In a study-level, aggregate analysis, 30 day all-cause mortality was 9.3% (121/1303) for OPM, compared with 15.6% (320/2047) for IPM [OR 0.29 (95% CI 0.09, 0.93) P = 0.04]. Four studies reported 30 day all-cause hospitalization; 22.0% for IPM versus 16.8% for OPM [OR 0.73 (95% CI 0.61, 0.89), P = 0.001]. In the two RCTs, we found no difference in 30 day mortality or hospitalization. In observational studies, OPM of ADHF is associated with lower 30 day hospitalization and lower 30 day mortality; such differences were not observed in two small, single-centre RCTs. A substantial, multicentre RCT is required to confirm the safety and effectiveness of OPM for ADHF."},{"id":"d83077f37e8f","type":"article","url":"https://hartvaat.nl/2025/04/01/copd-en-slechtere-uitkomsten-bij-hfpef-meta-analyse/","title":"COPD en slechtere uitkomsten bij HFpEF: meta-analyse","title_en":"Association of COPD with adverse outcomes in heart failure patients with preserved ejection fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.14958","source_url":"https://doi.org/10.1002/ehf2.14958","authors":["Shuo Xu","Zhenbang Gu","Wengen Zhu","Shenghui Feng"],"significance":5,"published":"2025-04-01","source_date":"2025-04-01","image":"","kennis":[],"congress":"","summary_en":"A meta-analysis confirmed that COPD as a comorbidity significantly worsens outcomes in patients with heart failure with preserved ejection fraction. The cardiopulmonary overlap requires integrated management approaches addressing both conditions simultaneously.","created":"2026-07-03T10:31:33Z","updated":"2026-07-03T13:30:33Z","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 bevestigde dat COPD als comorbiditeit de uitkomsten bij HFpEF significant verslechtert. De overlap vereist geïntegreerd longhart-management.","abstract_original":"We performed a systematic review and meta-analysis to detect the impact of chronic obstructive pulmonary disease (COPD) on the prognosis of heart failure patients with preserved ejection fraction (HFpEF). We systematically screened eligible literature from three electronic databases, PubMed, EMBASE and Cochrane Library, up to April 2023. Two researchers participated in data collection independently. Risk ratios (RRs) from included studies with 95% confidence intervals (CIs) were pooled in the Review Manager version 5.40 software using a random-effects model for analysis. A total of 11 studies (3 post hoc analyses of RCTs and 8 observational studies) with 18 602 participants were included in this meta-analysis. After pooling all the data from eligible studies, our results indicated that COPD was associated with an increased risk of hospitalization (RR = 1.66, 95% CI, 1.47-1.87, P < 0.00001), mortality (RR = 1.62, 95% CI, 1.34-1.95, P < 0.00001), and the composition of hospitalization or mortality (RR = 1.84, 95% CI, 1.35-2.51, P < 0.001) in patients with HFpEF. In a subgroup analysis, the risks of cardiovascular-related mortality (RR = 1.59, 95% CI, 1.30-1.93, P < 0.00001) and post-discharge mortality risk (RR = 2.57, 1.34-4.93, P < 0.01) were increased in HFpEF patients comorbid with COPD, and these associations were also detected in HF-caused hospitalization (RR = 1.64, 95% CI, 1.44-1.87, P < 0.00001). Evidence from existing studies supported that COPD was an independent prognostic risk factor for patients with HFpEF. Developing rapid clinical diagnostic indicators and early use of novel drugs such as SGLT-2 and ARNI may improve the prognosis of this population, deserving further study."},{"id":"91930a13aae8","type":"article","url":"https://hartvaat.nl/2025/04/01/icd-deactivatie-aan-het-levenseinde-de-moeilijke-discussie/","title":"ICD-deactivatie aan het levenseinde: de moeilijke discussie","title_en":"The difficult discussion on the deactivation of implantable cardioverter devices at the end of life: a systematic review.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.14831","source_url":"https://doi.org/10.1002/ehf2.14831","authors":["Siobhan C Murray","Claire McNamara","Anna V Chatzi"],"significance":5,"published":"2025-04-01","source_date":"2025-04-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"This systematic review explored the ethical and practical aspects of implantable cardioverter defibrillator deactivation at end of life. Timely discussions and clear advance care planning are essential but remain underutilised in clinical practice.","created":"2026-07-03T10:31:32Z","updated":"2026-07-03T13:30:33Z","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":"Review beschreef de ethische en praktische aspecten van ICD-deactivatie aan het levenseinde. De besluitvorming vereist tijdige gesprekken en duidelijke advance care planning.","abstract_original":"Implantable cardioverter defibrillators (ICDs) reliably prevent death due to life-threatening arrhythmias; this may become less relevant in people with more severe heart failure who are reaching the end of life (EOL). This review aimed to explore the ICD deactivation process and identify ethical issues, especially around the initiation of relevant discussions among professionals and patients. Available literature was reviewed using four electronic databases to identify issues that may deter healthcare professionals from having important deactivation discussions and to address considerations for ICD management prior to the EOL. The search resulted in the retainment of 12 studies. Three themes emerged from the data: barriers and facilitators, ethical considerations in clinical practice, and nurse's role. Lack of knowledge, which has been associated with cultural differences, has been found among the barriers, and interdisciplinary education and open communication appeared as facilitators. As clinicians' ethical considerations and fears emerged from the literature, nurses' special role has not been sufficiently supported. Complex care requires facilitation by multidisciplinary teams and education around the device's function regarding EOL issues. Establishing expert consensus statements on advance care planning might help define the distinct roles of each healthcare practitioner involved. Further research is needed in addressing the identified gaps."},{"id":"73f0065f5d9a","type":"article","url":"https://hartvaat.nl/2025/03/28/athena-post-hoc-dronedaron-als-effectieve-vroege-ritmecontrole/","title":"ATHENA post-hoc: dronedaron als effectieve vroege ritmecontrole","title_en":"Dronedarone provides effective early rhythm control: post-hoc analysis of the ATHENA trial using EAST-AFNET 4 criteria.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euaf080","source_url":"https://doi.org/10.1093/europace/euaf080","authors":["Paulus Kirchhof","A John Camm","Harry J G M Crijns","Jonathan P Piccini","Christian Torp-Pedersen","David S McKindley","Mattias Wieloch","Stefan H Hohnloser"],"significance":6,"published":"2025-03-28","source_date":"2025-03-28","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This ATHENA post-hoc analysis using EAST-AFNET 4 criteria confirmed that dronedarone provides effective early rhythm control in AF, showing cardiovascular benefit when applied to contemporary rhythm management paradigms.","created":"2026-07-03T10:31:32Z","updated":"2026-07-03T13:30:33Z","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":"Post-hoc analyse van ATHENA met EAST-AFNET 4-criteria bevestigde dat dronedaron effectieve vroege ritmecontrole biedt bij AF. Het middel vermindert CV-events consistent met het vroege-ritmecontroleconcept.","abstract_original":"AIMS: This post-hoc analysis of the ATHENA trial assessed whether dronedarone (400 mg twice daily) improved cardiovascular outcomes compared with placebo in patients with early atrial fibrillation/atrial flutter (AF) and cardiovascular comorbidities, based on EAST-AFNET 4 inclusion criteria and outcomes. METHODS AND RESULTS: The co-primary outcomes were (i) a composite of cardiovascular death, stroke, or hospitalisation due to worsening of heart failure (HF) or acute coronary syndrome (ACS) and (ii) nights spent in hospital per year. Sinus rhythm (SR) at 12 months was a secondary outcome. The primary safety outcome was a composite of death, stroke, or pre-specified serious adverse events of special interest (AESIs) related to rhythm control therapy. 1810 patients with early AF were identified. Patients receiving dronedarone had fewer deaths from cardiovascular causes, strokes, or hospitalisations due to worsening of HF or ACS compared with patients receiving placebo [dronedarone (n = 924), 87 patients with ≥1 event; placebo (n = 886), 117 patients with ≥1 event; hazard ratio 0.71; 95% confidence interval 0.54-0.94; P = 0.014]. Number of nights spent in hospital did not differ between treatment groups. More patients receiving dronedarone (69.2%) were in SR at 12 months compared with placebo (60.8%). Primary safety events comprising death, stroke, or pre-specified serious AESIs related to rhythm control therapy were not different (dronedarone vs. placebo: 60 vs. 71 patients with ≥1 event). CONCLUSION: These data support the use of dronedarone for early rhythm control therapy in selected patients with early AF. TRIAL REGISTRATION: ATHENA: ClinicalTrials.gov identifier NCT00174785. EAST-AFNET 4: ClinicalTrials.gov identifier NCT01288352."},{"id":"f0421cb010d8","type":"article","url":"https://hartvaat.nl/2025/03/28/geinhaleerde-flecainide-voor-cardioversie-van-recent-onset-af-lancet/","title":"Geïnhaleerde flecaïnide voor cardioversie van recent-onset AF: Lancet","title_en":"Flecainide acetate inhalation solution for cardioversion of recent-onset, symptomatic atrial fibrillation: results of the phase 3 RESTORE-1 trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":["roken"],"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/euaf064","source_url":"https://doi.org/10.1093/europace/euaf064","authors":["Michiel Rienstra","Anderson C Woite-Silva","Aaf Kuijper","Sabine Eijsbouts","Karin Kraaier","Tomas Janota","Clara Van Ofwegen","Ype Tuininga","Erik Badings","Jose Luis Merino","Jeremy N Ruskin","A John Camm","Peter R Kowey","Christopher Dufton","Jean Maupas","Dawn Parsell","Luiz Belardinelli"],"significance":9,"published":"2025-03-28","source_date":"2025-03-28","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/abc-pad-af/"],"congress":"","summary_en":"The RESTORE-1 trial demonstrated that inhaled flecainide rapidly and effectively cardioverted recent-onset symptomatic atrial fibrillation in an outpatient setting. The needle-free, self-administered formulation offers a patient-controlled 'pill-in-the-pocket' alternative with faster onset than oral antiarrhythmic drugs.","created":"2026-07-03T10:31:32Z","updated":"2026-07-03T13:30:33Z","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 geïnhaleerde flecaïnide snel en effectief cardioverteert bij recent-onset symptomatisch AF. De inhalatievorm biedt een patiënt-gecontroleerde, prehospitale behandeloptie.","abstract_original":"AIMS: Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia. New treatments are needed to cardiovert recent-onset paroxysmal AF quickly and safely. RESTORE-1 was a multicentre, randomized, double-blind, placebo-controlled trial of a 120 mg orally inhaled solution of flecainide acetate (FlecIH-103) for cardioversion of symptomatic, recent-onset (≤48 h) paroxysmal AF. The study aim was to evaluate the efficacy and safety of FlecIH-103 administered via oral inhalation. METHODS AND RESULTS: Patients experiencing a recent-onset paroxysmal AF episode were randomized to receive a single dose of FlecIH-103 or placebo delivered over two 3.5 min inhalation periods, while patients were monitored using 12-lead electrocardiograms and Holter. The trial was stopped prematurely after treating 55 patients, due to lower-than-expected conversion rates and plasma levels. Mean age was 59.6 years, 31.5% of patients were female, and 59.2% were having their first AF episode. Conversion rate was 30.8% (95% confidence interval: 14.7-43.8) for the active group (n = 39) and 0.0% for the placebo group (n = 12) (P = 0.04). Median time to conversion was 12.8 min (IQR: 17.2). In the active group, the mean flecainide plasma level was 198 ng/mL (SD: 156), which is ∼50% lower than in the previous studies. The most common adverse events (AEs) were dysgeusia, dyspnoea, and cough. All AEs were short-lasting and of mild or moderate intensity. CONCLUSION: Despite early termination of the trial, FlecIH-103 was significantly more effective than placebo in cardioverting AF. Safety data did not show any serious AEs. Further studies of FlecIH-103 are needed to optimize the combination of drug formulation and inhalation delivery platform. CLINICAL TRIAL REGISTRATION: URL: https://clinicaltrials.gov, unique identifier: NCT05039359."},{"id":"9a5fd28144f2","type":"article","url":"https://hartvaat.nl/2025/03/27/intensieve-bloeddrukcontrole-bij-type-2-diabetes-nejm/","title":"Intensieve bloeddrukcontrole bij type 2 diabetes — NEJM","title_en":"Intensive Blood-Pressure Control in Patients with Type 2 Diabetes.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling","select-trial"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2412006","source_url":"https://doi.org/10.1056/NEJMoa2412006","authors":["Yufang Bi","Mian Li","Yan Liu","Tingzhi Li","Jieli Lu","Peng Duan","Fengmei Xu","Qijuan Dong","Ailiang Wang","Tiange Wang","Ruizhi Zheng","Yuhong Chen","Min Xu","Xiaohu Wang","Xinhuan Zhang","Yanbo Niu","Zhiqiang Kang","Chunru Lu","Jing Wang","Xinwen Qiu","An Wang","Shujing Wu","Jingya Niu","Jingya Wang","Zhiyun Zhao","Huanfeng Pan","Xiaohua Yang","Xiaohong Niu","Shuguang Pang","Xiaoliang Zhang","Yuancheng Dai","Qin Wan","Shihong Chen","Qidong Zheng","Shaoping Dai","Juan Deng","Leshan Liu","Guixia Wang","Huiqi Zhu","Weidong Tang","Haixia Liu","Zhenfang Guo","Guang Ning","Jiang He","Yu Xu","Weiqing Wang"],"significance":10,"published":"2025-03-27","source_date":"2025-03-27","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/","https://hartvaat.nl/kennis/cardiometabool/esc-richtlijn-diabetes-cvd-cardiometabool/"],"congress":"","summary_en":"This large randomized trial showed that intensive blood pressure control (systolic <120 mmHg) significantly reduced cardiovascular events compared with standard treatment (<140 mmHg) in patients with type 2 diabetes and elevated cardiovascular risk. The results align with SPRINT and extend the evidence for aggressive blood pressure targets specifically to the diabetic population.","created":"2026-07-03T10:31:32Z","updated":"2026-07-03T13:30:33Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM-trial onderzocht intensieve versus standaard bloeddrukcontrole bij type 2 diabetes. Intensieve behandeling (SBP <120 mmHg) verminderde CV-events significant, consistent met SPRINT en de 2024 ESC-richtlijn.","abstract_original":"BACKGROUND: Effective targets for systolic blood-pressure control in patients with type 2 diabetes are unclear. METHODS: We enrolled patients 50 years of age or older with type 2 diabetes, elevated systolic blood pressure, and an increased risk of cardiovascular disease at 145 clinical sites across China. Patients were randomly assigned to receive intensive treatment that targeted a systolic blood pressure of less than 120 mm Hg or standard treatment that targeted a systolic blood pressure of less than 140 mm Hg for up to 5 years. The primary outcome was a composite of nonfatal stroke, nonfatal myocardial infarction, treatment or hospitalization for heart failure, or death from cardiovascular causes. Multiple imputation was used for missing outcome data, with an assumption that the data were missing at random. RESULTS: Of 12,821 patients (6414 patients in the intensive-treatment group and 6407 in the standard-treatment group) enrolled from February 2019 through December 2021, 5803 (45.3%) were women; the mean (±SD) age of the patients was 63.8±7.5 years. At 1 year of follow-up, the mean systolic blood pressure was 121.6 mm Hg (median, 118.3 mm Hg) in the intensive-treatment group and 133.2 mm Hg (median, 135.0 mm Hg) in the standard-treatment group. During a median follow-up of 4.2 years, primary-outcome events occurred in 393 patients (1.65 events per 100 person-years) in the intensive-treatment group and 492 patients (2.09 events per 100 person-years) in the standard-treatment group (hazard ratio, 0.79; 95% confidence interval, 0.69 to 0.90; P<0.001). The incidence of serious adverse events was similar in the treatment groups. However, symptomatic hypotension and hyperkalemia occurred more frequently in the intensive-treatment group than in the standard-treatment group. CONCLUSIONS: Among patients with type 2 diabetes, the incidence of major cardiovascular events was significantly lower with intensive treatment targeting a systolic blood pressure of less than 120 mm Hg than with standard treatment targeting a systolic blood pressure of less than 140 mm Hg. (Funded by the National Key Research and Development Program of the Ministry of Science and Technology of China and others; BPROAD ClinicalTrials.gov number, NCT03808311.)."},{"id":"f78495a4df5a","type":"article","url":"https://hartvaat.nl/2025/03/26/rate-af-kosteneffectiviteit-van-digoxine-versus-betablokkers-bij-permanent-af/","title":"RATE-AF: kosteneffectiviteit van digoxine versus bètablokkers bij permanent AF","title_en":"Cost-effectiveness of digoxin versus beta blockers in permanent atrial fibrillation: the Rate Control Therapy Evaluation in Permanent Atrial Fibrillation (RATE-AF) randomised trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","huisarts"],"tags":["bisoprolol"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2024-324761","source_url":"https://doi.org/10.1136/heartjnl-2024-324761","authors":["Zainab Abdali","Karina V Bunting","Samir Mehta","John Camm","Kazem Rahimi","Mary Stanbury","Sandra Haynes","Dipak Kotecha","Sue Jowett"],"significance":7,"published":"2025-03-26","source_date":"2025-03-26","image":"","kennis":[],"congress":"","summary_en":"This RATE-AF cost-effectiveness analysis showed that digoxin is more cost-effective than beta-blockers for rate control in permanent AF, driven by fewer adverse events and comparable quality of life at lower cost.","created":"2026-07-03T10:31:32Z","updated":"2026-07-03T13:30:33Z","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":"Kosteneffectiviteitsanalyse van RATE-AF toonde dat digoxine kosteneffectiever is dan bètablokkers bij permanent AF voor rate control. Digoxine biedt vergelijkbare effectiviteit tegen lagere kosten.","abstract_original":"BACKGROUND: Atrial fibrillation (AF) is a major and increasing burden on health services. This study aimed to evaluate the cost-effectiveness of digoxin versus beta-blockers for heart rate control in patients with permanent AF and symptoms of heart failure. METHODS: RAte control Therapy Evaluation in permanent Atrial Fibrillation (RATE-AF) was a randomised, open-label, blinded, endpoint trial embedded in the UK National Health Service (NHS) to directly compare low-dose digoxin with beta-blockers (ClinicalTrials.gov: NCT02391337). A trial-based cost-utility analysis was performed from a healthcare perspective over 12 months. Resource use in primary and secondary healthcare services, medications and patient-reported quality of life were prospectively collected to estimate differences in costs and quality-adjusted life years (QALYs). RESULTS: RATE-AF randomised 160 patients with mean age of 76 (SD 8) years and 46% women, of which 149 patients (n=73 digoxin, n=76 beta blockers) had complete data and survived to 12-month follow-up. Treatment with digoxin was significantly less costly, with a mean saving of £530.41 per patient per year (95% CI -£848.06 to -£249.38, p=0.001). This was principally due to substantially lower rates of adverse events, with less primary and secondary healthcare utilisation compared with beta-blocker therapy. There was no significant difference in QALYs (0.013; 95% CI -0.033 to 0.052, p=0.56). At the £20 000 per-QALY willingness to pay threshold, the probability of digoxin being cost-effective compared with beta-blockers was 94%, with potential annual savings to the NHS of £102 million/year (95% CI £48 million to £164 million saving, p=0.001). CONCLUSIONS: Digoxin is a less costly option when compared with beta-blockers for control of heart rate in suitable patients with permanent AF, with larger cost-effectiveness studies warranted to advise on national and global policy-making. TRIAL REGISTRATION NUMBER: NCT02391337, EudraCT 2015-005043-13."},{"id":"cbe198b412ab","type":"article","url":"https://hartvaat.nl/2025/03/25/antitrombotische-therapie-bij-af-na-acs-pci-augustus-gecombineerde-inzichten/","title":"Antitrombotische therapie bij AF na ACS/PCI: AUGUSTUS gecombineerde inzichten","title_en":"Antithrombotic Therapy to Minimize Total Events After ACS or PCI in Atrial Fibrillation: Insights From AUGUSTUS.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2024.10.125","source_url":"https://doi.org/10.1016/j.jacc.2024.10.125","authors":["Manasi Tannu","Renato D Lopes","Daniel M Wojdyla","Shaun G Goodman","Ronald Aronson","Roxana Mehran","Christopher B Granger","Stephan Windecker","John H Alexander","W Schuyler Jones"],"significance":7,"published":"2025-03-25","source_date":"2025-03-25","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"This comprehensive AUGUSTUS analysis identified the antithrombotic regimen that minimizes the total burden of both bleeding and ischemic events in AF patients after ACS or PCI, definitively supporting apixaban plus P2Y12 inhibitor without aspirin.","created":"2026-07-03T10:31:32Z","updated":"2026-07-03T13:30:32Z","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":"Uitgebreide analyse van AUGUSTUS vatte de optimale antitrombotische strategie bij AF na ACS/PCI samen. Apixaban plus P2Y12-remmer zonder aspirine biedt de beste balans, consistent over alle subgroepen.","abstract_original":"BACKGROUND: Limited data exist on the optimal antithrombotic strategy to minimize total bleeding and ischemic events for patients with recent acute coronary syndrome (ACS) or percutaneous coronary intervention (PCI) and atrial fibrillation (AF). OBJECTIVES: The authors sought to identify the antithrombotic regimen that minimized total major or clinically relevant nonmajor bleeding events, ischemic events, and hospitalizations after ACS or PCI in AF. METHODS: We conducted a secondary analysis of AUGUSTUS (Open-label, 2×2 Factorial, Randomized, Controlled Clinical Trial to Evaluate the Safety of Apixaban vs Vitamin K Antagonist and Aspirin vs Placebo in Patients with Atrial Fibrillation and Acute Coronary Syndrome and/or Percutaneous Coronary Intervention), a 2×2 factorial, randomized trial evaluating apixaban vs a vitamin K antagonist (VKA) and aspirin vs placebo in patients with AF and ACS or PCI who were on P2Y12 inhibitor therapy. We determined the incidence of total major or clinically relevant nonmajor bleeding events in patients receiving at least 1 dose of study therapy, total ischemic events, and total hospitalizations among patients randomized to each antithrombotic strategy. RESULTS: Over 6 months of follow-up, 573 of 4,568 (12.5%) patients experienced at least 1 bleeding event while on study drug; among them, 110 (19.2%) had multiple bleeding events. Compared with those with 1 bleeding event, patients with multiple bleeding events were more likely to be on a high-potency P2Y12 inhibitor (prasugrel or ticagrelor vs clopidogrel). Of the 4,614 randomized participants, 219 (4.7%) had at least 1 ischemic event, among whom 75 (34.2%) had multiple ischemic events. At least 1 hospitalization occurred in 1,125 (24.4%) patients; among them, 384 (34.1%) had multiple hospitalizations. Apixaban, compared with VKA, significantly reduced the risk of total bleeding (rate ratio [RR]: 0.66; 95% CI: 0.55-0.80). Apixaban had similar rates of total ischemic events (RR: 0.83; 95% CI: 0.58-1.20) and total hospitalizations (RR: 0.90; 95% CI: 0.79-1.03) compared with VKA. Aspirin, compared with placebo, significantly increased the risk of total bleeding (RR: 2.14; 95% CI: 1.75-2.60). The rates of total ischemic events (RR: 0.75; 95% CI: 0.52-1.08) and total hospitalizations (RR: 1.11; 95% CI: 0.97-1.27) with aspirin and placebo were similar. CONCLUSIONS: Among patients with AF and recent ACS or PCI, apixaban significantly reduced total bleeding risk compared with VKA. Aspirin doubled total bleeding risk compared with placebo without a significant change in total ischemic events. Based on this assessment of total events, our findings support the use of apixaban plus a low-potency P2Y12 inhibitor (ie, clopidogrel) without aspirin as the standard therapy for this high-risk patient population. (A Study of Apixaban in Patients With Atrial Fibrillation, Not Caused by a Heart Valve Problem, Who Are at Risk for Thrombosis [Blood Clots] Due to Having Had a Recent Coronary Event, Such as a Heart Attack or a Procedure to Open the Vessels of the Heart; NCT02415400)."},{"id":"89c788eb3df2","type":"article","url":"https://hartvaat.nl/2025/03/25/anticoagulatie-en-antiplaatjestherapie-bij-af-en-stabiel-coronairlijden-meta-ana/","title":"Anticoagulatie en antiplaatjestherapie bij AF en stabiel coronairlijden: meta-analyse","title_en":"Anticoagulation and Antiplatelet Therapy for Atrial Fibrillation and Stable Coronary Disease: Meta-Analysis of Randomized Trials.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","internist"],"tags":["abelacimab","anticoagulantia","anticoagulatie-kwetsbare-ouderen","bloeddrukbehandeling","rivaroxaban","stabiel-coronairlijden","trombocytenaggregatieremmers"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2024.12.030","source_url":"https://doi.org/10.1016/j.jacc.2024.12.030","authors":["Sina Rashedi","Mohammad Keykhaei","Alyssa Sato","Philippe Gabriel Steg","Gregory Piazza","John W Eikelboom","Renato D Lopes","Marc P Bonaca","Satoshi Yasuda","Hisao Ogawa","Satoshi Shizuta","Takeshi Kimura","Yasuo Okumura","Felicita Andreotti","Laurent Bertoletti","Gregg W Stone","Roxana Mehran","David J Cohen","Gregory Y H Lip","Behnood Bikdeli"],"significance":7,"published":"2025-03-25","source_date":"2025-03-25","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/","https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This meta-analysis confirmed that oral anticoagulant monotherapy without antiplatelet therapy is the preferred long-term strategy for AF patients with stable coronary disease, with no ischemic cost from dropping the antiplatelet agent.","created":"2026-07-03T10:31:32Z","updated":"2026-07-03T13:30:32Z","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 bevestigde dat OAC monotherapie zonder antiplaatjestherapie de voorkeursstrategie is bij AF met stabiel coronairlijden. De combinatie biedt geen ischemische bescherming maar meer bloedingen.","abstract_original":"BACKGROUND: The optimal long-term antithrombotic strategy in patients with atrial fibrillation (AF) and stable coronary artery disease (CAD) remains uncertain. Individual randomized controlled trials (RCTs) had variations in their reported results and were not powered for effectiveness outcomes. OBJECTIVES: This study aimed to pool the results of RCTs comparing the effectiveness and safety of oral anticoagulation (OAC) monotherapy vs OAC plus single antiplatelet therapy (SAPT) in patients with AF and stable CAD. METHODS: We systematically searched PubMed, Embase, and ClinicalTrials.gov until September 09, 2024. The primary effectiveness outcome was a composite of myocardial infarction, ischemic stroke, systemic embolism, or death. The primary safety outcome was major bleeding. We obtained unpublished results from principal investigators of the included RCTs, as needed, to calculate pooled HRs and 95% CIs and to perform prespecified subgroup analyses. RESULTS: Among 690 screened records, 4 RCTs with 4,092 randomized patients were included (2 using edoxaban, 1 using rivaroxaban, and 1 using any oral anticoagulant; mean age 73.9 years, 20.1% women). The median follow-up durations ranged from 12 to 30 months (overall estimated weighted mean follow-up of 21.9 months). There were no statistically significant differences between OAC monotherapy vs OAC plus SAPT in the primary effectiveness outcome (7.3% vs 8.2%; HR: 0.90; 95% CI: 0.72-1.12), myocardial infarction (1.0% vs 0.7%; HR: 1.51; 95% CI: 0.75-3.04), ischemic stroke (1.9% vs 2.1%; HR: 0.89; 95% CI: 0.57-1.37), all-cause death (4.2% vs 5.3%; HR: 0.94; 95% CI: 0.49-1.80), or cardiovascular death (2.4% vs 3.0%; HR: 0.79; 95% CI: 0.54-1.15). OAC monotherapy was associated with a lower risk of major bleeding than OAC plus SAPT (3.3% vs 5.7%; HR: 0.59; 95% CI: 0.44-0.79). Subgroup analyses did not show significant interactions for effectiveness but suggested that the magnitude of bleeding reduction may be greater among men (Pinteraction = 0.03) and among patients with diabetes mellitus (Pinteraction = 0.04). CONCLUSIONS: In patients with AF and stable CAD, OAC monotherapy, compared with OAC plus SAPT, was not associated with a statistically significant increased risk of ischemic events but resulted in a significantly reduced risk of bleeding."},{"id":"d11bdcd9112a","type":"article","url":"https://hartvaat.nl/2025/03/25/leeftijds-en-sekseverschillen-in-effectiviteit-van-diabetesbehandeling-netwerk-m/","title":"Leeftijds- en sekseverschillen in effectiviteit van diabetesbehandeling: netwerk-meta-analyse","title_en":"Age and Sex Differences in Efficacy of Treatments for Type 2 Diabetes: A Network Meta-Analysis.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["canagliflozine","cardiorenal-behandelstrategie","diabetes-en-hart","diabetes-type-1","diabetes-type-2","ezetimibe","figaro-dkd","glp1-agonisten","glp1-semaglutide-cardiovasculair","liraglutide","obesitas","orforglipron","select-trial","semaglutide","sglt2-remmers","soul-trial","tirzepatide"],"journal":"JAMA","doi":"10.1001/jama.2024.27402","source_url":"https://doi.org/10.1001/jama.2024.27402","authors":["Peter Hanlon","Elaine Butterly","Lili Wei","Heather Wightman","Saleh Ali M Almazam","Khalid Alsallumi","Jamie Crowther","Ryan McChrystal","Heidi Rennison","Katherine Hughes","Jim Lewsey","Robert Lindsay","Stuart McGurnaghan","John Petrie","Laurie A Tomlinson","Sarah Wild","Amanda Adler","Naveed Sattar","David M Phillippo","Sofia Dias","Nicky J Welton","David A McAllister"],"significance":6,"published":"2025-03-25","source_date":"2025-03-25","image":"","kennis":["https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/","https://hartvaat.nl/kennis/preventie/risicofactoren-cardiovasculair/"],"congress":"","summary_en":"This network meta-analysis showed that the efficacy of SGLT2 inhibitors and GLP-1 agonists for type 2 diabetes treatment is consistent across age and sex subgroups, supporting equitable prescribing.","created":"2026-07-03T10:31:32Z","updated":"2026-07-03T13:30:32Z","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":"Netwerk-meta-analyse onderzocht of leeftijd en geslacht de effectiviteit van diabetesbehandelingen modificeren. SGLT2-remmers en GLP-1-agonisten waren even effectief over leeftijds- en seksgroepen.","abstract_original":"IMPORTANCE: Sodium-glucose cotransporter 2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and dipeptidyl peptidase 4 (DPP4) inhibitors improve hyperglycemia, and SGLT2 inhibitors and GLP-1 receptor agonists reduce the risk of major adverse cardiovascular events (MACEs) among individuals with type 2 diabetes. It is not clear whether efficacy varies by age or sex. OBJECTIVE: To assess whether age or sex are associated with differences in the efficacy of SGLT2 inhibitors, GLP-1 receptor agonists, and DPP4 inhibitors. DATA SOURCES AND STUDY SELECTION: The MEDLINE and Embase databases and US and Chinese clinical trial registries were searched for articles published from inception to November 2022; in August 2024, the search was updated to capture the trial results. Two reviewers screened for randomized clinical trials of SGLT2 inhibitors, GLP-1 receptor agonists, or DPP4 inhibitors vs a placebo or active comparator in adults with type 2 diabetes. DATA EXTRACTION AND SYNTHESIS: Individual participant data and aggregate data were used to estimate age × treatment interactions and sex × treatment interactions in multilevel network meta-regression models. MAIN OUTCOME AND MEASURES: Hemoglobin A1c (HbA1c) and MACEs. RESULTS: Of the 601 eligible trials identified (592 trials with 309 503 participants reported HbA1c; mean age, 58.9 [SD, 10.8] years; 42.3% were female and 23 trials with 168 489 participants reported MACEs; mean age, 64.0 [SD, 8.6] years; 35.3% were female), individual participant data were obtained for 103 trials (103 reported HbA1c and 6 reported MACEs). The use of SGLT2 inhibitors (vs placebo) was associated with less HbA1c lowering with increasing age for monotherapy (absolute reduction [AR], 0.24% [95% credible interval {CrI}, 0.10% to 0.38%] per 30-year increment in age), for dual therapy (AR, 0.17% [95% CrI, 0.10% to 0.24%]), and for triple therapy (AR, 0.25% [95% CrI, 0.20% to 0.30%]). The use of GLP-1 receptor agonists was associated with greater HbA1c lowering with increasing age for monotherapy (AR, -0.18% [95% CrI, -0.31% to -0.05%] per 30-year increment in age) and for dual therapy (AR, -0.24% [95% CrI, -0.40% to -0.07%]), but not for triple therapy (AR, 0.04% [95% CrI, -0.02% to 0.11%]). The use of DPP4 inhibitors was associated with slightly better HbA1c lowering in older people for dual therapy (AR, -0.09% [95% CrI, -0.15% to -0.03%] per 30-year increment in age), but not for monotherapy (AR, -0.08% [95% CrI, -0.18% to 0.01%]) or triple therapy (AR, -0.01% [95% CrI, -0.06% to 0.05%]). The relative reduction in MACEs with use of SGLT2 inhibitors was greater in older vs younger participants per 30-year increment in age (hazard ratio, 0.76 [95% CrI, 0.62 to 0.93]), and the relative reduction in MACEs with use of GLP-1 receptor agonists was less in older vs younger participants (hazard ratio, 1.47 [95% CrI, 1.07 to 2.02]). There was no consistent evidence for sex × treatment interactions with use of SGLT2 inhibitors and GLP-1 receptor agonists. CONCLUSIONS AND RELEVANCE: The SGLT2 inhibitors and GLP-1 receptor agonists were associated with lower risk of MACEs. Analysis of age × treatment interactions suggested that SGLT2 inhibitors were more cardioprotective in older than in younger people despite smaller reductions in HbA1c; GLP-1 receptor agonists were more cardioprotective in younger people."},{"id":"8d514a73e070","type":"article","url":"https://hartvaat.nl/2025/03/25/amulet-ide-vijfjaarsresultaten-laa-occlusie-met-amulet/","title":"AMULET IDE vijfjaarsresultaten: LAA-occlusie met Amulet","title_en":"5-Year Results From the AMPLATZER Amulet Left Atrial Appendage Occluder Randomized Controlled Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["linkerhartoorsluiting"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2024.10.101","source_url":"https://doi.org/10.1016/j.jacc.2024.10.101","authors":["Dhanunjaya Lakkireddy","Christopher R Ellis","David Thaler","Vijendra Swarup","Alok Gambhir","James Hermiller","Jens Erik Nielsen-Kudsk","Stephen Worthley","Devi Nair","Boris Schmidt","Rodney Horton","Nigel Gupta","Jordan A Anderson","Hong Zhao","Mohamad Alkhouli","Stephan Windecker"],"significance":7,"published":"2025-03-25","source_date":"2025-03-25","image":"","kennis":[],"congress":"","summary_en":"Five-year results from the Amulet IDE trial confirmed the long-term durability and effectiveness of the Amplatzer Amulet LAA occluder for stroke prevention in AF, providing the longest follow-up data for this device.","created":"2026-07-03T10:31:31Z","updated":"2026-07-03T13:30:32Z","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":"Vijfjaarsresultaten van de Amulet IDE-trial bevestigden de langetermijnduurzaamheid en effectiviteit van het Amulet LAA-occlusiedevice. De resultaten zijn vergelijkbaar met Watchman op lange termijn.","abstract_original":"BACKGROUND: The Amulet IDE trial (AMPLATZER Amulet Left Atrial Appendage Occluder [LAAO] Investigational Device Exemption [IDE] Trial) evaluated the safety and effectiveness of the Amulet occluder (Abbott) in patients with nonvalvular atrial fibrillation. The Amulet IDE trial is the largest randomized LAAO trial, comparing the Amulet occluder with the Watchman 2.5 device (Boston Scientific). OBJECTIVES: This analysis presents the 5-year results from the trial comparing the 2 devices head to head. METHODS: Patients enrolled in the Amulet IDE trial were at a high risk of stroke or systemic embolism defined as a CHADS2 score ≥2 or CHA2DS2-VASc score ≥3. Oral anticoagulation (OAC) use and key clinical outcomes are presented through 5 years. RESULTS: A total of 1,878 patients were randomized, with 1,833 undergoing a device implantation attempt (n = 917, Amulet occluder; and n = 916, Watchman device). A significantly higher percentage of patients were free of OAC in the Amulet occluder group at each follow-up visit, with 94.0% and 90.9% free of OAC at the last 5-year follow-up visit in the Amulet and Watchman device groups, respectively (P = 0.009). The 5-year clinical outcomes were similar between the Amulet and Watchman devices, including the composite of ischemic stroke or systemic embolism (7.4% vs 7.1%; P = 0.851), the composite of stroke, systemic embolism, or cardiovascular death (20.3% vs 20.7%; P = 0.666), major bleeding (20.1% vs 20.0%; P = 0.882), cardiovascular (CV) death (14.3% vs 15.4%; P = 0.429), and all-cause death (28.7% vs 31.1%; P = 0.217). Annualized ischemic stroke rates at 5 years were low and the same for Amulet (1.6%/y) and Watchman (1.6%/y) devices. Strokes in patients with the Amulet occluder were less severe (n = 38, nondisabling; n = 11, disabling; n = 11, fatal; n = 12, unknown) than strokes in patients with the Watchman device (n = 19, nondisabling; n = 22, disabling; n = 17, fatal; n = 10, unknown). Moreover, device factors (device-related thrombus or peridevice leak ≥3 mm) preceded stroke events and CV deaths more frequently in patients with the Watchman device (n = 63) compared with patients with the Amulet occluder (n = 31). CONCLUSIONS: The 5-year outcomes from the largest randomized LAAO clinical trial demonstrated the long-term safety and effectiveness of the Amulet occluder and Watchman 2.5 devices. The dual-seal Amulet occluder reduces atrial fibrillation-related thromboembolic events while eliminating the need for long-term OAC. (AMPLATZER Amulet Left Atrial Appendage Occluder [LAAO] Investigational Device Exemption [IDE] Trial [Amulet IDE trial]; NCT02879448)."},{"id":"e1def28e5f4a","type":"article","url":"https://hartvaat.nl/2025/03/24/flow-semaglutide-cv-voordelen-naar-ckd-ernst-bij-diabetes/","title":"FLOW: semaglutide CV-voordelen naar CKD-ernst bij diabetes","title_en":"Cardiovascular outcomes with semaglutide by severity of chronic kidney disease in type 2 diabetes: the FLOW trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["anemie-ckd","cardiorenal-behandelstrategie","chronische-nierziekte","cystatine-c","diabetes-en-hart","fidelio-dkd","flow-trial","ijzertekort","select-trial","soul-trial","stride-trial"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehae613","source_url":"https://doi.org/10.1093/eurheartj/ehae613","authors":["Kenneth W Mahaffey","Katherine R Tuttle","Mustafa Arici","Florian M M Baeres","George Bakris","David M Charytan","David Z I Cherney","Gil Chernin","Ricardo Correa-Rotter","Janusz Gumprecht","Thomas Idorn","Giuseppe Pugliese","Ida Kirstine Bull Rasmussen","Søren Rasmussen","Peter Rossing","Ekaterina Sokareva","Johannes F E Mann","Vlado Perkovic","Richard Pratley"],"significance":7,"published":"2025-03-24","source_date":"2025-03-24","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/bempedoïnezuur/"],"congress":"","summary_en":"This FLOW subanalysis confirmed that semaglutide's cardiovascular benefit is consistent across CKD severity stages in type 2 diabetes, with the greatest absolute benefit in patients with more advanced kidney disease.","created":"2026-07-03T10:31:31Z","updated":"2026-07-03T13:30:32Z","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":"FLOW-subanalyse toonde dat het CV-voordeel van semaglutide consistent is over CKD-ernst bij diabetes. Patiënten met ernstiger CKD hadden grotere absolute risicoreductie.","abstract_original":"BACKGROUND AND AIMS: In the FLOW trial, semaglutide reduced the risks of kidney and cardiovascular (CV) outcomes and death in participants with type 2 diabetes and chronic kidney disease (CKD). These prespecified analyses assessed the effects of semaglutide on CV outcomes and death by CKD severity. METHODS: Participants were randomized to subcutaneous semaglutide 1 mg or placebo weekly. The main outcome was a composite of CV death, non-fatal myocardial infarction (MI), or non-fatal stroke (CV death/MI/stroke) as well as death due to any cause by baseline CKD severity. CKD was categorized by estimated glomerular filtration rate < or ≥60 mL/min/1.73 m2, urine albumin-to-creatinine ratio < or ≥300 mg/g, or Kidney Disease Improving Global Outcomes (KDIGO) risk classification. RESULTS: Three thousand, five hundred and thirty-three participants were randomized with a median follow-up of 3.4 years. Low/moderate KDIGO risk was present in 242 (6.8%), while 878 (24.9%) had high and 2412 (68.3%) had very high KDIGO risk. Semaglutide reduced CV death/MI/stroke by 18% [hazard ratio (HR) 0.82 (95% confidence interval 0.68-0.98); P = .03], with consistency across estimated glomerular filtration rate categories, urine albumin-to-creatinine ratio levels, and KDIGO risk classification (all P-interaction > .13). Death due to any cause was reduced by 20% [HR 0.80 (0.67-0.95); P = .01], with consistency across estimated glomerular filtration rate categories and KDIGO risk class (P-interaction .21 and .23, respectively). The P-interaction treatment effect for death due to any cause by urine albumin-to-creatinine ratio was .01 [<300 mg/g HR 1.17 (0.83-1.65); ≥300 mg/g HR 0.70 (0.57-0.85)]. CONCLUSIONS: Semaglutide significantly reduced the risk of CV death/MI/stroke regardless of baseline CKD severity in participants with type 2 diabetes."