Publications by authors named "Gabe Bleeker"
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.
Ischaemic electrocardiogram patterns and its association with survival in out-of-hospital cardiac arrest patients without ST-segment elevation myocardial infarction: a COACT trials' post-hoc subgroup analysis.
Eur Heart J Acute Cardiovasc Care
July 2022
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.
Article 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.
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.
Objective: 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.
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.
Aims: To evaluate the effects of cardiac resynchronization therapy (CRT) on long-term survival of patients without baseline left ventricular (LV) mechanical dyssynchrony.
Methods And Results: A total of 290 heart failure patients (age 67 ± 10 years, 77% males) without significant baseline LV dyssynchrony (<60 ms as assessed with tissue Doppler imaging) were treated with CRT. Patients were divided according to the median LV dyssynchrony measured after 48 h of CRT into two groups.
Background: Whether sequential biventricular pacing provides substantial benefits over conventional simultaneous stimulation remains unclear, particularly regarding the differences between ischemic and non-ischemic patients. The purpose of this study was to evaluate the acute effect of interventricular pacing interval (V-V) optimization on left ventricular (LV) systolic performance and dyssynchrony in ischemic versus non-ischemic patients.
Methods: Sixty-nine consecutive patients underwent cardiac resynchronization therapy.
The aim of this study was to assess the effects of replacement with recombinant human growth hormone (rhGH) in patients with GH deficiency (GHD) after treatment of acromegaly. Intervention study. Sixteen patients (8 men, age 56 years), treated for acromegaly by surgery and radiotherapy, with an insufficient GH response to insulin-induced hypoglycaemia, were treated with 1 year of rhGH replacement.
View Article and Find Full Text PDFThe time course of the effects of cardiac resynchronization therapy (CRT) on left ventricular (LV) systolic function and reverse remodeling is still unknown and was the subject of this study. In particular, whether the acute benefit of CRT translates in late response was explored. Furthermore, the time course of response was compared between ischemic and nonischemic patients.
View Article and Find Full Text PDFObjectives: The aim of the current study was to evaluate the relation between the extent of left ventricular (LV) reverse remodeling and clinical/echocardiographic improvement after 6 months of cardiac resynchronization therapy (CRT) as well as long-term outcome.
Background: Despite the current selection criteria, individual response to CRT varies significantly. Furthermore, it has been suggested that reduction in left ventricular end-systolic volume (LVESV) after CRT is related to outcome.
Cardiac resynchronization therapy (CRT) has become a therapeutic option for drug-refractory heart failure. Several noninvasive imaging techniques play an increasingly important role before and after device implantation. This review highlights the acute and long-term CRT benefits after implantation as assessed with echocardiography and nuclear imaging.
View Article and Find Full Text PDFThe success of cardiac resynchronization therapy is influenced by several issues including cardiac venous anatomy and myocardial scar tissue. This article discusses non-invasive imaging modalities that could contribute significantly to the selection process of cardiac resynchronization therapy (CRT) candidates: multi-slice computed tomography to depict the coronary sinus tributaries and magnetic resonance imaging to identify scar tissue.
View Article and Find Full Text PDFNoninvasive imaging in cardiac resynchronization therapy--part 1: selection of patients.
Pacing Clin Electrophysiol
November 2008
Cardiac resynchronization therapy (CRT) is an established therapy for patients with advanced heart failure, depressed left ventricular function, and wide QRS complex. However, individual response varies, and a substantial amount of patients do not respond to CRT. Recent studies observed that assessment of inter- and particularly intraventricular dyssynchrony may allow identification of potential responders to CRT.
View Article and Find Full Text PDFObjectives: The aim of the current study was to evaluate echocardiographic parameters after 6 months of cardiac resynchronization therapy (CRT) as well as long-term outcome in patients with the left ventricular (LV) lead positioned at the site of latest activation (concordant LV lead position) as compared with that seen in patients with a discordant LV lead position.
Background: A nonoptimal LV pacing lead position may be a potential cause for nonresponse to CRT.
Methods: The site of latest mechanical activation was determined by speckle tracking radial strain analysis and related to the LV lead position on chest X-ray in 244 CRT candidates.
Objective: Both GH excess and GH deficiency (GHD) lead to specific cardiac pathology. The aim of this study was to evaluate cardiac morphology and function in patients with GHD after treatment for acromegaly.
Design: Cross-sectional study.
Background: Real-time 3-dimensional echocardiography (RT3DE) is a novel promising technique for the assessment of left ventricular (LV) dyssynchrony.
Objective: This study sought to explore the value of RT3DE to assess LV and left atrium (LA) reverse remodeling and to predict response to cardiac resynchronization therapy (CRT).
Methods: A total of 57 consecutive heart failure patients scheduled for CRT were included, and RT3DE was performed before and 6 months after implantation.