Netherlands Heart Journal最新文献

The European Society of Cardiology (ESC) has updated its guidelines on cardiac pacing and cardiac resynchronisation. As the majority are class II recommendations (61%) and based on expert opinion (59%), a critical appraisal for the Dutch situation was warranted. A working group has been established, consisting of specialists in cardiology, cardiothoracic surgery, geriatrics, allied professionals in cardiac pacing, and patient organisations with support from the Knowledge Institute of the Dutch Association of Medical Specialists. They assessed the evidence leading to the recommendations and the suitability for daily Dutch practice. Several recommendations have been amended or omitted altogether if a conflicting Dutch guideline has recently been published, such as a guideline on performing magnetic resonance imaging in patients with cardiac implantable electronic devices. The recent Dutch guideline on implantable cardioverter defibrillator implantation in patients with non-ischaemic cardiomyopathy has recommended implanting cardiac resynchronisation therapy devices without a defibrillator function. Shared decision making has received a more prominent role in the ESC guidelines and is discussed in more detail in this document. The recommendations given in this document are intended for health care professionals involved in the care of patients with an indication for cardiac pacing and are approved by the participating professional societies and the patient organisation Harteraad.

Introduction: Current family screening approaches in dilated cardiomyopathy (DCM) depend on the presence or absence of a familial genetic variant, in which variant pathogenicity (i.e. benign or pathogenic) classification drives screening recommendations. However, this approach has never been systematically evaluated.

Methods: To describe the yield of DCM family screening stratified by variant classification in the Netherlands, we included 358 relatives (mean age ± standard deviation: 44.4 ± 15.9 years at baseline; 52% female; 41% (likely) pathogenic (LP/P) variant carriers from 210 families). Demographics, symptoms and genetic/cardiac test results were obtained. Endpoints were the development of DCM (left ventricular ejection fraction < 50% of non-ischaemic aetiology) or occurrence of major adverse cardiovascular events (MACE) (i.e. heart failure hospitalisation, ventricular arrhythmia or death). Probability of DCM or MACE was assessed with the Kaplan-Meier method.

Results: DCM was present in 32 relatives (9%) (25/32 (78%) with LP/P variant) at baseline and in an additional 10/97 relatives (10%) (9/10 (90%) with LP/P variant) who were re-evaluated during a median follow-up time of 5.0 years (interquartile range: 3.2-7.4). Of the 128 relatives without the familial LP/P variant, none developed DCM. MACE was experienced by 5 relatives (1%) (4/5 (80%) with LP/P variant), all of whom had DCM at the time of the event.

Conclusion: The yield of DCM family screening was ~10% at baseline and another ~10% during 5‑year follow-up. Relatives without the familial LP/P variant could be safely discharged. These results reinforce the use of a genetics-first screening approach in relatives from families with an LP/P variant. This will lower the burden on resources in Dutch hospitals and help allocate resources to those who are most likely to benefit.

Objectives: Coronary graft failure (CGF) may occur early after coronary bypass graft surgery (CABG). The study aimed to identify clinical and perioperative risk factors and to evaluate the long-term clinical impact of symptomatic early CGF.

Methods: Patients who underwent clinically indicated coronary angiography (CAG) prior to post-CABG discharge between 2012 and 2022 were included. Symptomatic early CGF was defined as a dysfunctional coronary graft, evaluated on clinically indicated CAG, caused by stenosis of the proximal or distal anastomosis or bypass conduit, bypass occlusion, thrombosis, reduced flow (TIMI < 1) and kinking/tenting. Patients were divided into symptomatic early CGF and non-early CGF groups. Kaplan-Meier and multivariate analysis estimated cumulative survival free of major adverse cardiovascular events (MACE: death, myocardial infarction and revascularisation) up to 5 years' follow-up and identified predictors of symptomatic early CGF.

Results: A total of 92 patients (79% male, 66.1 ± 10 years old) were included, of whom 55 (59.8%) had symptomatic early CGF. Baseline characteristics, surgical parameters and post-surgical parameters potentially indicative of ischaemia were comparable between groups. Patients with symptomatic early CGF had a significantly lower MACE rate over a median follow-up period of 33 months (p = 0.023). Venous graft integration (p = 0.005), Y‑graft configuration (p = 0.002) and prolonged inotropic support (p = 0.032) were associated with symptomatic early CGF.