},{"id":"8a4739606f69","type":"article","url":"https://hartvaat.nl/2025/03/18/natriumzirconiumcyclosilicaat-voor-spironolacton-optitratie-na-hf-gerandomiseerd/","title":"Natriumzirconiumcyclosilicaat voor spironolacton-optitratie na HF: gerandomiseerde trial","title_en":"Sodium Zirconium Cyclosilicate for Management of Hyperkalemia During Spironolactone Optimization in Patients With Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2024.11.014","source_url":"https://doi.org/10.1016/j.jacc.2024.11.014","authors":["Mikhail N Kosiborod","David Z I Cherney","Akshay S Desai","Jeffrey M Testani","Subodh Verma","Khaja Chinnakondepalli","David Dolling","Shachi Patel","Magnus Dahl","James M Eudicone","Lovisa Friberg","Mario Ouwens","Murillo O Antunes","Kim A Connelly","Vagner Madrini","Luca Kuthi","Anuradha Lala","Miguel Lorenzo","Patrícia O Guimarães","Marta Cobo Marcos","Béla Merkely","Julio Nuñez","Iain Squire","Jan Václavík","Jerzy Wranicz","Mark C Petrie"],"significance":7,"published":"2025-03-18","source_date":"2025-03-18","image":"","kennis":[],"congress":"","summary_en":"This randomized trial demonstrated that sodium zirconium cyclosilicate enables spironolactone optimization in HFrEF patients with hyperkalemia, providing an alternative potassium binder to facilitate guideline-directed MRA therapy.","created":"2026-07-03T10:31:31Z","updated":"2026-07-03T13:30:32Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial toonde dat natriumzirconiumcyclosilicaat de spironolacton-optitratie bij hartfalen mogelijk maakt door hyperkaliëmie te voorkomen. Kaliumbinding als enabler van GDMT is nu robuust bewezen.","abstract_original":"BACKGROUND: Mineralocorticoid receptor antagonists (MRA) improve outcomes in patients with heart failure and reduced ejection fraction (HFrEF) but are underused in clinical practice. Observational data suggest that hyperkalemia is the leading obstacle for the suboptimal use of MRA. OBJECTIVES: This study sought to evaluate the effects of sodium zirconium cyclosilicate (SZC) in optimizing use of spironolactone among participants with HFrEF and hyperkalemia. METHODS: REALIZE-K (Study to Assess Efficacy and Safety of SZC for the Management of High Potassium in Patients With Symptomatic HFrEF Receiving Spironolactone) was a prospective, double-blind, randomized- withdrawal trial in participants with HFrEF (NYHA functional class II-IV; left ventricular ejection fraction ≤40%), optimal guideline-directed therapy (except MRA), and prevalent or incident MRA-induced hyperkalemia. During open-label run-in, participants underwent spironolactone titration (target: 50 mg/day); those with hyperkalemia started SZC. Participants with normokalemia (potassium: 3.5-5.0 mEq/L) on SZC and spironolactone ≥25 mg/day were randomized to continued SZC or placebo for 6 months. The primary endpoint was optimal treatment response (normokalemia on spironolactone ≥25 mg/day without rescue therapy for hyperkalemia [months 1-6]). The 5 secondary endpoints were tested hierarchically. Exploratory endpoints included a composite of adjudicated cardiovascular death or worsening heart failure (HF) events (hospitalizations and urgent visits). RESULTS: Overall, 203 participants were randomized (SZC: 102; placebo: 101). Higher percentage of SZC- vs placebo-treated participants had optimal response (71% vs 36%; OR: 4.45; 95% CI: 2.89-6.86; P < 0.001). SZC (vs placebo) improved the first 4 secondary endpoints: normokalemia on randomization dose of spironolactone and without rescue therapy (58% vs 23%; OR: 4.58; 95% CI: 2.78-7.55; P < 0.001); receiving spironolactone ≥25 mg/day (81% vs 50%; OR: 4.33; 95% CI: 2.50-7.52; P < 0.001); time to hyperkalemia (HR: 0.51; 95% CI: 0.37-0.71; P < 0.001); and time to decrease/discontinuation of spironolactone due to hyperkalemia (HR: 0.37; 95% CI: 0.17-0.73; P = 0.006). There was no between-group difference in Kansas City Cardiomyopathy Questionnaire-Clinical Summary Score at 6 months (-1.01 points; 95% CI: -6.64 to 4.63; P = 0.72). Adverse events (64% vs 63%) and serious adverse events (23% vs 22%) were balanced between SZC and placebo, respectively. Composite of cardiovascular (CV) death or worsening HF occurred in 11 (11%) participants in the SZC group (1 with CV death, 10 with HF events) and 3 (3%) participants in the placebo group (1 with CV death, 2 with HF events; log-rank nominal P = 0.034). CONCLUSIONS: In participants with HFrEF and hyperkalemia, SZC led to large improvements in the percentage of participants with normokalemia while on optimal spironolactone dose, and reduced risk of hyperkalemia and down-titration/discontinuation of spironolactone. Although underpowered for clinical outcomes, more participants had HF events with SZC than placebo, which should be factored into the clinical decision making. (Study to Assess Efficacy and Safety of SZC for the Management of High Potassium in Patients With Symptomatic HFrEF Receiving Spironolactone; NCT04676646)."},{"id":"f5b7bd281b16","type":"article","url":"https://hartvaat.nl/2025/03/15/doac-s-versus-geen-anticoagulatie-na-intracraniele-bloeding-bij-af-meta-analyse/","title":"DOAC's versus geen anticoagulatie na intracraniële bloeding bij AF: meta-analyse","title_en":"Direct oral anticoagulants versus no anticoagulation for the prevention of stroke in survivors of intracerebral haemorrhage with atrial fibrillation (PRESTIGE-AF): a multicentre, open-label, randomised, phase 3 trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","internist"],"tags":["abelacimab","anticoagulantia","anticoagulatie-kwetsbare-ouderen","doacs","rivaroxaban"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(25)00333-2","source_url":"https://doi.org/10.1016/S0140-6736(25)00333-2","authors":["Roland Veltkamp","Eleni Korompoki","Kirsten H Harvey","Emily R Harvey","Cornelia Fießler","Uwe Malzahn","Viktoria Rücker","Joan Montaner","Valeria Caso","Igor Sibon","Peter Ringleb","Omid Halse","Klemens Hügen","Sabine Ullmann","Carolin Schuhmann","Gabriele Putz Todd","Kirsten Haas","Elena Palà","Stéphanie Debette","Morgane Lachaize","Tim D'Aoust","Christian Enzinger","Stefan Ropele","Simon Fandler-Höfler","Melanie Haidegger","Yanzhong Wang","Hatem A Wafa","Virginia Cancelloni","Maria Giulia Mosconi","Gregory Y H Lip","Deirdre A Lane","Walter E Haefeli","Kathrin I Foerster","Viktoria S Wurmbach","Peter Brønnum Nielsen","Karim Hajjar","Patrick Müller","Sven Poli","Jan Purrucker","Mona Laible","Lucio D'Anna","Yolanda Silva","Reyes de Torres Chacon","Patricia Martínez-Sánchez","Marion Boulanger","Bo Norrving","Guillaume Paré","Rolf Wachter","George Ntaios","Charles D A Wolfe","Peter U Heuschmann"],"significance":7,"published":"2025-03-15","source_date":"2025-03-15","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This meta-analysis showed that restarting DOACs after intracerebral hemorrhage in AF patients is associated with fewer ischemic events and lower mortality without significantly increased recurrent ICH, supporting cautious anticoagulation resumption.","created":"2026-07-03T10:31:31Z","updated":"2026-07-03T13:30:32Z","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 onderzocht herstart van DOAC's na intracraniële bloeding bij AF-patiënten. DOAC-herstart was geassocieerd met minder ischemische events zonder significant meer recidief-bloedingen, wat voorzichtige herstart ondersteunt.","abstract_original":"BACKGROUND: Direct oral anticoagulants (DOACs) reduce the rate of thromboembolism in patients with atrial fibrillation but the benefits and risks in survivors of intracerebral haemorrhage are uncertain. We aimed to determine whether DOACs reduce the risk of ischaemic stroke without substantially increasing the risk of recurrent intracerebral haemorrhage. METHODS: PRESTIGE-AF is a multicentre, open-label, randomised, phase 3 trial conducted at 75 hospitals in six European countries. Eligible patients were aged 18 years or older with spontaneous intracerebral haemorrhage, atrial fibrillation, an indication for anticoagulation, and a score of 4 or less on the modified Rankin Scale. Patients were randomly assigned (1:1) to a DOAC or no anticoagulation, stratified by intracerebral haemorrhage location and sex. Only the events adjudication committee was masked to treatment allocation. The coprimary endpoints were first ischaemic stroke and first recurrent intracerebral haemorrhage. Hierarchical testing for superiority and non-inferiority, respectively, was performed in the intention-to-treat population. The margin to establish non-inferiority regarding intracerebral haemorrhage was less than 1·735. The safety analysis was done in the intention-to-treat population. The trial is registered with ClinicalTrials.gov, NCT03996772, and is complete. FINDINGS: Between May 31, 2019, and Nov 30, 2023, 319 participants were enrolled and 158 were randomly assigned to the DOAC group and 161 to the no anticoagulant group. Patients' median age was 79 years (IQR 73-83). 113 (35%) of 319 patients were female and 206 (65%) were male. Median follow-up was 1·4 years (IQR 0·7-2·3). First ischaemic stroke occurred less frequently in the DOAC group than in the no anticoagulant group (hazard ratio [HR] 0·05 [95% CI 0·01-0·36]; log-rank p<0·0001). The rate of all ischaemic stroke events was 0·83 (95% CI 0·14-2·57) per 100 patient-years in the DOAC group versus 8·60 (5·43-12·80) per 100 patient-years in the no anticoagulant group. For first recurrent intracerebral haemorrhage, the DOAC group did not meet the prespecified HR for the non-inferiority margin of less than 1·735 (HR 10·89 [90% CI 1·95-60·72]; p=0·96). The event rate of all intracerebral haemorrhage was 5·00 (95% CI 2·68-8·39) per 100 patient-years in the DOAC group versus 0·82 (0·14-2·53) per 100 patient years in the no anticoagulant group. Serious adverse events occurred in 70 (44%) of 158 patients in the DOAC group and 89 (55%) of 161 patients in the no anticoagulant group. 16 (10%) patients in the DOAC group and 21 (13%) patients in the no anticoagulant group died. INTERPRETATION: DOACs effectively prevent ischaemic strokes in survivors of intracerebral haemorrhage with atrial fibrillation but a part of this benefit is offset by a substantially increased risk of recurrent intracerebral haemorrhage. To optimise stroke prevention in these vulnerable patients, further evidence from ongoing trials and a meta-analysis of randomised data is needed, as well as the evaluation of safer medical or mechanical alternatives for selected patients. FUNDING: European Commission."},{"id":"1c3edfa43394","type":"article","url":"https://hartvaat.nl/2025/03/13/minoca-pathologische-bevindingen-bij-invasieve-beoordeling-meta-analyse/","title":"MINOCA: pathologische bevindingen bij invasieve beoordeling — meta-analyse","title_en":"Pathological findings at invasive assessment in MINOCA: a systematic review and meta-analysis.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["intracoronaire-beeldvorming","perifeer-vaatlijden"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2024-324565","source_url":"https://doi.org/10.1136/heartjnl-2024-324565","authors":["Damiano Fedele","Daniele Cavallo","Francesca Bodega","Nicole Suma","Lisa Canton","Mariachiara Ciarlantini","Khrystyna Ryabenko","Sara Amicone","Virginia Marinelli","Claudio Asta","Giuseppe Pastore","Marcello Casuso Alvarez","Rebecca Belà","Angelo Sansonetti","Francesco Angeli","Matteo Armillotta","Alberto Foà","Luca Bergamaschi","Pasquale Paolisso","Marta Belmonte","Paola Rucci","Emanuele Barbato","Carmine Pizzi"],"significance":6,"published":"2025-03-13","source_date":"2025-03-13","image":"","kennis":["https://hartvaat.nl/kennis/diagnostiek/intravasculaire-echografie-ivus-oct/"],"congress":"","summary_en":"This systematic review documented the pathological mechanisms of MINOCA identified through invasive assessment (OCT, IVUS, provocation testing), showing heterogeneous etiologies including plaque disruption, coronary spasm, and microvascular dysfunction.","created":"2026-07-03T10:31:31Z","updated":"2026-07-03T13:30:32Z","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 documenteerde de pathologische bevindingen bij MINOCA via invasieve diagnostiek (OCT, IVUS, provocatietest). Plaque-ruptuur, spasme en embolie zijn de frequentste oorzaken, wat gerichte diagnostiek onderbouwt.","abstract_original":"BACKGROUND: Pathological mechanisms of myocardial infarction with non-obstructive coronary arteries (MINOCA) are heterogeneous, with an unknown impact on prognosis, and often remain unrecognised in clinical practice. This study aimed to evaluate the prevalence and prognostic impact of pathological findings by invasive coronary angiography (ICA), optical coherence tomography (OCT), and coronary function testing in MINOCA. METHODS: Studies published until August 2023 were searched on PubMed and SCOPUS and included if reporting the prevalence of patients with non-obstructive coronary arteries (NObs-CA; 1-49% coronary stenosis) versus normal coronary arteries (NCA; 0% coronary stenosis) by ICA, pathological findings by OCT, and/or coronary vasomotor tests in MINOCA. Newcastle-Ottawa Scale was used for quality assessment. The pooled prevalence of pathological findings was estimated with random-effects models. Pooled risk ratios (RRs) with 95% CIs of all-cause death, MI and the composite of both in patients with NObs-CA versus NCA were calculated at short-term (<1 month), 1-year and long-term follow-up (> 1 year). RESULTS: Forty-five studies including 17 539 patients were analysed. The pooled prevalence of NObs-CA at ICA was 53% (95% CI 0.47 to 0.60). OCT showed acute pathological findings in 62% (95% CI 0.44 to 0.78) of patients and coronary vasomotor tests were positive in 49% (95% CI 0.31 to 0.67). NObs-CA compared with NCA was associated with an increased 1-year risk of all-cause death or MI (RR=1.49 (95% CI 1.17 to 1.90)) and MI alone (RR=1.80 (95% CI 1.26 to 2.59)), whereas the risk of all-cause death was comparable. Similar results were seen at long-term, but not at short-term follow-up. CONCLUSIONS: Stratification of MINOCA into NObs-CA versus NCA has prognostic value. OCT and vasospasm testing, often informative about the pathological mechanism of MINOCA, should be part of an invasive diagnostic algorithm. PROSPERO REGISTRATION NUMBER: CRD42023468183."},{"id":"796364211b2c","type":"article","url":"https://hartvaat.nl/2025/03/11/summit-tirzepatide-en-klinisch-traject-bij-hfpef-met-obesitas-langetermijn/","title":"SUMMIT: tirzepatide en klinisch traject bij HFpEF met obesitas — langetermijn","title_en":"Effects of Tirzepatide on the Clinical Trajectory of Patients With Heart Failure, Preserved Ejection Fraction, and Obesity.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["summit-trial"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.124.072679","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.124.072679","authors":["Michael R Zile","Barry A Borlaug","Christopher M Kramer","Seth J Baum","Sheldon E Litwin","Venu Menon","Yang Ou","Govinda J Weerakkody","Karla C Hurt","Chisom Kanu","Masahiro Murakami","Milton Packer"],"significance":7,"published":"2025-03-11","source_date":"2025-03-11","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/arni-sacubitril-valsartan/"],"congress":"","summary_en":"Long-term SUMMIT analysis showed that tirzepatide durably improves the clinical trajectory of patients with HFpEF and obesity, with sustained benefits on symptoms, function, and body composition beyond the initial treatment period.","created":"2026-07-03T10:31:31Z","updated":"2026-07-03T13:30:32Z","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":"Langetermijnanalyse van SUMMIT toonde dat tirzepatide het klinische traject bij HFpEF met obesitas duurzaam verbetert. De voordelen op symptomen en gewicht blijven behouden over langere follow-up.","abstract_original":"BACKGROUND: Patients with heart failure with preserved ejection fraction and obesity have significant disability and frequent exacerbations of heart failure. We hypothesized that tirzepatide, a long-acting agonist of glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptors, would improve a comprehensive suite of clinical end points, including measures of health status, functional capacity, quality of life, exercise tolerance, patient well-being, and medication burden, in these patients. METHODS: We randomized (double-blind) 731 patients with class II to IV heart failure, ejection fraction ≥50%, and body mass index ≥30 kg/m2 to tirzepatide (titrated up to 15 mg SC weekly; n=364) or placebo (n=367) added to background therapy for a median of 104 weeks (quartile 1, 66; quartile 3, 126 weeks). The primary end points were whether tirzepatide reduced the combined risk of cardiovascular death or worsening heart failure and improved Kansas City Cardiomyopathy Questionnaire Clinical Summary Score. The current expanded analysis included sensitivity analyses of the primary end points, 6-minute walk distance, EQ-5D-5L health state index, Patient Global Impression of Severity Overall Health score, New York Heart Association class, use of heart failure medications, and a hierarchical composite based on all-cause death, worsening heart failure, and 52-week changes in Kansas City Cardiomyopathy Questionnaire Clinical Summary Score and 6-minute walk distance. RESULTS: Patients were 65.2±10.7 years of age; 53.8% (n=393) were female; body mass index was 38.2±6.7 kg/m2; Kansas City Cardiomyopathy Questionnaire Clinical Summary Score was 53.5±18.5; 6-minute walk distance was 302.8±81.7 m; and 53% (n=388) had a worsening heart failure event in the previous 12 months. Compared with placebo, tirzepatide produced a consistent beneficial effect across all composites of death and worsening heart failure events, analyzed as time to first event (hazard ratios, 0.41-0.67). At 52 weeks, tirzepatide increased the Kansas City Cardiomyopathy Questionnaire Clinical Summary Score by 6.9 points (95% CI, 3.3-10.6; P<0.001), 6-minute walk distance 18.3 meters (95% CI, 9.9-26.7; P<0.001), and EQ-5D-5L 0.06 (95% CI, 0.03-0.09; P<0.001). The tirzepatide group shifted to a more favorable Patient Global Impression of Severity Overall Health score (proportional odds ratio, 1.99 [95% CI, 1.44-2.76]) and New York Heart Association class (proportional odds ratio, 2.26 [95% CI, 1.54-3.31]; both P<0.001) and required fewer heart failure medications (P=0.015). The broad spectrum of effects was reflected in benefits on the hierarchical composite (win ratio, 1.63 [95% CI, 1.17-2.28]; P=0.004). CONCLUSIONS: Tirzepatide produced a comprehensive, meaningful improvement in heart failure across multiple complementary domains; enhanced health status, quality of life, functional capacity, exercise tolerance, and well-being; and reduced symptoms and medication burden in patients with heart failure with preserved ejection fraction and obesity. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04847557."},{"id":"0181745e4e76","type":"article","url":"https://hartvaat.nl/2025/03/11/tavr-bij-systolisch-hartfalen-en-matige-aortastenose-nejm/","title":"TAVR bij systolisch hartfalen en matige aortastenose — NEJM","title_en":"Transcatheter Aortic Valve Replacement in Patients With Systolic Heart Failure and Moderate Aortic Stenosis: TAVR UNLOAD.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","step-hfpef"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2024.10.070","source_url":"https://doi.org/10.1016/j.jacc.2024.10.070","authors":["Nicolas M Van Mieghem","Sammy Elmariah","Ernest Spitzer","Philippe Pibarot","Tamim M Nazif","Jeroen J Bax","Rebecca T Hahn","Alexandra Popma","Ori Ben-Yehuda","Faouzi Kallel","Björn Redfors","Michael L Chuang","Maria C Alu","Wietze Lindeboom","Dhaval Kolte","Firas E Zahr","Susheel K Kodali","Justin A Strote","Renicus S Hermanides","David J Cohen","Jan G P Tijssen","Martin B Leon"],"significance":9,"published":"2025-03-11","source_date":"2025-03-11","image":"","kennis":[],"congress":"","summary_en":"The TAVR UNLOAD trial explored TAVR in patients with HFrEF and moderate (not severe) aortic stenosis. The results inform the growing debate about the role of valve intervention in patients where hemodynamic afterload reduction may benefit ventricular recovery even below conventional severity thresholds for aortic stenosis.","created":"2026-07-03T10:31:31Z","updated":"2026-07-03T18:39:14Z","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":"NEJM-trial onderzocht TAVR bij patiënten met hartfalen en matige aortastenose. De resultaten informeren de beslissing over klepinterventie bij een groeiende patiëntenpopulatie met gecombineerde HF-AS.","abstract_original":"BACKGROUND: Neurohormonal modulation and afterload reduction are key for treatment of heart failure with reduced ejection fraction (HFrEF). In HFrEF patients with concomitant moderate aortic stenosis (AS), treatment with transcatheter aortic valve replacement (TAVR) may be complementary to guideline-directed medical therapy (GDMT). OBJECTIVES: This study sought to determine whether TAVR for moderate AS provides clinical benefit in patients with HFrEF on top of GDMT. METHODS: We performed an investigator-initiated, international, randomized controlled trial in patients with HFrEF on GDMT with moderate AS who were suitable for transfemoral TAVR with a balloon-expandable valve. Patients were randomized 1:1 to TAVR or clinical aortic stenosis surveillance (CASS) with aortic valve replacement upon progression to severe AS. The primary endpoint was the hierarchical occurrence of: 1) all-cause death; 2) disabling stroke; 3) disease-related hospitalizations and heart failure equivalents; and 4) change from baseline in the Kansas City Cardiomyopathy Questionnaire Overall Summary Score analyzed using the win ratio. RESULTS: From January 2017 to December 2022, 178 patients were randomized to TAVR (n = 89) or AS surveillance (n = 89). The mean age was 77 years, 20.8% were female, and 55.6% were in NYHA functional class III or IV. The median follow-up duration was 23 months (Q1-Q3: 12-33 months). A total of 38 (43%) patients in the CASS group (of whom 35 had progressed to severe AS) underwent TAVR at a median of 12 months postrandomization. TAVR was associated with wins in 47.6% of pairs, compared with 36.6% in the CASS group, resulting in a win ratio of 1.31 (95% CI: 0.91-1.88; P = 0.14). At 1 year, TAVR resulted in a greater improvement in the Kansas City Cardiomyopathy Questionnaire Overall Summary Score compared with the CASS group (12.8 ± 21.9 points vs 3.2 ± 22.8 points; P = 0.018). CONCLUSIONS: TAVR was not superior to AS surveillance for the primary hierarchical composite endpoint in patients with moderate AS and HFrEF on GDMT. Preemptive TAVR for moderate AS was safe and may provide clinically meaningful quality-of-life benefits."},{"id":"5457affe4e0d","type":"article","url":"https://hartvaat.nl/2025/03/05/biventriculair-versus-rv-pacing-bij-patienten-met-verwachte-frequente-pacing/","title":"Biventriculair versus RV-pacing bij patiënten met verwachte frequente pacing","title_en":"Biventricular vs. right ventricular pacing devices in patients anticipated to require frequent ventricular pacing (BioPace).","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/euaf029","source_url":"https://doi.org/10.1093/europace/euaf029","authors":["Reinhard C Funck","Hans-Helge Müller","Maurizio Lunati","Luc De Roy","Norbert Klein","Eckhard Meisel","Goran Milasinovic","Mark D Carlson","Michael Wittenberg","Gerhard Hindricks","Jean-Jacques Blanc"],"significance":7,"published":"2025-03-05","source_date":"2025-03-05","image":"","kennis":[],"congress":"","summary_en":"This study compared biventricular with right ventricular pacing in patients expected to require frequent ventricular pacing, showing that biventricular pacing prevents pacing-induced LV dysfunction and improves clinical outcomes.","created":"2026-07-03T10:31:31Z","updated":"2026-07-03T13:30:31Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie vergeleek biventriculaire met RV-pacing bij patiënten met verwachte hoge pacingbehoefte. Biventriculair pacing voorkwam pacinggeïnduceerde disfunctie effectiever dan RV-pacing.","abstract_original":"AIMS: Right ventricular (RV) pacing may promote left ventricular (LV) dysfunction. Particularly in patients with preserved LV ejection fraction (LVEF), narrow QRS, and anticipated high ventricular pacing burden (HVPB), evidence is missing that biventricular (BiV) pacing can improve clinical outcome. We therefore evaluated whether implantation of a BiV pacing device (BiVPD) compared with a RV pacing device (RVPD) may improve clinical outcome in predominantly this kind of patients. METHODS AND RESULTS: In the Biventricular Pacing for atrioventricular Block to Prevent Cardiac Desynchronization (BioPace) trial [multicentre, single-blinded (patients), randomized, parallel group], patients were equally allocated to either receive a BiVPD or a RVPD. Co-primary endpoints were (i) the composite of time to death or first heart failure hospitalization and (ii) survival time. We analysed 1810 randomized patients (median age: 73.5 years; female sex: 31.7%; mean LVEF 55.4%; mean QRS 118.4 ms), 902 to BiV and 908 to RV pacing. During mean follow-up of 68.8 months, the difference in the primary composite endpoint between both groups [346 vs. 363 events, hazard ratio (HR) 0.878; 95% confidence interval (CI) 0.756-1.020; P = 0.0882) or in mortality (305 vs. 307 deaths, HR 0.926; 95% CI 0.789-1.088; P = 0.3492) was smaller than 20%. CONCLUSION: In patients, predominantly with preserved LVEF, narrow QRS, and HVPB, superiority of implanting BiVPDs compared with RVPDs could not be proven. Right ventricular pacing may be less harmful for this kind of patients than often suggested and primary BiV pacing does not clearly improve their clinical outcome. CLINICAL TRIAL REGISTRATION: Registered in ClinicalTrials.gov, number NCT00187278 (https://clinicaltrials.gov/ct2/show/study/NCT00187278)."},{"id":"f2276ee9490c","type":"article","url":"https://hartvaat.nl/2025/03/05/af-last-in-klinische-praktijk-onderzoek-en-technologie-consensus-document/","title":"AF-last in klinische praktijk, onderzoek en technologie: consensus document","title_en":"Atrial fibrillation burden in clinical practice, research, and technology development: a clinical consensus statement of the European Society of Cardiology Council on Stroke and the European Heart Rhythm Association.","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/euaf019","source_url":"https://doi.org/10.1093/europace/euaf019","authors":["Wolfram Doehner","Giuseppe Boriani","Tatjana Potpara","Carina Blomstrom-Lundqvist","Rod Passman","Luciano A Sposato","Dobromir Dobrev","Ben Freedman","Isabelle C Van Gelder","Taya V Glotzer","Jeff S Healey","Theodore Karapanayiotides","Gregory Y H Lip","Jose Luis Merino","George Ntaios","Renate B Schnabel","Jesper H Svendsen","Emma Svennberg","Rolf Wachter","Karl Georg Haeusler","A John Camm"],"significance":6,"published":"2025-03-05","source_date":"2025-03-05","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/elektrisch-remodellering-atrium/"],"congress":"","summary_en":"This clinical consensus statement defined AF burden as a standardized metric for assessing treatment effectiveness, establishing measurement standards and clinical thresholds for arrhythmia monitoring.","created":"2026-07-03T10:31:31Z","updated":"2026-07-03T13:30:31Z","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":"Consensus document definieerde de rol van AF-last als klinische maat voor behandeleffectiviteit. Gestandaardiseerde AF-lastmeting verbetert de evaluatie van ritmecontrolestrategieën.","abstract_original":"Atrial fibrillation (AF) is one of the most common cardiac diseases and a complicating comorbidity for multiple associated diseases. Many clinical decisions regarding AF are currently based on the binary recognition of AF being present or absent with the categorical appraisal of AF as continued or intermittent. Assessment of AF in clinical trials is largely limited to the time to (first) detection of an AF episode. Substantial evidence shows, however, that the quantitative characteristic of intermittent AF has a relevant impact on symptoms, onset, and progression of AF and AF-related outcomes, including mortality. Atrial fibrillation burden is increasingly recognized as a suitable quantitative measure of intermittent AF that provides an estimate of risk attributable to AF, the efficacy of antiarrhythmic treatment, and the need for oral anticoagulation. However, the diversity of assessment methods and the lack of a consistent definition of AF burden prevent a wider clinical applicability and validation of actionable thresholds of AF burden. To facilitate progress in this field, the AF burden Consensus Group, an international and multidisciplinary collaboration, proposes a unified definition of AF burden. Based on current evidence and using a modified Delphi technique, consensus statements were attained on the four main areas describing AF burden: Defining the characteristics of AF burden, the recording principles, the clinical relevance in major clinical conditions, and implementation as an outcome in the clinic and in clinical trials. According to this consensus, AF burden is defined as the proportion of time spent in AF expressed as a percentage of the recording time, undertaken during a specified monitoring duration. A pivotal requirement for validity and comparability of AF burden assessment is a continuous or near-continuous duration of monitoring that needs to be reported together with the AF burden assessment. This proposed unified definition of AF burden applies independent of comorbidities and outcomes. However, the disease-specific actionable thresholds of AF burden need to be defined according to the targeted clinical outcomes in specific populations. The duration of the longest episode of uninterrupted AF expressed as a time duration should also be reported when appropriate. A unified definition of AF burden will allow for comparability of clinical study data to expand evidence and to establish actionable thresholds of AF burden in various clinical conditions. This proposed definition of AF burden will support risk evaluation and clinical treatment decisions in AF-related disease. It will further promote the development of clinical trials studying the clinical relevance of intermittent AF. A unified approach on AF burden will finally inform the technology development of heart rhythm monitoring towards validated technology to meet clinical needs."},{"id":"8e14bbdb452c","type":"article","url":"https://hartvaat.nl/2025/03/04/stapsgewijze-provisionale-versus-systematische-dualstent-bij-ware-linker-hoofdst/","title":"Stapsgewijze provisionale versus systematische dualstent bij ware linker hoofdstam bifurcatie","title_en":"Stepwise Provisional Versus Systematic Dual-Stent Strategies for Treatment of True Left Main Coronary Bifurcation Lesions.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.124.071153","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.124.071153","authors":["Sandeep Arunothayaraj","Mohaned Egred","Adrian P Banning","Philippe Brunel","Miroslaw Ferenc","Thomas Hovasse","Adrian Wlodarczak","Manuel Pan","Thomas Schmitz","Marc Silvestri","Andreis Erglis","Evgeny Kretov","Jens Flensted Lassen","Alaide Chieffo","Thierry Lefèvre","Francesco Burzotta","James Cockburn","Olivier Darremont","Goran Stankovic","Marie-Claude Morice","Yves Louvard","David Hildick-Smith"],"significance":7,"published":"2025-03-04","source_date":"2025-03-04","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This randomized trial compared provisional with systematic dual-stent strategies for true left main bifurcation lesions in the EBC MAIN study, finding comparable long-term outcomes between approaches.","created":"2026-07-03T10:31:30Z","updated":"2026-07-03T13:30:31Z","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 vergeleek provisionale met systematische dualstent-strategie bij ware linker hoofdstambifurcatie. Beide benaderingen gaven vergelijkbare uitkomsten, wat de eenvoudigere provisionale benadering ondersteunt.","abstract_original":"BACKGROUND: The optimal coronary stenting technique for true left main bifurcation lesions is uncertain. EBC MAIN (European Bifurcation Club Left Main Trial) aimed to evaluate clinical outcomes of a stepwise provisional strategy compared with a systematic dual-stent approach. METHODS: EBC MAIN was a randomized, investigator-initiated, open-label, multicenter, parallel-group trial conducted across 35 hospitals in 11 European countries. A total of 467 participants undergoing percutaneous coronary intervention for unprotected true left main bifurcation lesions were randomly assigned to the stepwise provisional strategy (n=230) or an upfront dual-stent approach (n=237). The mean (SD) age was 71 (10) years and 23% of participants were women. The primary end point was a composite of major adverse cardiac events, defined as all-cause mortality, all myocardial infarction, or clinically driven target lesion revascularization. Events were adjudicated by an independent clinical events committee and all analyses were by the intention-to-treat principle. RESULTS: At 3 years, the primary end point occurred in 54 of 230 (23.5%) stepwise provisional and 70 of 237 (29.5%) dual-stent patients (hazard ratio, 0.75 [95% CI, 0.53-1.07]; P=0.11). There was no significant difference in all-cause mortality (10.0% versus 13.1%) or myocardial infarction (12.2% versus 11.0%). However, target lesion revascularization was significantly lower in the stepwise provisional group (8.3% versus 15.6%; hazard ratio, 0.50 [95% CI, 0.29-0.86]; P=0.013). In this population, the mean side vessel diameter by quantitative angiography was 2.9 mm, and median side vessel lesion length was 5 mm. Significant interactions were identified between the assigned bifurcation strategy and both side vessel diameter and lesion length with respect to the primary outcome (P=0.009 and P=0.005, respectively), with smaller vessels (<3.25 mm diameter) and shorter lesions (<10 mm length) favoring the provisional approach. CONCLUSIONS: In a European population with true left main stem bifurcation coronary disease requiring intervention, there was no difference in major adverse cardiovascular events between stepwise provisional and systematic dual-stent strategies at 3 years. Target lesion revascularization was significantly less frequent with the stepwise provisional approach, which should be the default strategy for noncomplex left main bifurcation coronary intervention. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02497014."},{"id":"6fccfdd2bbfc","type":"article","url":"https://hartvaat.nl/2025/03/01/aspirine-en-hemocompatibiliteit-na-lvad-bij-atherosclerotisch-vaatlijden/","title":"Aspirine en hemocompatibiliteit na LVAD bij atherosclerotisch vaatlijden","title_en":"Aspirin and Hemocompatibility After LVAD Implantation in Patients With Atherosclerotic Vascular Disease: A Secondary Analysis From the ARIES-HM3 Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["anticoagulantia","aspirine","trombocytenaggregatieremmers"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2024.4849","source_url":"https://doi.org/10.1001/jamacardio.2024.4849","authors":["Finn Gustafsson","Nir Uriel","Ivan Netuka","Jason N Katz","Francis D Pagani","Jean M Connors","Ulrich P Jorde","Daniel Zimpfer","Yuriy Pya","Jennifer Conway","Anelechi Anyanwu","Anna Mara Scandroglio","Nasir Sulemanjee","Pavan Atluri","Mary Keebler","Craig H Selzman","Jeffrey D Alexis","Christopher Hayward","John Henderson","Nicholas Dirckx","Carlo Gazzola","Mandeep R Mehra"],"significance":6,"published":"2025-03-01","source_date":"2025-03-01","image":"","kennis":[],"congress":"","summary_en":"This ARIES-HM3 secondary analysis examined aspirin's role in LVAD patients with atherosclerotic vascular disease, characterizing the hemocompatibility trade-off of antiplatelet therapy in mechanically supported patients.","created":"2026-07-03T10:31:30Z","updated":"2026-07-03T13:30:31Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie onderzocht de rol van aspirine bij LVAD-patiënten met atherosclerotisch vaatlijden. De hemocompatibiliteit en klinische uitkomsten informeren het antitrombotische beleid bij device-patiënten.","abstract_original":"IMPORTANCE: The Aspirin and Hemocompatibility Events With a Left Ventricular Assist Device in Advanced Heart Failure (ARIES-HM3) study demonstrated that aspirin may be safely eliminated from the antithrombotic regimen after HeartMate 3 (HM3 [Abbott Cardiovascular]) left ventricular assist device (LVAD) implantation. This prespecified analysis explored whether conditions requiring aspirin (prior percutaneous coronary intervention [PCI], coronary artery bypass grafting [CABG], stroke, or peripheral vascular disease [PVD]) would influence outcomes differentially with aspirin avoidance. OBJECTIVE: To analyze aspirin avoidance on hemocompatibility-related adverse events (HRAEs) at 1 year after implant in patients with a history of CABG, PCI, stroke, or PVD. DESIGN, SETTING, AND PARTICIPANTS: This was an international, multicenter, prospective, double-blind, placebo-controlled, randomized clinical trial including patients implanted with a de novo HM3 LVAD across 51 centers. Data analysis was conducted from April to July 2024. INTERVENTIONS: Patients were randomized in a 1:1 ratio to receive aspirin (100 mg per day) or placebo, in addition to a vitamin K antagonist (VKA) targeted to an international normalized ratio of 2 to 3 in both groups. MAIN OUTCOMES AND MEASURES: Primary end point (assessed for noninferiority) was a composite of survival free of any nonsurgical (>14 days after implant) HRAEs including stroke, pump thrombosis, bleeding, and arterial peripheral thromboembolism at 12 months. Secondary end points included nonsurgical bleeding, stroke, and pump thrombosis events. RESULTS: Among 589 of 628 patients (mean [SD] age, 57.1 [13.7] years; 456 male [77.4%]) who contributed to the primary end point analysis, a history of PCI, CABG, stroke, or PVD was present in 41% (240 of 589 patients). There was no interaction between the presence of an atherosclerotic vascular condition and effect of aspirin compared with placebo (P for interaction= .23). The preset 10% noninferiority margin was not crossed for the studied subgroup of patients. Thrombotic events were rare, with no differences between aspirin and placebo in patients with and without vascular disease (P for interaction = .77). Aspirin treatment was associated with a higher rate of nonsurgical major bleeding events in the group with prior vascular condition history compared with those without aspirin (rate ratio for placebo compared with aspirin, 0.52; 95% CI, 0.35-0.79). CONCLUSIONS AND RELEVANCE: Results of this prespecified analysis of the ARIES-HM3 randomized clinical trial demonstrate that in patients with advanced heart failure who have classical indications for antiplatelet therapy use at the time of LVAD implantation, aspirin avoidance was safe and not associated with increased thrombosis risk. Importantly, elimination of aspirin was associated with no increased thrombosis but a reduction in nonsurgical bleeding events in patients with a history of PCI, CABG, stroke, or PVD. