Publications by authors named "Bleeker G"
Article Synopsis
- In out-of-hospital cardiac arrest (OHCA) cases without ST-elevation, researchers investigated the usefulness of troponin-T (cTnT) levels in predicting the risk of acute coronary syndrome and patient survival.
- The study analyzed data from 352 patients, revealing that higher cTnT values were independent predictors for 90-day mortality and the presence of acute unstable lesions and thrombotic occlusions.
- However, cTnT levels did not show a significant correlation with left ventricular function, highlighting its role primarily in assessing mortality risk and acute coronary issues in these patients.
Article Synopsis
- Mortality rates in patients with cardiogenic shock due to acute myocardial infarction (AMICS) remain high, prompting research into how prehospital symptom duration affects patient outcomes.
- A study analyzed data from 1,363 AMICS patients, revealing that longer symptom durations significantly increased the 30-day mortality rates, especially for those with symptoms lasting over 24 hours.
- The findings highlight the importance of early identification and intervention, suggesting that prolonged symptoms are a strong predictor of poor survival rates in AMICS patients, particularly those receiving mechanical circulatory support.
Article Synopsis
- - Cardiogenic shock (CS) following acute myocardial infarction (AMI) leads to high rates of morbidity and mortality, with a study examining 2328 patients revealing a 30-day mortality rate of 39% and common characteristics among non-survivors.
- - Patients who did not survive presented with lower blood pressure, higher heart rates, elevated blood lactate and glucose levels, and a greater prevalence of conditions like diabetes and prior coronary events.
- - The study found that while a significant percentage of patients received mechanical support (mainly through intra-aortic balloon pumps) and vasoactive agents, and many underwent multivessel percutaneous coronary intervention (PCI), these treatments were administered despite limited evidence supporting their effectiveness in improving survival.
Article Synopsis
- Extracorporeal CPR is a method used to restore blood flow and oxygen to patients with cardiac arrest who don’t regain spontaneous circulation, but its effectiveness on survival and neurological outcomes is unclear.
- A randomized trial in the Netherlands compared extracorporeal CPR with conventional CPR in patients aged 18 to 70 who experienced out-of-hospital cardiac arrest and received bystander CPR.
- The results showed that after 30 days, 20% of patients in the extracorporeal CPR group had a favorable neurologic outcome compared to 16% in the conventional CPR group, indicating similar outcomes for both methods.
Article Synopsis
- The study aimed to evaluate the prognostic value of ischaemic ECG patterns, specifically ST-depression and T-wave inversion, in patients who experienced out-of-hospital cardiac arrest.
- Analysis of data from 510 patients revealed that 66.7% had ischaemic ECG patterns, which were linked to a significantly lower 90-day survival rate compared to those without such patterns.
- While ischaemic ECG patterns correlated with worse survival and poorer heart function, these associations disappeared after adjusting for age and time to restore blood circulation.
Diagnostic imaging in pregnant patients often causes worries about radiation effects and IV contrast. We use a step-by-step plan to choose the right method and illustrate this with a case. First, we choose the method of imaging, non-ionizing imaging being preferred over ionizing.
View Article and Find Full Text PDFAim: A multimodal approach is advised for neurological prognostication in comatose patients after out-of-hospital cardiac arrest (OHCA). Grey-white matter differentiation (grey-white ratio, GWR) obtained from a brain CT scan performed < 24 hours after return of circulation can be part of this approach. The aims of this study were to investigate the frequency and method of reporting the GWR in brain CT scan reports and their association with outcome.
View Article and Find Full Text PDFArticle Synopsis
- A study comparing immediate versus delayed coronary angiography in patients with out-of-hospital cardiac arrest showed no significant difference in overall mean costs between the two strategies during the initial hospital stay.
- Although immediate angiography resulted in higher procedural costs, expenses related to intensive care and ward stays were similar in both groups.
- The findings suggest that a delayed approach, allowing for neurological recovery before invasive procedures, may be a more cost-effective strategy.
Objectives: The optimal targeted temperature in patients with shockable rhythm is unclear, and current guidelines recommend targeted temperature management with a correspondingly wide range between 32°C and 36°C. Our aim was to study survival and neurologic outcome associated with targeted temperature management strategy in postarrest patients with initial shockable rhythm.
Design: Observational substudy of the Coronary Angiography after Cardiac Arrest without ST-segment Elevation trial.
Introduction: Chronic total coronary occlusion (CTO) has been identified as a risk factor for ventricular arrhythmias, especially a CTO in an infarct-related artery (IRA). This study aimed to evaluate the effect of an IRA-CTO on the occurrence of ventricular tachyarrhythmic events (VTEs) in out-of-hospital cardiac arrest survivors without ST-segment elevation.
Methods: We conducted a post hoc analysis of the COACT trial, a multicentre randomised controlled trial.
Article Synopsis
- A study was conducted on 552 patients who were resuscitated after cardiac arrest without STEMI, comparing immediate versus delayed coronary angiography and its impact on heart function.
- Results showed no significant improvement in left ventricular function, with ejection fractions of 45.2% and 48.4% for immediate and delayed groups, respectively.
- The conclusion indicates that immediate coronary angiography does not enhance heart dimensions or function compared to delaying the procedure after neurological recovery.
