Netherlands Heart Journal最新文献

Spontaneous coronary artery dissection (SCAD) occurs in 1-4% of acute coronary syndromes (ACS). In SCAD, an intramural hematoma compresses the true lumen of the coronary artery, leading to ischemia and, even acute myocardial infarction.Approximately, 90% percent of SCAD patients are premenopausal women without classical risk factors for atherosclerosis. The gold standard for diagnosis is invasive coronary angiography and optical coherence tomography or intravascular ultrasound can be useful tools to confirm the diagnosis. Coronary intervention with stent placement is generally not recommended unless there is complete occlusion of the coronary artery with ongoing ischemia. In the acute phase, antiplatelet therapy and beta-blockers are advised, which are usually continued for life. Despite medical treatment, 10-20% of SCAD patients experience a recurrence within 4 years. Nearly two-thirds of SCAD patients have fibromuscular dysplasia (FMD) based on CT angiography. Current treatment recommendations are based on expert opinion. Therapy and follow-up are advised to include at least one antiplatelet agent, a beta-blocker, screening for FMD, cardiac rehabilitation and among patients with left ventricular systolic dysfunction ACE inhibitor or aldosterone receptor blocker. Randomized controlled trials have been initiated to evaluate the treatment effects of beta-blocker and antiplatelet therapy in SCAD patients.

Supraventricular tachyarrhythmias (SVTs) in newborns and infants (< 1 year) can usually be managed with antiarrhythmic drug therapy and often resolve spontaneously within the first year of life. However, some SVTs may be drug-refractory, leading to hemodynamic instability or tachycardia-induced cardiomyopathy, necessitating catheter ablation. Refinements in ablation techniques like electro-anatomical mapping and increased expertise have made catheter ablation an effective option for young children (< 5 years). Nonetheless, due to a lack of large-scale studies involving newborns and infants (< 1 year), concerns persist regarding the risk of major complications associated with ablation energy in small hearts. Potential risks include coronary artery lesions, valve damage, vessel injury, complications related to the transseptal puncture, and ablation lesion growth. In this review, we discuss the current literature on the indications, techniques, and outcomes of radiofrequency catheter ablation in newborns and infants, illustrated by recent cases.

Background: There is very limited data available on the impact of cardiovascular disease (CVD) on absenteeism occurrence, absenteeism duration, and the associated rough cost-estimate for employers.

Methods: We extracted routinely collected absenteeism data for the years 2019-2022 from a database maintained by two large, nationally operating occupational health services (n = 443,740). All diagnoses and included sickness cases were recorded > 6 weeks of absenteeism. Descriptive statistics, including median values (IQR) and percentages, were calculated and compared using the Mann-Whitney U test and Pearson chi-square test. Subgroup comparisons were performed using the Kruskal-Wallis test. To analyse return-to-work over time, a Kaplan-Meier curve was constructed, and differences in return-to-work were assessed using the Log Rank (Mantel-Cox) test.

Results: CVD is the primary cause of absenteeism in 3.2% of all absenteeism cases. The median duration of absenteeism following CVD was 119 working days (IQR 156; Q1-Q3 62.9-218.6) with a minimum rough cost-estimate to employers of € 37,000 per employee. The most frequently occurring CVD diagnoses were: acute myocardial infarction, cerebrovascular disease, cardiac arrhythmia, unspecified cardiovascular complaints and angina.

Conclusions: CVD occurs frequently, results in prolonged absenteeism, and incurs high costs for employers. We strongly believe that CVD-related absenteeism should receive greater attention. Specifically, both in-hospital and outpatient treatments should place a stronger emphasis on work-related issues, including strategies for returning to work with or without tailored assignments in the workplace. This focus will help ensure that employees can sustainably return to work and continue to contribute to society.

Background: In recent years, hospital stays after transcatheter aortic valve replacement (TAVR) have shortened. Previous studies have shown that next-day discharge (NDD) is feasible without compromising patient safety, but data from the Dutch hospital setting are lacking. To assess the real-world effect of a NDD policy after TAVR.

Methods: A next-day discharge policy was introduced in 2022 at St. Antonius Hospital Nieuwegein, the Netherlands. We included elective TAVR patients between August 2022 and August 2024, excluding those with pre-existing hospitalisation, transapical access, or intraprocedural mortality.

Results: Among 460 patients (mean age 80.1 ± 6.2 years, 40.9% female, and a median Edmonton Frail score of 3.0 [1.0-4.0]), the majority underwent transfemoral TAVR (99.1%), under local anaesthesia (97.0%), using self-expanding valves (78.3%). Patients in the NDD group were more often male, less frail, and less likely to have right bundle branch block before TAVR compared to delayed discharge (DD) patients. NDD was feasible in 269 patients (58.5%) with a low number of post-discharge complications at 30 days: 1.9% permanent pacemaker implantation and 2.2% minor vascular complications. There were no cases of mortality, major vascular complications, or in-hospital stroke. Main reasons for DD were conduction disorders, access site complications, and stroke, which contributed to a higher incidence of complications in the DD group (18.3% permanent pacemaker implantation, p < 0.001, 3.1% stroke, p = 0.004, 1.6% major vascular complication, overall p-value 0.02).

Conclusion: After implementing an NDD policy, 58.5% of patients were eligible for NDD after TAVR with a very low post-discharge complication rate.

Objective: To provide insight into the longitudinal (> 10 years) results of a dedicated CTO PCI program in a single center.

Background: Percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) requires substantial operator experience. Dedicated CTO programs aim to increase technical success rates through sufficient case volume. However, longitudinal data beyond 10 years on such programs are scarce.

Methods: We included 1185 patients who underwent CTO PCI in the Amsterdam University Medical Center between 2013 and 2024. Technical CTO PCI success was defined as thrombolysis in myocardial infarction flow grade 3 and < 30% residual stenosis. Procedural success was defined as technical success in the absence of in-hospital major adverse cardiovascular events. Multivariable logistic regression analyses were used to identify predictors for technical success.

Results: Mean age was 66 ± 11 years; 81% were male. Overall technical CTO PCI success (92%) and procedural success (87%) rates were high and consistent. We observed temporal changes in wire crossing time (31 [7-56] to 23 [5-67] minutes), contrast volume (360 ± 160 to 210 ± 101 mL), and procedural time (90 [60-130] to 121 [80-165] minutes). Additionally, MACE rate improved from 13% (in 2013-2015) to 7% (in 2021-2024). Age ≥ 65 years, prior CABG, three-vessel disease, and an intermediate to high J‑CTO score (≥ 2) predicted technical failure.

Conclusions: This study reports the longitudinal (> 10 years) results of a dedicated CTO PCI program, which confirms that high technical CTO PCI and procedural success rates can be achieved by a single center.