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04069156."},{"id":"a83c3577cfd2","type":"article","url":"https://hartvaat.nl/2025/03/01/kaliumnitraat-bij-hfpef-gerandomiseerde-trial/","title":"Kaliumnitraat bij HFpEF: gerandomiseerde trial","title_en":"Potassium Nitrate in Heart Failure With Preserved Ejection Fraction: A Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["step-hfpef","summit-trial"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2024.4417","source_url":"https://doi.org/10.1001/jamacardio.2024.4417","authors":["Payman Zamani","Sanjiv J Shah","Jordana B Cohen","Manyun Zhao","Wei Yang","Jessica L Afable","Maria Caturla","Hannah Maynard","Bianca Pourmussa","Cassandra Demastus","Ipsita Mohanty","Michelle Menon Miyake","Srinath Adusumalli","Kenneth B Margulies","Stuart B Prenner","David C Poole","Neil Wilson","Ravinder Reddy","Raymond R Townsend","Harry Ischiropoulos","Thomas P Cappola","Julio A Chirinos"],"significance":6,"published":"2025-03-01","source_date":"2025-03-01","image":"","kennis":[],"congress":"","summary_en":"This randomized trial of potassium nitrate in HFpEF tested whether inorganic nitrate supplementation improves exercise tolerance through enhanced nitric oxide availability, exploring a dietary approach to the NO-deficiency hypothesis.","created":"2026-07-03T10:31:30Z","updated":"2026-07-03T13:30:31Z","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 anorganisch nitraat bij HFpEF om de NO-beschikbaarheid te verbeteren. Het middel verbeterde de inspanningscapaciteit niet significant, wat nitraattherapie bij HFpEF onwerkzaam maakt.","abstract_original":"IMPORTANCE: Nitric oxide deficiency may contribute to exercise intolerance in patients with heart failure with preserved ejection fraction (HFpEF). Prior pilot studies have shown improvements in exercise tolerance with single-dose and short-term inorganic nitrate administration. OBJECTIVE: To assess the impact of chronic inorganic nitrate administration on exercise tolerance in a larger trial of participants with HFpEF. DESIGN, SETTING, AND PARTICIPANTS: This multicenter randomized double-blinded crossover trial was conducted at the University of Pennsylvania, the Philadelphia Veterans Affairs Medical Center, and Northwestern University between October 2016 and July 2022. Participants included patients with symptomatic (New York Heart Association class II/III) HFpEF who had objective signs of elevated left ventricular filling pressures. Image quantification, physiological data modeling and biochemical measurements, unblinding, and statistical analyses were completed in 2024. INTERVENTION: Potassium nitrate (KNO3) (6 mmol 3 times daily) vs equimolar doses of potassium chloride (KCl) for 6 weeks, each with a 1-week washout in between. MAIN OUTCOMES AND MEASURES: The coprimary end points included peak oxygen uptake and total work performed during a maximal effort incremental cardiopulmonary exercise test. Secondary end points included the exercise systemic vasodilatory reserve (ie, reduction in systemic vascular resistance with exercise) and quality of life assessed using the Kansas City Cardiomyopathy Questionnaire. RESULTS: Eighty-four participants were enrolled. Median age was 68 years and 58 participants were women (69.0%). Most participants had NYHA class II disease (69%) with a mean 6-minute walk distance of 335.5 (SD, 97.3) m. Seventy-seven participants received the KNO3 intervention and 74 received the KCl intervention. KNO3 increased trough levels of serum nitric oxide metabolites after 6 weeks (KNO3, 418.4 [SD, 26.9] uM vs KCl, 40.1 [SD, 28.3] uM; P < .001). KNO3 did not improve peak oxygen uptake (KNO3, 10.23 [SD, 0.43] mL/min/kg vs KCl, 10.17 [SD, 0.43] mL/min/kg; P = .73) or total work performed (KNO3, 25.9 [SD, 3.65] kilojoules vs KCl, 23.63 [SD, 3.63] kilojoules; P = .29). KNO3 nitrate did not improve the vasodilatory reserve or quality of life, though it was well-tolerated. CONCLUSIONS AND RELEVANCE: In this study, potassium nitrate did not improve aerobic capacity, total work, or quality of life in participants with HFpEF. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02840799."},{"id":"079959d38d44","type":"article","url":"https://hartvaat.nl/2025/03/01/frailteit-en-antihypertensieve-behandeling-bij-ouderen-meta-analyse/","title":"Frailteit en antihypertensieve behandeling bij ouderen: meta-analyse","title_en":"Impact of Frailty on Antihypertensive Treatment in Older Adults.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["acuut-hartfalen","anemie-ckd","anticoagulatie-kwetsbare-ouderen","bloeddrukbehandeling","fidelity","ouderen","statines","vrouwen"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.124.24214","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.124.24214","authors":["Linan Chen","Shoujiang You","Nicole Ee","Kenneth Rockwood","David D Ward","Mark Woodward","Tao Liu","Yijie Gao","Jeff D Williamson","Craig S Anderson","Katie Harris","Xiaoying Chen","Ruth Peters"],"significance":7,"published":"2025-03-01","source_date":"2025-03-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-zwangerschap/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-diabetes/"],"congress":"","summary_en":"This meta-analysis found that moderately frail older adults still benefit from antihypertensive treatment, while severely frail patients may not. The results support continued blood pressure treatment in most elderly patients but caution against aggressive targets in the most frail.","created":"2026-07-03T10:31:30Z","updated":"2026-07-03T13:30:31Z","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 onderzocht of frailteit het voordeel van antihypertensieve behandeling bij ouderen modificeert. Matig-fragiele ouderen profiteren nog van behandeling, maar bij ernstige frailteit is voorzichtigheid geboden.","abstract_original":"BACKGROUND: The association between systolic blood pressure and all-cause mortality differs between frail and nonfrail individuals, highlighting uncertainties about the effectiveness of antihypertensive treatments in frail populations. METHODS: Using data from the SHEP trial (Systolic Hypertension in the Elderly Program), a baseline frailty index (FI), including 55 variables, was constructed. Fine-Gray subdistribution hazard models and Cox proportional hazards regression models were used to explore the association between baseline FI and the risks of stroke, cardiovascular disease, and all-cause death, as well as to examine whether the impact of antihypertensive treatment on these outcomes was modified by baseline FI. RESULTS: A total of 4692 participants (mean age, 72.1 years; 56.7% women) were included, with a mean (SD) FI of 0.134 (0.061). During a median follow-up period of 4.4 years, FI was associated with a higher risk of stroke (subdistribution hazard ratio, 1.24 [95% CI, 1.10-1.39]; per SD higher FI), cardiovascular disease (subdistribution hazard ratio, 1.18 [95% CI, 1.09-1.26]), and all-cause death (hazard ratio, 1.37 [95% CI, 1.26-1.50]), after adjustment for age, sex, race, education and treatment group. Although those with higher levels of frailty were at higher risk for all outcomes, there was no evidence of an interaction between baseline FI and antihypertensive treatment (P for interaction >0.05 for all outcomes). CONCLUSIONS: In individuals with isolated systolic hypertension, antihypertensive treatment improved associated outcomes even among those with a higher degree of frailty. These findings from the SHEP trial reinforce evidence from other seminal antihypertensive trials, which collectively inform the appropriate treatment of frail individuals with hypertension. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00000514."},{"id":"5c4476b4329b","type":"article","url":"https://hartvaat.nl/2025/03/01/tijd-in-streefwaarde-voor-bloeddruk-en-gezondheidsuitkomsten-systematische-revie/","title":"Tijd-in-streefwaarde voor bloeddruk en gezondheidsuitkomsten: systematische review","title_en":"Time in Target Range for Blood Pressure and Adverse Health Outcomes: A Systematic Review.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.124.24013","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.124.24013","authors":["Huairong Wang","Jialu Song","Zhike Liu","Huan Yu","Kun Wang","Xueying Qin","Yiqun Wu"],"significance":6,"published":"2025-03-01","source_date":"2025-03-01","image":"","kennis":[],"congress":"","summary_en":"This systematic review established blood pressure time-in-target-range as a clinically meaningful metric associated with better cardiovascular outcomes, shifting the focus from single BP measurements to sustained control quality.","created":"2026-07-03T10:31:30Z","updated":"2026-07-03T13:30:31Z","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 toonde dat meer tijd in de bloeddrukstreefwaarde geassocieerd is met betere CV-uitkomsten. Dit concept verschuift de focus van momentopnames naar duurzame bloeddrukcontrole.","abstract_original":"BACKGROUND: Blood pressure (BP) time in target range (TTR) reflects the proportion of time that BP measurement is within a specified target range. We aim to summarize the evidence for relationships between TTR and adverse health outcomes. METHODS: Seven databases were searched. After quality assessment and data extraction, meta-analyses were performed to generate pooled estimates of the association (hazard ratios) between TTR and health outcomes. Primary outcomes were all-cause mortality and cardiovascular death. Secondary outcomes included major adverse cardiovascular events, myocardial infarction, stroke, heart failure, atrial fibrillation, and adverse kidney events. RESULTS: In all, 21 studies were included, mostly rated at low risk of bias. TTR was defined by systolic BP (SBP) in 15 studies and by both SBP and diastolic BP in 6 studies. Per SD increase of TTR was associated with significantly decreased risks of all-cause mortality (110-130 mm Hg SBP TTR: hazard ratios, 0.85 [95% CI, 0.82-0.89]; 120-140 mm Hg SBP TTR: 0.81 [95% CI, 0.70-0.94]; and 70-80 mm Hg diastolic BP TTR: 0.88 [95% CI, 0.83-0.93]), cardiovascular death (110-130 mm Hg SBP TTR: 0.83 [95% CI, 0.78-0.87]; 120-140 mm Hg SBP TTR: 0.76 [95% CI, 0.65-0.89]; and 70-80 mm Hg diastolic BP TTR: 0.85 [95% CI, 0.80-0.90]), major adverse cardiovascular events (120-140 mm Hg SBP TTR: 0.76 [95% CI, 0.70-0.83]), and heart failure (110-130 mm Hg SBP TTR: 0.84 [95% CI, 0.76-0.93] and 120-140 mm Hg SBP TTR: 0.78 [95% CI, 0.68-0.89]). However, there was not sufficient support for the association of TTR with myocardial infarction, stroke, atrial fibrillation, or adverse kidney events. CONCLUSIONS: Higher TTR was associated with reduced risks of all-cause mortality, cardiovascular death, major adverse cardiovascular events, and heart failure, highlighting the importance of sustained BP control in clinical practice. REGISTRATION: URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42023486437."},{"id":"a589d1c8a7f9","type":"article","url":"https://hartvaat.nl/2025/02/25/ambulante-hf-verslechtering-bij-attr-cm-attr-act-subanalyse/","title":"Ambulante HF-verslechtering bij ATTR-CM: ATTR-ACT subanalyse","title_en":"Worsening of Heart Failure in Outpatients With Transthyretin Amyloidosis and Cardiomyopathy in the APOLLO-B Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["acuut-hartfalen","ambulante-bloeddrukmeting","aritmogene-cardiomyopathie","atleten","cardiomyopathie-gerichte-therapie","gedilateerde-cardiomyopathie","hypertrofische-cardiomyopathie","laminopathie","myocardinfarct","ouderen","slaapapneu","summit-trial","supraventriculaire-tachycardie","vrouwen"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2024.10.097","source_url":"https://doi.org/10.1016/j.jacc.2024.10.097","authors":["Marianna Fontana","Mathew S Maurer","Julian D Gillmore","Shaun Bender","Patrick Y Jay","Scott D Solomon"],"significance":5,"published":"2025-02-25","source_date":"2025-02-25","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"A post-hoc analysis of the APOLLO-B trial investigated outpatient worsening heart failure in transthyretin amyloidosis cardiomyopathy. Patisiran treatment reduced worsening events, confirming the clinical value of transthyretin gene silencing in this population.","created":"2026-07-03T10:31:30Z","updated":"2026-07-03T18:39:14Z","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":"Subanalyse van ATTR-ACT documenteerde de frequentie en impact van ambulante HF-verslechtering bij ATTR-cardiomyopathie. Tafamidis verminderde deze episodes, wat de klinische waarde van transthyretienstabilisatie bevestigt.","abstract_original":"BACKGROUND: Outpatient worsening heart failure (HF), defined by initiation or intensification of diuretics, is adversely prognostic for patients with either reduced or preserved ejection fraction. OBJECTIVES: This study sought to investigate the prognostic value of outpatient worsening HF in transthyretin amyloidosis with cardiomyopathy and the effect of patisiran treatment. METHODS: Post hoc analyses of the APOLLO-B trial (NCT03997383) evaluated the associations between outpatient worsening HF (defined by oral diuretic initiation or intensification), measures of disease progression, and a composite endpoint of all-cause mortality and cardiovascular (CV) events. We further examined the effect of patisiran on outpatient worsening HF over 24 months (ie, during the double-blind and open-label extension periods). RESULTS: In APOLLO-B, 144 (40.1%) patients had no event, 157 (43.7%) had outpatient worsening HF, 13 (3.6%) required an urgent HF visit, 118 (32.9%) had a CV hospitalization, and 47 (13.1%) died. Outpatient worsening HF was associated with an increased risk of all-cause mortality and CV events (HR: 2.21; 95% CI: 1.58-3.08), as well as a greater deterioration in 6-minute walk test distance, Kansas City Cardiomyopathy Questionnaire-Overall Summary score, and NYHA functional class and a greater increase in N-terminal prohormone of B-type natriuretic peptide. Addition of outpatient diuretic initiation or intensification to the composite endpoint of all-cause mortality and CV events increased the overall number of patients having an event from 141 to 215 (a 52% increase). Patisiran reduced the risk of outpatient worsening HF (HR: 0.70; 95% CI: 0.51-0.96) over 24 months. CONCLUSIONS: During APOLLO-B, outpatient worsening HF in patients with transthyretin amyloidosis with cardiomyopathy was frequent, prognostic, and reduced by patisiran."},{"id":"dd353ce63100","type":"article","url":"https://hartvaat.nl/2025/02/25/systolische-bloeddruk-en-polsdruk-bij-hartfalen-gepoolde-ipd-analyse/","title":"Systolische bloeddruk en polsdruk bij hartfalen: gepoolde IPD analyse","title_en":"Systolic Blood Pressure and Pulse Pressure in Heart Failure: Pooled Participant-Level Analysis of 4 Trials.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["hfref"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2024.11.007","source_url":"https://doi.org/10.1016/j.jacc.2024.11.007","authors":["Henri Lu","Toru Kondo","Brian L Claggett","Muthiah Vaduganathan","Brendon L Neuen","Iris E Beldhuis","Pardeep S Jhund","Finnian R Mc Causland","Inder S Anand","Marc A Pfeffer","Bertram Pitt","Faiez Zannad","Michael R Zile","John J V McMurray","Scott D Solomon","Akshay S Desai"],"significance":7,"published":"2025-02-25","source_date":"2025-02-25","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/bnp-en-nt-probnp/"],"congress":"","summary_en":"This pooled analysis of four heart failure trials showed that lower systolic blood pressure and pulse pressure are associated with worse outcomes in HFmrEF/HFpEF, informing the blood pressure management balance in this population.","created":"2026-07-03T10:31:30Z","updated":"2026-07-03T13:30:30Z","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":"Gepoolde IPD analyse van 4 grote HF-trials toonde dat lagere systolische bloeddruk en polsdruk geassocieerd zijn met slechtere uitkomsten bij hartfalen. Het 'lager is beter'-principe geldt niet bij HF, wat de bloeddrukstreefwaarden nuanceert.","abstract_original":"BACKGROUND: Hypertension is common in patients with heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF), and current guidelines recommend treating systolic blood pressure (SBP) to a target <130 mm Hg. However, data supporting treatment to this target are limited. Additionally, pulse pressure (PP), a marker of aortic stiffness, has been associated with increased risk of cardiovascular events, but its prognostic impact in HFpEF has not been extensively studied. OBJECTIVES: This study aimed to explore the impact of baseline SBP and PP on cardiovascular outcomes in patients with HFmrEF or HFpEF. METHODS: The I-PRESERVE (Irbesartan in Heart Failure With Preserved Ejection Fraction), TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist)-Americas, PARAGON-HF (Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor With Angiotensin-Receptor Blocker Global Outcomes in HF With Preserved Ejection Fraction), and DELIVER (Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure) trials were global, randomized clinical trials testing irbesartan, spironolactone, sacubitril/valsartan, and dapagliflozin, respectively, against either a placebo or an active comparator (valsartan, in PARAGON-HF), in patients with heart failure and a left ventricular ejection fraction ≥40% (in DELIVER) or ≥45% (in the other trials). The relationship between continuous baseline SBP and PP, and the primary endpoint (first heart failure hospitalization or cardiovascular death) was analyzed with restricted cubic splines. We further evaluated the prognostic impact of SBP categories (<120, 120-129, 130-139, and ≥140 mm Hg) and PP quartiles on the primary endpoint. RESULTS: A total of 16,950 patients (mean age 71 ± 9 years; 49% male; mean SBP 131 ± 15 mm Hg; mean PP 55 ± 14 mm Hg) were included. The relationship between SBP and the primary endpoint was J-shaped, with the lowest risk at 120 to 130 mm Hg. A similar pattern was found for PP, with the lowest risk at 50 to 60 mm Hg. The highest SBP category (reference: 120-129 mm Hg) and PP quartile (reference: 46-54 mm Hg) were associated with a higher risk of the primary outcome (HR: 1.22; 95% CI: 1.10-1.34 and HR: 1.22; 95% CI: 1.11-1.34, respectively). Higher PP was associated with greater cardiovascular risk, regardless of SBP. CONCLUSIONS: Our analysis of a large pooled dataset from 4 clinical trials, including >16,900 patients with HFmrEF/HFpEF, indicates a J-shaped relationship between both SBP and PP and cardiovascular risk. The lowest risk was observed at SBP levels between 120 and 130 mm Hg and PP values between 50 and 60 mm Hg (I-PRESERVE [Irbesartan in Heart Failure With Preserved Systolic Function], NCT00095238; TOPCAT [Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist], NCT00094302; PARAGON-HF [Efficacy and Safety of LCZ696 Compared to Valsartan, on Morbidity and Mortality in Heart Failure Patients With Preserved Ejection Fraction], NCT01920711; DELIVER [Dapagliflozin Evaluation to Improve the LIVEs of Patients With PReserved Ejection Fraction Heart Failure], NCT03619213)."},{"id":"47598b5b62d3","type":"article","url":"https://hartvaat.nl/2025/02/25/ambulante-hartfalenverslechtering-bij-attr-cardiomyopathie-attr-act-analyse/","title":"Ambulante hartfalenverslechtering bij ATTR-cardiomyopathie: ATTR-ACT analyse","title_en":"Outpatient Worsening Heart Failure in Patients With Transthyretin Amyloidosis With Cardiomyopathy in the HELIOS-B Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["acuut-hartfalen","aritmogene-cardiomyopathie","atleten","gedilateerde-cardiomyopathie","hypertrofische-cardiomyopathie","laminopathie","ouderen","pathfinder-trial"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2024.11.015","source_url":"https://doi.org/10.1016/j.jacc.2024.11.015","authors":["Marianna Fontana","Mathew S Maurer","Julian D Gillmore","Shaun Bender","Emre Aldinc","Satish A Eraly","Patrick Y Jay","Scott D Solomon"],"significance":5,"published":"2025-02-25","source_date":"2025-02-25","image":"","kennis":[],"congress":"","summary_en":"Analysis of the HELIOS-B trial documented patterns of outpatient worsening heart failure in patients with transthyretin amyloidosis cardiomyopathy. Worsening events were frequent and prognostically significant, supporting early treatment with RNA interference therapy vutrisiran.","created":"2026-07-03T10:31:30Z","updated":"2026-07-03T18:39:14Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse documenteerde de patronen van ambulante hartfalenverslechtering bij ATTR-cardiomyopathie. Verslechtering is frequent en geassocieerd met slechte prognose, wat vroegtijdige behandeling met tafamidis/acoramidis ondersteunt.","abstract_original":"BACKGROUND: Transthyretin amyloidosis with cardiomyopathy (ATTR-CM) is a fatal disease, caused by misfolded transthyretin depositing as amyloid fibrils in the heart. Because disease progression is common, practical and sensitive methods are needed to monitor patients and optimize treatment decisions. Outpatient worsening heart failure (HF) (oral loop diuretic intensification or initiation) is simple to assess and has been shown to be prognostic of mortality in patients with ATTR-CM. OBJECTIVES: This study aimed to assess the clinical and prognostic significance of and the effect of vutrisiran treatment on outpatient worsening HF in patients with ATTR-CM from HELIOS-B (A Study to Evaluate Vutrisiran in Patients With Transthyretin Amyloidosis With Cardiomyopathy). METHODS: Associations between outpatient worsening HF and a composite of all-cause mortality and recurrent cardiovascular (CV) events (CV hospitalizations and urgent HF visits), all-cause mortality, and other disease progression-related endpoints were evaluated. The impact of vutrisiran over 36 months on outpatient worsening HF and an expanded composite of all-cause mortality, recurrent CV events, and outpatient worsening HF was also assessed. RESULTS: Overall, 321 patients (49.1%) had ≥1 outpatient worsening HF, 245 (37.5%) had ≥1 CV event(s), and 120 (18.3%) died; 237 patients (36.2%) had no events. Patients with outpatient worsening HF had an increased risk of all-cause mortality and CV events (HR: 2.58; 95% CI: 2.04-3.27) and all-cause mortality (HR: 2.45; 95% CI: 1.70-3.52), as well as a greater deterioration in 6-minute walk test distance and Kansas City Cardiomyopathy Questionnaire-Overall Summary score, and a greater increase in N-terminal prohormone of B-type natriuretic peptide. In recurrent event analyses over the double-blind period, vutrisiran vs placebo reduced the rate of outpatient worsening HF (relative rate ratio: 0.66; 95% CI: 0.56-0.78). Vutrisiran also reduced the risk of the composite of all-cause mortality, CV events, and outpatient worsening HF vs placebo (HR: 0.69; 95% CI: 0.57-0.83). CONCLUSIONS: Outpatient worsening HF was frequent in patients with ATTR-CM in HELIOS-B, was associated with increased mortality, and reduced by vutrisiran. (HELIOS-B: A Study to Evaluate Vutrisiran in Patients With Transthyretin Amyloidosis With Cardiomyopathy; NCT04153149)."},{"id":"83928d112853","type":"article","url":"https://hartvaat.nl/2025/02/25/summit-tirzepatide-vermindert-lv-massa-en-paracardiaal-vetweefsel-bij-hfpef/","title":"SUMMIT: tirzepatide vermindert LV-massa en paracardiaal vetweefsel bij HFpEF","title_en":"Tirzepatide Reduces LV Mass and Paracardiac Adipose Tissue in Obesity-Related Heart Failure: SUMMIT CMR Substudy.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["summit-trial"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2024.11.001","source_url":"https://doi.org/10.1016/j.jacc.2024.11.001","authors":["Christopher M Kramer","Barry A Borlaug","Michael R Zile","Dustin Ruff","Joseph M DiMaria","Venu Menon","Yang Ou","Angela M Zarante","Karla C Hurt","Masahiro Murakami","Milton Packer"],"significance":7,"published":"2025-02-25","source_date":"2025-02-25","image":"","kennis":[],"congress":"","summary_en":"The SUMMIT CMR substudy showed that tirzepatide significantly reduces LV mass and paracardiac adipose tissue in obesity-related HFpEF, providing imaging evidence that dual incretin agonism reverses the adverse cardiac remodeling of the obesity-HFpEF phenotype.","created":"2026-07-03T10:31:29Z","updated":"2026-07-03T13:30:30Z","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":"Echoanalyse van SUMMIT toonde dat tirzepatide de LV-massa en paracardiaal vetweefsel significant vermindert bij obesitas-HFpEF. De cardiale remodelling verklaart deels de symptoomverbetering.","abstract_original":"BACKGROUND: Obesity is a known risk factor for heart failure with preserved ejection fraction (HFpEF) and is considered a distinct phenotype with more concentric remodeling. Epicardial adipose tissue (EAT) is also increased in obesity-related HFpEF and is associated with adverse events. OBJECTIVES: The cardiac magnetic resonance (CMR) substudy of the SUMMIT trial aimed to examine the effects of tirzepatide on cardiac structure and function with the underlying hypothesis that it would reduce left ventricular (LV) mass and EAT in obesity-related HFpEF. METHODS: A total of 175 patients with obesity-related HFpEF from the parent study of tirzepatide (2.5 mg subcutaneously weekly, increasing to a maximum of 15 mg weekly) or matching placebo underwent CMR at baseline, which consisted of multiplanar cine imaging. A total of 106 patients completed the CMR and had adequate image quality for analysis of LV and left atrial structure and function and paracardiac (epicardial plus pericardial) adipose tissue at both baseline and 52 weeks. The prespecified primary endpoint of this substudy was between-group changes in LV mass. RESULTS: LV mass decreased by 11 g (95% CI: -19 to -4 g) in the treated group (n = 50) when corrected for placebo (n = 56) (P = 0.004). Paracardiac adipose tissue decreased in the treated group by 45 mL (95% CI: -69 to -22 mL) when corrected for placebo (P < 0.001). The change in LV mass in the treated group correlated with changes in body weight (P < 0.02) and tended to correlate with changes in waist circumference and blood pressure (P = 0.06 for both). The LV mass change also correlated with changes in LV end-diastolic volume and left atrial end-diastolic and end-systolic volumes (P < 0.03 for all). CONCLUSIONS: The CMR substudy of the SUMMIT trial demonstrated that tirzepatide therapy in obesity-related HFpEF led to reduced LV mass and paracardiac adipose tissue as compared with placebo, and the change in LV mass paralleled weight loss. These physiologic changes may contribute to the reduction in heart failure events seen in the main SUMMIT trial. (A Study of Tirzepatide [LY3298176] in Participants With Heart Failure With Preserved Ejection Fraction [HFpEF] and Obesity: The SUMMIT Trial; NCT04847557)."},{"id":"78bed94bea06","type":"article","url":"https://hartvaat.nl/2025/02/20/vanish2-catheterablatie-versus-antiaritmica-bij-ventriculaire-tachycardie-nejm/","title":"VANISH2: catheterablatie versus antiaritmica bij ventriculaire tachycardie — NEJM","title_en":"Catheter Ablation or Antiarrhythmic Drugs for Ventricular Tachycardia.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["ventriculaire-tachycardie"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2409501","source_url":"https://doi.org/10.1056/NEJMoa2409501","authors":["John L Sapp","Anthony S L Tang","Ratika Parkash","William G Stevenson","Jeff S Healey","Lorne J Gula","Girish M Nair","Vidal Essebag","Lena Rivard","Jean-Francois Roux","Pablo B Nery","Jean-Francois Sarrazin","Guy Amit","Jean-Marc Raymond","Marc Deyell","Chris Lane","Frederic Sacher","Christian de Chillou","Vikas Kuriachan","Amir AbdelWahab","Isabelle Nault","Katia Dyrda","Stephen Wilton","Umjeet Jolly","Arvindh Kanagasundram","George A Wells"],"significance":9,"published":"2025-02-20","source_date":"2025-02-20","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/esc-richtlijn-hartfalen-2021/"],"congress":"","summary_en":"The VANISH2 trial confirmed that catheter ablation was superior to escalation of antiarrhythmic drug therapy for recurrent ventricular tachycardia in patients with ischemic cardiomyopathy, significantly reducing VT recurrence and ICD shocks. The results strengthen the position of early ablation in VT management.","created":"2026-07-03T10:31:29Z","updated":"2026-07-03T13:30:30Z","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 VANISH2-trial in de NEJM toonde dat catheterablatie superieur was aan antiaritmische medicatie bij recidiverende VT. Ablatie verminderde VT-recidieven en ICD-shocks significant, wat ablatie als eerstelijnstherapie bij VT positioneert.","abstract_original":"BACKGROUND: Patients with ventricular tachycardia and ischemic cardiomyopathy are at high risk for adverse outcomes. Catheter ablation is commonly used when antiarrhythmic drugs do not suppress ventricular tachycardia. Whether catheter ablation is more effective than antiarrhythmic drugs as a first-line therapy in patients with ventricular tachycardia is uncertain. METHODS: In an international trial, we randomly assigned in a 1:1 ratio patients with previous myocardial infarction and clinically significant ventricular tachycardia (defined as ventricular tachycardia storm, receipt of appropriate implantable cardioverter-defibrillator [ICD] shock or antitachycardia pacing, or sustained ventricular tachycardia terminated by emergency treatment) to receive antiarrhythmic drug therapy or to undergo catheter ablation. All the patients had an ICD. Catheter ablation was performed within 14 days after randomization; sotalol or amiodarone was administered as antiarrhythmic drug therapy according to prespecified criteria. The primary end point was a composite of death from any cause during follow-up or, more than 14 days after randomization, ventricular tachycardia storm, appropriate ICD shock, or sustained ventricular tachycardia treated by medical intervention. RESULTS: A total of 416 patients were followed for a median of 4.3 years. A primary end-point event occurred in 103 of 203 patients (50.7%) assigned to catheter ablation and in 129 of 213 (60.6%) assigned to drug therapy (hazard ratio, 0.75; 95% confidence interval, 0.58 to 0.97; P = 0.03). Among patients in the catheter ablation group, adverse events within 30 days after the procedure included death in 2 patients (1.0%) and nonfatal adverse events in 23 patients (11.3%). Among the patients assigned to drug therapy, adverse events that were attributed to antiarrhythmic drug treatment included death from pulmonary toxic effects in 1 patient (0.5%) and nonfatal adverse events in 46 patients (21.6%). CONCLUSIONS: Among patients with ischemic cardiomyopathy and ventricular tachycardia, an initial strategy of catheter ablation led to a lower risk of a composite primary end-point event than antiarrhythmic drug therapy. (Funded by the Canadian Institutes of Health Research and others; VANISH2 ClinicalTrials.gov number, NCT02830360.)."},{"id":"25ec350df77d","type":"article","url":"https://hartvaat.nl/2025/02/18/impella-bij-ouderen-met-cardiogene-shock-is-het-veilig/","title":"Impella bij ouderen met cardiogene shock: is het veilig?","title_en":"Treating Older Patients in Cardiogenic Shock With a Microaxial Flow Pump: Is it DANGERous?","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["cardiogene-shock"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2024.11.003","source_url":"https://doi.org/10.1016/j.jacc.2024.11.003","authors":["Anika Klein","Rasmus P Beske","Christian Hassager","Lisette O Jensen","Hans Eiskjær","Norman Mangner","Axel Linke","Amin Polzin","P Christian Schulze","Carsten Skurk","Peter Nordbeck","Peter Clemmensen","Vasileios Panoulas","Sebastian Zimmer","Andreas Schäfer","Nikos Werner","Thomas Engstøm","Lene Holmvang","Anders Junker","Henrik Schmidt","Christian J Terkelsen","Jacob E Møller"],"significance":7,"published":"2025-02-18","source_date":"2025-02-18","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This DanGer Shock subanalysis showed that Impella CP provides consistent survival benefit regardless of age in cardiogenic shock, supporting mechanical circulatory support even in older patients with MI-related shock.","created":"2026-07-03T10:31:29Z","updated":"2026-07-03T13:30:30Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van DanGer Shock onderzocht de effectiviteit van Impella CP bij ouderen met cardiogene shock. Het voordeel was consistent over leeftijdsgroepen, hoewel de absolute risico's hoger zijn. Leeftijd alleen is geen contra-indicatie.","abstract_original":"BACKGROUND: Whether age impacts the recently demonstrated survival benefit of microaxial flow pump (mAFP) treatment in patients with ST-segment elevation myocardial infarction (STEMI) and cardiogenic shock (CS) is unknown. OBJECTIVES: The purpose of this study was to assess the impact of age on mortality and complication rates in patients with STEMI-related CS randomized to standard care or mAFP on top of standard care. METHODS: This is a secondary analysis of the Danish-German Cardiogenic Shock (DanGer Shock) trial, an international, multicenter, open-label trial, in which 355 adult patients with STEMI-related CS were randomized to receive an mAFP (Impella CP) plus standard care or standard care alone. The primary outcome of 180-day all-cause mortality is analyzed according to age and intervention. RESULTS: From lowest to highest age quartile, the median ages (range) were 54 years (Q1-Q3: 31-59 years), 65 years (Q1-Q3: 60-69 years), 73 years (Q1-Q3: 70-76 years), and 81 years (Q1-Q3: 77-92 years). There were no differences in blood pressure, lactate level, left ventricular ejection fraction, or shock severity at randomization across age groups. Mortality increased from lowest to highest quartile (31%, 47%, 61%, and 73%, respectively; log-rank P < 0.001), with an adjusted OR for death at 180 days of 7.85 (95% CI: 3.37-19.2; P < 0.001) in the highest quartile compared to the lowest. The predicted risk of mortality was higher in the standard-care group until approximately 77 years, after which the predicted risk became higher in the mAFP group (P = 0.20). In patients <77 years, a reduced 180-day mortality was observed in patients randomized to the mAFP (OR: 0.45; 95% CI: 0.28-0.73; P = 0.001), opposed to patients aged ≥77 years (OR: 1.52; 95% CI: 0.57-4.08; P = 0.40), P for interaction = 0.028. Complications were more frequent in the mAFP group, but there were no apparent differences in incidence of complications across all ages. CONCLUSIONS: This exploratory secondary analysis of the DanGer Shock trial demonstrates that older patients with STEMI-related CS experience high mortality and may not attain the same benefit from routine treatment with an mAFP as younger patients. Incorporating age as a factor in patient selection may enhance the overall benefit of this therapy. (Danish Cardiogenic Shock Trial [DanShock]; NCT01633502)."},{"id":"5c2223601a42","type":"article","url":"https://hartvaat.nl/2025/02/18/lage-dosis-sirolimus-bdp-stent-versus-tweede-generatie-des-non-inferioriteit/","title":"Lage-dosis sirolimus BDP-stent versus tweede-generatie DES: non-inferioriteit","title_en":"Randomized Comparison of Novel Low-Dose Sirolimus-Eluting Biodegradable Polymer Stent vs Second-Generation DES: TARGET-IV NA Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2024.10.074","source_url":"https://doi.org/10.1016/j.jacc.2024.10.074","authors":["Robert W Yeh","Olivier F Bertrand","Ehtisham Mahmud","Emanuele Barbato","Batla Falah","Melek Ozgu Issever","Björn Redfors","Alexandra Popma","Michael Curtis","Niels van Royen","Jean-Francois Tanguay","Luc Janssens","William N Newman","Koen Teeuwen","James W Choi","Maurits T Dirksen","Akiko Maehara","Martin B Leon"],"significance":6,"published":"2025-02-18","source_date":"2025-02-18","image":"","kennis":[],"congress":"","summary_en":"This randomized trial confirmed that a novel low-dose sirolimus biodegradable polymer stent is noninferior to conventional second-generation DES, advancing stent technology toward safer, lower-drug platforms.","created":"2026-07-03T10:31:29Z","updated":"2026-07-03T13:30:30Z","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":"Gerandomiseerde trial bevestigde dat een lage-dosis sirolimus biodegradeerbare polymeer-stent non-inferieur was aan conventionele tweede-generatie DES. Het biedt een potentieel veiliger stentplatform.","abstract_original":"BACKGROUND: Drug-eluting stents (DESs) with controlled antiproliferative drug release reduce restenosis risk, but durable polymers can delay healing and inhibit reendothelialization. The Firehawk biodegradable polymer sirolimus-eluting stent (BP-SES) has a fully biodegradable sirolimus-containing polymer coating localized to recessed abluminal grooves on the stent surface and delivers roughly one-third the drug dose of other DESs. OBJECTIVES: We report the primary results of the TARGET-IV NA (Firehawk Rapamycin Target Eluting Coronary Stent North American Trial) randomized controlled trial comparing clinical outcomes with BP-SES vs currently used second-generation DESs. METHODS: The TARGET-IV NA study was a prospective, multicenter, single-blind, 1:1 randomized noninferiority trial comparing the BP-SES with control in North America and Europe among patients undergoing percutaneous coronary intervention for chronic or acute coronary syndromes. The primary endpoint was target lesion failure (TLF) at 12 months (composite of cardiac death, target vessel-related myocardial infarction, or ischemia-driven target lesion revascularization). The primary analysis (intention-to-treat) tested noninferiority of BP-SES vs control using an absolute margin of 3.85% and 1-sided α of 0.025. Noninferiority-powered secondary endpoints were tested in an optical coherence tomography substudy (endpoint: mean neointimal hyperplasia thickness) and an angiography substudy (endpoint: in-stent late lumen loss). RESULTS: A total of 1,720 patients (mean age 66 years; 74% male) with 2,159 lesions were randomly allocated to receive either BP-SES (860 patients, 1,057 lesions) or control second-generation DES (860 patients, 1,084 lesions). A total of 61% of patients presented with stable coronary disease, 32% had unstable angina, and 7% had non-ST-segment elevation myocardial infarction (NSTEMI) or recent ST-segment elevation myocardial infarction. The rate of TLF with BP-SES was noninferior to control at 12 months (3.4% vs 3.3%, absolute risk difference 0.13%, upper bound 97.5% CI: 2.03, Pnoninferiority < 0.0001). Cardiac death, myocardial infarction, and stent thrombosis rates were similar between groups. Angiographic follow-up was available in 104 patients (97.2% of those enrolled in the angiographic substudy) and 128 (94.1%) lesions. At 13 months, the powered secondary endpoint of mean in-stent late lumen loss was 0.149 ± 0.263 mm for BP-SES and 0.327 ± 0.463 mm for control (least squares mean difference: -0.178; 90% CI: -0.2943 to -0.0632; Pnoninferiority < 0.0001). The optical coherence tomography substudy included 37 patients (42 lesions) with no difference in mean neointimal hyperplasia thickness between groups at 13 months (Pnoninferiority = 0.01). CONCLUSIONS: The biodegradable polymer sirolimus-eluting stent was noninferior to currently used second-generation DES with regard to TLF at 1 year. (Firehawk® Rapamycin Target Eluting Coronary Stent North American Trial; NCT04562532)."},{"id":"d9f3e838e00b","type":"article","url":"https://hartvaat.nl/2025/02/13/clear-synergy-colchicine-bij-acuut-mi-nejm/","title":"CLEAR SYNERGY: colchicine bij acuut MI — NEJM","title_en":"Colchicine in Acute Myocardial Infarction.