Netherlands Heart Journal最新文献

Aim: To evaluate the impact of the 2023 Dutch national guidelines for primary prevention implantable cardioverter-defibrillator (ICD) implantation on outcomes in non-ischaemic cardiomyopathy (NICM) patients and to assess the role of late gadolinium enhancement cardiac magnetic resonance imaging (LGE-CMR) in predicting ICD therapy.

Methods: This retrospective, single-centre observational exploratory cohort study included patients with NICM who received a primary prevention single-chamber, dual-chamber or subcutaneous ICD between January 2008 and April 2022 and underwent LGE-CMR prior to implantation. Patients were classified into LGE+ and LGE- groups based on the presence of late enhancement detected by CMR. The primary endpoint was time to first appropriate ICD therapy. The secondary endpoint was all-cause mortality.

Results: Of the 258 NICM patients in the database, a total of 85 patients were included, of whom 41 had LGE on CMR. After a 5-year follow-up period, appropriate ICD therapy occurred in 20% of the patients in the LGE+ group and 14% of patients in the LGE- group (p = 0.37). All-cause mortality was 7% in the LGE+ group and 14% in the LGE- group (p = 0.46). Multivariable analysis showed no parameters significantly associated with appropriate ICD therapy.

Conclusion: Applying the 2023 national guidelines retrospectively on a population of NICM patients with a primary prevention ICD indication demonstrated no significant association between LGE on CMR and appropriate ICD therapy over a follow-up period of 5 years. These findings underscore the need for further research and randomised trials to refine risk stratification and ICD implantation guidelines in NICM, ideally leveraging a multicentre approach to address current limitations in sample size and enhance the generalisability of the results.

Introduction: Heart failure (HF) is a global health issue, imposing a significant burden on healthcare systems. Deventer Hospital recently introduced DZThuis, a hybrid Hospital-at-Home care model for patients with acute decompensated heart failure (ADHF). Patients receive treatment with intravenous diuretics at home when possible and in hospital when necessary. This pilot study evaluated the feasibility of DZThuis and compared outcomes with conventional in-hospital care to assess safety.

Methods: This retrospective, single-centre cohort study compared 47 DZThuis patients (July 2022-November 2023) with 60 in-hospital ADHF patients admitted between August 2021 and July 2022. Kaplan-Meier curves and log-rank tests were used to analyse mortality and time to the composite endpoint of mortality or HF readmission. Secondary endpoints included total treatment duration, renal function, and complications.

Results: No significant differences were found in mortality (p = 0.987) or time to the composite endpoint (p = 0.745). Treatment duration did not significantly differ (DZThuis: 11.3 ± 8.4 days vs in-hospital: 8.8 ± 4.9 days; p = 0.068). Complication rates were comparable. Five DZThuis patients transitioned to in-hospital care, in line with the hybrid model's design.

Conclusion: Despite a higher prevalence of comorbidities, DZThuis demonstrated outcomes comparable with traditional in-hospital care for ADHF patients and proved to be a feasible and safe model. Further long-term research in larger cohorts is needed to confirm safety and efficacy, with a particular focus on the impact of Hospital-at-Home care on quality of life and patient satisfaction.

Background: Meticulous implantation strategies (i.e. lesion predilatation, stent sizing and postdilatation) are known to decrease lesion-oriented adverse events (LOCE) following percutaneous coronary intervention (PCI) with bioresorbable scaffolds. Their impact on PCI with drug-eluting stents remains unclear.

Objective: To assess the impact of meticulous implantation strategies on long-term LOCE in PCI with everolimus-eluting stents (EES).

Methods: This substudy of the AIDA trial (NCT01858077) focused on the evaluation of predilatation, stent sizing and postdilatation through analyses of vessel and device diameters at various locations around the lesion. Their interrelations were assessed using quantitative coronary angiography across various lesion locations. Logistic regression was used to evaluate how predictors influenced the primary outcome LOCE, which includes target lesion revascularisation (TLR), target-vessel myocardial infarction (TV-MI) and definite stent thrombosis (ST).

