Netherlands Heart Journal最新文献

Background: Management of asymptomatic severe mitral regurgitation (MR) is challenging. Both early mitral valve repair surgery and active surveillance with facilitated surgery are possible strategies. The DutchAMR registry compares clinical outcomes between these two strategies.

Methods: Patients were included between 2013-2019. Primary endpoints were cerebrovascular accidents (CVA), reoperations, and mortality. Facilitated surgery was defined as mitral valve repair surgery performed after developing a surgical indication during active surveillance.

Results: Ninety-nine patients were enrolled; 71 in active surveillance and 28 in early surgery. Over a median follow-up time of 5.1 years, 51% of active surveillance patients underwent facilitated surgery due to ESC guideline triggers. Both the early and facilitated surgery groups had one perioperative CVA. During follow-up, in the active surveillance group, 5 (7%) patients died (3 without surgery and 2 after facilitated surgery), and 3 (4%) underwent reoperations. In the early surgery group, 4 (14%) patients reached a primary endpoint, including 2 (7%) CVAs (without residual symptoms) and 2 (7%) deaths. No reoperations occurred in the early surgery group. Baseline additional testing parameters based on CPET, Holter monitoring, and CMR showed no differences between the groups.

Conclusions: After 5.1 years, half of the active surveillance patients required facilitated surgery, with comparable postoperative outcomes to early surgery. Clinical endpoints were comparable between the early and facilitated surgery strategies. There were no differences in baseline additional testing parameters, suggesting no clear targets for upfront stratificatio. Thus, shared decision making weighing the different risks can be used to determine the strategy per patient.

Background: Functional mitral regurgitation (FMR) contributes significantly to morbidity and mortality and may result from left ventricular (VFMR) or atrial (AFMR) remodelling. Left atrial reservoir strain (LASR) is a sensitive marker of atrial dysfunction and may offer incremental prognostic value. This study evaluated whether LASR predicts all-cause mortality and heart failure (HF) hospitalizations in FMR, its performance in VFMR versus AFMR, and its utility over standard echocardiographic parameters.

Methods: We retrospectively analyzed 102 patients (mean age 68 ± 14 years, 41.2% female) with at least moderate FMR who underwent transesophageal echocardiography between 2018 and 2023. Patients were categorized into VFMR (LV dysfunction or remodelling) and AFMR (LA enlargement with preserved LV function). LASR was assessed using speckle-tracking echocardiography. Primary and secondary endpoints were all-cause mortality and HF hospitalization, respectively. Cox models evaluated associations with outcomes, including subgroup analysis by LASR quartiles and additional risk stratification combining LASR with peak tricuspid regurgitation (TR) velocity.

Results: LASR was independently associated with all-cause mortality in multivariate Cox regression (adjusted HR = 0.887, p = 0.039). Higher LASR quartiles were associated with improved survival (p = 0.013). When combined with peak TR velocity in a composite risk model, patients with LASR ≤ 9.0% or TR velocity > 3.0 m/s had significantly higher risks of mortality (HR = 2.853, p = 0.012) and HF hospitalization (HR = 3.922, p = 0.029).

Conclusions: LASR, particularly when combined with TR velocity, provides strong prognostic value in FMR, supporting its potential role in refining risk assessment.

Background: Despite recent advances in the treatment of acute heart failure (AHF), implementation of new evidence into clinical practice remains challenging.

Methods: We conducted a single-center descriptive exploratory study within an ongoing prospective AHF registry. Adult patients admitted with AHF, without requiring intensive care, were included consecutively. An updated local AHF protocol was developed and implemented by group-education sessions, pocket cards, and posters. Patients before (control group) and after (intervention group) implementation of the new protocol were compared in terms of compliance to the protocol and 90-day outcomes-blanking the implementation period. Subgroups entailed HF with (mildly) reduced and preserved ejection fraction.

Results: Patients were elderly, with almost half being de novo HF patients. Groups were comparable except for higher NT-proBNP in the implementation group and a higher cancer prevalence in the control group. The intervention group showed an increase in in-hospital use of acetazolamide (59.8 vs 0%, p < 0.001), in iron deficiency testing and correct iv. iron administration (42.9% vs 78.6% p ≤ 0.001). Pre-discharge installation of SGLT2 inhibitors showed a positive trend (44.2 vs 20% in HF(m)rEF patients and 29.4 vs 4% in HFpEF, both p = 0.01) HF-event-free survival at 90 days numerically favored the intervention group (29.9 vs 44.3%, p = 0.054), whereas length of hospital stay increased by 1 day (p = 0.011).

Conclusion: Implementing a local updated AHF protocol improved adoption of several evidence based AHF interventions. This may translate into improved patient outcomes, against a minor increase in hospital duration.

Background: Failure to identify the underlying cause of chest pain in patients presenting to the cardiac emergency department (ED) poses a significant health and economic challenge. Non-typical chest pain in patients without a history of cardiovascular disease often leads to uncertainty regarding appropriate follow-up care.

Research question: Does outpatient follow-up consultation with a cardiologist impact recurrent cardiac ED visits and major adverse cardiac and cerebrovascular events (MACCE) in patients with non-typical chest pain and no prior cardiovascular history?

Study design and methods: This retrospective cohort study included 429 patients presenting to the cardiac ED with non-typical chest pain and no history of cardiovascular disease. Of these, 213 patients (49.7%) received follow-up consultations with a cardiologist within three months of their index ED visit. We compared rates of recurrent (cardiac) ED visits, MACCE, and healthcare resource utilization during a one-year follow-up between patients who received follow-up consultations and those who did not.

Results: Patients with follow-up consultations had a significantly higher rate of revisits to the cardiac ED (13.6% vs. 5.1%) during the one-year follow-up period. There was no significant difference in MACCE between the two groups. Additionally, follow-up consultations were associated with an increase in healthcare resource utilization, including specialized cardiac tests.

Conclusion: This study highlights the potential drawbacks of routine follow-up consultations in this patient population and calls for further prospective research to validate these findings.

Background: Reducing AF-related symptoms and improving health-related quality of life (HRQoL) are important drivers in the decision for pulmonary vein isolation (PVI) in treating symptomatic atrial fibrillation (AF). We assessed the association between various patient characteristics, intervention, and outcome variables, and HRQoL both prior to and one year after PVI, with specific attention to groups that did not improve or were still impaired in HRQoL post PVI.

Methods: Observational, retrospective multicenter cohort study within 8 hospitals participating in the Netherlands Heart Registration (NHR). Patients who underwent PVI between 2016 and 2019 and completed the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire both prior to and one year after were included. Accepted cut-off values for impaired HRQoL and clinically important difference (CID) were used.

Results: Mean AFEQT score (n = 2,534) was 55.6 ± 19.7 prior to intervention and 79.8 ± 20.2 after. Post-PVI, 39.5% of the population was still impaired in HRQoL (< 80 points), and 19.2% failed to achieve CID (delta ≥ 5 points). Lower baseline AFEQT-score (odds ratio [OR], 0.96 [per 1‑point increase]; 95% CI, 0.96-0.97; p < 0.001) and female sex (odds ratio [OR], 1.42; 95% CI, 1.16-1.75; p < 0.001) were the most prominent related factors with impaired HRQoL post-PVI. Higher baseline AFEQT-score (odds ratio [OR], 1.04 [per 1‑point increase]; 95% CI, 1.04-1.05; p < 0.001) was strongly associated with failure to achieve CID.

Conclusion: Despite a major increase in HRQoL across the population, over one-third of patients were still impaired in HRQoL post-PVI. Multiple factors were identified that may guide counselling of AF patients about treatment choice.