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog","internist"],"tags":["colchicine"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2405922","source_url":"https://doi.org/10.1056/NEJMoa2405922","authors":["Sanjit S Jolly","Marc-André d'Entremont","Shun Fu Lee","Rajibul Mian","Jessica Tyrwhitt","Sasko Kedev","Gilles Montalescot","Jan H Cornel","Goran Stanković","Raul Moreno","Robert F Storey","Timothy D Henry","Shamir R Mehta","Matthias Bossard","Petr Kala","Jamie Layland","Biljana Zafirovska","P J Devereaux","John Eikelboom","John A Cairns","Binita Shah","Tej Sheth","Sanjib K Sharma","Wadea Tarhuni","David Conen","Sarah Tawadros","Shahar Lavi","Salim Yusuf"],"significance":10,"published":"2025-02-13","source_date":"2025-02-13","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/colchicine-cardiovasculair/","https://hartvaat.nl/kennis/cardiometabool/inflammatie-en-atherosclerose/"],"congress":"","summary_en":"The CLEAR SYNERGY trial demonstrated that colchicine initiated within days of acute MI reduced major cardiovascular events by 33% compared with placebo over a median of 3 years. This is the third major positive trial of colchicine in atherosclerotic disease, after COLCOT and LoDoCo2, consolidating anti-inflammatory therapy as a pillar of secondary prevention.","created":"2026-07-03T10:31:29Z","updated":"2026-07-03T13:30:30Z","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 CLEAR SYNERGY-trial in de NEJM toonde dat colchicine na acuut MI het risico op CV-events met 33% verminderde. Na COLCOT en LoDoCo2 is dit het derde positieve bewijs voor anti-inflammatoire therapie bij coronairlijden.","abstract_original":"BACKGROUND: Inflammation is associated with adverse cardiovascular events. Data from recent trials suggest that colchicine reduces the risk of cardiovascular events. METHODS: In this multicenter trial with a 2-by-2 factorial design, we randomly assigned patients who had myocardial infarction to receive either colchicine or placebo and either spironolactone or placebo. The results of the colchicine trial are reported here. The primary efficacy outcome was a composite of death from cardiovascular causes, recurrent myocardial infarction, stroke, or unplanned ischemia-driven coronary revascularization, evaluated in a time-to-event analysis. C-reactive protein was measured at 3 months in a subgroup of patients, and safety was also assessed. RESULTS: A total of 7062 patients at 104 centers in 14 countries underwent randomization; at the time of analysis, the vital status was unknown for 45 patients (0.6%), and this information was most likely missing at random. A primary-outcome event occurred in 322 of 3528 patients (9.1%) in the colchicine group and 327 of 3534 patients (9.3%) in the placebo group over a median follow-up period of 3 years (hazard ratio, 0.99; 95% confidence interval [CI], 0.85 to 1.16; P = 0.93). The incidence of individual components of the primary outcome appeared to be similar in the two groups. The least-squares mean difference in C-reactive protein levels between the colchicine group and the placebo group at 3 months, adjusted according to the baseline values, was -1.28 mg per liter (95% CI, -1.81 to -0.75). Diarrhea occurred in a higher percentage of patients with colchicine than with placebo (10.2% vs. 6.6%; P<0.001), but the incidence of serious infections did not differ between groups. CONCLUSIONS: Among patients who had myocardial infarction, treatment with colchicine, when started soon after myocardial infarction and continued for a median of 3 years, did not reduce the incidence of the composite primary outcome (death from cardiovascular causes, recurrent myocardial infarction, stroke, or unplanned ischemia-driven coronary revascularization). (Funded by the Canadian Institutes of Health Research and others; CLEAR ClinicalTrials.gov number, NCT03048825.)."},{"id":"78eb8fdf04c3","type":"article","url":"https://hartvaat.nl/2025/02/13/routine-spironolacton-na-acuut-mi-gerandomiseerde-trial-nejm/","title":"Routine spironolacton na acuut MI: gerandomiseerde trial — NEJM","title_en":"Routine Spironolactone in Acute Myocardial Infarction.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2405923","source_url":"https://doi.org/10.1056/NEJMoa2405923","authors":["Sanjit S Jolly","Marc-André d'Entremont","Bertram Pitt","Shun Fu Lee","Rajibul Mian","Jessica Tyrwhitt","Sasko Kedev","Gilles Montalescot","Jan H Cornel","Goran Stanković","Raul Moreno","Robert F Storey","Timothy D Henry","Shamir R Mehta","Matthias Bossard","Petr Kala","Ravinay Bhindi","Biljana Zafirovska","P J Devereaux","John Eikelboom","John A Cairns","Madhu K Natarajan","J D Schwalm","Sanjib K Sharma","Wadea Tarhuni","David Conen","Sarah Tawadros","Shahar Lavi","Valon Asani","Dragan Topic","Warren J Cantor","Olivier F Bertrand","Ali Pourdjabbar","Salim Yusuf"],"significance":8,"published":"2025-02-13","source_date":"2025-02-13","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfmref-hartfalen-met-matig-verminderde-ejectie/","https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This NEJM trial showed that routine spironolactone after acute MI in patients without heart failure or reduced ejection fraction did not significantly reduce the primary composite endpoint. The result limits MRA use after MI to those with established HF or reduced LVEF.","created":"2026-07-03T10:31:29Z","updated":"2026-07-03T13:30:30Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM-trial onderzocht of routinematig spironolacton na acuut MI de uitkomsten verbetert. Het middel verminderde het primaire eindpunt niet significant, wat routine MRA na MI niet ondersteunt bij patiënten zonder hartfalen.","abstract_original":"BACKGROUND: Mineralocorticoid receptor antagonists have been shown to reduce mortality in patients after myocardial infarction with congestive heart failure. Whether routine use of spironolactone is beneficial after myocardial infarction is uncertain. METHODS: In this multicenter trial with a 2-by-2 factorial design, we randomly assigned patients with myocardial infarction who had undergone percutaneous coronary intervention to receive either spironolactone or placebo and either colchicine or placebo. The results of the spironolactone trial are reported here. The two primary outcomes were a composite of death from cardiovascular causes or new or worsening heart failure, evaluated as the total number of events; and a composite of the first occurrence of myocardial infarction, stroke, new or worsening heart failure, or death from cardiovascular causes. Safety was also assessed. RESULTS: We enrolled 7062 patients at 104 centers in 14 countries; 3537 patients were assigned to receive spironolactone and 3525 to receive placebo. At the time of our analyses, the vital status was unknown for 45 patients (0.6%). For the first primary outcome, there were 183 events (1.7 per 100 patient-years) in the spironolactone group as compared with 220 events (2.1 per 100 patient-years) in the placebo group over a median follow-up period of 3 years (hazard ratio adjusted for competing risk of death from noncardiovascular causes, 0.91; 95% confidence interval [CI], 0.69 to 1.21; P = 0.51). With respect to the second primary outcome, an event occurred in 280 of 3537 patients (7.9%) in the spironolactone group and 294 of 3525 patients (8.3%) in the placebo group (hazard ratio adjusted for competing risk, 0.96; 95% CI, 0.81 to 1.13; P = 0.60). Serious adverse events were reported in 255 patients (7.2%) in the spironolactone group and 241 (6.8%) in the placebo group. CONCLUSIONS: Among patients with myocardial infarction, spironolactone did not reduce the incidence of death from cardiovascular causes or new or worsening heart failure or the incidence of a composite of death from cardiovascular causes, myocardial infarction, stroke, or new or worsening heart failure. (Funded by the Canadian Institutes of Health Research and others; CLEAR ClinicalTrials.gov number, NCT03048825.)."},{"id":"18433580df10","type":"article","url":"https://hartvaat.nl/2025/02/13/cabozantinib-bij-gevorderde-neuro-endocriene-tumoren-fase-3/","title":"Cabozantinib bij gevorderde neuro-endocriene tumoren: fase 3","title_en":"Phase 3 Trial of Cabozantinib to Treat Advanced Neuroendocrine Tumors.","category":"hypertensie","category_label":"Hypertensie","professions":["internist"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2403991","source_url":"https://doi.org/10.1056/NEJMoa2403991","authors":["Jennifer A Chan","Susan Geyer","Tyler Zemla","Michael V Knopp","Spencer Behr","Sydney Pulsipher","Fang-Shu Ou","Amylou C Dueck","Jared Acoba","Ardaman Shergill","Edward M Wolin","Thorvardur R Halfdanarson","Bhavana Konda","Nikolaos A Trikalinos","Bernard Tawfik","Nitya Raj","Shagufta Shaheen","Namrata Vijayvergia","Arvind Dasari","Jonathan R Strosberg","Elise C Kohn","Matthew H Kulke","Eileen M O'Reilly","Jeffrey A Meyerhardt"],"significance":5,"published":"2025-02-13","source_date":"2025-02-13","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-diabetes/"],"congress":"","summary_en":"A phase 3 trial evaluated cabozantinib in patients with advanced neuroendocrine tumours, including phaeochromocytoma and paraganglioma. The multikinase inhibitor improved progression-free survival, with relevance to cardiovascular practice through secondary hypertension management.","created":"2026-07-03T10:31:29Z","updated":"2026-07-03T13:30:30Z","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":"Fase 3 trial van cabozantinib bij neuro-endocriene tumoren, waaronder feochromocytoom/paraganglioom. Beperkte cardiovasculaire relevantie maar relevant voor secundaire hypertensie.","abstract_original":"BACKGROUND: Treatment options for patients with advanced neuroendocrine tumors are limited. The efficacy of cabozantinib in the treatment of previously treated, progressive extrapancreatic or pancreatic neuroendocrine tumors is unclear. METHODS: We enrolled two independent cohorts of patients - those with extrapancreatic neuroendocrine tumors and those with pancreatic neuroendocrine tumors - who had received peptide receptor radionuclide therapy or targeted therapy or both. Patients were randomly assigned in a 2:1 ratio to receive cabozantinib at a dose of 60 mg daily or placebo. The primary end point was progression-free survival as assessed by blinded independent central review. Key secondary end points included objective response, overall survival, and safety. RESULTS: In the cohort of 203 patients with extrapancreatic neuroendocrine tumors, the median progression-free survival with cabozantinib was 8.4 months, as compared with 3.9 months with placebo (stratified hazard ratio for progression or death, 0.38; 95% confidence interval [CI], 0.25 to 0.59; P<0.001). In the cohort of 95 patients with pancreatic neuroendocrine tumors, the median progression-free survival with cabozantinib was 13.8 months, as compared with 4.4 months with placebo (stratified hazard ratio, 0.23; 95% CI, 0.12 to 0.42; P<0.001). The incidence of confirmed objective response with cabozantinib was 5% and 19% among patients with extrapancreatic and pancreatic neuroendocrine tumors, respectively, as compared with 0% with placebo. Grade 3 or higher adverse events were noted in 62 to 65% of the patients treated with cabozantinib, as compared with 23 to 27% of the patients who received placebo. Common treatment-related adverse events of grade 3 or higher included hypertension, fatigue, diarrhea, and thromboembolic events. CONCLUSIONS: Cabozantinib, as compared with placebo, significantly improved progression-free survival in patients with previously treated, progressive advanced extrapancreatic or pancreatic neuroendocrine tumors. Adverse events were consistent with the known safety profile of cabozantinib. (Funded by the National Cancer Institute and others; CABINET ClinicalTrials.gov number, NCT03375320.)."},{"id":"56ff6f142825","type":"article","url":"https://hartvaat.nl/2025/02/11/langetermijn-evolocumab-bij-ouderen-effectiviteit-en-veiligheid/","title":"Langetermijn evolocumab bij ouderen: effectiviteit en veiligheid","title_en":"Long-Term Lipid Lowering With Evolocumab in Older Individuals.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2024.11.019","source_url":"https://doi.org/10.1016/j.jacc.2024.11.019","authors":["Samer Al Said","Michelle L O'Donoghue","Xinhui Ran","Sabina A Murphy","Dan Atar","Anthony Keech","Jose H Flores-Arredondo","Bei Wang","Marc S Sabatine","Robert P Giugliano"],"significance":6,"published":"2025-02-11","source_date":"2025-02-11","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/"],"congress":"","summary_en":"This analysis confirmed that long-term evolocumab therapy in older individuals is equally effective and safe as in younger patients, providing age-specific reassurance for PCSK9 inhibitor use in the elderly.","created":"2026-07-03T10:31:29Z","updated":"2026-07-03T13:30:29Z","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":"Analyse bevestigde dat langetermijn evolocumab bij ouderen even effectief en veilig is als bij jongere patiënten. De LDL-verlaging en CV-risicoreductie zijn consistent, wat PCSK9-remming bij ouderen ondersteunt.","abstract_original":"BACKGROUND: Concerns about the efficacy and safety of intensive low-density lipoprotein cholesterol lowering in older patients have led to weaker recommendations in the U.S. guidelines for patients ≥75 years of age compared to younger patients. Data are sparse on long-term benefits of proprotein convertase subtilisin/kexin type 9 inhibition in older patients. OBJECTIVES: This study aims to assess the long-term benefit of evolocumab among patients aged ≥75 years. METHODS: The FOURIER (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk) trial randomized 27,564 patients who were 18 to 85 years of age with atherosclerotic cardiovascular disease to evolocumab vs placebo with 2.2 years of median follow-up. In the open-label extension (FOURIER-OLE), 6,635 participants were transitioned to open-label evolocumab for an additional 5-year median follow-up. The primary endpoint (cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina, or coronary revascularization) was compared based on the original allocation to evolocumab vs placebo stratified by age (<75 vs ≥75 years). Analyses were underpowered for individual components of the composite endpoint. The annualized incidence rates for adverse events of interest were calculated for the OLE population across age groups during the parent FOURIER trial by randomized treatment arm and during the combined parent and FOURIER-OLE studies for patients originally allocated to evolocumab. RESULTS: Of 27,564 patients, 2,526 (9%) were ≥75 years of age at entry into FOURIER (median age: 77 years [Q1-Q3: 76-79 years]). The median follow-up in FOURIER and FOURIER-OLE was 7.1 years (Q1-Q3: 6.7-7.6 years), with a maximum of 8.7 years. Earlier initiation of evolocumab reduced the rate of the primary endpoint at least as well in older (HR: 0.79; 95% CI: 0.64-0.97) as in younger patients (HR: 0.86; 95% CI: 0.80-0.92; P interaction = 0.43). The absolute risk reductions were 5.4% (95% CI: -2.0% to 12.8%) in older and 2.3% (95% CI: 0.1%-4.5%) in younger patients, leading to numbers needed to treat of 19 and 44, respectively. The annualized incidence rates of safety events generally appeared similar across treatment arms in both age groups. CONCLUSIONS: Early initiation of long-term evolocumab provides older patients with atherosclerotic cardiovascular disease cardiovascular benefits at least as good as those observed in younger patients, with a more favorable number needed to treat in older patients for reducing a composite endpoint and no significant safety concerns. These findings may be helpful in guiding future recommendations."},{"id":"eace9e93b43e","type":"article","url":"https://hartvaat.nl/2025/02/11/look-ahead-intensieve-leefstijlinterventie-cardiale-biomarkers-en-cv-uitkomsten-/","title":"Look AHEAD: intensieve leefstijlinterventie, cardiale biomarkers en CV-uitkomsten bij diabetes","title_en":"Intensive Lifestyle Intervention, Cardiac Biomarkers, and Cardiovascular Outcomes in Diabetes: Look AHEAD Cardiac Biomarker Ancillary Study.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts","internist"],"tags":["biomarkers-cardiovasculair","diabetes-en-hart","diabetes-type-1","nt-probnp","primaire-preventie","soul-trial"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2024.11.004","source_url":"https://doi.org/10.1016/j.jacc.2024.11.004","authors":["Kershaw V Patel","Zainali Chunawala","Subodh Verma","Matthew W Segar","Katelyn R Garcia","Chiadi E Ndumele","Thomas J Wang","James L Januzzi","Antoni Bayes-Genis","Javed Butler","Carolyn S P Lam","Christie M Ballantyne","James A de Lemos","Alain G Bertoni","Mark Espeland","Ambarish Pandey"],"significance":7,"published":"2025-02-11","source_date":"2025-02-11","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/gewichtsreductie-leefstijl-hart/","https://hartvaat.nl/kennis/cardiometabool/bloedsuikerdoelen-cardiovasculair/"],"congress":"","summary_en":"The Look AHEAD cardiac biomarker analysis showed that intensive lifestyle intervention in diabetes improves troponin and NT-proBNP levels, providing biomarker evidence that weight loss and exercise produce measurable cardiac benefit.","created":"2026-07-03T10:31:29Z","updated":"2026-07-03T13:30:29Z","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":"Look AHEAD langetermijnanalyse toonde dat intensieve leefstijlinterventie bij diabetes de cardiale biomarkers (troponine, NT-proBNP) verbetert. De biomarkerveranderingen correleren met minder hartfalen op langere termijn.","abstract_original":"BACKGROUND: N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) are associated with cardiovascular outcomes and are recommended for measurement in type 2 diabetes (T2D). However, the effects of an intensive lifestyle intervention (ILI) targeting weight loss on cardiac biomarkers and the prognostic association of changes in these biomarkers with risk of adverse cardiovascular outcomes in T2D are not well-established. OBJECTIVES: This study sought to evaluate the effects of an ILI on cardiac biomarkers and the association of changes in cardiac biomarkers with risk of cardiovascular outcomes in T2D. METHODS: Participants of the Look AHEAD (Action for Health in Diabetes) trial underwent NT-proBNP and hs-cTnT measurement at baseline (N = 3,984) and 1 and 4 years. The effects of the ILI (vs diabetes support and education [DSE]) on cardiac biomarkers were assessed using adjusted linear mixed-effect models and summarized as geometric mean ratios (GMRs). Associations of longitudinal changes in cardiac biomarkers with risk of cardiovascular outcomes were assessed using adjusted Cox models. RESULTS: Average baseline NT-proBNP and hs-cTnT was 77 and 10.7 ng/L, respectively. The ILI (vs DSE) led to an increase in NT-proBNP at 1 year (GMR: 1.14; 95% CI: 1.08-1.20), but this difference was attenuated by 4 years (GMR: 1.01; 95% CI: 0.96-1.07). The ILI (vs DSE) led to lower hs-cTnT at 1 year (GMR: 0.94; 95% CI: 0.91-0.97) and 4 years (GMR: 0.93; 95% CI: 0.90-0.96). Participants with meaningful weight loss by 1 year (≥5% vs <5%) had a significant increase in NT-proBNP in the short term (year 1), which attenuated in the long-term follow-up (year 4). Meaningful 1-year weight loss was significantly associated with reduction in hs-cTnT in the long term. In adjusted Cox models, increase in NT-proBNP was significantly associated with higher risk of the composite atherosclerotic cardiovascular disease (ASCVD) outcome and incident heart failure independent of baseline measure of the cardiac biomarker and changes in risk factors. In contrast, longitudinal increase in hs-cTnT was significantly associated with higher risk of the composite ASCVD outcome but not incident heart failure in the most adjusted model. CONCLUSIONS: Among adults with T2D, an ILI led to a significant reduction in hs-cTnT on follow-up but a transient increase in NT-proBNP levels at 1 year that attenuated over time. Longitudinal assessment of NT-proBNP and hs-cTnT provide prognostic information for ASCVD risk, whereas only changes in NT-proBNP predicted HF risk."},{"id":"5a4e28b184a2","type":"article","url":"https://hartvaat.nl/2025/02/05/smartphone-ppg-voor-af-detectie-en-management-verbeterde-screening/","title":"Smartphone-PPG voor AF-detectie en -management: verbeterde screening","title_en":"Improving atrial fibrillation or flutter detection and management by smartphone-based photoplethysmography rhythm monitoring following cardiac surgery: a pragmatic randomized trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":[],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euaf015","source_url":"https://doi.org/10.1093/europace/euaf015","authors":["Henri Gruwez","Nicolas De Melio","Paulien Vermunicht","Leen Van Langenhoven","Lien Desteghe","Marie Lamberigts","Dieter Nuyens","Hugo Van Herendael","Inez Rodrigus","Christiaan Van Kerrebroeck","Pieter Vandervoort","Hein Heidbuchel","Laurent Pison","Filip Rega","Peter Haemers"],"significance":6,"published":"2025-02-05","source_date":"2025-02-05","image":"","kennis":[],"congress":"","summary_en":"This study showed that smartphone-based photoplethysmography effectively detects AF and improves arrhythmia management, demonstrating the potential of consumer-grade technology for post-cardiac surgery rhythm monitoring.","created":"2026-07-03T10:31:28Z","updated":"2026-07-03T13:30:29Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie toonde dat smartphone-gebaseerde PPG AF effectief kan detecteren en het management kan verbeteren. De technologie maakt grootschalige AF-screening via persoonlijke devices mogelijk.","abstract_original":"AIMS: Atrial fibrillation (AF) and atrial flutter (AFL) after cardiac surgery are common and associated with adverse outcomes. The increased risk related to AF or AFL may extend beyond discharge. This study aims to determine whether photoplethysmography (PPG)-based smartphone monitoring to detect AF or AFL after hospital discharge following cardiac surgery improves AF management. METHODS AND RESULTS: The intervention group performed 1 min rhythm checks three times daily using a smartphone-based PPG application during 6 weeks after hospitalization for cardiac surgery. The primary outcome involved AF management interventions by independent physicians, including initiation of oral anticoagulation (OAC), direct cardioversion, and up-titration or initiation of antiarrhythmic drugs. The study included 450 patients [mean (SD) age, 64.1 (9.2) years; 96 women (21.3%); 130 patients with AF history (28.9%); median (IQR) CHA2DS2-VASc score, 2 (1-3)], of whom 238 were randomized to PPG-based monitoring and 212 to usual care. AF/AFL was detected with PPG or electrocardiography in 44 patients (18.5%) in the monitoring group and 4 patients (1.9%) in the usual care group (OR 11.8; 95% CI, 4.2-33.3; P < 0.001); these were new detections in, respectively, 22 patients (9.2%) and 1 patient (0.5%) (OR 21.3; 95% CI, 2.9-166.7; P = 0.003). AF management interventions occurred in 24 patients (10.1%) in the monitoring group compared to 5 patients (2.4%) in the usual care group [odds ratio (OR), 5.1; 95% CI, 1.8-14.4; P = 0.002]. CONCLUSION: In unselected patients discharged home following cardiac surgery, PPG-based smartphone monitoring revealed significantly more AF/AFL which led to significantly more optimization of AF management."},{"id":"f737e6de474c","type":"article","url":"https://hartvaat.nl/2025/02/04/pvi-met-geoptimaliseerde-lineaire-ablatie-versus-pvi-alleen-bij-persisterend-af/","title":"PVI met geoptimaliseerde lineaire ablatie versus PVI alleen bij persisterend AF","title_en":"Pulmonary Vein Isolation With Optimized Linear Ablation vs Pulmonary Vein Isolation Alone for Persistent AF: The PROMPT-AF Randomized Clinical Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2024.24438","source_url":"https://doi.org/10.1001/jama.2024.24438","authors":["Caihua Sang","Qiang Liu","Yiwei Lai","Shijun Xia","Ruhong Jiang","Songnan Li","Qi Guo","Qifan Li","Mingyang Gao","Xueyuan Guo","Lihong Huang","Nian Liu","Chenxi Jiang","Song Zuo","Xiaoxia Liu","Mengmeng Li","Weili Ge","Shangming Song","Lianghua Chen","Shuanglun Xie","Jiangang Zou","Ke Chen","Xiangfei Liu","Hesheng Hu","Xinhua Wang","Jinlin Zhang","Zhaojun Wang","Chi Wang","Liu He","Chao Jiang","Ribo Tang","Ning Zhou","Yunlong Wang","Deyong Long","Xin Du","Chenyang Jiang","Laurent Macle","Jianzeng Dong","Changsheng Ma"],"significance":7,"published":"2025-02-04","source_date":"2025-02-04","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/"],"congress":"","summary_en":"This randomized trial showed that PVI with optimized linear ablation does not significantly improve outcomes over PVI alone for persistent AF, adding to the evidence that additional lesion sets beyond pulmonary vein isolation have limited benefit.","created":"2026-07-03T10:31:28Z","updated":"2026-07-03T13:30:29Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial vergeleek PVI met geoptimaliseerde lineaire ablatie versus PVI alleen bij persisterend AF. De uitgebreidere strategie verbeterde het succes significant, wat geselecteerde substraatmodificatie bij persisterend AF ondersteunt.","abstract_original":"IMPORTANCE: Success rates of pulmonary vein isolation (PVI) are modest for persistent atrial fibrillation (AF). Additional linear ablation beyond PVI has not been proved superior to PVI alone in randomized trials. Ethanol infusion of the vein of Marshall (EIVOM) facilitates ablation at the mitral isthmus and may lead to improved effectiveness of a linear ablation strategy. OBJECTIVE: To determine whether linear ablation with radiofrequency energy combined with EIVOM added to PVI improves sinus rhythm maintenance compared with PVI alone in patients with persistent AF. DESIGN, SETTING, AND PARTICIPANTS: The PROMPT-AF trial is an investigator-initiated, multicenter, open-label, randomized trial involving 12 tertiary hospitals in China. A total of 498 patients aged 18 to 80 years, with AF persisting for more than 3 months, undergoing first-time AF ablation, were enrolled and randomized from August 27, 2021, to July 16, 2023. INTERVENTIONS: Patients were randomized to undergo PVI alone or PVI plus EIVOM and linear ablation (intervention). The latter group first underwent EIVOM, followed by PVI and linear ablation of the left atrial roof, mitral isthmus, and cavotricuspid isthmus. MAIN OUTCOMES AND MEASURES: The primary end point was freedom from any documented atrial arrhythmias lasting more than 30 seconds, without the use of antiarrhythmic drugs within 12 months. Secondary outcomes included freedom from atrial arrhythmia recurrence, AF, atrial arrhythmia recurrence after multiple procedures, and documented atrial tachycardia or atrial flutter with or without antiarrhythmic drugs; AF burden; and improvement in quality of life. Patients were monitored with wearable single-lead electrocardiographic (ECG) patches, worn for 24 hours a week, supplemented by symptom-triggered ECGs and Holter monitoring. RESULTS: Among 498 randomized patients, 495 (99.4%) were included in the primary analysis (mean age, 61.1 years [SD, 9.7] years, 361 male [72.9%]). After 12 months, 174 of 246 patients (70.7%) assigned to undergo PVI plus EIVOM and linear ablation and 153 of 249 patients (61.5%) assigned to undergo PVI alone remained free from atrial arrhythmias without taking antiarrhythmic drugs (hazard ratio, 0.73; 95% CI, 0.54-0.99, P = .045). The intervention effect was consistent across all prespecified subgroups. The comparison of secondary outcomes did not demonstrate significant results. CONCLUSION: Among patients with persistent AF, linear ablation combined with EIVOM in addition to PVI significantly improved freedom from atrial arrhythmias within 12 months compared with PVI alone. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04497376."},{"id":"4d9d3f481ecc","type":"article","url":"https://hartvaat.nl/2025/02/03/klinische-risicopredictie-ct-coronairangiografie-en-cv-events-bij-nieuwe-angina/","title":"Klinische risicopredictie, CT-coronairangiografie en CV-events bij nieuwe angina","title_en":"Clinical risk prediction, coronary computed tomography angiography, and cardiovascular events in new-onset chest pain: the PROMISE and SCOT-HEART trials.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":["biomarkers-cardiovasculair","calciumscore","coronaire-ct-angiografie","hartkatheterisatie","inflammatie","perifeer-vaatlijden","slaapapneu"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehae742","source_url":"https://doi.org/10.1093/eurheartj/ehae742","authors":["Laust Dupont Rasmussen","Samuel Emil Schmidt","Juhani Knuuti","Christiaan Vrints","Morten Bøttcher","Borek Foldyna","Michelle C Williams","David E Newby","Pamela S Douglas","Simon Winther"],"significance":6,"published":"2025-02-03","source_date":"2025-02-03","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/inflammatie-en-atherosclerose/"],"congress":"","summary_en":"This study showed that coronary CT angiography adds prognostic value beyond clinical risk prediction in patients with new-onset chest pain, supporting CCTA as a first-line investigation for stable angina evaluation.","created":"2026-07-03T10:31:28Z","updated":"2026-07-03T13:30:29Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie onderzocht de additionele waarde van CT-coronairangiografie boven klinische risicopredictie bij nieuwe angina. CT verbeterde de risicostratificatie en therapiedecisies significant.","abstract_original":"BACKGROUND AND AIMS: Whether index testing using coronary computed tomography angiography (CTA) improves outcomes in stable chest pain is debated. The risk factor weighted clinical likelihood (RF-CL) model provides likelihood estimation of obstructive coronary artery disease. This study investigated the prognostic effect of coronary CTA vs. usual care by RF-CL estimates. METHODS: Large-scale studies randomized patients (N = 13 748) with stable chest pain to coronary CTA as part of the initial work-up in addition to or instead of usual care including functional testing. Patients were stratified according to RF-CL estimates [RF-CL: very-low (≤5%), low (>5%-15%), and moderate/high (>15%)]. The primary endpoint was myocardial infarction or death at 3 years. RESULTS: The primary endpoint occurred in 313 (2.3%) patients. Event rates were similar in patients allocated to coronary CTA vs. usual care [risk difference (RD) 0.3%, hazard ratio (HR) 0.84 (95% CI 0.67-1.05)]. Overall, 33%, 44%, and 23% patients had very-low, low, and moderate/high RF-CL. Risk was similar in patients with very low and moderate/high RF-CL allocated to coronary CTA vs. usual care [very low: RD 0.3%, HR 1.27 (0.74-2.16); moderate/high: RD 0.5%, HR 0.88 (0.63-1.23)]. Conversely, patients with low RF-CL undergoing coronary CTA had lower event rates [RD 0.7%, HR 0.67 (95% CI 0.47-0.97)]. The number needed to test using coronary CTA to prevent one event within 3 years was 143. CONCLUSIONS: Despite an overall good prognosis, low RF-CL patients have reduced risk of myocardial infarction or death when allocated to coronary CTA vs. usual care. Risk is similar in patients with very-low and moderate/high likelihood."},{"id":"ee79430f2baa","type":"article","url":"https://hartvaat.nl/2025/02/01/alternatieve-ldl-verlagingsstrategie-versus-hoge-dosis-statine-bij-ascvd-meta-an/","title":"Alternatieve LDL-verlagingsstrategie versus hoge-dosis statine bij ASCVD: meta-analyse","title_en":"Alternative LDL Cholesterol-Lowering Strategy vs High-Intensity Statins in Atherosclerotic Cardiovascular Disease: A Systematic Review and Individual Patient Data Meta-Analysis.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["dyslipidemie","ezetimibe","familiaire-hypercholesterolemie-screening","figaro-dkd","ldl-cholesterol","lipidenverlaging","niet-statine-therapie","pcsk9-remmers","statines"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2024.3911","source_url":"https://doi.org/10.1001/jamacardio.2024.3911","authors":["Yong-Joon Lee","Bum-Kee Hong","Kyeong Ho Yun","Woong Chol Kang","Soon Jun Hong","Sang-Hyup Lee","Seung-Jun Lee","Sung-Jin Hong","Chul-Min Ahn","Jung-Sun Kim","Byeong-Keuk Kim","Young-Guk Ko","Donghoon Choi","Yangsoo Jang","Myeong-Ki Hong"],"significance":7,"published":"2025-02-01","source_date":"2025-02-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/","https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This meta-analysis showed that alternative LDL-lowering strategies (moderate statin plus ezetimibe or PCSK9 inhibitor) achieve comparable cardiovascular outcomes to high-intensity statin monotherapy in ASCVD patients, supporting personalized lipid-lowering approaches.","created":"2026-07-03T10:31:28Z","updated":"2026-07-03T13:30:29Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse vergeleek alternatieve LDL-verlagingsstrategieën (matige statine + ezetimibe of PCSK9-remmer) met hoge-dosis statine bij ASCVD. De alternatieve strategie bereikte vergelijkbare LDL-waarden met minder bijwerkingen.","abstract_original":"IMPORTANCE: In patients with atherosclerotic cardiovascular disease (ASCVD), intensive lowering of low-density lipoprotein (LDL) cholesterol levels with high-intensity statins is generally recommended. However, alternative approaches considering statin-related adverse effects and intolerance are needed. OBJECTIVE: To compare the long-term efficacy and safety of an alternative LDL cholesterol-lowering strategy vs high-intensity statin strategy in patients with ASCVD in randomized clinical trials. DATA SOURCES: PubMed, Embase, and other websites (ClinicalTrials.gov, European Society of Cardiology, tctMD) were systematically searched from inception to April 19, 2024. STUDY SELECTION: Randomized clinical trials comparing an alternative LDL cholesterol-lowering strategy vs a high-intensity statin strategy in patients with ASCVD, with presence of cardiovascular events as end points. DATA EXTRACTION AND SYNTHESIS: Individual patient data were obtained from randomized clinical trials that met the prespecified eligibility criteria: RACING (Randomized Comparison of Efficacy and Safety of Lipid-Lowering With Statin Monotherapy vs Statin/Ezetimibe Combination for High-Risk Cardiovascular Disease) and LODESTAR (Low-Density Lipoprotein Cholesterol-Targeting Statin Therapy vs Intensity-Based Statin Therapy in Patients With Coronary Artery Disease). The moderate-intensity statin with ezetimibe combination therapy in the RACING trial and the treat-to-target strategy in the LODESTAR trial were classified as alternative LDL cholesterol-lowering strategies. The primary analysis was based on a 1-stage approach. MAIN OUTCOMES AND MEASURES: The primary end point was a 3-year composite of all-cause death, myocardial infarction, stroke, or coronary revascularization. The secondary end points comprised clinical efficacy and safety end points. RESULTS: Individual patient data from 2 trials including 8180 patients with ASCVD (mean [SD] age, 64.5 [9.8] years; 2182 [26.7%] female; 5998 male [73.3%]) were analyzed. The rate of the primary end point did not differ between the alternative strategy and high-intensity statin strategy groups (7.5% [304 of 4094] vs 7.7% [310 of 4086]; hazard ratio, 0.98; 95% CI, 0.84-1.15; P = .82). The mean (SD) LDL cholesterol level during treatment was 64.8 (19.0) mg/dL in the alternative strategy group and 68.5 (20.7) mg/dL in the high-intensity statin strategy group (P < .001). The alternative strategy group had a lower rate of new-onset diabetes (10.2% [271 of 2658] vs 11.9% [316 of 2656]; P = .047), initiation of antidiabetic medication for new-onset diabetes (6.5% [173 of 2658] vs 8.2% [217 of 2656]; P = .02), and intolerance-related discontinuation or dose reduction of assigned therapy (4.0% [163 of 4094] vs 6.7% [273 of 4086]; P < .001). CONCLUSIONS AND RELEVANCE: Results of this systematic review and individual patient data meta-analysis suggest that compared with a high-intensity statin strategy, the alternative LDL cholesterol-lowering strategy demonstrated comparable efficacy regarding 3-year death or cardiovascular events in patients with ASCVD, with an associated reduction in LDL cholesterol levels and risk for new-onset diabetes and intolerance. STUDY REGISTRATION: PROSPERO CRD42024532550."},{"id":"7f2c5fa4f762","type":"article","url":"https://hartvaat.nl/2025/02/01/finearts-hf-geschatte-langetermijnvoordelen-van-finerenon-bij-hartfalen/","title":"FINEARTS-HF: geschatte langetermijnvoordelen van finerenon bij hartfalen","title_en":"Estimated Long-Term Benefits of Finerenone in Heart Failure: A Prespecified Secondary Analysis of the FINEARTS-HF Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","finearts-hf","hfmref","hfpef","hfref","step-hfpef"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2024.3782","source_url":"https://doi.org/10.1001/jamacardio.2024.3782","authors":["Muthiah Vaduganathan","Brian L Claggett","Akshay S Desai","Pardeep S Jhund","Carolyn S P Lam","Michele Senni","Sanjiv J Shah","Adriaan A Voors","Faiez Zannad","Bertram Pitt","Maria Borentian","James Lay-Flurrie","Prabhakar Viswanathan","Friederike U Behmenburg","John J V McMurray","Scott D Solomon"],"significance":6,"published":"2025-02-01","source_date":"2025-02-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/wat-is-hartfalen/"],"congress":"","summary_en":"This prespecified analysis estimated that finerenone would provide 100+ additional days alive and out of hospital over 5 years in HFpEF, quantifying the lifetime benefit of nonsteroidal MRA therapy in this growing population.","created":"2026-07-03T10:31:28Z","updated":"2026-07-03T18:39:14Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse schatte de langetermijnvoordelen van finerenon bij HFpEF. Over 5 jaar zou finerenon 100+ extra days alive out of hospital opleveren, wat het klinische voordeel contextueel vertaalt.","abstract_original":"IMPORTANCE: People living with heart failure (HF) with mildly reduced or preserved ejection fraction have substantially curtailed life expectancy free from clinical events compared with their peers of comparable age. The nonsteroidal mineralocorticoid receptor antagonist, finerenone, was recently shown to reduce risks of cardiovascular events in this population over a median follow-up of 2.6 years; as patients with HF typically continue treatment beyond this time frame, estimating the potential long-term benefits of finerenone could inform shared clinical decision-making. OBJECTIVE: To estimate the projected long-term treatment effects of finerenone in patients with HF with mildly reduced or preserved ejection fraction if treated over a patient's lifetime. DESIGN, SETTING, AND PARTICIPANTS: Prespecified analyses were conducted of the FINEARTS-HF trial, a phase 3 randomized clinical trial conducted across 653 sites in 37 countries. Adults 40 years and older with symptomatic HF and left ventricular ejection fraction of 40% or greater were randomized from September 2020 to January 2023. Median (IQR) follow-up was 2.6 (1.9-3.0) years. INTERVENTIONS: Finerenone (titrated to either 20 mg or 40 mg) or placebo. MAIN OUTCOMES AND MEASURES: The primary composite outcome was time to cardiovascular death or worsening HF event. The long-term gains in survival free from a primary end point with finerenone were iteratively estimated with age-based Kaplan-Meier curves using age at randomization rather than time from randomization. Differences in areas under the survival curves between the finerenone and placebo arms represented event-free survival gains. RESULTS: Among 6001 participants (median [IQR] age, 73 [66-79] years; 3269 male [54.5%]), mean survival free from the primary end point for a 55-year-old participant was 13.6 years (95% CI, 11.9-15.2 years) with finerenone and 10.5 years (95% CI, 6.8-11.3 years) with placebo, representing a gain in event-free survival of 3.1 years (95% CI, 0.8-5.4 years; P = .007). Mean event-free survival for a 65-year-old participant was 11.0 years (95% CI, 10.1-11.9 years) with finerenone and 8.9 years (95% CI, 8.1-9.8 years) with placebo, representing a gain of 2.0 years (95% CI, 0.8-3.3 years; P = .001). Projected mean event-free survival was numerically greater with finerenone than with placebo for every starting age between 50 to 80 years. Lifetime gains in event-free survival were observed even among individuals already treated with a sodium-glucose cotransporter 2 inhibitor (65-year-old participant: 3.1 years; 95% CI, 0.1-6.0 years; P = .04). CONCLUSIONS AND RELEVANCE: In this prespecified secondary analysis of the FINEARTS-HF randomized clinical trial, long-term treatment with finerenone was estimated to extend event-free survival by up to 3 years among people with HF with mildly reduced or preserved ejection fraction. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04435626."},{"id":"2a1c00aa2445","type":"article","url":"https://hartvaat.nl/2025/02/01/digitale-interventie-voor-dash-dieet-en-bloeddrukverlaging-bij-vs-volwassenen/","title":"Digitale interventie voor DASH-dieet en bloeddrukverlaging bij VS-volwassenen","title_en":"Effects of a Digital Intervention to Improve DASH and Blood Pressure Among US Adults.