Results: LOCE occurred in 84 (7.7%) of 1098 lesions, mainly driven by TLR (63, 5.7%) and TV-MI (46, 4.2%), with ST occurring in 9 (0.8%) lesions. Predilatation and postdilatation were performed in 92 and 49% of lesions, respectively. The difference between the diameter of the predilatation balloon and the reference vessel diameter was significantly associated with an increased risk for LOCE (odds ratio 4.84, 95% confidence interval: 1.91-12.7) with significant interaction with diabetes (p for interaction = 0.04), thus disfavouring predilatation with oversized balloons.

Conclusion: The low LOCE rate (7.7%) over 5 years underscores the efficacy of PCI with EES. The use of 'oversized' balloons for predilatation was associated with an increased risk of LOCE by up to fivefold, a risk that was interestingly reduced in patients with diabetes mellitus.

Background: Phospholamban (PLN) p.Arg14del (R14del, R14^∆/+) is the most commonly identified pathogenic variant that causes cardiomyopathy in the Netherlands. Many disease characteristics are still unclear, including the phenotypic triggers, disease progression and disease-specific biomarkers. We aim to gain a better understanding of the R14^∆/+ pathophysiology by establishing a cohort across the R14^∆/+ disease spectrum.

Methods: The Disease spECifIc PatHways and modifiERs in PhosphoLambaN r14del cardiomyopathy (DECIPHER-PLN) cohort includes 101 participants, categorised as unaffected R14^∆/+ (n = 21), early affected R14^∆/+ (n = 42), end-stage R14^∆/+ (n = 28) and heart failure (HF) of another aetiology (n = 10). R14^∆/+ category was based on left ventricular ejection fraction, HF symptoms, electrocardiogram (ECG) and N‑terminal pro-brain natriuretic peptide concentrations. Of the 91 included R14^∆/+ carriers, 46 (51%) were female, with a mean age of 55 years (standard deviation: 14). Low-voltage ECG older age, arrhythmias, and conduction and repolarisation abnormalities were common in (early) affected R14^∆/+ carriers. Serum and plasma were collected from all participants. Induced pluripotent stem cells were generated from fibroblasts of end-stage R14^∆/+ patients and unaffected R14^∆/+ family members (n = 4) and differentiated into cardiomyocytes. Explanted heart tissue was obtained from R14^∆/+ patients undergoing cardiac surgery and patients with other HF aetiologies as control. Abnormal PLN protein localisation was confirmed in R14^∆/+ carriers.

Conclusion: DECIPHER-PLN comprises R14^∆/+ carriers across the disease and non-disease spectrum and can be used to identify disease-specific biological pathways and modifiers that play a role in R14^∆/+ cardiomyopathy. Using a multi-omics approach and in vitro disease modelling, we aim to identify novel biomarkers and improve our understanding of R14^∆/+ pathophysiology. Material is available upon request.

Background: To detect recurrent atrial fibrillation (AF) after pulmonary vein isolation (PVI), different methods can be used, ranging from incidental electrocardiograms (ECGs) to rhythm monitoring with implantable loop recorders. We investigated whether telemonitoring (TM) with photoplethysmography (PPG) is feasible for post-PVI follow-up.

Methods: In total, 157 pre-PVI patients were included. Of them, 78 underwent TM at a virtual AF clinic, for which they received a PPG application and were monitored by trained eNurses. The numbers of hospital contacts, hospital visits, ECGs and Holter recordings were assessed. Patient satisfaction and quality of life were analysed. Comparisons were made with a historical control group with a traditional follow-up of outpatient visits, ECGs and Holter recordings (n = 79).

Results: Mean ± standard deviation (SD) age was 63 ± 10 years, and 64% were male. AF was paroxysmal in 68% of the patients. Follow-up at 1 year was completed in all patients. In the TM group, the mean ± SD annual number of recordings per patient was 16 ± 29, and AF was detected in 37 patients (47%). The TM group experienced significant decreases in the numbers of unplanned outpatient clinic visits and AF-related hospital admissions, as well as reductions in the numbers of ECGs and Holter recordings performed. Patients reported high satisfaction with this form of TM.

Conclusion: The use of a virtual AF clinic was feasible, and satisfaction was high. Compared with patients with a traditional follow-up, patients on PPG-based TM needed fewer hospital visits and admissions and underwent fewer ECGs and Holter recordings.