Conclusions: Symptomatic early CGF was observed in the majority of post-CABG patients undergoing clinically indicated CAG prior to discharge. Patients with symptomatic early CGF exhibited higher MACE rates over a median follow-up period of 33 months. Venous graft integration, Y‑graft configuration and prolonged use of inotropic agents were associated with symptomatic early CGF. However, these clinical findings should be interpreted with caution.

Background: Cardiac sarcoidosis (CS) is associated with poor prognosis, making early diagnosis and treatment important. This study evaluated the results of a diagnostic approach in patients with known sarcoidosis and suspected cardiac involvement in a tertiary centre and their long-term outcomes.

Methods: We included 180 patients with sarcoidosis and a clinical suspicion of CS. In addition to an electrocardiogram (ECG)/transthoracic echocardiogram (TTE), cardiovascular magnetic resonance imaging (CMR) and positron emission tomography (PET) were performed in 66% and 37% of the patients, respectively. The diagnosis of CS was based on the Heart Rhythm Society criteria. Follow-up was performed, and a composite endpoint of sustained ventricular tachycardia, ventricular fibrillation, aborted sudden cardiac death, heart failure hospitalisation, heart transplantation or cardiac death was used for the survival analysis.

Results: Symptoms were present in 87% of the patients, and ECG/TTE abnormalities were found in 92/180 patients (51%). Using CMR and/or PET, 31/92 patients (34%) were diagnosed with CS. In 15 patients, an alternative diagnosis was found. CS was diagnosed in 11/88 patients (13%) without ECG/TTE abnormalities. During a median follow-up time of 4.4 years (interquartile range: 2.3-6.8), 11 composite endpoints occurred, more frequently in CS patients than in sarcoidosis patients without cardiac involvement (p < 0.001). Patients with ECG/TTE abnormalities at baseline had worse outcomes than those without abnormalities (p = 0.019).

Conclusion: CS was diagnosed in 23% of the referred sarcoidosis patients. ECG/TTE were of limited diagnostic value for screening for CS but seemed to have important prognostic value as patients with normal ECG/TTE results who did meet the diagnostic CS criteria had a very good prognosis. CMR/PET provided a good diagnostic yield and identified other cardiac diseases.

Objectives: Controversies exist regarding sex differences in outcomes after coronary artery bypass grafting (CABG). This study assessed sex differences in early and mid-term outcomes after CABG and factors associated with these differences. Outcomes were based on data from the Netherlands Heart Registration (NHR).

Methods: Data of patients undergoing CABG in the Netherlands between 2013 and 2019 were retrieved from the NHR database. Primary outcomes were early mortality, morbidity and mid-term survival. The population was divided into subgroups based on age (≥ 70 years and < 70 years). Regression analyses investigated the correlation between sex and both early and mid-term mortality.

Results: This study included 41,705 male and 10,048 female patients. Median follow-up was 3.6 (1.8-4.8) years. Female patients were less likely to receive ≥ 2 arterial grafts (15.9% vs 23.2%, p < 0.001), had fewer anastomoses (3.2 ± 1.1 vs 3.5 ± 1.1, p < 0.001), higher 30-day mortality (1.9% vs 1.0%; p < 0.001) and a lower mid-term survival rate (91.3% vs 93.1%, p < 0.001). Perioperative complications, including myocardial infarction and stroke, were more common in female patients (all p < 0.001). Women aged < 70 years had a lower mid-term survival rate than men < 70 years (94.5% vs 96.0%, p < 0.001). Cox regression analysis showed that female sex was not significantly associated with mid-term mortality in the total cohort [hazard ratio (HR) 1.03; p = 0.45] but was associated with mid-term mortality in patients aged < 70 years (HR 1.19; p < 0.001).

Conclusions: Women undergoing CABG in our cohort presented with more complex risk profiles, received different surgical strategies and had worse early and mid-term outcomes compared to men. Female sex was associated with mid-term mortality only in patients < 70 years of age.