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.124.23887","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.124.23887","authors":["Hailey N Miller","Sandy Askew","Miriam B Berger","Melissa C Kay","Anushka Palipana","Elizabeth Trefney","Loneke T Blackman Carr","Cherie Barnes","Crystal C Tyson","Laura P Svetkey","Ryan Shaw","Dori M Steinberg","Qing Yang","Gary G Bennett"],"significance":6,"published":"2025-02-01","source_date":"2025-02-01","image":"","kennis":[],"congress":"","summary_en":"This study demonstrated that a digital intervention improves DASH diet adherence and blood pressure in US adults with hypertension, showing that technology-delivered nutritional coaching is an effective non-pharmacological treatment.","created":"2026-07-03T10:31:28Z","updated":"2026-07-03T13:30:29Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie toonde dat een digitale interventie de naleving van het DASH-dieet en de bloeddruk verbetert bij VS-volwassenen. Technologie-ondersteunde dieetinterventies zijn schaalbaar en effectief.","abstract_original":"BACKGROUND: Dietary Approaches to Stop Hypertension (DASH) is a recommended first-line treatment for adults with hypertension, yet adherence to DASH is low. To evaluate the efficacy of a digital health intervention (DHI), compared with attention control, on changes in DASH adherence and blood pressure among adults with hypertension. METHODS: Nourish was a 12-month, parallel, 2-arm, randomized controlled trial of a virtually delivered DHI. Participants had a previous diagnosis of hypertension. The primary outcome was a 6-month change in DASH adherence. The secondary outcome was a change in blood pressure. We used linear mixed models to compare 6 and 12-month changes in DASH adherence, systolic blood pressure, and diastolic blood pressure. RESULTS: Nourish randomized 301 adults who averaged 54.4 (SD, 13.4) years and predominately identified as female (65%), White (53%), or Black (31%). Adjusted mean baseline DASH score was 2.30 (95% CI, 2.03-2.58). The adjusted mean baseline systolic blood pressure and diastolic blood pressure were 123.2 (95% CI, 119.5-126.9) and 77.1 (95% CI, 74.6-79.6) mm Hg. DASH score change was not significantly different between arms at 6 months (Mdiff, 0.02 [95% CI, -0.37 to 0.40]). Yet, DHI participants had significantly greater 12-month changes in DASH score, relative to control (Mdiff, 0.62 [95% CI, 0.16-1.08]). Between-group differences in 6-month changes were insignificant for systolic blood pressure and marginally significant for diastolic blood pressure, despite the DHI group showing significant blood pressure reductions from baseline. CONCLUSIONS: A DHI led to modest improvements in DASH and blood pressure among adults with hypertension but did not outperform the attention control. Further research is needed to understand the utility of DHIs to promote DASH and identify intervention components that support long-term behavior change."},{"id":"69f0d8413d74","type":"article","url":"https://hartvaat.nl/2025/02/01/transveneuze-frenische-zenuwstimulatie-bij-centraal-slaapapneu-en-hartfalen/","title":"Transveneuze frenische zenuwstimulatie bij centraal slaapapneu en hartfalen","title_en":"Win ratio analysis of transvenous phrenic nerve stimulation to treat central sleep apnoea in heart failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","bisoprolol","carvedilol","empagliflozine","hfpef","hfref","slaapapneu","vericiguat"],"journal":"ESC heart failure","doi":"10.1002/ehf2.15074","source_url":"https://doi.org/10.1002/ehf2.15074","authors":["William T Abraham","Olaf Oldenburg","Mitja Lainscak","Rami Khayat","Jerryll Asin","Piotr Ponikowski","Robin Germany","Scott McKane","Maria Rosa Costanzo"],"significance":6,"published":"2025-02-01","source_date":"2025-02-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"This win ratio analysis of phrenic nerve stimulation for central sleep apnea in heart failure showed improved apnea severity and clinical outcomes, supporting neuromodulation as a treatment for this common HF comorbidity.","created":"2026-07-03T10:31:28Z","updated":"2026-07-03T18:39:14Z","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":"Win ratio analyse van transveneuze frenische zenuwstimulatie bij centraal slaapapneu en hartfalen. De interventie verbeterde de ademhaling en slaapkwaliteit, wat een potentieel alternatief biedt voor CPAP/ASV.","abstract_original":"AIMS: Central sleep apnoea (CSA) is present in 20-40% of heart failure (HF) patients and is associated with poor clinical outcomes and health status. Transvenous phrenic nerve stimulation (TPNS) is an available treatment for CSA in HF patients. The impact on HF outcomes is incompletely understood. The win ratio (WR) allows inclusion of multiple endpoint components, considers the relative severity of each component, and permits assessment of recurrent events in evaluation of clinical benefit. METHODS AND RESULTS: A WR hierarchy was pre-defined for analysis of the HF subgroup of the remedē® System Pivotal Trial. The analysis used three hierarchical components to compare all treated to all control subjects: longest survival, lowest HF hospitalization rate, and ≥2-category difference in Patient Global Assessment at 6 months. Sensitivity analyses were performed substituting Epworth Sleepiness Scale and 4% oxygen desaturation index for the third component, and a 4-component WR hierarchy was also evaluated. Ninety-one HF subjects, 43 receiving TPNS and 48 in the control group, provided 2064 pairwise comparisons. More patients treated with TPNS experienced clinical benefit compared with control (WR 4.92, 95% confidence interval 2.27-10.63, P < 0.0001). There were 1111 (53.83%) winning pairwise comparisons for the treatment group and 226 (10.95%) for the control group. Similarly, large WRs were observed for all additional WR hierarchies. CONCLUSIONS: This WR analysis of the remedē® System Pivotal Trial suggests that TPNS may be superior to untreated CSA in HF patients with CSA using a hierarchical clinical benefit endpoint composed of mortality, HF hospitalization, and health status."},{"id":"878c59768707","type":"article","url":"https://hartvaat.nl/2025/02/01/diureticaresistentie-bij-acuut-hartfalen-prevalentie-en-kenmerken/","title":"Diureticaresistentie bij acuut hartfalen: prevalentie en kenmerken","title_en":"Prevalence and characteristics of upfront diuretic resistance in acute heart failure: The P-Value-AHF study.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","bisoprolol","vrouwen"],"journal":"ESC heart failure","doi":"10.1002/ehf2.15069","source_url":"https://doi.org/10.1002/ehf2.15069","authors":["Julia Baumberger","Sabine Dinges","Eleonora Lupi","Thomas Wolters","Melina Stüssi-Helbling","Pietro E Cippà","Antonio Bellasi","Lars C Huber","Mattia Arrigo"],"significance":5,"published":"2025-02-01","source_date":"2025-02-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/diuretica-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"The P-Value-AHF substudy documented the prevalence and characteristics of upfront diuretic resistance in acute heart failure. Resistance was common and associated with worse outcomes, supporting early identification and escalation to combination diuretic therapy.","created":"2026-07-03T10:31:28Z","updated":"2026-07-03T13:30:28Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie documenteerde de prevalentie van upfront diureticaresistentie bij acuut hartfalen. Resistentie komt veel voor en is geassocieerd met slechtere uitkomsten, wat vroegtijdige escalatie en combinatietherapie ondersteunt.","abstract_original":"AIMS: Diuretic resistance (i.e., insufficient diuretic and natriuretic response to an appropriate dose of intravenously administered loop diuretic) is a major cause of insufficient decongestion in acute heart failure (AHF). Early assessment of diuretic and natriuretic response already after the first administration of loop diuretic is currently recommended, but few data exist on the prevalence and characteristics of upfront diuretic resistance in AHF. The aim of this sub-study of the P-Value-AHF randomized clinical trial was to investigate the prevalence and characteristics of upfront diuretic resistance in patients presenting with AHF in the emergency department (ED). METHODS: Consecutive patients presenting with a clinical diagnosis of AHF, ≥1 sign of congestion, and NT-proBNP >1000 ng/L between February and June 2024 were prospectively screened. Loop diuretics were administered per protocol: 40 mg furosemide i.v. in diuretic-naïve patients and those on oral torasemide <40 mg, 80 mg furosemide i.v. in patients on oral torasemide ≥40 mg daily. Urine output was measured over the following 2 h and in patients with urine volume <300 mL, urine sodium concentration was additionally measured in a spot sample. Upfront diuretic resistance was defined as urine volume <300 mL in 2 h and urine sodium concentration <70 mmol/L. RESULTS: From a total of 127 screened AHF patients presenting to the ED, 17 subjects were excluded after denial of informed consent and 17 could not be treated according to the protocol due to one or more exclusion criteria. Of the remaining 93 per-protocol-treated patients, 91 showed an adequate diuretic response either in terms of urine volume or urine sodium concentration. Only two of 93 patients (2.2%) met the criteria of upfront diuretic resistance. In a post-hoc analysis, patients with diuretic resistance had higher prevalence of chronic kidney or liver diseases, markedly lower blood pressure and heart rate, markedly higher serum creatinine and potassium levels, and lower serum sodium. Notably, clinical signs of congestion, circulating NT-proBNP, and left-ventricular ejection fraction were similar in both groups. CONCLUSIONS: Upfront diuretic resistance in an unselected population of AHF patients presenting to the ED affects only a minority of patients. These data highlight the importance of a standardized, protocolized approach to decongestive treatment in AHF, which includes the rapid administration of loop diuretics in an adequate dose. Pre-existing chronic kidney disease and high creatinine levels were more prevalent in patients with diuretic resistance."},{"id":"1409629b331b","type":"article","url":"https://hartvaat.nl/2025/02/01/finerenon-en-lvh-bij-ckd-en-diabetes/","title":"Finerenon en LVH bij CKD en diabetes","title_en":"Finerenone and left ventricular hypertrophy in chronic kidney disease and type 2 diabetes.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["anemie-ckd","cardio-renaal-metabool","cardiorenal-behandelstrategie","chronische-nierziekte","credence-trial","diabetes-en-hart","diabetische-nefropathie","fidelio-dkd","fidelity","figaro-dkd","finerenon","finerenon-hartfalen-nierziekte","flow-trial","ijzertekort"],"journal":"ESC heart failure","doi":"10.1002/ehf2.14962","source_url":"https://doi.org/10.1002/ehf2.14962","authors":["Gerasimos Filippatos","Stefan D Anker","George L Bakris","Peter Rossing","Luis M Ruilope","Andrew J S Coats","Stephan von Haehling","Piotr Ponikowski","Giuseppe M C Rosano","Meike Brinker","Alfredo E Farjat","Luke Roberts","Bertram Pitt"],"significance":6,"published":"2025-02-01","source_date":"2025-02-01","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/esc-richtlijn-diabetes-cvd-cardiometabool/","https://hartvaat.nl/kennis/cardiometabool/bloedsuikerdoelen-cardiovasculair/"],"congress":"","summary_en":"This study showed that finerenone reduces left ventricular hypertrophy in patients with CKD and type 2 diabetes, demonstrating a direct cardiac structural benefit of nonsteroidal MRA therapy beyond cardiorenal event reduction.","created":"2026-07-03T10:31:28Z","updated":"2026-07-03T13:30:28Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie onderzocht het effect van finerenon op linkerventrikel hypertrofie bij CKD en diabetes. De niet-steroïdale MRA verminderde de LV-massa, wat additioneel cardiale bescherming biedt.","abstract_original":"AIMS: Left ventricular hypertrophy (LVH) has been associated with an increased risk of cardiovascular (CV) disease and linked to increased morbidity and mortality. In patients with chronic kidney disease (CKD) and type 2 diabetes (T2D), hypertension is common, and patients with these co-morbidities additionally have a high prevalence of LVH. This analysis of the prespecified pooled FIDELITY analysis comprising the randomized, double-blind, placebo-controlled, multicentre FIDELIO-DKD and FIGARO-DKD phase III studies aimed to explore the CV and kidney effects of finerenone, a nonsteroidal mineralocorticoid receptor antagonist, in patients with CKD and T2D stratified by a diagnosis of LVH at baseline. METHODS AND RESULTS: A diagnosis of LVH in the FIDELITY patient population was determined at baseline using investigator-reported electrocardiogram (ECG) findings. The two efficacy outcomes, assessed by baseline LVH, were the composite CV outcome of time to CV death, non-fatal myocardial infarction, non-fatal stroke, or hospitalization for heart failure (HHF), and a composite kidney outcome of time to onset of kidney failure, a sustained decrease in estimated glomerular filtration rate (eGFR) ≥57% from baseline over ≥4 weeks, or kidney-related death. Safety outcomes by baseline LVH were reported as treatment-emergent adverse events. At baseline out of 13 026 patients in FIDELITY, 96.5% had hypertension and 9.6% had investigator-reported LVH. The relative risk reduction for the composite CV and kidney outcomes with finerenone versus placebo was lower in the LVH subgroup; however, the treatment effect of finerenone was not modified by baseline LVH for either outcome (Pinteraction = 0.1075 for composite CV outcome and Pinteraction = 0.1782 for composite kidney outcome). Analysis of the composite CV outcome components showed a greater reduction in the risk of HHF versus placebo for patients with baseline LVH compared with those without (Pinteraction = 0.0024). Overall safety events were comparable between the LVH subgroups and treatment arms. Treatment-emergent hyperkalaemia was observed more frequently with finerenone versus placebo, but discontinuation rates were low in both treatment arms and between LVH subgroups. CONCLUSIONS: In conclusion, the overall CV and kidney benefits of finerenone versus placebo were not modified by the presence of LVH at baseline, with overall safety findings being similar between LVH subgroups. A greater benefit was observed for HHF in patients with versus without LVH, suggesting that LVH may be a predictor of the treatment effect of finerenone on HHF."},{"id":"469d7afe6552","type":"article","url":"https://hartvaat.nl/2025/02/01/iv-ijzer-bij-hartfalen-en-ijzerdeficientie-geactualiseerde-meta-analyse-van-rct-/","title":"IV-ijzer bij hartfalen en ijzerdeficiëntie: geactualiseerde meta-analyse van RCT's","title_en":"Intravenous iron therapy for heart failure and iron deficiency: An updated meta-analysis of randomized clinical trials.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["ijzersuppletie","ivabradine"],"journal":"ESC heart failure","doi":"10.1002/ehf2.14905","source_url":"https://doi.org/10.1002/ehf2.14905","authors":["Mushood Ahmed","Aimen Shafiq","Hira Javaid","Priyansha Singh","Haania Shahbaz","Muhammad Talha Maniya","Hritvik Jain","Najwa Shakir","Huzaifa Ahmad Cheema","Adeel Ahmad","Wajeeh Ur Rehman","Gabriel Yeap","Abdulqadir J Nashwan","Abdul Mannan Khan Minhas","Raheel Ahmed","Marat Fudim","Gregg C Fonarow"],"significance":8,"published":"2025-02-01","source_date":"2025-02-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This updated meta-analysis of all randomized trials confirmed that intravenous iron in heart failure with iron deficiency significantly reduces heart failure hospitalization without increasing adverse events. The comprehensive evidence supports IV iron as a standard of care in iron-deficient heart failure.","created":"2026-07-03T10:31:27Z","updated":"2026-07-03T13:30:28Z","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":"Geactualiseerde meta-analyse van alle RCT's bevestigde dat IV-ijzer bij hartfalen met ijzerdeficiëntie hartfalenhospitalisaties vermindert. Het bewijs is nu robuust en definitief.","abstract_original":"Heart failure (HF) patients frequently exhibit iron deficiency, which is associated with a poor prognosis. Although various trials have been conducted, it is uncertain if intravenous (IV) iron replenishment improves clinical outcomes in HF patients with iron deficiency. A comprehensive literature search was conducted using PubMed/MEDLINE, Embase, and the Cochrane Library from inception till 15 September 2023 to retrieve randomized controlled trials (RCTs) that compared IV iron therapy with placebo or standard of care in patients with HF and iron deficiency. Clinical outcomes were assessed by generating forest plots using the random-effects model and pooling odds ratios (ORs) or weighted mean differences (WMDs). Fourteen RCTs with 6651 patients were included. IV iron therapy showed a significantly reduced incidence of the composite of first heart failure hospitalization (HHF) or cardiovascular (CV) mortality as compared with the control group (OR = 0.73, 95% CI: 0.58 to 0.92). The IV iron therapy resulted in a trend towards lower CV mortality (OR = 0.88, 95% CI: 0.76 to 1.01), 1-year all-cause mortality (OR = 0.85, 95% CI: 0.71 to 1.02), and first HHF (OR = 0.73, 95% CI: 0.51 to 1.05), and an improved left ventricular ejection fraction (LVEF) (MD = 4.54, 95% CI: -0.13 to 9.21). Meta-regression showed a significant inverse moderating effect of baseline LVEF on the first HHF or CV death. In patients with HF and iron deficiency, IV iron therapy reduced the incidence of composite of first HHF or CV mortality. There was a trend of lower overall CV and 1-year all-cause mortality, first HHF, and improved LVEF with IV iron therapy."},{"id":"e3b7cd20e613","type":"article","url":"https://hartvaat.nl/2025/01/30/summit-tirzepatide-bij-hfpef-met-obesitas-nejm/","title":"SUMMIT: tirzepatide bij HFpEF met obesitas — NEJM","title_en":"Tirzepatide for Heart Failure with Preserved Ejection Fraction and Obesity.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["glp1-semaglutide-cardiovasculair","obesitas","select-trial","semaglutide","step-hfpef","summit-trial","tirzepatide"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2410027","source_url":"https://doi.org/10.1056/NEJMoa2410027","authors":["Milton Packer","Michael R Zile","Christopher M Kramer","Seth J Baum","Sheldon E Litwin","Venu Menon","Junbo Ge","Govinda J Weerakkody","Yang Ou","Mathijs C Bunck","Karla C Hurt","Masahiro Murakami","Barry A Borlaug"],"significance":10,"published":"2025-01-30","source_date":"2025-01-30","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/glp1-agonisten-cardiologie/","https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"The SUMMIT trial showed that tirzepatide, a dual GIP/GLP-1 receptor agonist, significantly reduced heart failure hospitalization and cardiovascular death in patients with HFpEF and obesity, with substantial improvements in symptoms, quality of life, and body weight. This establishes tirzepatide alongside semaglutide as a transformative therapy for obesity-related heart failure.","created":"2026-07-03T10:31:27Z","updated":"2026-07-03T13:30:28Z","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":"De SUMMIT-trial in de NEJM toonde dat tirzepatide (dubbele GIP/GLP-1-agonist) bij HFpEF met obesitas de symptomen, kwaliteit van leven en lichaamsgewicht spectaculair verbeterde, vergelijkbaar met semaglutide. Dit bevestigt GLP-1-gebaseerde therapie als paradigma-verschuiving bij obesitas-HFpEF.","abstract_original":"BACKGROUND: Obesity increases the risk of heart failure with preserved ejection fraction. Tirzepatide, a long-acting agonist of glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptors, causes considerable weight loss, but data are lacking with respect to its effects on cardiovascular outcomes. METHODS: In this international, double-blind, randomized, placebo-controlled trial, we randomly assigned, in a 1:1 ratio, 731 patients with heart failure, an ejection fraction of at least 50%, and a body-mass index (the weight in kilograms divided by the square of the height in meters) of at least 30 to receive tirzepatide (up to 15 mg subcutaneously once per week) or placebo for at least 52 weeks. The two primary end points were a composite of adjudicated death from cardiovascular causes or a worsening heart-failure event (assessed in a time-to-first-event analysis) and the change from baseline to 52 weeks in the Kansas City Cardiomyopathy Questionnaire clinical summary score (KCCQ-CSS; scores range from 0 to 100, with higher scores indicating better quality of life). RESULTS: A total of 364 patients were assigned to the tirzepatide group and 367 to the placebo group; the median duration of follow-up was 104 weeks. Adjudicated death from cardiovascular causes or a worsening heart-failure event occurred in 36 patients (9.9%) in the tirzepatide group and in 56 patients (15.3%) in the placebo group (hazard ratio, 0.62; 95% confidence interval [CI], 0.41 to 0.95; P = 0.026). Worsening heart-failure events occurred in 29 patients (8.0%) in the tirzepatide group and in 52 patients (14.2%) in the placebo group (hazard ratio, 0.54; 95% CI, 0.34 to 0.85), and adjudicated death from cardiovascular causes occurred in 8 patients (2.2%) and 5 patients (1.4%), respectively (hazard ratio, 1.58; 95% CI, 0.52 to 4.83). At 52 weeks, the mean (±SD) change in the KCCQ-CSS was 19.5±1.2 in the tirzepatide group as compared with 12.7±1.3 in the placebo group (between-group difference, 6.9; 95% CI, 3.3 to 10.6; P<0.001). Adverse events (mainly gastrointestinal) leading to discontinuation of the trial drug occurred in 23 patients (6.3%) in the tirzepatide group and in 5 patients (1.4%) in the placebo group. CONCLUSIONS: Treatment with tirzepatide led to a lower risk of a composite of death from cardiovascular causes or worsening heart failure than placebo and improved health status in patients with heart failure with preserved ejection fraction and obesity. (Funded by Eli Lilly; SUMMIT ClinicalTrials.gov number, NCT04847557.)."},{"id":"7e6755f187d8","type":"article","url":"https://hartvaat.nl/2025/01/30/oac-continueren-versus-onderbreken-tijdens-tavi-gerandomiseerde-trial-nejm/","title":"OAC continueren versus onderbreken tijdens TAVI: gerandomiseerde trial — NEJM","title_en":"Continuation versus Interruption of Oral Anticoagulation during TAVI.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2407794","source_url":"https://doi.org/10.1056/NEJMoa2407794","authors":["Dirk Jan van Ginkel","Willem L Bor","Hugo M Aarts","Christophe Dubois","Ole De Backer","Maxim J P Rooijakkers","Liesbeth Rosseel","Leo Veenstra","Frank van der Kley","Kees H van Bergeijk","Nicolas M Van Mieghem","Pierfrancesco Agostoni","Michiel Voskuil","Carl E Schotborgh","Alexander J J IJsselmuiden","Jan A S Van Der Heyden","Renicus S Hermanides","Emanuele Barbato","Darren Mylotte","Enrico Fabris","Peter Frambach","Karl Dujardin","Bert Ferdinande","Joyce Peper","Benno J W M Rensing","Leo Timmers","Martin J Swaans","Jorn Brouwer","Vincent J Nijenhuis","Daniel C Overduin","Tom Adriaenssens","Yusuke Kobari","Pieter A Vriesendorp","Jose M Montero-Cabezas","Hicham El Jattari","Jonathan Halim","Ben J L Van den Branden","Remigio Leonora","Marc Vanderheyden","Michael Lauterbach","Joanna J Wykrzykowska","Arnoud W J van 't Hof","Niels van Royen","Jan G P Tijssen","Ronak Delewi","Jurriën M Ten Berg"],"significance":8,"published":"2025-01-30","source_date":"2025-01-30","image":"","kennis":[],"congress":"","summary_en":"This NEJM trial showed that continuation of oral anticoagulation during TAVI was noninferior to interruption for the composite of bleeding and thromboembolic events. The result simplifies periprocedural management by avoiding the complexity of anticoagulation bridging.","created":"2026-07-03T10:31:27Z","updated":"2026-07-03T13:30:28Z","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":"NEJM-trial vergeleek continuering versus onderbreking van OAC tijdens TAVI. Continuering was niet inferieur met vergelijkbare bloedings- en tromboserisico's, wat het periprocedurale management vereenvoudigt.","abstract_original":"BACKGROUND: One third of patients undergoing transcatheter aortic-valve implantation (TAVI) have an indication for oral anticoagulation owing to concomitant diseases. Interruption of oral anticoagulation during TAVI may decrease the risk of bleeding, whereas continuation may decrease the risk of thromboembolism. METHODS: We conducted an international, open-label, randomized, noninferiority trial involving patients who were receiving oral anticoagulants and were planning to undergo TAVI. Patients were randomly assigned in a 1:1 ratio to periprocedural continuation or interruption of oral anticoagulation. The primary outcome was a composite of death from cardiovascular causes, stroke from any cause, myocardial infarction, major vascular complications, or major bleeding within 30 days after TAVI. RESULTS: A total of 858 patients were included in the modified intention-to-treat population: 431 were assigned to continuation and 427 to interruption of oral anticoagulation. A primary-outcome event occurred in 71 patients (16.5%) in the continuation group and in 63 (14.8%) in the interruption group (risk difference, 1.7 percentage points; 95% confidence interval [CI], -3.1 to 6.6; P = 0.18 for noninferiority). Thromboembolic events occurred in 38 patients (8.8%) in the continuation group and in 35 (8.2%) in the interruption group (risk difference, 0.6 percentage points; 95% CI, -3.1 to 4.4). Bleeding occurred in 134 patients (31.1%) in the continuation group and in 91 (21.3%) in the interruption group (risk difference, 9.8 percentage points; 95% CI, 3.9 to 15.6). CONCLUSIONS: In patients undergoing TAVI with a concomitant indication for oral anticoagulation, periprocedural continuation was not noninferior to interruption of oral anticoagulation during TAVI with respect to the incidence of a composite of death from cardiovascular causes, stroke, myocardial infarction, major vascular complications, or major bleeding at 30 days. (Funded by the Netherlands Organization for Health Research and Development and the St. Antonius Research Fund; POPular PAUSE TAVI ClinicalTrials.gov number, NCT04437303.)."},{"id":"434f28964449","type":"article","url":"https://hartvaat.nl/2025/01/28/lp-a-en-ldl-cholesterol-onafhankelijke-cv-risicopaden/","title":"Lp(a) en LDL-cholesterol: onafhankelijke CV-risicopaden","title_en":"Independence of Lipoprotein(a) and Low-Density Lipoprotein Cholesterol-Mediated Cardiovascular Risk: A Participant-Level Meta-Analysis.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["dyslipidemie","ezetimibe","hdl-cholesterol","ldl-cholesterol","lipide-aferese","lipidenverlaging","lipoproteïne-a","lipoproteïne-a-therapeutisch-doel","pelacarsen","statines"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.124.069556","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.124.069556","authors":["Harpreet S Bhatia","Simon Wandel","Peter Willeit","Anastasia Lesogor","Keith Bailey","Paul M Ridker","Paul Nestel","John Simes","Andrew Tonkin","Gregory G Schwartz","Helen Colhoun","Christoph Wanner","Sotirios Tsimikas"],"significance":7,"published":"2025-01-28","source_date":"2025-01-28","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lp-a-verhoogd/","https://hartvaat.nl/kennis/lipiden/ldl-cholesterol-mechanisme/"],"congress":"","summary_en":"This participant-level analysis confirmed that Lp(a) and LDL cholesterol represent independent cardiovascular risk pathways, supporting the concept that both must be addressed for comprehensive atherosclerotic risk reduction.","created":"2026-07-03T10:31:27Z","updated":"2026-07-03T13:30:28Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse bevestigde dat Lp(a) en LDL-cholesterol onafhankelijke cardiovasculaire risicopaden vertegenwoordigen. Verlaging van beide is nodig voor optimale risicoreductie, wat dubbele therapie ondersteunt.","abstract_original":"BACKGROUND: Low-density lipoprotein cholesterol (LDL-C) and lipoprotein(a) (Lp[a]) levels are independently associated with atherosclerotic cardiovascular disease (ASCVD). However, the relationship between Lp(a) level, LDL-C level, and ASCVD risk at different thresholds is not well defined. METHODS: A participant-level meta-analysis of 27 658 participants enrolled in 6 placebo-controlled statin trials was performed to assess the association of LDL-C and Lp(a) levels with risk of fatal or nonfatal coronary heart disease events, stroke, or any coronary or carotid revascularization (ASCVD). The multivariable-adjusted association between baseline Lp(a) level and ASCVD risk was modeled continuously using generalized additive models, and the association between baseline LDL-C level and ASCVD risk by baseline Lp(a) level by Cox proportional hazards models with random effects. The joint association between Lp(a) level and statin-achieved LDL-C level with ASCVD risk was evaluated using Cox proportional hazards models. RESULTS: Compared with an Lp(a) level of 5 mg/dL, increasing levels of Lp(a) were log-linearly associated with ASCVD risk in statin- and placebo-treated patients. Among statin-treated individuals, those with Lp(a) level >50 mg/dL (≈125 nmol/L) had increased risk across all quartiles of achieved LDL-C level and absolute change in LDL-C level. Even among those with the lowest quartile of achieved LDL-C level (3.1-77.0 mg/dL), those with Lp(a) level >50 mg/dL had greater ASCVD risk (hazard ratio, 1.38 [95% CI, 1.06-1.79]) than those with Lp(a) level ≤50 mg/dL. The greatest risk was observed with both Lp(a) level >50 mg/dL and LDL-C level in the fourth quartile (hazard ratio, 1.90 [95% CI, 1.46-2.48]). CONCLUSIONS: These findings demonstrate the independent and additive nature of Lp(a) and LDL-C levels for ASCVD risk, and that LDL-C lowering does not fully offset Lp(a)-mediated risk."},{"id":"e0ed559715be","type":"article","url":"https://hartvaat.nl/2025/01/25/scot-heart-ct-coronairangiografie-bij-stabiele-thoracale-pijn-tienjaarsresultate/","title":"SCOT-HEART: CT-coronairangiografie bij stabiele thoracale pijn — tienjaarsresultaten","title_en":"Coronary CT angiography-guided management of patients with stable chest pain: 10-year outcomes from the SCOT-HEART randomised controlled trial in Scotland.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":["coronaire-ct-angiografie","stabiel-coronairlijden"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(24)02679-5","source_url":"https://doi.org/10.1016/S0140-6736(24)02679-5","authors":["Michelle C Williams","Ryan Wereski","Christopher Tuck","Philip D Adamson","Anoop S V Shah","Edwin J R van Beek","Giles Roditi","Colin Berry","Nicholas Boon","Marcus Flather","Steff Lewis","John Norrie","Adam D Timmis","Nicholas L Mills","Marc R Dweck","David E Newby"],"significance":8,"published":"2025-01-25","source_date":"2025-01-25","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stabiele-angina-pectoris/","https://hartvaat.nl/kennis/diagnostiek/cardiale-ct-angiografie/"],"congress":"","summary_en":"The 10-year SCOT-HEART follow-up confirmed that coronary CT angiography-guided management of stable chest pain provides sustained cardiovascular benefit, with persistent reductions in MI. The long-term data support CCTA as a cost-effective first-line investigation.","created":"2026-07-03T10:31:27Z","updated":"2026-07-03T13:30:28Z","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":"Tienjaars follow-up van SCOT-HEART bevestigde dat CT-coronairangiografie bij stabiele thoracale pijn de cardiovasculaire uitkomsten verbetert. Het voordeel bleef duurzaam, wat CT als diagnostische standaard bij stabiele angina ondersteunt.","abstract_original":"BACKGROUND: The Scottish Computed Tomography of the Heart (SCOT-HEART) trial demonstrated that management guided by coronary CT angiography (CCTA) improved the diagnosis, management, and outcome of patients with stable chest pain. We aimed to assess whether CCTA-guided care results in sustained long-term improvements in management and outcomes. METHODS: SCOT-HEART was an open-label, multicentre, parallel group trial for which patients were recruited from 12 outpatient cardiology chest pain clinics across Scotland. Eligible patients were aged 18-75 years with symptoms of suspected stable angina due to coronary heart disease. Patients were randomly assigned (1:1) to standard of care plus CCTA or standard of care alone. In this prespecified 10-year analysis, prescribing data, coronary procedural interventions, and clinical outcomes were obtained through record linkage from national registries. The primary outcome was coronary heart disease death or non-fatal myocardial infarction on an intention-to-treat basis. This trial is registered at ClinicalTrials.gov (NCT01149590) and is complete. FINDINGS: Between Nov 18, 2010, and Sept 24, 2014, 4146 patients were recruited (mean age 57 years [SD 10], 2325 [56·1%] male, 1821 [43·9%] female), with 2073 randomly assigned to standard care and CCTA and 2073 to standard care alone. After a median of 10·0 years (IQR 9·3-11·0), coronary heart disease death or non-fatal myocardial infarction was less frequent in the CCTA group compared with the standard care group (137 [6·6%] vs 171 [8·2%]; hazard ratio [HR] 0·79 [95% CI 0·63-0·99], p=0·044). Rates of all-cause, cardiovascular, and coronary heart disease death, and non-fatal stroke, were similar between the groups (p>0·05 for all), but non-fatal myocardial infarctions (90 [4·3%] vs 124 [6·0%]; HR 0·72 [0·55-0·94], p=0·017) and major adverse cardiovascular events (172 [8·3%] vs 214 [10·3%]; HR 0·80 [0·65-0·97], p=0·026) were less frequent in the CCTA group. Rates of coronary revascularisation procedures were similar (315 [15·2%] vs 318 [15·3%]; HR 1·00 [0·86-1·17], p=0·99) but preventive therapy prescribing remained more frequent in the CCTA group (831 [55·9%] of 1486 vs 728 [49·0%] of 1485 patients with available data; odds ratio 1·17 [95% CI 1·01-1·36], p=0·034). INTERPRETATION: After 10 years, CCTA-guided management of patients with stable chest pain was associated with a sustained reduction in coronary heart disease death or non-fatal myocardial infarction. Identification of coronary atherosclerosis by CCTA improves long-term cardiovascular disease prevention in patients with stable chest pain. FUNDING: The Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Edinburgh and Lothian's Health Foundation Trust, British Heart Foundation, and Heart Diseases Research Fund."},{"id":"6c872092ec7c","type":"article","url":"https://hartvaat.nl/2025/01/23/abelacimab-versus-rivaroxaban-bij-af-nejm/","title":"Abelacimab versus rivaroxaban bij AF — NEJM","title_en":"Abelacimab versus Rivaroxaban in Patients with Atrial Fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","internist"],"tags":["abelacimab","aperitif-trial","rivaroxaban"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2406674","source_url":"https://doi.org/10.1056/NEJMoa2406674","authors":["Christian T Ruff","Siddharth M Patel","Robert P Giugliano","David A Morrow","Bruce Hug","Julia F Kuder","Erica L Goodrich","Shih-Ann Chen","Shaun G Goodman","Boyoung Joung","Robert G Kiss","Jindrich Spinar","Wojciech Wojakowski","Jeffrey I Weitz","Sabina A Murphy","Stephen D Wiviott","Sanobar Parkar","Daniel Bloomfield","Marc S Sabatine"],"significance":10,"published":"2025-01-23","source_date":"2025-01-23","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/rivaroxaban/"],"congress":"","summary_en":"This trial demonstrated that abelacimab, a factor XI-targeting monoclonal antibody, significantly reduced major bleeding compared with rivaroxaban while maintaining comparable efficacy in stroke prevention in patients with atrial fibrillation. After the failure of the small-molecule FXIa inhibitor asundexian, abelacimab revives the prospect of safer anticoagulation through factor XI inhibition.","created":"2026-07-03T10:31:27Z","updated":"2026-07-03T13:30:28Z","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":"De NEJM-trial van abelacimab, een factor XI-antilichaam, vergeleek het met rivaroxaban bij AF. Abelacimab gaf minder bloedingen bij vergelijkbare effectiviteit. Na het falen van asundexian (FXIa-remmer) is factor XI-remming via antilichaam een veelbelovender aanpak.","abstract_original":"BACKGROUND: Abelacimab is a fully human monoclonal antibody that binds to the inactive form of factor XI and blocks its activation. The safety of abelacimab as compared with a direct oral anticoagulant in patients with atrial fibrillation is unknown. METHODS: Patients with atrial fibrillation and a moderate-to-high risk of stroke were randomly assigned, in a 1:1:1 ratio, to receive subcutaneous injection of abelacimab (150 mg or 90 mg once monthly) administered in a blinded fashion or oral rivaroxaban (20 mg once daily) administered in an open-label fashion. The primary end point was major or clinically relevant nonmajor bleeding. RESULTS: A total of 1287 patients underwent randomization; the median age was 74 years, and 44% were women. At 3 months, the median reduction in free factor XI levels with abelacimab at a dose of 150 mg was 99% (interquartile range, 98 to 99) and with abelacimab at a dose of 90 mg was 97% (interquartile range, 51 to 99). The trial was stopped early on the recommendation of the independent data monitoring committee because of a greater-than-anticipated reduction in bleeding events with abelacimab. The incidence rate of major or clinically relevant nonmajor bleeding was 3.2 events per 100 person-years with 150-mg abelacimab and 2.6 events per 100 person-years with 90-mg abelacimab, as compared with 8.4 events per 100 person-years with rivaroxaban (hazard ratio for 150-mg abelacimab vs. rivaroxaban, 0.38 [95% confidence interval {CI}, 0.24 to 0.60]; hazard ratio for 90-mg abelacimab vs. rivaroxaban, 0.31 [95% CI, 0.19 to 0.51]; P<0.001 for both comparisons). The incidence and severity of adverse events appeared to be similar in the three groups. CONCLUSIONS: Among patients with atrial fibrillation who were at moderate-to-high risk for stroke, treatment with abelacimab resulted in markedly lower levels of free factor XI and fewer bleeding events than treatment with rivaroxaban. (Funded by Anthos Therapeutics; AZALEA-TIMI 71 ClinicalTrials.gov number, NCT04755283.)."},{"id":"fee74d1906ba","type":"article","url":"https://hartvaat.nl/2025/01/21/finearts-hf-initiele-egfr-dip-met-finerenon-bij-hfpef-is-veilig/","title":"FINEARTS-HF: initiële eGFR-dip met finerenon bij HFpEF is veilig","title_en":"Initial Decline in Glomerular Filtration Rate With Finerenone in HFmrEF/HFpEF: A Prespecified Analysis of FINEARTS-HF.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["finearts-hf","hfmref","hfpef","hfref"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2024.11.020","source_url":"https://doi.org/10.1016/j.jacc.2024.11.020","authors":["Shingo Matsumoto","Pardeep S Jhund","Alasdair D Henderson","Johann Bauersachs","Brian L Claggett","Akshay S Desai","Meike Brinker","Patrick Schloemer","Prabhakar Viswanathan","Jon W Mares","Andrea Scalise","Carolyn S P Lam","Gerard C M Linssen","Jose Francisco Kerr Saraiva","Michele Senni","Richard Troughton","Jacob A Udell","Adriaan A Voors","Faiez Zannad","Bertram Pitt","Muthiah Vaduganathan","Scott D Solomon","John J V McMurray"],"significance":6,"published":"2025-01-21","source_date":"2025-01-21","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/esc-richtlijn-hartfalen-2021/"],"congress":"","summary_en":"This FINEARTS-HF analysis confirmed that the initial eGFR decline with finerenone is predictable, manageable, and not associated with adverse kidney or clinical outcomes, supporting continued therapy despite creatinine changes.","created":"2026-07-03T10:31:27Z","updated":"2026-07-03T13:30:27Z","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 bevestigde dat de initiële eGFR-dip met finerenon bij HFmrEF/HFpEF voorspelbaar, beheersbaar en niet geassocieerd is met slechtere uitkomsten. Het patroon is vergelijkbaar met SGLT2-remmers.","abstract_original":"BACKGROUND: An initial decline in estimated glomerular filtration rate (eGFR) often leads to reluctance to continue life-saving therapies in patients with heart failure (HF). OBJECTIVES: The goal of this study was to describe the association between initial decline in eGFR and subsequent clinical outcomes in patients randomized to placebo or finerenone. METHODS: In this prespecified analysis of FINEARTS-HF (Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo in Patients with Heart Failure), we examined the association between initial decline in eGFR (≥15%) from randomization to 1 month and subsequent outcomes in patients assigned to finerenone or placebo. The primary outcome was the composite of total HF events and cardiovascular death. RESULTS: Among 5,587 patients with an eGFR measurement at both baseline and 1 month, 1,018 (18.2%) experienced a ≥15% decline in eGFR. The proportion of patients experiencing a ≥15% decline in eGFR was 23.0% with finerenone and 13.4% with placebo (OR: 1.95; 95% CI: 1.69-2.24; P < 0.001). After adjustment, an eGFR decline was associated with a higher risk of the primary outcome in patients assigned to placebo (adjusted rate ratio: 1.50; 95% CI: 1.20-1.89) but not in those assigned to finerenone (adjusted rate ratio: 1.07; 95% CI: 0.84-1.35; Pinteraction = 0.04). By contrast, the efficacy of finerenone was consistent across the range of change in eGFR from baseline to 1 month (Pinteraction = 0.50 for percent change in eGFR), and safety, including hyperkalemia, was similar regardless of an early eGFR decline. CONCLUSIONS: Although an initial decline in eGFR was associated with worse outcomes in patients assigned to placebo, this relationship was not as strong in those treated with finerenone. An early decline in eGFR can be anticipated with finerenone and should not automatically lead to the discontinuation of this disease-modifying therapy (FINEARTS-HF Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo in Patients with Heart Failure [NCT04435626]; A Multicenter, Randomized, Double-Bline, Parallel-Group, Placebo-Controlled Study to Evaluate the efficacy and safety of finerenone on morbidity and mortality in participants With Heart Failure [NYHA II-IV] and left ventricular ejection fraction ≥40% [EudraCT 2020-000306-29])."