Neuroblastoma is the most common extracranial solid malignancy in children. At diagnosis, approximately 50% of patients present with metastatic disease. These patients are at high risk for refractory or recurrent disease, which conveys a very poor prognosis.
View Article and Find Full Text PDFObjective: To assess whether combining venoarterial extracorporeal membrane oxygenation (VA-ECMO) with intra-aortic balloon pump (IABP) improves outcomes in ST-segment elevation myocardial infarction (STEMI) over VA-ECMO alone.
Background: VA-ECMO is an upcoming technique in the treatment of cardiogenic shock (CS); however, it increases afterload. IABP + VA-ECMO has been suggested to reduce afterload and increase survival.
Sex differences in out-of-hospital cardiac arrest (OHCA) patients are increasingly recognized. Although it has been found that post-resuscitated women are less likely to have significant coronary artery disease (CAD) than men, data on follow-up in these patients are limited. Data for this data in brief article was obtained as a part of the randomized controlled Coronary Angiography after Cardiac Arrest without ST-segment elevation (COACT) trial.
View Article and Find Full Text PDFArticle Synopsis
- The study investigates whether sex influences survival rates in patients who experience out-of-hospital cardiac arrest (OHCA) without ST-segment elevation myocardial infarction (STEMI).
- Overall one-year survival rates were similar for men (63.4%) and women (59.6%), with no significant sex differences found.
- Women had a lower occurrence of significant coronary artery disease (CAD), but when CAD was present, their survival was worse compared to women without CAD, while men did not show this discrepancy; immediate coronary angiography did not improve survival for either sex.
Article Synopsis
- Ischemic heart disease often leads to cardiac arrest, and this study aims to assess how immediate coronary angiography affects long-term clinical outcomes in patients resuscitated from cardiac arrest without STEMI.
- The research involves a multicenter clinical trial with 552 patients from Dutch centers, comparing immediate versus delayed angiography strategies, with follow-up after one year.
- Results indicate no significant difference in survival rates or adverse events between the immediate and delayed angiography groups, suggesting that the timing of the procedure may not impact outcomes significantly.
Article Synopsis
- * In a multicenter trial, 552 patients without STEMI were randomly assigned to receive immediate or delayed coronary angiography, with survival rates at 90 days as the primary focus.
- * Results showed no significant difference in survival rates between the immediate angiography (64.5% alive) and delayed angiography (67.2% alive) groups after 90 days, suggesting that immediate intervention may not offer a survival advantage in these cases.
Purpose: Data on MitraClip procedural safety and efficacy in the Netherlands are scarce. We aim to provide an overview of the Dutch MitraClip experience.
Methods: We pooled anonymised demographic and procedural data of 1151 consecutive MitraClip patients, from 13 Dutch hospitals.
Aim Of The Study: Radiolabelled meta-iodobenzylguanidine (MIBG) is an effective option in treatment of neuroblastoma (NBL) tumours. We studied feasibility, toxicity and efficacy of upfront I-MIBG and induction treatment in stage 4 NBL patients.
Patients And Methods: Retrospective, multi-centre (AMC and EMC) pilot regimen (1/1/2005-2011).
Background: Ischemic heart disease is a major cause of out-of-hospital cardiac arrest. The role of immediate coronary angiography (CAG) and percutaneous coronary intervention (PCI) after restoration of spontaneous circulation following cardiac arrest in the absence of ST-segment elevation myocardial infarction (STEMI) remains debated.
Hypothesis: We hypothesize that immediate CAG and PCI, if indicated, will improve 90-day survival in post-cardiac arrest patients without signs of STEMI.
123I-MIBG scintigraphy and 18F-FDG-PET imaging for diagnosing neuroblastoma.
Cochrane Database Syst Rev
September 2015
Background: Neuroblastoma is an embryonic tumour of childhood that originates in the neural crest. It is the second most common extracranial malignant solid tumour of childhood.Neuroblastoma cells have the unique capacity to accumulate Iodine-123-metaiodobenzylguanidine (¹²³I-MIBG), which can be used for imaging the tumour.
View Article and Find Full Text PDFPurpose: The aim of this study was to find clinically relevant MIBG-avid metastatic patterns in patients with newly diagnosed stage 4 neuroblastoma.
Methods: Diagnostic (123)I-MIBG scans from 249 patients (123 from a European and 126 from the COG cohort) were assessed for metastatic spread in 14 body segments and the form of the lesions: "focal" (clear margins distinguishable from adjacent background) or "diffuse" (indistinct margins, dispersed throughout the body segment). The total numbers of diffuse and focal lesions were recorded.
Purpose: In the treatment of patients with high-risk neuroblastoma, different doses of (131)I-metaiodobenzylguanidine ((131)I-MIBG) are administered at different time points during treatment. Toxicity, mainly haematological (thrombocytopenia), from (131)I-MIBG therapy is known to occur in extensively chemotherapy pretreated neuroblastoma patients. Up to now, acute toxicity from (131)I-MIBG as initial treatment has never been studied in a large cohort.
View Article and Find Full Text PDFPurpose: In patients with localised neuroblastoma without adverse genetic aberrations, observational treatment is justified. Therapy is required when organ or respiratory functions have become compromised. As the outcome is good, side effects of treatment should be prevented.
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