Netherlands Heart Journal最新文献

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 and aims: In 15-40% of patients undergoing repeat ablation for AF recurrence, all pulmonary veins (PVs) are durably isolated. Currently, there is limited evidence on the appropriate treatment strategy for these patients. We aimed to characterize and compare the effectiveness of different re-ablation strategies.

Methods: All patients referred for repeat AF ablation with all PVs durably isolated at 8 hospitals in the Netherlands were included [Netherlands-Heart-Registration (NHR); 2016-2019]. NHR data were were used to determine the presence of PV-reconnection, the ablation strategy used, and the outcome of ablation (atrial arrhythmia recurrence > 30 sec.). The effectiveness of ablation strategies was assessed with multivariable Cox models.

Results: Of 2311 repeat AF ablations performed, 274 (11.9%) patients had all PVs durably isolated. Median age was 66 (IQR:58-70) years, 44.2% women, 45.6% had persistent/long-standing-persistent AF. In 33 (12.0%) patients, no ablation was performed. A single ablation strategy was performed most often (41.2%). Posterior wall ablation (58.4%) was performed most often, followed by PV-antralization (26.3%). Over 2.0 (1.0-3.3) years, 147 (59.8%) patients had an atrial arrhythmia recurrence, and 30 (12.7%) patients had another repeat AF ablation within 1 year. After multivariable adjustment, no difference in atrial-arrhythmia recurrences was detected between individual ablation strategies, number of strategies performed, and type of atrial-arrhythmia (p > 0.05 for all). Left-atrial-volume-index was associated with a higher recurrence-risk [aHR 1.03(95%CI 1.01-1.05)].

Conclusion: In patients with durably isolated PVs, a high proportion experienced recurrence of atrial arrhythmias, with no difference in recurrence rates between different re-ablation strategies.

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: 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.