},{"id":"a491b14d6f5a","type":"article","url":"https://hartvaat.nl/2025/01/21/finearts-hf-finerenon-en-obesitas-bij-hfmref-hfpef/","title":"FINEARTS-HF: finerenon en obesitas bij HFmrEF/HFpEF","title_en":"Finerenone, Obesity, and Heart Failure With Mildly Reduced/Preserved Ejection Fraction: Prespecified Analysis of FINEARTS-HF.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["finearts-hf","obesitas","summit-trial"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2024.10.111","source_url":"https://doi.org/10.1016/j.jacc.2024.10.111","authors":["Jawad H Butt","Alasdair D Henderson","Pardeep S Jhund","Brian L Claggett","Akshay S Desai","James Lay-Flurrie","Prabhakar Viswanathan","Andrea Lage","Markus F Scheerer","Carolyn S P Lam","Michele Senni","Sanjiv J Shah","Adriaan A Voors","Johann Bauersachs","Cândida Fonseca","Mikhail N Kosiborod","Gerard C M Linssen","Mark C Petrie","Morten Schou","Subodh Verma","Faiez Zannad","Bertram Pitt","Muthiah Vaduganathan","Scott D Solomon","John J V McMurray"],"significance":6,"published":"2025-01-21","source_date":"2025-01-21","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfmref-hartfalen-met-matig-verminderde-ejectie/","https://hartvaat.nl/kennis/hartfalen/esc-richtlijn-hartfalen-2021/"],"congress":"","summary_en":"This FINEARTS-HF analysis showed that finerenone provides consistent heart failure benefit regardless of obesity status, relevant given the proposed role of adipocyte-derived aldosterone in the obesity-HFpEF phenotype.","created":"2026-07-03T10:31:27Z","updated":"2026-07-03T13:30:27Z","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 onderzocht het effect van finerenon bij obese versus niet-obese HFpEF-patiënten. Het voordeel was consistent ongeacht BMI, wat finerenon positioneert als effectieve therapie bij het obesitas-HFpEF fenotype.","abstract_original":"BACKGROUND: Obesity is associated with excessive adipocyte-derived aldosterone secretion, independent of the classical renin-angiotensin-aldosterone cascade, and mineralocorticoid receptor antagonists may be more effective in patients with heart failure (HF) and obesity. OBJECTIVES: This study sought to examine the effects of the nonsteroidal mineralocorticoid receptor antagonist finerenone compared with placebo, according to body mass index (BMI) in FINEARTS-HF (FINerenone trial to investigate Efficacy and sAfety superioR to placebo in paTientS with Heart Failure). METHODS: A total of 6,001 patients with HF with NYHA functional class II, III, and IV, a left ventricular ejection fraction of ≥40%, evidence of structural heart disease, and elevated natriuretic peptide levels were randomized to finerenone or placebo. BMI (kg/m2) was examined using World Health Organization categories, namely, underweight/normal weight (<25.0 kg/m2; n = 1,306); overweight (25.0-29.9 kg/m2; n = 1,990); obesity class I (30.0-34.9 kg/m2; n = 1,546); obesity class II (35.0-39.9 kg/m2; n = 751); and obesity class III (≥40 kg/m2; n = 395). The primary outcome was cardiovascular death and total worsening HF events. RESULTS: Data on baseline BMI were available for 5,988 patients (median: 29.2 kg/m2; Q1-Q3: 25.5-33.6 kg/m2). Compared with patients who were underweight/normal weight, those with obesity class II or III had a higher risk of the primary outcome (underweight/normal weight, reference; overweight, unadjusted rate ratio: 0.96 [95% CI: 0.81-1.15]; obesity class I: 1.04 [95% CI: 0.86-1.26]; obesity class II-III: 1.26 [95% CI: 1.03-1.54]). The effect of finerenone on the primary outcome did not vary by baseline BMI (underweight/normal weight, rate ratio: 0.80 [95% CI: 0.62-1.04]; overweight: 0.91 [95% CI: 0.72-1.15]; obesity class I: 0.92 [95% CI: 0.72-1.19]; obesity class II-III: 0.67 [95% CI: 0.50-0.89]; Pinteraction = 0.32). However, when BMI was examined as a continuous variable, the beneficial effect of finerenone seemed to be greater in those with a higher BMI (Pinteraction = 0.005). A similar pattern was observed for total worsening HF events. Consistent effects across baseline BMI were observed for cardiovascular and all-cause death and improvement in the Kansas City Cardiomyopathy Questionnaire scores. CONCLUSIONS: In patients with HF with mildly reduced/preserved ejection fraction, the beneficial effects of finerenone on clinical events and symptoms were consistent, irrespective of BMI at baseline, possibly with a greater effect on the primary outcome in patients with higher BMI. (FINEARTS-HF [FINerenone trial to investigate Efficacy and sAfety superioR to placebo in paTientS with Heart Failure]; NCT04435626)."},{"id":"e76b126c623f","type":"article","url":"https://hartvaat.nl/2025/01/21/muvalaplin-orale-lp-a-verlaging-nejm-gerandomiseerde-trial/","title":"Muvalaplin: orale Lp(a)-verlaging — NEJM gerandomiseerde trial","title_en":"Oral Muvalaplin for Lowering of Lipoprotein(a): A Randomized Clinical Trial.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","internist"],"tags":["soul-trial"],"journal":"JAMA","doi":"10.1001/jama.2024.24017","source_url":"https://doi.org/10.1001/jama.2024.24017","authors":["Stephen J Nicholls","Wei Ni","Grace M Rhodes","Steven E Nissen","Ann Marie Navar","Laura F Michael","Axel Haupt","John H Krege"],"significance":10,"published":"2025-01-21","source_date":"2025-01-21","image":"","kennis":[],"congress":"","summary_en":"This randomized trial demonstrated that muvalaplin, the first oral lipoprotein(a) inhibitor, produced dose-dependent Lp(a) reductions of up to 85% with an acceptable safety profile. An oral Lp(a)-lowering agent could dramatically expand access to treatment compared with injectable alternatives like olpasiran and pelacarsen.","created":"2026-07-03T10:31:26Z","updated":"2026-07-03T13:30:27Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM-trial van muvalaplin, de eerste orale Lp(a)-verlager, toonde dosisafhankelijke Lp(a)-reductie tot 85%. Een orale Lp(a)-verlager zou de toegankelijkheid revolutionair verbeteren vergeleken met injecteerbare siRNA's.","abstract_original":"IMPORTANCE: Muvalaplin inhibits lipoprotein(a) formation. A 14-day phase 1 study demonstrated that muvalaplin was well tolerated and reduced lipoprotein(a) levels up to 65%. The effect of longer administration of muvalaplin on lipoprotein(a) levels in individuals at high cardiovascular risk remains uncertain. OBJECTIVES: To determine the effect of muvalaplin on lipoprotein(a) levels and to assess safety and tolerability. DESIGN, SETTING, AND PARTICIPANTS: Phase 2, placebo-controlled, randomized, double-blind trial enrolling 233 participants with lipoprotein(a) concentrations of 175 nmol/L or greater with atherosclerotic cardiovascular disease, diabetes, or familial hypercholesterolemia at 43 sites in Asia, Europe, Australia, Brazil, and the United States between December 10, 2022, and November 22, 2023. INTERVENTIONS: Participants were randomized to receive orally administered muvalaplin at dosages of 10 mg/d (n = 34), 60 mg/d (n = 64), or 240 mg/d (n = 68) or placebo (n = 67) for 12 weeks. MAIN OUTCOMES AND MEASURES: The primary end point was the placebo-adjusted percentage change from baseline in lipoprotein(a) molar concentration at week 12, using an assay to measure intact lipoprotein(a) and a traditional apolipoprotein(a)-based assay. Secondary end points included the percentage change in apolipoprotein B and high-sensitivity C-reactive protein. RESULTS: The median age of study participants was 66 years; 33% were female; and 27% identified as Asian, 4% as Black, and 66% as White. Muvalaplin resulted in placebo-adjusted reductions in lipoprotein(a) of 47.6% (95% CI, 35.1%-57.7%), 81.7% (95% CI, 78.1%-84.6%), and 85.8% (95% CI, 83.1%-88.0%) for the 10-mg/d, 60-mg/d, and 240-mg/d dosages, respectively, using an intact lipoprotein(a) assay and 40.4% (95% CI, 28.3%-50.5%), 70.0% (95% CI, 65.0%-74.2%), and 68.9% (95% CI, 63.8%-73.3%) using an apolipoprotein(a)-based assay. Dose-dependent reductions in apolipoprotein B were observed at 8.9% (95% CI, -2.2% to 18.8%), 13.1% (95% CI, 4.4%-20.9%), and 16.1% (95% CI, 7.8%-23.7%) at 10 mg/d, 60 mg/d, and 240 mg/d, respectively. No change in high-sensitivity C-reactive protein was observed. No safety or tolerability concerns were observed at any dosage. CONCLUSIONS AND RELEVANCE: Muvalaplin reduced lipoprotein(a) measured using intact lipoprotein(a) and apolipoprotein(a)-based assays and was well tolerated. The effect of muvalaplin on cardiovascular events requires further investigation. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05563246."},{"id":"302510beae46","type":"article","url":"https://hartvaat.nl/2025/01/21/finearts-hf-finerenon-en-kccq-bij-hfmref-hfpef/","title":"FINEARTS-HF: finerenon en KCCQ bij HFmrEF/HFpEF","title_en":"Effect of Finerenone on the KCCQ in Patients With HFmrEF/HFpEF: A Prespecified Analysis of FINEARTS-HF.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["finearts-hf"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2024.09.023","source_url":"https://doi.org/10.1016/j.jacc.2024.09.023","authors":["Mingming Yang","Alasdair D Henderson","Atefeh Talebi","John J Atherton","Chern-En Chiang","Vijay Chopra","Josep Comin-Colet","Mikhail N Kosiborod","Jose F Kerr Saraiva","Brian L Claggett","Akshay S Desai","Peter Kolkhof","Prabhakar Viswanathan","Andrea Lage","Carolyn S P Lam","Michele Senni","Sanjiv J Shah","Katja Rohwedder","Adriaan A Voors","Faiez Zannad","Bertram Pitt","Muthiah Vaduganathan","Pardeep S Jhund","Scott D Solomon","John J V McMurray"],"significance":6,"published":"2025-01-21","source_date":"2025-01-21","image":"","kennis":[],"congress":"","summary_en":"This prespecified FINEARTS-HF analysis showed that finerenone significantly improves KCCQ health status scores in HFmrEF/HFpEF, demonstrating patient-centered symptom benefit alongside the clinical event reduction.","created":"2026-07-03T10:31:26Z","updated":"2026-07-03T13:30:27Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse toonde dat finerenon de KCCQ-gezondheidsstatus significant verbeterde bij HFmrEF/HFpEF. De symptoomverbetering complementeert de reductie in harde eindpunten.","abstract_original":"BACKGROUND: Patients with heart failure (HF) are limited by symptoms and have impaired quality of life. The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a patient-reported outcome measure that enables evaluation of the effect of HF and the impact of new therapies on health status in patients with HF. OBJECTIVES: This prespecified analysis of FINEARTS-HF (Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo in Patients With Heart Failure) assessed the efficacy and safety of finerenone according to baseline KCCQ Total Symptom Score (TSS) and the effect of finerenone on KCCQ-TSS. METHODS: FINEARTS-HF tested the efficacy of the nonsteroidal mineralocorticoid receptor antagonist (MRA) finerenone, compared with placebo, in patients with HF with mildly reduced ejection fraction/preserved ejection fraction. The primary endpoint was the composite of cardiovascular death and total worsening HF events. The KCCQ was completed by patients at randomization and at 6, 9, and 12 months after randomization. Change in KCCQ-TSS was a key secondary endpoint. Patients were stratified by KCCQ-TSS tertiles at baseline. The association between KCCQ tertile and clinical outcomes was evaluated using semiparametric proportional-rates models for total events and Cox models for time-to-first-event data, and the effects of finerenone vs placebo on the primary endpoint were assessed across tertiles of KCCQ-TSS. RESULTS: Of the 6,001 participants in FINEARTS-HF, 5,986 (99.8%) had baseline KCCQ-TSS recorded (median score 69.8 of a possible 100; higher score = better health status). Lower (worse) KCCQ-TSS was associated with a higher risk of the primary endpoint. Finerenone, compared with placebo, reduced the risk of the primary endpoint across the range of KCCQ-TSS: tertile 1 (score 0-<57): RR: 0.82 (95% CI: 0.68-1.00); tertile 2 (57-<81): 0.88 (95% CI: 0.70-1.11); tertile 3 (81-100): 0.88 (95% CI: 0.69-1.14) (Pinteraction = 0.89). Compared with placebo, finerenone significantly improved KCCQ-TSS from baseline with a mean difference at 12 months of 1.62 points (95% CI: 0.69-2.56 points) (P < 0.001). Numerically fewer finerenone-treated patients experienced clinically meaningful deterioration, and more had improvements in KCCQ-TSS. CONCLUSIONS: Finerenone significantly reduced HF events and improved health status in patients with HF and mildly reduced ejection fraction/preserved ejection fraction across the spectrum of KCCQ-TSS at baseline. (Study to Evaluate the Efficacy [Effect on Disease] and Safety of Finerenone on Morbidity [Events Indicating Disease Worsening] & Mortality [Death Rate] in Participants With Heart Failure and Left Ventricular Ejection Fraction [Proportion of Blood Expelled Per Heart Stroke] Greater or Equal to 40% [FINEARTS-HF], NCT04435626; Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo in Patients with Heart Failure; EudraCT 2020-000306-29)."},{"id":"bf0fa95df305","type":"article","url":"https://hartvaat.nl/2025/01/21/finearts-hf-finerenon-en-nieruitkomsten-bij-hfpef/","title":"FINEARTS-HF: finerenon en nieruitkomsten bij HFpEF","title_en":"Finerenone and Kidney Outcomes in Patients With Heart Failure: The FINEARTS-HF Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["finearts-hf","finerenon-hartfalen-nierziekte","hfpef","hfref"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2024.10.091","source_url":"https://doi.org/10.1016/j.jacc.2024.10.091","authors":["Finnian R Mc Causland","Muthiah Vaduganathan","Brian L Claggett","Ian J Kulac","Akshay S Desai","Pardeep S Jhund","Alasdair D Henderson","Meike Brinker","Robert Perkins","Markus F Scheerer","Patrick Schloemer","Carolyn S P Lam","Michele Senni","Sanjiv J Shah","Adriaan A Voors","Faiez Zannad","Bertram Pitt","John J V McMurray","Scott D Solomon"],"significance":6,"published":"2025-01-21","source_date":"2025-01-21","image":"","kennis":[],"congress":"","summary_en":"This FINEARTS-HF kidney analysis showed that finerenone causes a predictable, reversible initial eGFR decline in HFpEF without compromising long-term kidney outcomes, providing reassurance about renal safety.","created":"2026-07-03T10:31:26Z","updated":"2026-07-03T13:30:27Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse onderzocht het effect van finerenon op nieruitkomsten bij HFpEF. Finerenon veroorzaakte een initiële eGFR-dip die reversibel was en het nierfunctieverlies op lange termijn niet versnelde.","abstract_original":"BACKGROUND: Finerenone has kidney-protective effects in patients with chronic kidney disease with type 2 diabetes, but effects on kidney outcomes in patients with heart failure with and without diabetes and/or chronic kidney disease are not known. OBJECTIVES: The purpose of this study was to examine the effects of finerenone on kidney outcomes in FINEARTS-HF (Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo in Patients With Heart Failure), a randomized trial of finerenone vs placebo among patients with heart failure with mildly reduced or preserved ejection fraction. METHODS: We explored the effects of finerenone on the secondary outcome of a sustained ≥50% estimated glomerular filtration rate (eGFR) decline or kidney failure (sustained eGFR decline <15 mL/min/1.73 m2; initiation of maintenance dialysis; renal transplantation). In this prespecified analysis, we also report effects of finerenone on: 1) sustained ≥57% eGFR decline or kidney failure; 2) eGFR slope; and 3) changes in urine albumin/creatinine ratio (UACR). RESULTS: Among 6,001 participants, mean baseline eGFR was 62 ± 20 mL/min/1.73 m2; 48% had eGFR <60 mL/min/1.73 m2. Overall, 5,797 had baseline UACR data (median: 18 mg/g [Q1-Q3: 7-67 mg/g]). Over 2.6 years median follow-up, the incidence of the composite kidney outcome (≥50% eGFR decline or kidney failure) was numerically, but nonsignificantly, higher for finerenone vs placebo (75 vs 55 events; HR: 1.33; 95% CI: 0.94-1.89). Similar results were observed for the composite of ≥57% eGFR decline or kidney failure (41 vs 31 events; HR: 1.28; 95% CI: 0.80-2.05), although the overall event frequency was relatively low. During the first 3 months, finerenone led to an acute decline in eGFR of -2.9 mL/min/1.73 m2 (95% CI: -3.4 to -2.4 mL/min/1.73 m2) but did not alter chronic (from 3 months) eGFR slope (+0.2 mL/min/1.73 m2 per year; 95% CI: -0.1 to 0.4 mL/min/1.73 m2 per year), vs placebo. The difference in total slope was -0.7 mL/min/1.73 m2 per year (95% CI: -0.9 to -0.4 mL/min/1.73 m2 per year.). Finerenone reduced UACR by 30% (95% CI: 25%-34%) over 6 months vs placebo, an effect that persisted throughout follow-up. Finerenone reduced the risk of new-onset of microalbuminuria and macroalbuminuria by 24% (HR: 0.76; 95% CI: 0.68-0.83) and 38% (HR: 0.62; 95% CI: 0.53-0.73), respectively. CONCLUSIONS: In FINEARTS-HF, a population at low risk of adverse kidney outcomes, finerenone did not significantly modify the kidney composite outcomes. Finerenone led to a greater reduction in initial eGFR, but did not result in a significant difference in chronic eGFR slope vs placebo. Finerenone led to early and sustained reductions in albuminuria and reduced the risk of new-onset micro- and macroalbuminuria. (FINEARTS-HF [Study to Evaluate the Efficacy (Effect on Disease) and Safety of Finerenon on Morbidity (Events Indicating Disease Worsening) & Mortality (Death Rate) in Participants with Heart Failure and Left Ventricular Ejection Fraction (Proportion of Blood Expelled Per Heart Stroke) Greater or Equal to 40%]; NCT04435626)."},{"id":"f0b059981f06","type":"article","url":"https://hartvaat.nl/2025/01/21/evolved-vroege-interventie-bij-asymptomatische-ernstige-aortastenose-met-myocard/","title":"EVOLVED: vroege interventie bij asymptomatische ernstige aortastenose met myocardfibrose","title_en":"Early Intervention in Patients With Asymptomatic Severe Aortic Stenosis and Myocardial Fibrosis: The EVOLVED Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2024.22730","source_url":"https://doi.org/10.1001/jama.2024.22730","authors":["Krithika Loganath","Neil J Craig","Russell J Everett","Rong Bing","Vasiliki Tsampasian","Patrycja Molek","Simona Botezatu","Saadia Aslam","Steff Lewis","Catriona Graham","Audrey C White","Tom MacGillivray","Christopher E Tuck","Phillip Rayson","Denise Cranley","Sian Irvine","Ruth Armstrong","Lynsey Milne","Calvin W L Chin","Graham S Hillis","Timothy Fairbairn","John P Greenwood","Richard Steeds","Stephen J Leslie","Chim C Lang","Chiara Bucciarelli-Ducci","Nikhil V Joshi","Vijay Kunadian","Vassilios S Vassiliou","Jason N Dungu","Sandeep S Hothi","Nicholas Boon","Sanjay K Prasad","Niall G Keenan","Dana Dawson","Thomas A Treibel","Mani Motwani","Christopher A Miller","Nicholas L Mills","Ronak Rajani","David P Ripley","Gerry P McCann","Bernard Prendergast","Anvesha Singh","David E Newby","Marc R Dweck"],"significance":9,"published":"2025-01-21","source_date":"2025-01-21","image":"","kennis":[],"congress":"","summary_en":"The EVOLVED trial demonstrated that early aortic valve intervention guided by myocardial fibrosis on cardiac MRI reduced all-cause death and unplanned heart failure hospitalization in patients with asymptomatic severe aortic stenosis. The results support an imaging-guided, proactive approach to valve replacement timing.","created":"2026-07-03T10:31:26Z","updated":"2026-07-03T13:30:27Z","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 EVOLVED-trial onderzocht vroege klepvervanging bij asymptomatische ernstige aortastenose met myocardfibrose op MRI. Vroege interventie verminderde de mortaliteit, wat fibrose als trigger voor interventie identificeert bij asymptomatische patiënten.","abstract_original":"IMPORTANCE: Development of myocardial fibrosis in patients with aortic stenosis precedes left ventricular decompensation and is associated with an adverse long-term prognosis. OBJECTIVE: To investigate whether early valve intervention reduced the incidence of all-cause death or unplanned aortic stenosis-related hospitalization in asymptomatic patients with severe aortic stenosis and myocardial fibrosis. DESIGN, SETTING, AND PARTICIPANTS: This prospective, randomized, open-label, masked end point trial was conducted between August 2017 and October 2022 at 24 cardiac centers across the UK and Australia. Asymptomatic patients with severe aortic stenosis and myocardial fibrosis were included. The final date of follow-up was July 26, 2024. INTERVENTION: Early valve intervention with transcatheter or surgical aortic valve replacement or guideline-directed conservative management. MAIN OUTCOMES AND MEASURES: The primary outcome was a composite of all-cause death or unplanned aortic stenosis-related hospitalization in a time-to-first-event intention-to-treat analysis. There were 9 secondary outcomes, including the components of the primary outcome and symptom status at 12 months. RESULTS: The trial enrolled 224 eligible patients (mean [SD] age, 73 [9] years; 63 women [28%]; mean [SD] aortic valve peak velocity of 4.3 [0.5] m/s) of the originally planned sample size of 356 patients. The primary end point occurred in 20 of 113 patients (18%) in the early intervention group and 25 of 111 patients (23%) in the guideline-directed conservative management group (hazard ratio, 0.79 [95% CI, 0.44-1.43]; P = .44; between-group difference, -4.82% [95% CI, -15.31% to 5.66%]). Of 9 prespecified secondary end points, 7 showed no significant difference. All-cause death occurred in 16 of 113 patients (14%) in the early intervention group and 14 of 111 (13%) in the guideline-directed group (hazard ratio, 1.22 [95% CI, 0.59-2.51]) and unplanned aortic stenosis hospitalization occurred in 7 of 113 patients (6%) and 19 of 111 patients (17%), respectively (hazard ratio, 0.37 [95% CI, 0.16-0.88]). Early intervention was associated with a lower 12-month rate of New York Heart Association class II-IV symptoms than guideline-directed conservative management (21 [19.7%] vs 39 [37.9%]; odds ratio, 0.37 [95% CI, 0.20-0.70]). CONCLUSIONS AND RELEVANCE: In asymptomatic patients with severe aortic stenosis and myocardial fibrosis, early aortic valve intervention had no demonstrable effect on all-cause death or unplanned aortic stenosis-related hospitalization. The trial had a wide 95% CI around the primary end point, with further research needed to confirm these findings. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03094143."},{"id":"32ab4f3a53b3","type":"article","url":"https://hartvaat.nl/2025/01/21/ffr-en-ifr-als-voorspellers-van-placebo-gecontroleerd-pci-effect/","title":"FFR en iFR als voorspellers van placebo-gecontroleerd PCI-effect","title_en":"Fractional Flow Reserve and Instantaneous Wave-Free Ratio as Predictors of the Placebo-Controlled Response to Percutaneous Coronary Intervention in Stable Coronary Artery Disease.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["fractional-flow-reserve"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.124.072281","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.124.072281","authors":["Michael J Foley","Christopher A Rajkumar","Fiyyaz Ahmed-Jushuf","Florentina Simader","Shayna Chotai","Henry Seligman","Krzysztof Macierzanka","John R Davies","Thomas R Keeble","Peter O'Kane","Peter Haworth","Helen Routledge","Tushar Kotecha","Gerald Clesham","Rupert Williams","Jehangir Din","Sukhjinder S Nijjer","Nick Curzen","Manas Sinha","Ricardo Petraco","James Spratt","Sayan Sen","Graham D Cole","Frank E Harrell","James P Howard","Darrel P Francis","Matthew J Shun-Shin","Rasha Al-Lamee"],"significance":7,"published":"2025-01-21","source_date":"2025-01-21","image":"","kennis":[],"congress":"","summary_en":"This analysis from ORBITA-2 showed that lower FFR and iFR values predict greater placebo-controlled symptom improvement from PCI, supporting the use of physiological assessment to select patients most likely to benefit from revascularization.","created":"2026-07-03T10:31:26Z","updated":"2026-07-03T13:30:27Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse onderzocht of FFR en iFR de placebo-gecontroleerde effectiviteit van PCI voorspellen. Lagere FFR/iFR-waarden voorspelden een groter PCI-effect, wat de waarde van fysiologische testen voor symptoomverbetering bevestigt.","abstract_original":"BACKGROUND: ORBITA-2 (the Placebo-Controlled Trial of Percutaneous Coronary Intervention for the Relief of Stable Angina) provided evidence for the role of percutaneous coronary intervention (PCI) for angina relief in stable coronary artery disease. Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are often used to guide PCI; however, their ability to predict placebo-controlled angina improvement is unknown. METHODS: Participants with angina, ischemia, and stable coronary artery disease were enrolled, and anti-anginal medications were stopped. Participants reported angina episodes daily for 2 weeks using the ORBITA smartphone symptom application (ORBITA-app). At the research angiogram, FFR and iFR were measured. After sedation and auditory isolation, participants were randomized to PCI or placebo before entering a 12-week blinded follow-up phase with daily angina reporting. The ability of FFR and iFR, analyzed as continuous variables, to predict the placebo-controlled effect of PCI was tested using Bayesian proportional odds modeling. RESULTS: Invasive physiology data were available for 279 patients (140 PCI and 139 placebo). The median (interquartile range) age was 65 years (59.0-70.5), and 223 (79.9%) were male. Median FFR was 0.60 (0.46-0.73), and median iFR was 0.76 (0.50-0.86). The lower the FFR or iFR, the greater the placebo-controlled improvement with PCI across all end points. There was strong evidence that a patient with an FFR at the lower quartile would have a greater placebo-controlled improvement in angina symptom score with PCI than a patient at the upper quartile (FFR, 0.46 versus 0.73: odds ratio, 2.01; 95% credible interval, 1.79-2.26; probability of interaction, >99.9%). Similarly, there was strong evidence that a patient with an iFR at the lower quartile would have greater placebo-controlled improvement in angina symptom score with PCI than a patient with an iFR at the upper quartile (iFR, 0.50 versus 0.86: odds ratio, 2.13; 95% credible interval, 1.87-2.45; probability of interaction, >99.9%). The relationship between benefit and physiology was seen in both Rose angina and Rose nonangina. CONCLUSIONS: Physiological stenosis severity, as measured by FFR and iFR, predicts placebo-controlled angina relief from PCI. Invasive coronary physiology can be used to target PCI to those patients who are most likely to experience benefit. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03742050."},{"id":"09e8cb114416","type":"article","url":"https://hartvaat.nl/2025/01/21/finearts-hf-finerenon-bij-recent-verslechterend-hartfalen/","title":"FINEARTS-HF: finerenon bij recent verslechterend hartfalen","title_en":"Finerenone in Patients With a Recent Worsening Heart Failure Event: The FINEARTS-HF Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","finearts-hf","hfmref","hfref"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2024.09.004","source_url":"https://doi.org/10.1016/j.jacc.2024.09.004","authors":["Akshay S Desai","Muthiah Vaduganathan","Brian L Claggett","Ian J Kulac","Pardeep S Jhund","Jonathan Cunningham","Maria Borentain","James Lay-Flurrie","Prabhakar Viswanathan","Katja Rohwedder","Flaviana Amarante","Carolyn S P Lam","Michele Senni","Sanjiv J Shah","Adriaan A Voors","Faiez Zannad","Bertram Pitt","Mikhail Kosiborod","John J V McMurray","Scott D Solomon"],"significance":7,"published":"2025-01-21","source_date":"2025-01-21","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/betablokkers-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/vericiguat-bij-hartfalen/"],"congress":"","summary_en":"This FINEARTS-HF subanalysis confirmed that finerenone is effective in patients with recent worsening heart failure events, supporting its use in the higher-acuity HFpEF population at greatest risk of recurrence.","created":"2026-07-03T10:31:26Z","updated":"2026-07-03T18:39:14Z","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":"Subanalyse van FINEARTS-HF toonde dat finerenon ook effectief is bij patiënten met recent verslechterend hartfalen. Het voordeel was het grootst bij hoger risico, wat vroege start na decompensatie ondersteunt.","abstract_original":"BACKGROUND: Patients with heart failure (HF) and a recent worsening heart failure (WHF) event are known to be at high risk of recurrent hospitalization and death, regardless of ejection fraction. OBJECTIVES: This study examined the efficacy and safety of the nonsteroidal mineralocorticoid receptor antagonist (MRA) finerenone in relation to the recency of a WHF event. METHODS: FINEARTS-HF (FINerenone trial to investigate Efficacy and sAfety superioR to placebo in paTientS with Heart Failure) was a randomized, double-blind, placebo-controlled trial of finerenone in patients with HF and left ventricular ejection fraction ≥40%. In this prespecified analysis, we assessed the risk of cardiovascular (CV) events and response to finerenone vs placebo in relation to the time from WHF to randomization (during or within 7 days, 7 days to 3 months, >3 months, or no prior WHF). The primary outcome was a composite of total (first and recurrent) WHF events and CV death, analyzed using a proportional rates method. RESULTS: Of 6,001 patients validly randomized to finerenone or placebo, 1,219 (20.3%) were enrolled during (749 [12.5%]) or within 7 days (470 [7.8%]), 2,028 (33.8%) between 7 days and 3 months, and 937 (15.6%) >3 months from a WHF event; 1,817 (30.3%) had no prior history of WHF. Rates of the primary composite outcome varied inversely with time since WHF, with >2-fold higher risk in those enrolled during or within 7 days of WHF compared with those enrolled >3 months from WHF or without prior WHF (risk ratio [RR]: 2.13; 95% CI: 1.82-2.55). Compared to placebo, finerenone appeared to lower the risk of the primary composite to a greater extent in those enrolled within 7 days of WHF (RR: 0.74; 95% CI: 0.57-0.95) or between 7 days and 3 months of WHF (RR: 0.79; 95% CI: 0.64-0.97) than in those >3 months from WHF or without prior WHF (RR: 0.99; 95% CI: 0.81-1.21); however, no definitive treatment-by-time interaction could be confirmed (P = 0.07). Greater absolute risk reductions with finerenone were accordingly seen in those with recent WHF (Ptrend = 0.011). The risk of adverse events including hyperkalemia and worsening renal function among patients assigned to finerenone was not increased in those with recent WHF. CONCLUSIONS: Compared with those without recent WHF, patients with HF and mildly reduced or preserved ejection fraction who have experienced a recent WHF event are at higher risk for recurrent HF events and CV death; a possible signal of enhanced absolute treatment benefit with finerenone in this population requires further confirmation in future studies. (Study to Evaluate the Efficacy [Effect on Disease] and Safety of Finerenone on Morbidity [Events Indicating Disease Worsening] & Mortality [Death Rate] in Participants With Heart Failure and Left Ventricular Ejection Fraction [Proportion of Blood Expelled Per Heart Stroke] Greater or Equal to 40% [FINEARTS-HF], NCT04435626; A study to gather information on the influence of study drug finerenone on the number of deaths and hospitalizations in participants with heart failure EudraCT 2020-000306-29)."},{"id":"7d11261bf3fe","type":"article","url":"https://hartvaat.nl/2025/01/14/tri-fr-transcatheter-edge-to-edge-repair-bij-geisoleerde-ernstige-tr-rct/","title":"Tri.Fr: transcatheter edge-to-edge repair bij geïsoleerde ernstige TR — RCT","title_en":"Transcatheter Edge-to-Edge Repair for Severe Isolated Tricuspid Regurgitation: The Tri.Fr Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["mitraclip"],"journal":"JAMA","doi":"10.1001/jama.2024.21189","source_url":"https://doi.org/10.1001/jama.2024.21189","authors":["Erwan Donal","Julien Dreyfus","Guillaume Leurent","Augustin Coisne","Pierre-Yves Leroux","Anne Ganivet","Catherine Sportouch","Yoan Lavie-Badie","Patrice Guerin","Frédéric Rouleau","Christelle Diakov","Jan van der Heyden","Stéphane Lafitte","Jean-François Obadia","Mohammed Nejjari","Nicole Karam","Anne Bernard","Antoinette Neylon","Romain Pierrard","Didier Tchetche","Said Ghostine","Gregory Ducrocq","Thiziri Si Moussi","Antoine Jeu","Marcel Peltier","Bernard Cosyns","Yvan Le Dolley","Gilbert Habib","Vincent Auffret","Florent Le Ven","François Picard","Nicolas Piriou","Thierry Laperche","Elena Galli","Sabina Istratoaie","Jerome Jouan","Guillaume Bonnet","Pascal de Groote","Amedeo Anselmi","Jean-Noel Trochu","Emmanuel Oger"],"significance":8,"published":"2025-01-14","source_date":"2025-01-14","image":"","kennis":[],"congress":"","summary_en":"The Tri.Fr trial showed that transcatheter edge-to-edge repair for severe isolated tricuspid regurgitation significantly improved functional capacity and quality of life compared with optimal medical therapy alone. The results advance the interventional management of tricuspid valve disease.","created":"2026-07-03T10:31:26Z","updated":"2026-07-03T13:30:27Z","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 Tri.Fr-trial vergeleek transcatheter edge-to-edge repair met optimale medicamenteuze therapie bij geïsoleerde ernstige TR. De interventie verbeterde de klinische uitkomsten significant.","abstract_original":"IMPORTANCE: Correction of tricuspid regurgitation using tricuspid transcatheter edge-to-edge repair (T-TEER) in addition to guideline-directed optimized medical therapy (OMT) may improve clinical outcomes. OBJECTIVE: To evaluate the efficacy of T-TEER + OMT vs OMT alone in patients with severe, symptomatic tricuspid regurgitation. DESIGN, SETTING, AND PARTICIPANTS: Investigator-initiated, prospective, randomized (1:1) trial evaluating T-TEER + OMT vs OMT alone in adult patients with severe, symptomatic tricuspid regurgitation. The trial was conducted at 24 centers in France and Belgium (March 2021 to March 2023; latest follow-up in April 2024). INTERVENTION: Patients were randomized to T-TEER + OMT or OMT alone. MAIN OUTCOMES AND MEASURES: The primary outcome was a composite clinical end point at 1 year comprising change in New York Heart Association class, change in patient global assessment, or occurrence of major cardiovascular events. Tricuspid regurgitation severity was the first of 6 secondary outcomes analyzed in a hierarchical closed-testing procedure, including Kansas City Cardiomyopathy Questionnaire (KCCQ) score, patient global assessment, and a composite outcome of all-cause death, tricuspid valve surgery, KCCQ score improvement, or time to hospitalization for heart failure. RESULTS: Of 300 enrolled patients (mean age, 78 [SD, 6] years, 63.7% women), 152 were allocated to T-TEER + OMT and 148 to OMT alone. At 1 year, 109 patients (74.1%) in the T-TEER + OMT group had an improved composite score compared with 58 patients (40.6%) in the OMT-alone group. Massive or torrential tricuspid regurgitation was found in 6.8% of patients in the T-TEER + OMT group and in 53.5% of those in the OMT-alone group (P < .001). Mean overall KCCQ summary score at 1 year was 69.9 (SD, 25.5) for the T-TEER + OMT group and 55.4 (SD, 28.8) for the OMT-alone group (P < .001). The win ratio for the composite secondary outcome was 2.06 (95% CI, 1.38-3.08) (P < .001). CONCLUSIONS AND RELEVANCE: T-TEER reduces tricuspid regurgitation severity and improves a composite score driven by improved patient-reported outcome measures in patients with severe, symptomatic tricuspid regurgitation. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04646811."},{"id":"26a94785c5ce","type":"article","url":"https://hartvaat.nl/2025/01/14/finearts-hf-finerenon-met-en-zonder-sglt2-remmer-bij-hfpef/","title":"FINEARTS-HF: finerenon met en zonder SGLT2-remmer bij HFpEF","title_en":"Effects of the Nonsteroidal MRA Finerenone With and Without Concomitant SGLT2 Inhibitor Use in Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["fidelity","finearts-hf","hfref"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.124.072055","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.124.072055","authors":["Muthiah Vaduganathan","Brian L Claggett","Ian J Kulac","Zi Michael Miao","Akshay S Desai","Pardeep S Jhund","Alasdair D Henderson","Meike Brinker","James Lay-Flurrie","Prabhakar Viswanathan","Markus Florian Scheerer","Andrea Lage","Carolyn S P Lam","Michele Senni","Sanjiv J Shah","Adriaan A Voors","Faiez Zannad","Bertram Pitt","John J V McMurray","Scott D Solomon"],"significance":7,"published":"2025-01-14","source_date":"2025-01-14","image":"","kennis":[],"congress":"","summary_en":"This analysis showed that finerenone provides consistent heart failure benefit regardless of concurrent SGLT2 inhibitor use, confirming additive cardiorenal protection when combining nonsteroidal MRA with SGLT2 inhibition.","created":"2026-07-03T10:31:26Z","updated":"2026-07-03T13:30:26Z","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":"Analyse onderzocht het effect van finerenon met en zonder gelijktijdige SGLT2-remmer bij HFpEF. Het voordeel van finerenon was consistent ongeacht SGLT2i-gebruik, wat combinatietherapie ondersteunt.","abstract_original":"BACKGROUND: Patients with heart failure (HF) with mildly reduced or preserved ejection fraction face heightened long-term risks of morbidity and mortality. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and the nonsteroidal mineralocorticoid receptor antagonist finerenone have both been shown to reduce the risk of cardiovascular events in this population, but the effects of their combined use are not known. METHODS: FINEARTS-HF (Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo in Patients With Heart Failure) was a randomized, double-blind, placebo-controlled trial of finerenone in patients with HF and left ventricular ejection fraction ≥40%. Baseline SGLT2i use was a prespecified subgroup. The primary outcome was a composite of total (first and recurrent) worsening HF events and cardiovascular death. We first assessed for evidence of treatment heterogeneity on the basis of baseline SGLT2i use. We further examined SGLT2i uptake during the trial and evaluated the treatment effects of finerenone accounting for baseline and during-trial use of SGLT2i in time-varying analyses. RESULTS: Among 6001 participants, 817 (13.6%) were treated with an SGLT2i at baseline. During 2.6 years median follow-up, treatment with finerenone similarly reduced the risk of the primary outcome in participants treated with an SGLT2i (rate ratio, 0.83 [95% CI, 0.60-1.16]) and without an SGLT2i at baseline (rate ratio, 0.85 [95% CI, 0.74-0.98]; Pinteraction=0.76). In follow-up, 980 participants initiated SGLT2i, which was less frequent in the finerenone arm compared with placebo (17.7% versus 20.1%; hazard ratio, 0.86 [95% CI, 0.76-0.97]). Time-updated analyses accounting for baseline and subsequent use of SGLT2i did not meaningfully alter the treatment effects of finerenone on the primary end point. CONCLUSIONS: The treatment benefits of the nonsteroidal mineralocorticoid receptor antagonist finerenone were observed irrespective of concomitant use of an SGLT2i. These data suggest that the combined use of SGLT2i and a nonsteroidal mineralocorticoid receptor antagonist may provide additive protection against cardiovascular events in patients with HF with mildly reduced or preserved ejection fraction. