Netherlands Heart Journal最新文献

Introduction: Patients with non-ischaemic cardiomyopathy (NICMP) have a class IIa primary prevention indication for an implantable cardioverter-defibrillator (ICD). Recent studies have shown that the evidence for a survival benefit following ICD implantation in this patient group is not particularly robust. In 2023, the Dutch Society of Cardiology published an update of the ESC guideline to better select patients with NICMP for ICD implantation. The objective of this study was to analyse the impact of this guideline on the number of indications in a retrospective cohort of patients who had received an ICD and whether the patients without an indication were also without appropriate ICD therapy.

Methods: A single-centre, retrospective observational study was performed in 134 patients with NICMP who underwent ICD implantation for primary prevention between 2015 and 2020.

Results: After applying the new Dutch guideline, 74 out of 134 patients with NICMP without a high-risk phenotype (35 patients) had no ICD indication (group 2). The remaining 25 patients were considered to have an ICD indication (group 1). During a median follow-up of 66 months (interquartile range 52-81) the incidence of appropriate ICD therapy (antitachycardia pacing and shock) was comparable in both groups: 4 patients in group 1 (16%) and 9 in group 2 (12%), p = 0.623.

Conclusion: The new 2023 guideline for ICD implantation in NICMP patients does indeed rule out a significant group of patients from ICD implantation. Nevertheless, our data show that patients without an indication still had comparable rates of appropriate ICD therapy.

Background: While randomised trials have shown that surgical and transcutaneous aortic valve replacement/implantation (SAVR/TAVI) have similar short- to mid-term outcomes, long-term outcome data are scarce. Additionally, no large-scale long-term follow-up data from Dutch databases and TAVI centres have been reported to inform national guidelines.

Methods: We retrospectively analysed baseline characteristics, 5‑year mortality and re-intervention rates of patients undergoing isolated SAVR or TAVI, stratified by age (65-75, 75-80 and > 80 years old) in the Netherlands Heart Registry.

Results: From 2013 through 2021, 7879 SAVR patients (median age: 73.0 years; interquartile range (IQR): 69.0-77.0; 43.7% female) and 14,461 TAVI patients (median age: 81.0 years; IQR: 77.0-84.0; 49.9% female) were treated in the Netherlands. Patients undergoing TAVI more frequently had chronic obstructive pulmonary disease, diabetes, atrial fibrillation, dialysis, poor mobility, previous stroke, unstable angina and recent myocardial infarction compared with SAVR patients. This higher comorbidity rate in TAVI was observed across all age groups. After 5‑year follow-up, mortality rates were higher after TAVI compared with SAVR (35.5% vs 13.0%; p < 0.001). This difference decreased with increasing age (p for interaction < 0.001). While the aortic re-intervention rate was low in both cohorts, it was higher after SAVR than TAVI (1.9% vs 0.9%; p < 0.001).

Conclusion: Demographics of patients undergoing SAVR versus TAVI in the Netherlands differed substantially. TAVI patients were older and had more comorbidities than SAVR patients, across all age groups. Mortality rates were highest after TAVI, while aortic re-intervention was more common after SAVR. These findings reflect differences in baseline patient characteristics and current daily practice in decision-making by the Heart Teams.

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.

This article contextualises the 2023 European Society of Cardiology (ESC) guidelines for the management of cardiomyopathies for clinical practice in the Netherlands. The guideline addendum provides additional recommendations for situations where the ESC guidelines may not fully align with Dutch clinical practice. By endorsing the ESC guidelines through this addendum, the Netherlands Society of Cardiology (Nederlandse Vereniging Voor Cardiologie) supports its members in adhering to evidence-based management strategies for cardiomyopathies. As Dutch cardiologists generally adopt the ESC guidelines quickly, this contextualisation is essential for effective application thereof within the Dutch healthcare setting.

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.