Netherlands Heart Journal最新文献

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.

Background: eHealth products have the potential to enhance heart failure (HF) care by identifying at-risk patients. However, existing risk models perform modestly and require extensive data, limiting their practical application in clinical settings. This study aims to address this gap by validating a more suitable risk model for eHealth integration.

Methods: We developed the Maastricht Decompensation Questionnaire (MDQ) based on expert opinion to assess HF patients' fluid status using common signs and symptoms. Subsequently, the MDQ was administered to a cohort of HF outpatients at Maastricht University Medical Centre. Patients with ≥ 10 MDQ points were categorised as 'decompensated', patients with < 10 MDQ points as 'not decompensated'. HF nurses, blinded to MDQ scores, served as the gold standard for fluid status assessment. Patients were classified as 'correctly' if MDQ and nurse assessments aligned; otherwise, they were classified as 'incorrectly'.

Results: A total of 103 elderly HF patients were included. The MDQ classified 50 patients as 'decompensated', with 17 of them being correctly classified (34%). Additionally, 53 patients were categorised as 'not decompensated', with 48 of them being correctly classified (90%). The calculated area under the curve was 0.69 (95% confidence interval: 0.57-0.81; p < 0.05). Cronbach's alpha reliability coefficient for the MDQ was 0.85.

Conclusions: The MDQ helps identify decompensated HF patients through clinical signs and symptoms. Further trials with larger samples are needed to confirm its validity, reliability and applicability. Tailoring the MDQ to individual patient profiles may improve its accuracy.

Background: Pulmonary embolism is an important cause of preventable mortality. Treatment strategies depend on risk stratification. High-risk patients, and some intermediate-high-risk patients, require urgent reperfusion therapy. Systemic thrombolysis (ST) is the effective first-choice treatment in these patients; however, the high risk of bleeding complications is a major drawback. In this single-centre retrospective cohort study, we report our experience with the FlowTriever thrombosuction system as an alternative or adjunct to ST in intermediate-high and high-risk pulmonary embolism.

Methods: Demographic and clinical data of all patients treated with the FlowTriever system from December 2021 until March 2024 were retrieved from the electronic medical records. Primary outcomes were technical success rate, 30-day all-cause mortality and major bleeding.

Results: Twenty-one patients were treated with the FlowTriever system, 14 of whom were considered high risk. The technical success rate was 100%. Thirty-day all-cause mortality was 29% and major bleeding was recorded in 5 patients (24%), of which one bleeding event was related to the FlowTriever procedure. A significant reduction was seen in mean pulmonary arterial pressure and right ventricular end-diastolic dimension.

Conclusion: In intermediate-high and high-risk pulmonary embolism patients with ST treatment failure or a contraindication for ST, the FlowTriever thrombosuction system seems to be a minimally invasive alternative treatment modality with low complication rates.

Background: This study investigates the effects of spondylodiscitis on the inflammation burden in infective endocarditis patients.

Methods: A prospective, observational study was conducted between September 2018 and October 2022 in a non-surgical teaching hospital. Patients with a definite or possible and treated as infective endocarditis were recruited from the Alkmaar Endocarditis Team meetings. Spondylodiscitis was diagnosed based on symptoms and radiological findings. The inflammation burden was defined as the area under the C‑reactive protein (CRP) curve.

Results: 174 consecutive patients with infective endocarditis were included (mean age 73 years, 34.5% female). Concomitant spondylodiscitis was present in 32 patients (18%), frequently associated with Streptococcus species (38%). At admission, the mean level of CRP was significantly higher in patients with concomitant spondylodiscitis (p = 0.004). The median CRP area under the curve was significantly higher in spondylodiscitis patients (4.2 × 10⁶ min.mg/l [1.2 × 10⁵ - 1.6 × 10⁷ min.mg/l] vs 2.0 × 10⁶ min.mg/l [8.7 × 10⁴ - 1.6 × 10⁷ min.mg/l], p < 0.001). This difference remained during the whole treatment period. At 6 months of follow-up, rates of mortality and relapse of infective endocarditis were not significantly different.

Conclusion: The prevalence of spondylodiscitis in non-referred patients with infective endocarditis was 18%. Endocarditis patients with spondylodiscitis had an increased inflammation burden at and during admission. This difference in normalisation of CRP levels was particularly apparent in the final phase of antibiotic treatment but not related to infectious complications. Despite an augmented inflammation burden, spondylodiscitis was not associated with mortality, cardiac surgery or infectious relapse.