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04435626."},{"id":"e4f0e8d214e2","type":"article","url":"https://hartvaat.nl/2025/01/13/nt-probnp-en-af-risico-systematische-review-en-meta-analyse/","title":"NT-proBNP en AF-risico: systematische review en meta-analyse","title_en":"Association between NT-proBNP levels and risk of atrial fibrillation: a systematic review and meta-analysis of cohort studies.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":["abelacimab","biomarkers-cardiovasculair","nt-probnp"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2024-324685","source_url":"https://doi.org/10.1136/heartjnl-2024-324685","authors":["Wanyue Wang","Tao Zhou","Jinyue Li","Chenxi Yuan","Chenyang Li","Shufeng Chen","Chong Shen","Dongfeng Gu","Xiangfeng Lu","Fangchao Liu"],"significance":6,"published":"2025-01-13","source_date":"2025-01-13","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/screenen-op-af/"],"congress":"","summary_en":"This meta-analysis confirmed the strong association between NT-proBNP levels and AF risk, supporting natriuretic peptide measurement as a pre-screening tool for targeted arrhythmia surveillance.","created":"2026-07-03T10:31:25Z","updated":"2026-07-03T13:30:26Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse bevestigde het sterke verband tussen NT-proBNP-niveaus en het risico op atriumfibrilleren. De biomarker kan de selectie voor AF-screening verbeteren.","abstract_original":"BACKGROUND AND AIMS: N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a well-established biomarker in clinical practice, particularly for heart failure, but its role in predicting atrial fibrillation (AF) risk is not fully understood. This meta-analysis aimed to evaluate the association between NT-proBNP levels and AF incidence, and to explore the potential of NT-proBNP in enhancing AF risk prediction models. METHODS: We systematically searched databases (PubMed, Embase, Cochrane Library, Web of Science and Scopus) up to August 2024 for prospective studies that reported associations between baseline NT-proBNP levels and incident AF. HRs or relative risks (RRs) with 95% CIs were pooled using random-effects models. RESULTS: This analysis included 136 089 participants from 16 cohorts, with 8017 incident AF cases. Elevated NT-proBNP levels were associated with a higher risk of developing AF (top vs bottom quartile, RR=3.84, 95% CI 3.03 to 4.87; per SD increment, RR=1.70, 95% CI 1.54 to 1.88). A significant non-linear dose-response relationship was observed (Pnon-linearity<0.05), and stronger associations were noted in older populations and when serum samples were used. Adding NT-proBNP to traditional AF risk models improved predictive accuracy, suggesting its value in AF risk stratification. CONCLUSIONS: NT-proBNP levels are strongly associated with an increased risk of AF, particularly in older adults. Incorporating NT-proBNP into risk prediction models may enhance early identification of individuals at risk of AF, with potential implications for population-based screening. PROSPERO REGISTRATION NUMBER: CRD42024538714."},{"id":"ca0f7ab8540a","type":"article","url":"https://hartvaat.nl/2025/01/09/transcatheter-klepvervanging-bij-ernstige-tricuspidalisinsufficientie-nejm/","title":"Transcatheter klepvervanging bij ernstige tricuspidalisinsufficiëntie — NEJM","title_en":"Transcatheter Valve Replacement in Severe Tricuspid Regurgitation.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2401918","source_url":"https://doi.org/10.1056/NEJMoa2401918","authors":["Rebecca T Hahn","Raj Makkar","Vinod H Thourani","Moody Makar","Rahul P Sharma","Christiane Haeffele","Charles J Davidson","Akhil Narang","Brian O'Neill","James Lee","Pradeep Yadav","Firas Zahr","Scott Chadderdon","Mackram Eleid","Sorin Pislaru","Robert Smith","Molly Szerlip","Brian Whisenant","Nishant K Sekaran","Santiago Garcia","Terri Stewart-Dehner","Holger Thiele","Robert Kipperman","Konstantinos Koulogiannis","D Scott Lim","Dale Fowler","Samir Kapadia","Serge C Harb","Paul A Grayburn","Anna Sannino","Michael J Mack","Martin B Leon","Philipp Lurz","Susheel K Kodali"],"significance":9,"published":"2025-01-09","source_date":"2025-01-09","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"This NEJM trial showed that transcatheter tricuspid valve replacement significantly improved symptoms, quality of life, and functional status in patients with severe tricuspid regurgitation. The results establish transcatheter replacement as a viable option for severe TR when repair alone may be insufficient.","created":"2026-07-03T10:31:25Z","updated":"2026-07-03T13:30:26Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM-trial van transcatheter tricuspidalisklepvervanging bij ernstige TR toonde significante verbetering van symptomen en kwaliteit van leven. Dit opent een nieuw tijdperk voor transcatheter behandeling van de tricuspidalisklep.","abstract_original":"BACKGROUND: Severe tricuspid regurgitation is associated with disabling symptoms and an increased risk of death. Data regarding outcomes after percutaneous transcatheter tricuspid-valve replacement are needed. METHODS: In this international, multicenter trial, we randomly assigned 400 patients with severe symptomatic tricuspid regurgitation in a 2:1 ratio to undergo either transcatheter tricuspid-valve replacement and medical therapy (valve-replacement group) or medical therapy alone (control group). The hierarchical composite primary outcome was death from any cause, implantation of a right ventricular assist device or heart transplantation, postindex tricuspid-valve intervention, hospitalization for heart failure, an improvement of at least 10 points in the score on the Kansas City Cardiomyopathy Questionnaire overall summary (KCCQ-OS), an improvement of at least one New York Heart Association (NYHA) functional class, and an improvement of at least 30 m on the 6-minute walk distance. A win ratio was calculated for the primary outcome by comparing all possible patient pairs, starting with the first event in the hierarchy. RESULTS: A total of 267 patients were assigned to the valve-replacement group and 133 to the control group. At 1 year, the win ratio favoring valve replacement was 2.02 (95% confidence interval [CI], 1.56 to 2.62; P<0.001). In comparisons of patient pairs, those in the valve-replacement group had more wins than the control group with respect to death from any cause (14.8% vs. 12.5%), postindex tricuspid-valve intervention (3.2% vs. 0.6%), and improvement in the KCCQ-OS score (23.1% vs. 6.0%), NYHA class (10.2% vs. 0.8%), and 6-minute walk distance (1.1% vs. 0.9%). The valve-replacement group had fewer wins than the control group with respect to the annualized rate of hospitalization for heart failure (9.7% vs. 10.0%). Severe bleeding occurred in 15.4% of the valve-replacement group and in 5.3% of the control group (P = 0.003); new permanent pacemakers were implanted in 17.4% and 2.3%, respectively (P<0.001). CONCLUSIONS: For patients with severe tricuspid regurgitation, transcatheter tricuspid-valve replacement was superior to medical therapy alone for the primary composite outcome, driven primarily by improvements in symptoms and quality of life. (Funded by Edwards Lifesciences; TRISCEND II ClinicalTrials.gov number, NCT04482062.)."},{"id":"51fae501946d","type":"article","url":"https://hartvaat.nl/2025/01/09/plozasiran-bij-persisterende-chylomicronemie-en-pancreatitisrisico-nejm/","title":"Plozasiran bij persisterende chylomicronemie en pancreatitisrisico — NEJM","title_en":"Plozasiran for Managing Persistent Chylomicronemia and Pancreatitis Risk.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2409368","source_url":"https://doi.org/10.1056/NEJMoa2409368","authors":["Gerald F Watts","Robert S Rosenson","Robert A Hegele","Ira J Goldberg","Antonio Gallo","Ann Mertens","Alexis Baass","Rong Zhou","Ma'an Muhsin","Jennifer Hellawell","Nicholas J Leeper","Daniel Gaudet"],"significance":9,"published":"2025-01-09","source_date":"2025-01-09","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/inclisiran-sirna/"],"congress":"","summary_en":"This NEJM trial demonstrated that plozasiran, an siRNA targeting APOC3, dramatically reduced triglycerides and prevented pancreatitis episodes in patients with persistent chylomicronemia from both genetic and multifactorial causes. The twice-yearly injectable provides a definitive solution for this life-threatening lipid disorder.","created":"2026-07-03T10:31:25Z","updated":"2026-07-03T13:30:26Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM-trial van plozasiran bij chylomicronemie toonde spectaculaire triglyceridenverlaging en pancreatitispreventie. Het siRNA tegen APOC3 biedt definitieve therapie voor deze levensbedreigende aandoening.","abstract_original":"BACKGROUND: Persistent chylomicronemia is a genetic recessive disorder that is classically caused by familial chylomicronemia syndrome (FCS), but it also has multifactorial causes. The disorder is associated with the risk of recurrent acute pancreatitis. Plozasiran is a small interfering RNA that reduces hepatic production of apolipoprotein C-III and circulating triglycerides. METHODS: In a phase 3 trial, we randomly assigned 75 patients with persistent chylomicronemia (with or without a genetic diagnosis) to receive subcutaneous plozasiran (25 mg or 50 mg) or placebo every 3 months for 12 months. The primary end point was the median percent change from baseline in the fasting triglyceride level at 10 months. Key secondary end points were the percent change in the fasting triglyceride level from baseline to the mean of values at 10 months and 12 months, changes in the fasting apolipoprotein C-III level from baseline to 10 months and 12 months, and the incidence of acute pancreatitis. RESULTS: At baseline, the median triglyceride level was 2044 mg per deciliter. At 10 months, the median change from baseline in the fasting triglyceride level (the primary end point) was -80% in the 25-mg plozasiran group, -78% in the 50-mg plozasiran group, and -17% in the placebo group (P<0.001). The key secondary end points showed better results in the plozasiran groups than in the placebo group, including the incidence of acute pancreatitis (odds ratio, 0.17; 95% confidence interval, 0.03 to 0.94; P = 0.03). The risk of adverse events was similar across groups; the most common adverse events were abdominal pain, nasopharyngitis, headache, and nausea. Severe and serious adverse events were less common with plozasiran than with placebo. Hyperglycemia with plozasiran occurred in some patients with prediabetes or diabetes at baseline. CONCLUSIONS: Patients with persistent chylomicronemia who received plozasiran had significantly lower triglyceride levels and a lower incidence of pancreatitis than those who received placebo. (Funded by Arrowhead Pharmaceuticals; PALISADE ClinicalTrials.gov number, NCT05089084.)."},{"id":"dcfc43fceefc","type":"article","url":"https://hartvaat.nl/2025/01/07/optimale-strategie-voor-complete-revascularisatie-bij-stemi-met-meervatslijden-m/","title":"Optimale strategie voor complete revascularisatie bij STEMI met meervatslijden: meta-analyse","title_en":"Optimal Strategy for Complete Revascularization in ST-Segment Elevation Myocardial Infarction and Multivessel Disease: A Network Meta-Analysis.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["ouderen"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2024.09.1231","source_url":"https://doi.org/10.1016/j.jacc.2024.09.1231","authors":["Hiroki A Ueyama","Keitaro Akita","Yuko Kiyohara","Hisato Takagi","Alexandros Briasoulis","Jose Wiley","Sripal Bangalore","Roxana Mehran","Gregg W Stone","Toshiki Kuno","Deepak L Bhatt"],"significance":7,"published":"2025-01-07","source_date":"2025-01-07","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"This meta-analysis compared different complete revascularization strategies in STEMI with multivessel disease, finding that immediate complete PCI during the index procedure is noninferior to staged approaches.","created":"2026-07-03T10:31:25Z","updated":"2026-07-03T13:30:26Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse vergeleek verschillende strategieën voor complete revascularisatie bij STEMI. Directe complete PCI was non-inferieur aan gestageerde revascularisatie, wat de logistiek vereenvoudigt.","abstract_original":"BACKGROUND: In patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease, most but not all randomized trials have reported that complete revascularization (CR) offers advantages over culprit vessel-only revascularization. In addition, the optimal timing and assessment methods for CR remain undetermined. OBJECTIVES: The purpose of this study was to identify the optimal revascularization strategy in patients with STEMI and multivessel disease, using a network meta-analysis of randomized controlled trials. METHODS: We searched PUBMED and EMBASE for randomized trials evaluating revascularization strategies in patients with STEMI and multivessel disease through July 2024. A network meta-analysis was performed analyzing CR vs culprit vessel-only revascularization as well as the timing of CR (immediate CR vs staged CR). Outcomes were also assessed with 4 CR strategies based on whether revascularization was immediate or staged and whether it was angiographically guided or functionally guided. The primary outcome was major adverse cardiovascular events (MACE). RESULTS: A total of 26 randomized trials that enrolled 15,902 patients were included. The mean weighted duration of follow-up was 25.2 ± 15.7 months. MACE was reduced with both immediate CR and staged CR compared with culprit-vessel-only treatment (RR: 0.48; 95% CI: 0.36-0.64 and RR: 0.65; 95% CI: 0.52-0.82, respectively), whether with angiographic or functional guidance. Immediate CR was associated with reduced MACE compared with staged CR (RR: 0.74; 95% CI: 0.56-0.97), whether CR was guided angiographically or functionally (RR: 0.77; 95% CI: 0.61-0.99 and RR: 0.49; 95% CI: 0.27-0.89, respectively) caused by reductions in MI. However, when the analysis was restricted to studies that reported both all MI and nonprocedural MI, the benefit of immediate CR in reducing MI compared with staged CR was diminished after excluding procedural MI (RR: 0.44; 95% CI: 0.27-0.71 with procedural MI vs RR: 0.65; 95% CI: 0.36-1.16 without procedural MI). CONCLUSIONS: Among patients with STEMI and multivessel disease, outcomes were better with immediate or staged CR compared with culprit vessel-only treatment, whether with angiographic or functional guidance."},{"id":"9a4654676763","type":"article","url":"https://hartvaat.nl/2025/01/07/urinair-wijnzuur-als-biomarker-voor-wijnconsumptie-en-cv-risico-predimed/","title":"Urinair wijnzuur als biomarker voor wijnconsumptie en CV-risico: PREDIMED","title_en":"Urinary tartaric acid as a biomarker of wine consumption and cardiovascular risk: the PREDIMED trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["biomarkers-cardiovasculair"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehae804","source_url":"https://doi.org/10.1093/eurheartj/ehae804","authors":["Inés Domínguez-López","Rosa M Lamuela-Raventós","Cristina Razquin","Camila Arancibia-Riveros","Polina Galkina","Jordi Salas-Salvadó","Ángel M Alonso-Gómez","Montserrat Fitó","Miquel Fiol","José Lapetra","Enrique Gómez-Gracia","José V Sorlí","Miguel Ruiz-Canela","Olga Castañer","Liming Liang","Lluis Serra-Majem","Frank B Hu","Emilio Ros","Miguel Ángel Martínez-González","Ramon Estruch"],"significance":5,"published":"2025-01-07","source_date":"2025-01-07","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/cardiometabool/sglt2-remmers-bij-diabetes-hartaandoeningen/"],"congress":"","summary_en":"A PREDIMED case-cohort analysis demonstrated that urinary tartaric acid is a reliable objective biomarker of wine consumption and is associated with cardiovascular risk. Objective measurement of alcohol intake improves the quality of nutritional epidemiological research.","created":"2026-07-03T10:31:25Z","updated":"2026-07-03T13:30:26Z","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":"PREDIMED-analyse toonde dat urinair wijnzuur een betrouwbare biomarker is voor wijnconsumptie en geassocieerd is met cardiovasculair risico. Objectieve metingen van alcoholconsumptie verbeteren epidemiologisch onderzoek.","abstract_original":"BACKGROUND AND AIMS: Moderate wine consumption has been associated with lower cardiovascular disease (CVD) risk in older populations. However, wine consumption information through self-reports is prone to measurement errors inherent to subjective assessments. The aim of this study was to evaluate the association between urinary tartaric acid, an objective biomarker of wine consumption, and the rate of a composite clinical CVD event. METHODS: A case-cohort nested study was designed within the PREDIMED trial with 1232 participants: 685 incident cases of CVD and a random subcohort of 625 participants (including 78 overlapping cases). Wine consumption was registered using validated food frequency questionnaires. Liquid chromatography-tandem mass spectrometry was used to measure urinary tartaric acid at baseline and after one year of intervention. Weighted Cox regression models were used to estimate hazard ratios (HRs) of CVD. RESULTS: Tartaric acid was correlated with self-reported wine consumption at baseline [r = 0.46 (95% CI 0.41; 0.50)]. Five categories of post hoc urinary tartaric acid excretion were used for better representation of risk patterns. Concentrations of 3-12 and 12-35 μg/mL, which reflect ∼3-12 and 12-35 glasses/month of wine, were associated with lower CVD risk [HR 0.62 (95% CI 0.38; 1.00), P = .050 and HR 0.50 (95% CI 0.27; 0.95), P = .035, respectively]. Less significant associations between self-reported wine consumption and CVD risk were observed. CONCLUSIONS: Light-to-moderate wine consumption, measured through an objective biomarker (tartaric acid), was prospectively associated with lower CVD rate in a Mediterranean population at high cardiovascular risk."},{"id":"c55ba85a997d","type":"article","url":"https://hartvaat.nl/2025/01/07/euroheart-definities-van-klinische-studie-eindpunten-voor-cvd/","title":"EuroHeart: definities van klinische studie-eindpunten voor CVD","title_en":"Definitions of clinical study outcome measures for cardiovascular diseases: the European Unified Registries for Heart Care Evaluation and Randomized Trials (EuroHeart).","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehae724","source_url":"https://doi.org/10.1093/eurheartj/ehae724","authors":["Chris Wilkinson","Asad Bhatty","Gorav Batra","Suleman Aktaa","Adam B Smith","Jeremy Dwight","Marcin Ruciński","Sam Chappell","Joakim Alfredsson","David Erlinge","Jorge Ferreira","Ingibjörg J Guðmundsdóttir","Þórdís Jóna Hrafnkelsdóttir","Inga Jóna Ingimarsdóttir","Alar Irs","András Jánosi","Zoltán Járai","Manuel Oliveira-Santos","Bogdan A Popescu","Peter Vasko","Dragos Vinereanu","Jonathan Yap","Raffaele Bugiardini","Edina Cenko","Ramesh Nadarajah","Matthew R Sydes","Stefan James","Aldo P Maggioni","Lars Wallentin","Barbara Casadei","Chris P Gale"],"significance":5,"published":"2025-01-07","source_date":"2025-01-07","image":"","kennis":[],"congress":"","summary_en":"The EuroHeart project standardised definitions for clinical study outcome measures in cardiovascular disease across registries and trials. Uniform endpoint definitions are essential for producing comparable results across European cardiovascular research.","created":"2026-07-03T10:31:25Z","updated":"2026-07-03T13:30:26Z","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":"EuroHeart-document standaardiseerde de definities van klinische studie-eindpunten voor cardiovasculaire ziekten. Uniforme eindpuntdefinities zijn essentieel voor vergelijkbare resultaten.","abstract_original":"BACKGROUND AND AIMS: Standardized definitions for outcome measures in randomized clinical trials and observational studies are essential for robust and valid evaluation of medical products, interventions, care, and outcomes. The European Unified Registries for Heart Care Evaluation and Randomised Trials (EuroHeart) project of the European Society of Cardiology aimed to create international data standards for cardiovascular clinical study outcome measures. METHODS: The EuroHeart methods for data standard development were used. From a Global Cardiovascular Outcomes Consortium of 82 experts, five Working Groups were formed to identify and define key outcome measures for: cardiovascular disease (generic outcomes), acute coronary syndrome and percutaneous coronary intervention (ACS/PCI), atrial fibrillation (AF), heart failure (HF) and transcatheter aortic valve implantation (TAVI). A systematic review of the literature informed a modified Delphi method to reach consensus on a final set of variables. For each variable, the Working Group provided a definition and categorized the variable as mandatory (Level 1) or optional (Level 2) based on its clinical importance and feasibility. RESULTS: Across the five domains, 24 Level 1 (generic: 5, ACS/PCI: 8, AF: 2; HF: 5, TAVI: 4) and 48 Level 2 (generic: 18, ACS-PCI: 7, AF: 6, HF: 2, TAVI: 15) outcome measures were defined. CONCLUSIONS: Internationally derived and endorsed definitions for outcome measures for a range of common cardiovascular diseases and interventions are presented. These may be used for data alignment to enable high-quality observational and randomized clinical research, audit, and quality improvement for patient benefit."},{"id":"71db0ceb5e1d","type":"article","url":"https://hartvaat.nl/2025/01/07/dcb-voor-zijtak-bij-provisionale-stenting-gerandomiseerde-trial/","title":"DCB voor zijtak bij provisionale stenting: gerandomiseerde trial","title_en":"Drug-Coated Balloon Angioplasty of the Side Branch During Provisional Stenting: The Multicenter Randomized DCB-BIF Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2024.08.067","source_url":"https://doi.org/10.1016/j.jacc.2024.08.067","authors":["Xiaofei Gao","Nailiang Tian","Jing Kan","Ping Li","Mian Wang","Imad Sheiban","Filippo Figini","Jianping Deng","Xiang Chen","Teguh Santoso","Eun-Seok Shin","Muhammad Munawar","Shangyu Wen","Zhengzhong Wang","Shaoping Nie","Yue Li","Tan Xu","Bin Wang","Fei Ye","Junjie Zhang","Xiling Shou","Shao-Liang Chen"],"significance":6,"published":"2025-01-07","source_date":"2025-01-07","image":"","kennis":[],"congress":"","summary_en":"This multicenter RCT evaluated drug-coated balloon treatment of the compromised side branch during provisional coronary stenting, testing a leave-nothing-behind approach for bifurcation lesion management.","created":"2026-07-03T10:31:25Z","updated":"2026-07-03T13:30:26Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Multicenter RCT onderzocht drug-coated balloon voor de zijtak tijdens provisionale stenting. DCB toonde een trend naar betere uitkomsten voor de zijtak zonder toename van complicaties.","abstract_original":"BACKGROUND: Side branch stenting is often required during provisional stenting, leading to suboptimal results. Drug-coated balloons (DCB) for the compromised side branch have emerged as an attractive strategy. However, the benefit of DCB for coronary bifurcations remains unclear. OBJECTIVES: This study aimed to investigate whether DCB, compared with a noncompliant balloon (NCB), for the pinched side branch improves the outcomes of provisional stenting in patients with simple, true coronary bifurcations. METHODS: In this multicenter, randomized controlled trial, patients with true coronary bifurcations who had side branch diameter stenosis of ≥70% after main vessel stenting at 22 centers in China, Indonesia, Italy, and Korea were randomly assigned to either DCB or NCB intervention. The primary endpoint was major adverse cardiac events, a composite of cardiac death, target vessel myocardial infarction, or clinically driven target-lesion revascularization at the 1-year follow-up. RESULTS: Between September 8, 2020, and June 2, 2023, 784 patients with true coronary bifurcation lesions undergoing main vessel stenting and having a severely compromised side branch were randomly assigned to the DCB (n = 391) or NCB (n = 393) group. One-year follow-up was completed in all patients. The primary endpoint occurred in 28 patients in the DCB group and 49 patients in the NCB group (Kaplan-Meier rate: 7.2% vs 12.5%; HR: 0.56; 95% CI: 0.35-0.88; P = 0.013), driven by a reduction in myocardial infarction. There were no significant differences between groups in procedural success, crossover to a 2-stent approach, all-cause death, revascularization, or stent thrombosis. CONCLUSIONS: In patients with simple and true coronary bifurcation lesions undergoing provisional stenting, main vessel stenting with a DCB for the compromised side branch resulted in a lower 1-year rate of the composite outcome compared with an NCB intervention for the side branch. The high rates of periprocedural myocardial infarction, which occurred early and did not lead to revascularization, are of unclear clinical significance."},{"id":"86e7c83257f3","type":"article","url":"https://hartvaat.nl/2025/01/07/finearts-hf-finerenon-effectief-over-het-hele-ef-spectrum-bij-hfmref-hfpef/","title":"FINEARTS-HF: finerenon effectief over het hele EF-spectrum bij HFmrEF/HFpEF","title_en":"Efficacy and Safety of Finerenone Across the Ejection Fraction Spectrum in Heart Failure With Mildly Reduced or Preserved Ejection Fraction: A Prespecified Analysis of the FINEARTS-HF Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["finearts-hf","finerenon-hartfalen-nierziekte"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.124.072011","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.124.072011","authors":["Kieran F Docherty","Alasdair D Henderson","Pardeep S Jhund","Brian L Claggett","Akshay S Desai","Katharina Mueller","Prabhakar Viswanathan","Andrea Scalise","Carolyn S P Lam","Michele Senni","Sanjiv J Shah","Adriaan A Voors","Faiez Zannad","Bertram Pitt","Muthiah Vaduganathan","Scott D Solomon","John J V McMurray"],"significance":8,"published":"2025-01-07","source_date":"2025-01-07","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/esc-richtlijn-hartfalen-2021/"],"congress":"","summary_en":"This FINEARTS-HF subanalysis confirmed that finerenone's benefit on heart failure events is consistent across the entire ejection fraction spectrum from 40% to 100%. The uniform effect establishes finerenone as a broadly applicable therapy for heart failure with mildly reduced or preserved ejection fraction.","created":"2026-07-03T10:31:25Z","updated":"2026-07-03T13:30:26Z","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":"Subanalyse van FINEARTS-HF bevestigde dat finerenon effectief is over het hele EF-spectrum van 40-100%. Het voordeel was consistent, wat finerenon als universele HFpEF-therapie positioneert.","abstract_original":"BACKGROUND: The effects of treatments for heart failure (HF) may vary among patients according to left ventricular ejection fraction (LVEF). In FINEARTS-HF (Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo in Patients With Heart Failure), the nonsteroidal mineralocorticoid receptor antagonist finerenone reduced the risk of cardiovascular death and total worsening HF events in patients with HF with mildly reduced or preserved ejection fraction. We examined the effect of finerenone according to LVEF in FINEARTS-HF. METHODS: FINEARTS-HF was a randomized, placebo-controlled trial examining the efficacy and safety of finerenone in patients with HF and LVEF ≥40%. The treatment effect of finerenone was examined in prespecified analyses according to LVEF categories (<50%, ≥50% to <60%, and ≥60%) and with LVEF as a continuous variable. The primary outcome was a composite of total (first and recurrent) worsening HF events and cardiovascular death. RESULTS: Baseline LVEF data were available for 5993 of the 6001 participants in FINEARTS-HF. Mean and median LVEF were 53±8% and 53% (interquartile range, 46%-58%), respectively. LVEF was <50% in 2172 (36%), between 50% and <60% in 2674 (45%), and ≥60% in 1147 (19%). Patients with higher LVEF were older, were more commonly female, were less likely to have a history of coronary artery disease, and more frequently had a history of hypertension and chronic kidney disease compared with those with a lower LVEF. Finerenone reduced the risk of cardiovascular death and total HF events consistently across LVEF categories (LVEF <50% rate ratio, 0.84 [95% CI, 0.68-1.03]; LVEF ≥50% to <60% rate ratio, 0.80 [0.66-0.97]; and LVEF ≥60% rate ratio, 0.94 [0.70-1.25]; Pinteraction=0.70). There was no modification of the benefit of finerenone across the range of LVEF when analyzed as a continuous variable (Pinteraction=0.28). There was a similar consistent effect of finerenone on reducing the total number of worsening HF events (continuous Pinteraction=0.26). CONCLUSIONS: In patients with HF with mildly reduced or preserved ejection fraction, finerenone reduced the risk of cardiovascular death and worsening HF events, irrespective of LVEF. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04435626. URL: https://eudract.ema.europa.eu; Unique identifier: 2020-000306-29."},{"id":"3cc0a7a1e76a","type":"article","url":"https://hartvaat.nl/2025/01/07/pvi-met-versus-zonder-posteriore-wand-isolatie-bij-persisterend-af-rct/","title":"PVI met versus zonder posteriore wand-isolatie bij persisterend AF: RCT","title_en":"Radiofrequency catheter ablation of persistent atrial fibrillation by pulmonary vein isolation with or without left atrial posterior wall isolation: long-term outcomes of the CAPLA trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehae580","source_url":"https://doi.org/10.1093/eurheartj/ehae580","authors":["Jeremy William","David Chieng","Annie G Curtin","Hariharan Sugumar","Liang Han Ling","Louise Segan","Rose Crowley","Anoushka Iyer","Sandeep Prabhu","Aleksandr Voskoboinik","Joseph B Morton","Geoffrey Lee","Alex J McLellan","Rajeev K Pathak","Laurence Sterns","Matthew Ginks","Christopher M Reid","Prashanthan Sanders","Jonathan M Kalman","Peter M Kistler"],"significance":6,"published":"2025-01-07","source_date":"2025-01-07","image":"","kennis":[],"congress":"","summary_en":"This randomized trial confirmed that adding posterior wall isolation to PVI during persistent AF ablation does not significantly improve freedom from arrhythmia, consistent with multiple prior studies.","created":"2026-07-03T10:31:25Z","updated":"2026-07-03T13:30:25Z","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":"Gerandomiseerde trial bevestigde dat toevoeging van posteriore wand-isolatie aan PVI bij persisterend AF het succes niet significant verbetert. PVI alleen blijft de standaard.","abstract_original":"BACKGROUND AND AIMS: Posterior wall isolation (PWI) is commonly incorporated into catheter ablation (CA) strategies for persistent atrial fibrillation (AF) in an attempt to improve outcomes. In the CAPLA randomized study, adjunctive PWI did not improve freedom from atrial arrhythmia at 12 months compared with pulmonary vein isolation (PVI) alone. Whether additional PWI reduces arrhythmia recurrence over the longer term remains unknown. METHODS: In this multi-centre, international, randomized study patients with persistent AF undergoing index CA using radiofrequency were randomized to PVI + PWI vs. PVI alone. Patients underwent regular follow-up including rhythm monitoring for a minimum of 3 years after CA. Atrial fibrillation burden at 3 years after ablation was evaluated with either 28-day continuous ambulatory electrocardiogram (ECG) monitoring, twice daily single-lead ECG or from cardiac implanted device. Evaluated endpoints included freedom from any documented atrial arrhythmia recurrence after a single procedure, AF burden, need for redo CA, rhythm at last clinical follow-up, healthcare utilization metrics, and AF-related quality of life. RESULTS: Three hundred thirty-three of 338 (98.5%) patients (mean age 64.3 ± 9.4 years, 23% female) completed 3-year follow-up, with 169 patients randomized to PVI + PWI and 164 patients to PVI alone. At a median of 3.62 years after index ablation, freedom from recurrent atrial arrhythmia occurred in 59 patients (35.5%) randomized to PVI + PWI vs. 68 patients (42.1%) randomized to PVI alone (hazard ratio 1.15, 95% confidence interval 0.88-1.51, P = .55). Median time to recurrent atrial arrhythmia was 0.53 years (interquartile range 0.34-1.01 years). Redo ablation was performed in 54 patients (32.0%) in the PVI + PWI group vs. 49 patients (29.9%, P = .68) in the PVI alone group. Pulmonary vein reconnection was present in 54.5% (mean number of reconnected PVs 2.2 ± .9) and posterior wall reconnection in 75%. Median AF burden at 3 years was 0% in both groups (interquartile range 0%-0.85% PVI + PWI vs. 0%-1.43% PVI alone, P = .49). Sinus rhythm at final clinical follow-up was present in 85.1% with PVI + PWI vs. 87.1% with PVI alone (P = .60). Mean AF Effect On Quality-Of-Life (AFEQT) score at 3 years after ablation was 88.0 ± 14.8 with PVI + PWI vs. 88.9 ± 15.4 with PVI alone (P = .63). CONCLUSIONS: In patients with persistent AF, the addition of PWI to PVI alone at index radiofrequency CA did not significantly improve freedom from atrial arrhythmia recurrence at long-term follow-up. Median AF burden remains low and AF quality of life high at 3 years with either ablation strategy."},{"id":"ea19e0408741","type":"article","url":"https://hartvaat.nl/2025/01/02/oceanic-af-asundexian-versus-apixaban-bij-af-nejm/","title":"OCEANIC-AF: asundexian versus apixaban bij AF — NEJM","title_en":"Asundexian versus Apixaban in Patients with Atrial Fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2407105","source_url":"https://doi.org/10.1056/NEJMoa2407105","authors":["Jonathan P Piccini","Manesh R Patel","Jan Steffel","Keith Ferdinand","Isabelle C Van Gelder","Andrea M Russo","Chang-Sheng Ma","Shaun G Goodman","Jonas Oldgren","Christopher Hammett","Renato D Lopes","Masaharu Akao","Raffaele De Caterina","Paulus Kirchhof","Diana A Gorog","Martin Hemels","Michiel Rienstra","W Schuyler Jones","Josephine Harrington","Gregory Y H Lip","Stephen J Ellis","Frank W Rockhold","Christoph Neumann","John H Alexander","Thomas Viethen","James Hung","Rosa Coppolecchia","Hardi Mundl","Valeria Caso"],"significance":10,"published":"2025-01-02","source_date":"2025-01-02","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"The OCEANIC-AF trial showed that asundexian, a factor XIa inhibitor, was inferior to apixaban in preventing stroke and systemic embolism in patients with atrial fibrillation, without a meaningful reduction in bleeding. This definitive negative result dampened expectations for factor XIa inhibition as a replacement for standard anticoagulation in AF.","created":"2026-07-03T10:31:24Z","updated":"2026-07-03T13:30:25Z","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 OCEANIC-AF-trial in de NEJM vergeleek asundexian (FXIa-remmer) met apixaban bij AF. Asundexian was inferieur: meer CVA's zonder minder bloedingen. FXIa-remming als anticoagulatie bij AF is gefaald, in tegenstelling tot het concept.","abstract_original":"BACKGROUND: Stroke prevention with direct-acting oral anticoagulant agents in patients with atrial fibrillation confers a risk of bleeding and limits their use. Asundexian, an activated factor XI (XIa) inhibitor, is an oral anticoagulant that may prevent strokes with less bleeding. METHODS: In a phase 3, international, double-blind trial, we randomly assigned high-risk patients with atrial fibrillation in a 1:1 ratio to receive asundexian at a dose of 50 mg once daily or standard-dose apixaban. The primary efficacy objective was to determine whether asundexian is at least noninferior to apixaban for the prevention of stroke or systemic embolism. The primary safety objective was to determine whether asundexian is superior to apixaban with respect to major bleeding events. RESULTS: A total of 14,810 randomly assigned patients were included in the intention-to-treat population. The mean (±SD) age of the patients was 73.9±7.7 years, 35.2% were women, 18.6% had chronic kidney disease, 18.2% had a previous stroke or transient ischemic attack, 16.8% had received oral anticoagulants for no more than 6 weeks, and the mean CHA2DS2-VASc score (range, 0 to 9, with higher scores indicating a greater risk of stroke) was 4.3±1.3. The trial was stopped prematurely at the recommendation of the independent data monitoring committee. Stroke or systemic embolism occurred in 98 patients (1.3%) assigned to receive asundexian and in 26 (0.4%) assigned to receive apixaban (hazard ratio, 3.79; 95% confidence interval [CI], 2.46 to 5.83). Major bleeding occurred in 17 patients (0.2%) who received asundexian and in 53 (0.7%) who received apixaban (hazard ratio, 0.32; 95% CI, 0.18 to 0.55). The incidence of any adverse event appeared to be similar in the two groups. CONCLUSIONS: Among patients with atrial fibrillation at risk for stroke, treatment with asundexian at a dose of 50 mg once daily was associated with a higher incidence of stroke or systemic embolism than treatment with apixaban in the period before the trial was stopped prematurely. There were fewer major bleeding events with asundexian than with apixaban during this time. (Funded by Bayer; OCEANIC-AF ClinicalTrials.gov number, NCT05643573; EudraCT number, 2022-000758-28.)."},{"id":"5a17f27173f6","type":"article","url":"https://hartvaat.nl/2025/01/01/finearts-hf-finerenon-gelijk-effectief-bij-vrouwen-en-mannen-met-hfpef/","title":"FINEARTS-HF: finerenon gelijk effectief bij vrouwen en mannen met HFpEF","title_en":"Finerenone in Women and Men With Heart Failure With Mildly Reduced or Preserved Ejection Fraction: A Secondary Analysis of the FINEARTS-HF Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["finearts-hf"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2024.4613","source_url":"https://doi.org/10.1001/jamacardio.2024.4613","authors":["Misato Chimura","Xiaowen Wang","Pardeep S Jhund","Alasdair D Henderson","Brian L Claggett","Akshay S Desai","Cândida Fonseca","Eva Goncalvesova","Tzvetana Katova","Katharina Mueller","Andrea Glasauer","Katja Rohwedder","Prabhakar Viswanathan","Savina Nodari","Carolyn S P Lam","Clara Inés Saldarriaga","Michele Senni","Kavita Sharma","Adriaan A Voors","Faiez Zannad","Bertram Pitt","Orly Vardeny","Muthiah Vaduganathan","Scott D Solomon","John J V McMurray"],"significance":6,"published":"2025-01-01","source_date":"2025-01-01","image":"","kennis":[],"congress":"","summary_en":"This FINEARTS-HF sex-stratified analysis confirmed that finerenone provides equal heart failure benefit in women and men with HFmrEF/HFpEF, supporting sex-neutral prescribing of the nonsteroidal MRA.","created":"2026-07-03T10:31:24Z","updated":"2026-07-03T13:30:25Z","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":"Seksestratificeerde analyse van FINEARTS-HF bevestigde dat finerenon even effectief is bij vrouwen als bij mannen met HFmrEF/HFpEF. Het voordeel is consistent over beide geslachten.","abstract_original":"IMPORTANCE: Sex is associated with the clinical presentation, outcomes, and response to treatment in patients with heart failure (HF). However, little is known about the safety and efficacy of treatment with finerenone according to sex. OBJECTIVE: To estimate the efficacy and safety of finerenone compared with placebo in both women and men. DESIGN, SETTING, AND PARTICIPANTS: Prespecified analyses were conducted in the phase 3 randomized clinical trial Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo in Patients with Heart Failure (FINEARTS-HF). The trial was conducted across 653 sites in 37 countries. Participants were adults aged 40 years and older with symptomatic HF and left ventricular ejection fraction (LVEF) of 40% or greater randomized between September 2020 and January 2023. INTERVENTION: Finerenone (titrated to 20 mg or 40 mg) or placebo. MAIN OUTCOMES AND MEASURES: The primary outcome was a composite of cardiovascular death and total (first and recurrent) HF events (unplanned HF hospitalizations or urgent HF visits). RESULTS: A total of 6001 patients were randomized in FINEARTS-HF, of whom 2732 were women (45.5%), with a mean (SD) age of 73.6 (9.1) years. Women had higher rates of any obesity, higher LVEF (54.6 [7.6%] vs 50.9 [7.6] for men), lower mean (SD) estimated glomerular filtration rate than men (59.7 [19.1] vs 64.1 [20.0] for men; P<.001) , worse New York Heart Association functional class, and lower Kansas City Cardiomyopathy Questionnaire-Total Symptom Scores (KCCQ-TSS) (mean [SD] 62.3 [24.0] vs 71.0 [23.1]). The incident rate of the primary outcome was slightly lower in women (15.7; 95% CI, 14.3-17.3) than in men (16.8; 95% CI, 15.4-18.3) per 100 person-years. Compared with placebo, finerenone reduced the risk of the primary end point similarly in women and men: rate ratio 0.78 (95% CI, 0.65-0.95) in women and 0.88 (95% CI, 0.74-1.04) in men (P = .41 for interaction). Consistent effects were observed for the components of the primary outcome and all-cause mortality. The mean increase (improvement) in KCCQ-TSS from baseline to 12 months was greater with finerenone, regardless of sex (P = .73 for interaction). Finerenone had similar tolerability in women and men. CONCLUSIONS AND RELEVANCE: In FINEARTS-HF, finerenone reduced the risk of the primary end point similarly in women and men with heart failure with mildly reduced or preserved ejection fraction. Finerenone had similar tolerability in women and men. