Netherlands Heart Journal最新文献

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.

Objective: Lowering low-density lipoprotein cholesterol (LDL-C) reduces the risk of developing atherosclerotic cardiovascular disease (ASCVD). In the PENELOPE study, a guideline-based, protocol-led LDL-C-lowering strategy was applied in patients after myocardial infarction and resulted in 87% reaching target LDL‑C levels of ≤ 1.8 mmol/l within a median of 45 days. This study evaluated PENELOPE's legacy effect on LDL‑C levels after 1 year.

Methods: In the PENELOPE study, 999 patients with a myocardial infarction and a history of ASCVD and/or diabetes mellitus were included. If LDL-C > 1.8 mmol/l, lipid-lowering therapy was intensified in three consecutive steps: (1) high-intensity statin (HIST) monotherapy, (2) HIST + ezetimibe, and (3) HIST + ezetimibe + proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i). LDL‑C levels were monitored 4-6 weeks after each step. The primary objective of this study was to assess the prevalence of the LDL‑C target level of ≤ 1.8 mmol/l being maintained after 1 year.

Results: Data of 738 patients (74%) were available for 1‑year follow-up. The target LDL‑C level was met in 471 patients (64%). Median LDL‑C levels changed from 1.5 (1.2-1.7) mmol/l immediately after implementation of the protocol-led strategy to 1.6 (1.3-2.0) mmol/l after 1 year. Major treatment regimens were statin (58%), statin + ezetimibe (30%) and PCSK9i + ezetimibe (+ statin) (7%).

Conclusion: After a myocardial infarction, implementation of a protocol-led LDL-C-lowering strategy resulted in 87% of patients attaining the LDL‑C target level of ≤ 1.8 mmol/l within a median of 45 (32-77) days. At 1‑year follow-up, 64% maintained this target level and the median LDL‑C increased by 0.1 mmol/l.

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.