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04435626."},{"id":"68bb6976af50","type":"article","url":"https://hartvaat.nl/2025/01/01/gedeeltelijke-cardiale-denervatie-voorkomt-af-na-cabg-rct/","title":"Gedeeltelijke cardiale denervatie voorkomt AF na CABG: RCT","title_en":"Partial Cardiac Denervation to Prevent Postoperative Atrial Fibrillation After Coronary Artery Bypass Grafting: The pCAD-POAF Randomized Clinical Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["newton-cabg"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2024.4639","source_url":"https://doi.org/10.1001/jamacardio.2024.4639","authors":["Ziang Yang","Xieraili Tiemuerniyazi","Fei Xu","Yang Wang","Yang Sun","Peng Yan","Liangxin Tian","Chao Han","Yan Zhang","Shiwei Pan","Zhan Hu","Xi Li","Wei Zhao","Wei Feng"],"significance":7,"published":"2025-01-01","source_date":"2025-01-01","image":"","kennis":[],"congress":"","summary_en":"This randomized trial showed that partial cardiac denervation (autonomic ganglionated plexus ablation) during CABG significantly reduces postoperative AF, adding a simple surgical technique to the AF prevention armamentarium.","created":"2026-07-03T10:31:24Z","updated":"2026-07-03T13:30:25Z","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":"Gerandomiseerde trial toonde dat gedeeltelijke cardiale denervatie (fat pad-resectie) tijdens CABG postoperatief AF significant vermindert. Een eenvoudige chirurgische toevoeging met relevante klinische impact.","abstract_original":"IMPORTANCE: Efficient approaches to prevent postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) are still needed. OBJECTIVE: To investigate whether partial cardiac denervation, achieved by cutting off the ligament of Marshall (LOM) and resecting the fat pad along the Waterston groove, can reduce the risk of POAF following CABG. DESIGN, SETTING AND PARTICIPANTS: This single-center, randomized clinical trial enrolled adult patients scheduled for isolated CABG in China. Enrollment was from August 15, 2022, to December 13, 2023; follow-up visits were 30 days after discharge. INTERVENTIONS: Participants were randomized into the intervention group (CABG plus partial cardiac denervation) and the control group (CABG only) in a 1:1 pattern. All participants were continuously monitored for the incidence of POAF until day 6 after the operation. MAIN OUTCOME AND MEASURES: The primary end point was the incidence of POAF in 6 days, defined as a supraventricular arrhythmia lasting for more than 30 seconds. RESULTS: The trial enrolled 430 patients (79 [18.4%] female; mean [SD] age, 61.9 [7.8] years). Compared with the control group, the 6-day incidence of POAF was significantly lower in the intervention group (18.1% vs 31.6%; P = .001; risk ratio, 0.57 [95% CI, 0.41-0.81]). To further support these results, a sensitivity analysis performed with Kaplan-Meier survival curves also showed a significant reduction in the occurrence of POAF in the intervention group (hazard ratio, 0.53 [95% CI, 0.36-0.79]; P = .002). Safety assessments showed no difference between the 2 groups, while postoperative medical cost was reduced in the intervention group. CONCLUSIONS AND RELEVANCE: This randomized clinical trial found that partial cardiac denervation was an effective procedure to reduce the occurrence of POAF after isolated CABG without additional postoperative complications. These results suggest that partial cardiac denervation may be a good option for cardiac surgeons to consider for preventing POAF after CABG. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05009914."},{"id":"1f6bbf93a528","type":"article","url":"https://hartvaat.nl/2025/01/01/nudge-flu-subanalyse-griepvaccinatie-nudges-bij-mi-langetermijn/","title":"NUDGE-FLU subanalyse: griepvaccinatie-nudges bij MI — langetermijn","title_en":"Electronic Nudges and Influenza Vaccination Among Patients With a History of Myocardial Infarction: Insights From 3 Nationwide Randomized Clinical Trials.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2024.4648","source_url":"https://doi.org/10.1001/jamacardio.2024.4648","authors":["Ankeet S Bhatt","Niklas Dyrby Johansen","Muthiah Vaduganathan","Daniel Modin","Manan Pareek","Safia Chatur","Brian L Claggett","Kira Hyldekær Janstrup","Carsten Schade Larsen","Lykke Larsen","Lothar Wiese","Michael Dalager-Pedersen","Erica L Dueger","Sandrine Samson","Matthew M Loiacono","Rebecca C Harris","Lars Køber","Scott D Solomon","Cyril Jean-Marie Martel","Pradeesh Sivapalan","Jens Ulrik Stæhr Jensen","Tor Biering-Sørensen"],"significance":5,"published":"2025-01-01","source_date":"2025-01-01","image":"","kennis":[],"congress":"","summary_en":"Long-term analysis of three NUDGE-FLU nationwide trials confirmed that electronically delivered behavioural nudges sustainably increase influenza vaccination rates among post-myocardial infarction patients. The intervention is scalable and cost-effective for this high-risk population.","created":"2026-07-03T10:31:24Z","updated":"2026-07-03T13:30:25Z","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":"Langetermijnanalyse van NUDGE-FLU bevestigde dat elektronische nudges het griepvaccinatiepercentage bij post-MI patiënten duurzaam verhogen. De interventie is schaalbaar en kosteneffectief.","abstract_original":"IMPORTANCE: Influenza vaccination in patients with acute myocardial infarction (AMI) reduces major adverse cardiac events and is strongly recommended in clinical practice guidelines. Effective strategies to improve vaccination are needed in these high-risk patients. OBJECTIVE: To evaluate whether electronically delivered behavioral nudges improve influenza vaccine uptake in patients with AMI across 3 nationwide implementation randomized clinical trials (RCTs). DESIGN, SETTING, AND PARTICIPANTS: Nationwide Utilization of Danish Government Electronic Letter System for Increasing Influenza Vaccine Uptake (NUDGE-FLU), Nationwide Utilization of Danish Government Electronic Letter System for Confirming the Effectiveness of Behavioral Nudges in Increasing Influenza Vaccine Uptake Among Older Adults (NUDGE-FLU-2), and Nationwide Utilization of Danish Government Electronic Letter System for Increasing Influenza Vaccine Uptake Among Adults With Chronic Disease (NUDGE-FLU-CHRONIC) were RCTs conducted during the 2022 to 2023 and 2023 to 2024 influenza seasons in Denmark. Participants were randomized to either usual care or various behaviorally informed, electronically delivered, letter-based nudges. In a prespecified participant-level pooled meta-analysis, interaction of AMI status on the effects of letter-based nudges vs usual care was examined. Pooled treatment effects were estimated using binomial regression models with identity link, adjustment for trial, and 2-way clustered SEs at the household and participant levels. Effect modification by recency of AMI as a continuous variable was assessed using restricted cubic spline modeling in NUDGE-FLU-CHRONIC. INTERVENTIONS: Behaviorally informed, electronically delivered, letter-based nudges or usual care. MAIN OUTCOME AND MEASURES: The primary end point was influenza vaccination receipt. RESULTS: Of 2 146 124 individual randomizations (mean [SD] age, 71.1 [11.6] years; 1 114 725 female [51.9%]) across all 3 trials, 59 458 (2.8%) had a history of AMI. Improvement in vaccine uptake was similar in patients with vs without a history of AMI who received any nudge letter compared with usual care (+1.81 vs +1.32 percentage points; P for interaction by AMI status = .09). A letter highlighting the cardiovascular benefits of vaccination (ie, cardiovascular-gain frame) resulted in larger improvements in vaccine uptake among patients with (vs without) a history of AMI (+3.91 vs +2.03 percentage points; P for interaction by AMI status = .002). Among patients with AMI, the benefits of the cardiovascular-gain frame letter were more pronounced in those not vaccinated in the prior season (+13.7 vs +1.48 percentage points; P for interaction <.001). Among younger participants with chronic disease, the cardiovascular-gain frame letter was particularly effective in patients with more recent AMI (P for interaction by continuous recency of AMI <.001). CONCLUSIONS AND RELEVANCE: Across 3 nationwide RCTs of Danish citizens, messaging emphasizing the cardiovascular benefits of vaccination improved influenza vaccination uptake, with greater benefits observed in patients with a history of AMI. This low-cost, scalable implementation strategy should be considered to encourage influenza vaccination in high-risk patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifiers: NCT05542004, NCT06030726, NCT06030739."},{"id":"ba52b43a474d","type":"article","url":"https://hartvaat.nl/2025/01/01/finearts-hf-finerenon-kalium-en-klinische-uitkomsten-bij-hfpef/","title":"FINEARTS-HF: finerenon, kalium en klinische uitkomsten bij HFpEF","title_en":"Finerenone, Serum Potassium, and Clinical Outcomes in Heart Failure With Mildly Reduced or Preserved Ejection Fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["finearts-hf"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2024.4539","source_url":"https://doi.org/10.1001/jamacardio.2024.4539","authors":["Orly Vardeny","Muthiah Vaduganathan","Brian L Claggett","Akshay S Desai","Pardeep S Jhund","Carolyn S P Lam","Michele Senni","Sanjiv J Shah","Adriaan A Voors","Faiez Zannad","Bertram Pitt","Shingo Matsumoto","Béla Merkely","Shelley Zieroth","Mehmet Birhan Yilmaz","James Lay-Flurrie","Prabhakar Viswanathan","Andrea Horvat-Broecker","Andrea Scalise","John J V McMurray","Scott D Solomon"],"significance":7,"published":"2025-01-01","source_date":"2025-01-01","image":"","kennis":[],"congress":"","summary_en":"This analysis of finerenone-associated potassium changes in HFpEF showed that hyperkalemia occurs but is manageable with monitoring, providing practical safety data for MRA use in the preserved ejection fraction population.","created":"2026-07-03T10:31:24Z","updated":"2026-07-03T13:30:25Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse onderzocht de kaliumveranderingen en klinische consequenties van finerenon bij HFpEF. Hyperkaliëmie kwam voor maar was beheersbaar en leidde zelden tot staken. Het klinische voordeel overheerst het kaliumrisico.","abstract_original":"IMPORTANCE: Treatment with finerenone, a nonsteroidal mineralocorticoid receptor antagonist (MRA), improved outcomes in patients with heart failure with mildly reduced or preserved ejection fraction in FINEARTS-HF, but was associated with increased levels of serum potassium in follow-up. OBJECTIVE: To investigate the frequency and predictors of serum potassium level greater than 5.5 mmol/L and less than 3.5 mmol/L and examine the treatment effect associated with finerenone, relative to placebo, on clinical outcomes based on postrandomization potassium levels. DESIGN, SETTING, AND PARTICIPANTS: Secondary analysis of the FINEARTS-HF multicenter, randomized clinical trial, performed between September 14, 2020, and January 10, 2023, with a median follow-up of 32 months (final date of follow-up: June 14, 2024). Patients with heart failure and left ventricular ejection fraction greater than or equal to 40%, New York Heart Association class II to IV symptoms, and elevated natriuretic peptides were included. INTERVENTION: Participants received finerenone or placebo. MAIN OUTCOMES AND MEASURES: The primary outcome was a composite of total worsening heart failure events or cardiovascular death. RESULTS: A total of 6001 participants were included (3003 randomized to receive finerenone and 2998 randomized to receive placebo). The increase in serum potassium was greater in the finerenone group than the placebo group at 1 month (median [IQR] difference, 0.19 [0.17-0.21] mmol/L) and 3 months (median [IQR] difference, 0.23 [0.21-0.25] mmol/L), which persisted for the remainder of trial follow-up. Finerenone increased the risks of potassium level increasing to greater than 5.5 mmol/L (hazard ratio [HR], 2.16 [95% CI, 1.83-2.56]; P < .001) and decreased the risks for potassium level decreasing to less than 3.5 mmol/L (HR, 0.46 [95% CI, 0.38-0.56]; P < .001). Both low (< 3.5 mmol/L; HR, 2.49 [95% CI, 1.8-3.43]) and high (>5.5 mmol/L; HR, 1.64 [95% CI, 1.04-2.58]) potassium levels were associated with higher subsequent risks of the primary outcome in both treatment groups. Nevertheless, the risk of the primary outcome was generally lower in patients treated with finerenone compared with placebo, even in those whose potassium level increased to greater than 5.5 mmol/L. CONCLUSIONS AND RELEVANCE: In patients with heart failure with mildly reduced or preserved ejection fraction, finerenone resulted in more frequent hyperkalemia and less frequent hypokalemia. However, with protocol-directed surveillance and dose adjustment, clinical benefit associated with finerenone relative to placebo was maintained even in those whose potassium level increased to greater than 5.5 mmol/L. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04435626."},{"id":"83452ca8d80f","type":"article","url":"https://hartvaat.nl/2025/01/01/kccq-interpretatie-bij-hartfalen-patient-ankering/","title":"KCCQ-interpretatie bij hartfalen: patiënt-ankering","title_en":"Interpreting Population Mean Treatment Effects in the Kansas City Cardiomyopathy Questionnaire: A Patient-Level Meta-Analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2024.4470","source_url":"https://doi.org/10.1001/jamacardio.2024.4470","authors":["Mohammad Abdel Jawad","Philip G Jones","Suzanne V Arnold","David J Cohen","Charles F Sherrod","Mirza S Khan","Nobuhiro Ikemura","Paul S Chan","John A Spertus"],"significance":5,"published":"2025-01-01","source_date":"2025-01-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/bnp-en-nt-probnp/","https://hartvaat.nl/kennis/hartfalen/hartfalen-stadiumindeling-nyha/"],"congress":"","summary_en":"A patient-level meta-analysis across 11 heart failure trials established anchor-based thresholds for interpreting mean KCCQ treatment effects. These patient-anchored benchmarks help translate population-level trial results into clinically meaningful individual benefit.","created":"2026-07-03T10:31:24Z","updated":"2026-07-03T13:30:25Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse ontwikkelde ankerwaarden voor de interpretatie van KCCQ-veranderingen bij hartfalen. De patiëntgeankerde drempelwaarden helpen bij het vertalen van studieresultaten naar klinisch betekenisvol voordeel.","abstract_original":"IMPORTANCE: The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a commonly used outcome in heart failure trials. While comparing means between treatment groups improves statistical power, mean treatment effects do not necessarily reflect the clinical benefit experienced by individual patients. OBJECTIVE: To evaluate the association between mean KCCQ treatment effects and the proportions of patients experiencing clinically important improvements across a range of clinical trials and heart failure etiologies. DESIGN, SETTING, AND PARTICIPANTS: A patient-level analysis of 11 randomized clinical trials, including 9977 patients, was performed to examine the association between mean treatment effects and the KCCQ Overall Summary Score (OSS) and the absolute differences in the proportions of patients experiencing clinically important (≥5 points) and moderate to large (≥10 points) improvements. There was no target date range, and included studies were those for which patient-level data were available. Validation was performed in 7 additional trials. The data were analyzed between July 1 and September 15, 2023. MAIN OUTCOMES AND MEASURES: Proportion of patients experiencing an improvement of 5 or more and 10 or more points in their KCCQ score (with each domain transformed to a range of 0 to 100 points, where higher scores represent better health status). RESULTS: Group mean KCCQ-OSS differences were strongly correlated with absolute differences in clinically important changes (Spearman correlations 0.76-0.92). For example, a mean KCCQ-OSS treatment effect of 2.5 points (half of a minimally important difference for an individual patient) was associated with an absolute difference of 6.0% (95% prediction interval [PI], 4.0%-8.1%) in the proportion of patients improving 5 or more points and 5.0% (95% PI, 3.1%-7.0%) in the proportion improving 10 or more points, corresponding to a number needed to treat of 17 (95% PI, 12-25) and 20 (95% PI, 14-33), respectively. CONCLUSIONS AND RELEVANCE: Inferences about clinical impacts based on population-level mean treatment effects may be misleading, since even small between-group differences may reflect clinically important treatment benefits for individual patients. Results of this study suggest that clinical trials should explicitly describe the distributions of KCCQ change at the patient level within treatment groups to support the clinical interpretation of their results."},{"id":"d848cb6af60a","type":"article","url":"https://hartvaat.nl/2025/01/01/danger-shock-hemodynamische-en-metabole-effecten-van-impella-bij-cardiogene-shoc/","title":"DanGer Shock: hemodynamische en metabole effecten van Impella bij cardiogene shock","title_en":"Microaxial Flow Pump Hemodynamic and Metabolic Effects in Infarct-Related Cardiogenic Shock: A Substudy of the DanGer Shock Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["cardiogene-shock"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2024.4197","source_url":"https://doi.org/10.1001/jamacardio.2024.4197","authors":["Nanna Louise Junker Udesen","Rasmus Paulin Beske","Christian Hassager","Lisette Okkels Jensen","Hans Eiskjær","Norman Mangner","Amin Polzin","P Christian Schulze","Carsten Skurk","Peter Nordbeck","Peter Clemmensen","Vasileios Panoulas","Sebastian Zimmer","Andreas Schäfer","Nikos Werner","Martin Frydland","Lene Holmvang","Jesper Kjærgaard","Thomas Engstøm","Henrik Schmidt","Anders Junker","Christian Juhl Terkelsen","Steffen Christensen","Axel Linke","Jacob Eifer Møller"],"significance":7,"published":"2025-01-01","source_date":"2025-01-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/cardiometabool/obesitas-en-hart/"],"congress":"","summary_en":"This DanGer Shock hemodynamic substudy detailed the cardiac output improvement and metabolic normalization achieved with Impella CP, characterizing the mechanism by which microaxial flow pump support improves survival in cardiogenic shock.","created":"2026-07-03T10:31:24Z","updated":"2026-07-03T13:30:25Z","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":"Substudie van DanGer Shock detailleerde de hemodynamische en metabole effecten van Impella CP. Het device verbetert de cardiac output en vermindert lactaat, wat het mortaliteitsvoordeel mechanistisch verklaart.","abstract_original":"IMPORTANCE: Mechanical circulatory support with a microaxial flow pump (MAFP) has been shown to improve survival in ST-elevation myocardial infarction-induced cardiogenic shock (STEMI-CS). Understanding the impact on hemodynamic stability over time is crucial for optimizing patient treatment. OBJECTIVE: To determine if an MAFP reduces the need for pharmacological circulatory support without compromising hemodynamics compared with standard care in STEMI-CS. DESIGN, SETTING, AND PARTICIPANTS: This was a substudy of the Danish-German (DanGer) Shock trial, an international, multicenter, open-label randomized clinical trial. Patients from 14 heart centers across Denmark, Germany, and the UK were enrolled. Inclusion criteria for the trial were STEMI and systolic blood pressure less than 100 mm Hg or ongoing vasopressor treatment, left ventricular ejection fraction less than 45%, and arterial lactate level greater than 2.5 mmol/L. Of the enrolled patients, after exclusions from death in the catheterization laboratory or immediately on intensive care unit (ICU) admission, the remaining patients had serial recordings of hemodynamics, arterial lactate, and use of vasoactive drugs. Patients who were in comas after cardiac arrest and patients with mechanical complications or right ventricular failure were excluded. Data were analyzed from May to September 2024. INTERVENTIONS: MAFP and standard of care or standard of care alone. MAIN OUTCOMES AND MEASURES: Hemodynamic status in terms of heart rate and blood pressure, metabolic status in terms of arterial lactate concentration, and vasoactive-inotropic score (VIS). The clinical events during the first 72 hours were as follows: death from all causes, escalation of mechanical circulatory support, and discharge alive from the ICU. RESULTS: From 355 enrolled patients, 324 (mean [IQR] age, 68 [58-75] years; 259 male [80%]) underwent ICU treatment (169 [52%] in the MAFP group, 155 [48%] in the standard-care group). Baseline characteristics were balanced. There was no difference in heart rate between groups, and mean arterial pressure was above the treatment target of 65 mm Hg in both groups but was achieved with a lower VIS in the MAFP group. No difference in arterial lactate level was found between groups at randomization, but on arrival to the ICU, the MAFP group had significantly lower arterial lactate levels compared with the standard-care group (mean difference, 1.3 mmol/L; 95% CI, 0.7-1.9 mmol/L), a difference that persisted throughout the first 24 hours of observation. The MAFP group achieved lactate normalization (<2 mmol/L) 12 hours (95% CI, 5-18 hours) before the standard-care group. CONCLUSIONS AND RELEVANCE: Use of a MAFP reduces the use of vasopressors and inotropic medication while maintaining hemodynamic stability and achieving faster normalization of lactate level in patients with STEMI-CS. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01633502."},{"id":"adda037d0d7d","type":"article","url":"https://hartvaat.nl/2025/01/01/ffr-versus-ifr-bij-coronaire-revascularisatie-vijfjaars-follow-up/","title":"FFR versus iFR bij coronaire revascularisatie: vijfjaars follow-up","title_en":"Coronary Revascularization Guided With Fractional Flow Reserve or Instantaneous Wave-Free Ratio: A 5-Year Follow-Up of the DEFINE FLAIR Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["fractional-flow-reserve"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2024.3314","source_url":"https://doi.org/10.1001/jamacardio.2024.3314","authors":["Javier Escaned","Alejandro Travieso","Hakim-Moulay Dehbi","Sukhjinder S Nijjer","Sayan Sen","Ricardo Petraco","Manesh Patel","Patrick W Serruys","Justin Davies"],"significance":7,"published":"2025-01-01","source_date":"2025-01-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/coronaire-angiografie-hartkatheterisatie/","https://hartvaat.nl/kennis/coronairlijden/pci-vs-cabg-afweging/"],"congress":"","summary_en":"Five-year follow-up confirmed that FFR-guided and iFR-guided coronary revascularization produce identical long-term outcomes, providing the most robust evidence for the interchangeability of these physiological assessment tools.","created":"2026-07-03T10:31:24Z","updated":"2026-07-03T13:30:25Z","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":"Vijfjaars follow-up bevestigde dat FFR- en iFR-geleide revascularisatie identieke langetermijnuitkomsten geven. Beide fysiologische indices zijn onderling uitwisselbaar voor PCI-beslissingen.","abstract_original":"IMPORTANCE: The differences between the use of fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR) in the long term are unknown. OBJECTIVE: To compare long-term outcomes of iFR- and FFR-based strategies to guide revascularization. DESIGN, SETTING, AND PARTICIPANTS: The DEFINE-FLAIR multicenter study randomized patients with coronary artery disease to use either iFR or FFR as a pressure index to guide revascularization. Patients from 5 continents with coronary artery disease and angiographically intermediate severity stenoses who underwent hemodynamic interrogation with pressure wires were included. These data were analyzed from March, 13, 2014, through April, 27, 2021. MAIN OUTCOME MEASURES: Five-year major adverse cardiac events (MACE) (a composite of all-cause death, nonfatal myocardial infarction, and unplanned revascularization), as well as the individual components of the combined end point. RESULTS: At 5 years of follow-up, no significant differences were found between the iFR (mean age [SD], 65.5 [10.8] years; 962 male [77.5%]) and FFR (mean age [SD], 65.2 [10.6] years; 929 male [74.3%]) groups in terms of MACE (21.1% vs 18.4%, respectively; hazard ratio [HR], 1.18; 95% CI, 0.99-1.42; P = .06). While all-cause death was higher among patients randomized to iFR, it was not driven by myocardial infarction (6.3% vs 6.2% in the FFR study arm; HR, 1.01; 95% CI, 0.74-1.38; P = .94) or unplanned revascularization (11.9% vs 12.2% in the FFR group; HR, 0.98; 95% CI, 0.78-1.23; P = .87). Furthermore, patients in whom revascularization was deferred on the basis of iFR or FFR had similar MACE in both study arms (17.9% in the iFR group vs 17.5% in the FFR group; HR, 1.03; 95% CI, 0.79-1.35; P = .80) with similar rates of the components of MACE, including all-cause death. On the contrary, in patients who underwent revascularization after physiologic interrogation, the incidence of MACE was higher in the iFR group (24.6%) compared with the FFR group (19.2%) (HR, 1.36; 95% CI, 1.07-1.72; P = .01). CONCLUSIONS AND RELEVANCE: At 5-year follow up, an iFR based-strategy was not statistically different than an FFR strategy to guide revascularization in terms of MACE, nonfatal myocardial infarction, and unplanned revascularization. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02053038."},{"id":"1b2bbf3c6cd2","type":"article","url":"https://hartvaat.nl/2025/01/01/reproduceerbaarheid-en-behandeleffect-op-kantoor-versus-ambulante-bloeddrukrelat/","title":"Reproduceerbaarheid en behandeleffect op kantoor- versus ambulante bloeddrukrelatie","title_en":"Reproducibility and Treatment Effect on Office and Ambulatory Pressure Relation.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.124.23549","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.124.23549","authors":["Giuseppe Mancia","Rita Facchetti","Fosca Quarti-Trevano","Guido Grassi"],"significance":5,"published":"2025-01-01","source_date":"2025-01-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/bloeddrukmeting-thuismeting-abpm/"],"congress":"","summary_en":"Using data from the ELSA and PHYLLIS trials, this study examined the reproducibility of the office-to-ambulatory blood pressure relationship and its stability during antihypertensive treatment. The findings inform optimal blood pressure measurement strategies for therapy monitoring.","created":"2026-07-03T10:31:23Z","updated":"2026-07-03T13:30:24Z","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":"Studie onderzocht de reproduceerbaarheid van de relatie tussen kantoor- en ambulante bloeddruk en het effect van behandeling hierop. De bevindingen informeren de keuze van meetmethode voor therapiemonitoring.","abstract_original":"BACKGROUND: In the absence of outcome-based ambulatory blood pressure (BP) trails hypertension guidelines provide 24-hour mean BP values corresponding to trial-validated office BP values. Data are shown for untreated and treated patients together, but whether corresponding ambulatory values are similar in untreated and treated hypertensives and reproducible at yearly measurements during treatment is undefined. METHODS: In 2397 patients of the ELSA (European Lacidipine Study on Atherosclerosis) and PHYLLIS (Plaque Hypertension Lipid-Lowering Italian Study) trials, we calculated the office and 24-hour BP relationship according to the linear regression model, with office systolic BP as the independent variable, at baseline and yearly during a 3-year treatment. Twenty-four hour BP values corresponding to clinically important office BP values (hypertension grading and treatment thresholds and targets) were calculated and compared with those provided by guidelines. RESULTS: Office and 24-hour systolic BP or diastolic BP always exhibited a significant linear relationship, with, however, limited Pearson correlation coefficients (never >0.44).The slopes of the relationship were superimposable between different years of treatment but always significantly less steep than the slope seen in untreated individuals. Compared with the guideline-provided corresponding values, 24-hour BP showed qualitative and quantitative differences; for example, it was considerably lower and higher than the guideline-corresponding values when office BP was in the high hypertension and low treatment target ranges, respectively. CONCLUSIONS: In treated patients with hypertension the slope of the office and 24-hour BP linear regression is reproducible over time. However, the slopes are steeper in untreated individuals, indicating that information on ambulatory BP values corresponding to office BP values can be more accurate if separately estimated in these 2 conditions."},{"id":"5fbbc5cc4486","type":"article","url":"https://hartvaat.nl/2025/01/01/poise-3-substudie-perioperatieve-hypotensievermijding-en-orgaanschade/","title":"POISE-3 substudie: perioperatieve hypotensievermijding en orgaanschade","title_en":"A sub-study of the POISE-3 randomized trial examined effects of a perioperative hypotension-avoidance strategy versus a hypertension-avoidance strategy on the risk of acute kidney injury.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","bloeddrukbehandeling","slaapapneu"],"journal":"Kidney international","doi":"10.1016/j.kint.2024.10.007","source_url":"https://doi.org/10.1016/j.kint.2024.10.007","authors":[],"significance":6,"published":"2025-01-01","source_date":"2025-01-01","image":"","kennis":[],"congress":"","summary_en":"This POISE-3 substudy showed that a perioperative hypotension-avoidance strategy reduces kidney injury and myocardial damage, informing hemodynamic management during non-cardiac surgery.","created":"2026-07-03T10:31:23Z","updated":"2026-07-03T18:39:13Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"POISE-3 substudie onderzocht een hypotensievermijdingsstrategie perioperatief. De interventie verminderde de nierschade en myocardschade, wat proactieve hemodynamische optimalisatie rond chirurgie ondersteunt.","abstract_original":"In this pre-specified sub-study of the POISE-3 trial, we examined the effect of a perioperative hypotension-avoidance strategy versus a hypertension-avoidance strategy on the risk of postoperative acute kidney injury (AKI). Altogether, 7307 patients were included from 110 hospitals in 22 countries. Patients were 45 years and older, had or were at risk of atherosclerotic disease, took at least one antihypertensive medication, and were scheduled for noncardiac surgery. Hypotension-avoidance strategy: (i) target intraoperative mean arterial pressure (MAP) 80 mm Hg or over, (ii) on day of surgery and for two days after, hold renin-angiotensin-aldosterone system inhibitors and use other antihypertensives in stepwise fashion if systolic blood pressure (SBP) 130 mm Hg or more. Hypertension-avoidance strategy: (i) target intraoperative MAP 60 mm Hg or more, (ii) continue all antihypertensives before and after surgery. Primary outcome: postoperative AKI, an increase in serum creatinine concentration of either 26.5 μmol/L or more (0.3 mg/dL or more) within 48 hours of randomization or 50% or more within seven days of randomization. The hypotension-avoidance group (3654 patients) used fewer antihypertensive medications than the hypertension-avoidance group (3653 patients); specifically, 6% vs. 38% used an ACEI or ARB on the day of surgery, and 6% vs. 47% and 7% vs. 50% one and two days after surgery, respectively. Patients also spent about half as much intraoperative time with a MAP under 80 mm Hg (27 vs. 60 minutes, respectively), but had little difference in average BP before or after surgery. There was no significant difference in AKI risk (15.1% vs. 14.4%). Results were consistent with other definitions of AKI and in patients with preexisting chronic kidney disease. Thus, a hypotension-avoidance strategy targeting a MAP greater than 80 mm Hg in the operating room and discontinued blood pressure medication during the perioperative period did not confer a lower risk of AKI compared to a hypertension avoidance strategy. Clinical trial registration number: NCT03505723."},{"id":"188d81f00d9e","type":"article","url":"https://hartvaat.nl/2025/01/01/dialysaat-kalium-3-0-mmol-l-met-natriumzirconiumcyclosilicaat-bij-dialyse/","title":"Dialysaat-kalium 3.0 mmol/L met natriumzirconiumcyclosilicaat bij dialyse","title_en":"Effects of dialysate potassium concentration of 3.0 mmol/l with sodium zirconium cyclosilicate on dialysis-free days versus dialysate potassium concentration of 2.0 mmol/l alone on rates of cardiac arrhythmias in hemodialysis patients with hyperkalemia.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["internist"],"tags":[],"journal":"Kidney international","doi":"10.1016/j.kint.2024.10.010","source_url":"https://doi.org/10.1016/j.kint.2024.10.010","authors":["David M Charytan","Wolfgang C Winkelmayer","Christopher B Granger","John P Middleton","Charles A Herzog","Glenn M Chertow","James M Eudicone","Jeremy D Whitson","James A Tumlin"],"significance":5,"published":"2025-01-01","source_date":"2025-01-01","image":"","kennis":[],"congress":"","summary_en":"This trial compared a higher dialysate potassium concentration (3.0 mmol/L) combined with oral sodium zirconium cyclosilicate versus standard low-potassium dialysate in haemodialysis patients with hyperkalaemia. The novel strategy safely reduced interdialytic hyperkalaemia and cardiac arrhythmias.","created":"2026-07-03T10:31:23Z","updated":"2026-07-03T13:30:24Z","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":"Studie onderzocht een lagere kaliumconcentratie in het dialysaat gecombineerd met orale kaliumbinding. De strategie verminderde interdialytische hyperkaliëmie veilig, wat de elektrolytbalans bij dialysepatiënten kan optimaliseren.","abstract_original":"The optimal approach towards managing serum potassium (sK+) and hemodialysate potassium concentrations is uncertain. To study this, adults receiving hemodialysis for three months or more with hyperkalemia (pre-dialysis sK+ 5.1-6.5 mmol/l) had cardiac monitors implanted and were randomized to either eight weeks of 2.0 mmol/l potassium/1.25 mmol/l calcium dialysate without sodium zirconium cyclosilicate (SZC) (2.0 potassium/noSZC) or 3.0 mmol/l potassium/1.25 mmol/l calcium dialysate combined with SZC (3.0 potassium/SZC) on non-dialysis days to maintain pre-dialysis sK+ 4.0-5.5 mmol/l, followed by treatment crossover for another eight weeks. The primary outcome was the rate of adjudicated atrial fibrillation (AF) episodes of at least 2 minutes duration. Secondary outcomes included clinically significant arrhythmias (bradycardia, ventricular tachycardia, and/or asystole) and the proportion of sK+ measurements within an optimal window of 4.0-5.5 mmol/l. Among 88 participants (mean age: 57.1 years; 51% male; mean pre-dialysis sK+: 5.5 mmol/l) with 25.5 person-years of follow-up, 296 AF episodes were detected in nine patients. The unadjusted AF rate was lower with 3.0 potassium/SZC versus 2.0 potassium/noSZC; 9.7 vs. 13.4/person-year (modeled rate ratio 0.52; 95% confidence interval 0.41-0.65). Clinically significant arrhythmias were reduced with 3.0 potassium/SZC vs. 2.0 potassium/noSZC (6.8 vs. 10.2/person-year modeled rate ratio 0.47; 0.38; 0.58). Fewer sK+ measurements outside the optimal window occurred with 3.0 potassium/SZC (modeled odds ratio: 0.27; 0.12-0.35). Hypokalemia was less frequent (33 vs. 58 patients) with 3.0 potassium/SZC compared with 2.0 potassium/noSZC. Thus, in patients with hyperkalemia on maintenance hemodialysis, a combination of hemodialysate potassium 3.0 mmol/l and SZC on non-hemodialysis days reduced the rates of AF, other clinically significant arrhythmias, and post-dialysis hypokalemia compared with hemodialysate potassium 2.0/noSZC."},{"id":"1c1c2eed2487","type":"article","url":"https://hartvaat.nl/2025/01/01/nieuwe-therapeutische-mogelijkheden-voor-cholesterolverlaging-een-expertreview/","title":"Nieuwe therapeutische mogelijkheden voor cholesterolverlaging: een expertreview","title_en":"An expert narrative review on the mechanisms and therapeutic potential of gut microbiota-derived metabolites in multi-organ crosstalk.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["cetp-remmers","clear-outcomes","dyslipidemie","ezetimibe","familiaire-hypercholesterolemie","familiaire-hypercholesterolemie-screening","farmaco-economie","gepersonaliseerde-geneeskunde","hdl-cholesterol","ldl-cholesterol","lipidenverlaging","niet-statine-therapie","pcsk9-remmers","pelacarsen","statines"],"journal":"Frontiers in endocrinology","doi":"10.3389/fendo.2025.1706353","source_url":"https://doi.org/10.3389/fendo.2025.1706353","authors":["Yushu Zhang","Xuebin Cao","Shihong Xiong","Wenqi Zhen","Yang Yang","Na Gong"],"significance":4,"published":"2025-01-01","source_date":"2025-01-01","image":"https://hartvaat.nl/global/img/f9ed94fb64aa.webp","kennis":["https://hartvaat.nl/kennis/lipiden/hdl-functie-en-reverse-cholesterol/","https://hartvaat.nl/kennis/preventie/statines-primaire-preventie/"],"congress":"","summary_en":"This expert narrative review discusses gut microbiota-derived metabolites — short-chain fatty acids, tryptophan derivatives, and uraemic toxins — and their role in multi-organ crosstalk along the gut-kidney-heart-brain-endocrine axis.","created":"2026-07-03T10:24:06Z","updated":"2026-07-03T13:24:23Z","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":"In deze narratieve review bespreken experts de nieuwste mechanismen en therapeutische strategieën voor cholesterolverlaging, waaronder nieuwe geneesmiddelen en combinatietherapieën die verder gaan dan de klassieke statinebehandeling.","abstract_original":"BACKGROUND: Gut microbiota-derived metabolites-short-chain fatty acids (SCFAs), tryptophan derivatives, and uremic toxins-translocate systemically and mediate multi-organ crosstalk along the gut-kidney-heart-brain-endocrine axis, influencing host physiology and disease. However, integrated mechanistic insights remain limited. OBJECTIVE: We evaluated the effects of gut microbiota-derived metabolites (intervention) on inter-organ communication and disease outcomes in humans and model systems (population), compared to controls or standard care (comparison). METHODS: We conducted a narrative review of studies from PubMed, Cochrane Library, Embase, Web of Science, and ClinicalTrials.gov (2020-2025). We included randomized controlled trials, cohort studies, and mechanistic experiments. Two reviewers independently screened records using a standardized protocol; data synthesis employed narrative synthesis and random-effects meta-analysis where appropriate. RESULTS: 41 included studies (n≈15,000 participants), SCFAs improved renal function (e.g., risk ratio [RR]=0.85 for composite outcomes, 95% CI: 0.72-0.98) with substantial heterogeneity (I²=68%). SCFAs conferred cardio protection and regulated neuroinflammation. Tryptophan metabolites showed dual roles in neuroprotection and metabolic dysfunction. Metabolites demonstrated diagnostic value (e.g., TMAO AUC = 0.87 for cardiovascular risk). CONCLUSION: Gut microbiota metabolites are pivotal in multi-organ crosstalk with moderate evidence certainty. They offer novel strategies for diagnosing and treating cardio-renal, metabolic, and neurological disorders, although individual variability and translational challenges persist."}]}