Whipple's endocarditis: a case report of a blood culture-negative endocarditis.

Background: Whipple's disease is caused by and causes a self-limiting gastrointestinal infection. The majority of the population is an asymptomatic carrier, however, in some patients, it causes an invasive infection with for example arthritis, endocarditis, or involvement of the eyes.

Case Summary: This case describes a man with long-lasting complaints of progressive dyspnoea caused by heart failure due to total destruction of the aortic and mitral valve as a result of endocarditis, diagnosed with serum polymerase chain reaction.

Effect of Using the HEART Score in Patients With Chest Pain in the Emergency Department: A Stepped-Wedge, Cluster Randomized Trial.

Background: The HEART (History, Electrocardiogram, Age, Risk factors, and initial Troponin) score is an easy-to-apply instrument to stratify patients with chest pain according to their short-term risk for major adverse cardiac events (MACEs), but its effect on daily practice is unknown.

Objective: To measure the effect of use of the HEART score on patient outcomes and use of health care resources.

Design: Stepped-wedge, cluster randomized trial.

No cardiac damage after endurance exercise in cardiologists cycling to the European Society of Cardiology meeting in Barcelona.

Aims: There are variable results reported for athletes and potential cardiac damage during exercise. In 2009 a group of cardiologists went by bicycle from the Netherlands to the European Society of Cardiology meeting in Barcelona and collected functional and biochemical parameters during this trip in order to evaluate whether cardiac damage was observed in a group of moderately trained amateur cyclists.

Methods And Results: All of the 20 amateur cyclists (17 men) completed the 1580 km in eight days with an average speed of 27.

Long-term comparison of sirolimus-eluting and bare-metal stents in ST-segment elevation myocardial infarction.

Objectives: We aimed to investigate, in patients with ST-segment elevation myocardial infarction (STEMI), whether the previously reported clinical benefits of sirolimus-eluting stent(s) (SES) in terms of reducing a major adverse cardiac and cerebrovascular event (MACCE) compared with bare-metal stent(s) (BMS) were maintained over a 5-year time period.

Background: In the prospective single-centre randomized DEBATER trial, SES significantly reduced the rate of MACCE in STEMI patients within 1 year compared with BMS, mainly driven by a reduction of target lesion revascularization. Randomized data on the long-term safety and efficacy of SES in STEMI patients are conflicting and limited.

Can postoperative mean transprosthetic pressure gradient predict survival after aortic valve replacement?

Background: In this study, we sought to determine the effect of the mean transprosthetic pressure gradient (TPG), measured at 6 weeks after aortic valve replacement (AVR) or AVR with coronary artery bypass grafting (CABG) on late all-cause mortality.

Methods: Between January 1998 and March 2012, 2,276 patients (mean age 68 ± 11 years) underwent TPG analysis at 6 weeks after AVR (n = 1,318) or AVR with CABG (n = 958) at a single institution. Mean TPG was 11.

Effect of a nurse-coordinated prevention programme on cardiovascular risk after an acute coronary syndrome: main results of the RESPONSE randomised trial.

Objective: To quantify the impact of a practical, hospital-based nurse-coordinated prevention programme on cardiovascular risk, integrated into the routine clinical care of patients discharged after an acute coronary syndrome, as compared with usual care only.

Design: RESPONSE (Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists) was a randomised clinical trial.

Setting: Multicentre trial in secondary and tertiary healthcare settings.

Impact of prosthesis-patient mismatch on early and late mortality after aortic valve replacement.

Background: The influence of prosthesis-patient mismatch (PPM) on survival after aortic valve replacement (AVR) remains controversial. In this study, we sought to determine the effect of PPM on early (≤30 days) and late mortality (>30 days) after AVR or AVR combined with coronary artery bypass grafting (AVR with CABG).

Methods: Between January 1998 and March 2012, 2976 patients underwent AVR (n= 1718) or AVR with CABG (n=1258) at a single institution.

Tropheryma whipplei aortic valve endocarditis, cured without surgical treatment.

Background: Culture-negative endocarditis due to Tropheryma whipplei is a rare disease. Mostly the diagnosis is made by histologic examination of resected heart valve tissue.

Case Presentation: In this case report, we described a patient with a classical Whipple's disease.

Increased septum wall thickness in patients undergoing aortic valve replacement predicts worse late survival.

Background: Following guidelines, aortic valve replacement (AVR) in asymptomatic patients with severe aortic valve stenosis is often postponed until symptoms do occur. Delaying AVR will inevitably lead to progression of left ventricular hypertrophy. We studied the relationship between septum wall thickness indexed for body surface area (SWTI) as a measure for LV hypertrophy and 30-day and late all-cause mortality after AVR.

Comparison of drug-eluting and bare-metal stents for primary percutaneous coronary intervention with or without abciximab in ST-segment elevation myocardial infarction: DEBATER: the Eindhoven reperfusion study.

Objectives: The goal of this study was to demonstrate superiority of sirolimus-eluting stents (SES) over bare-metal stents (BMS) and of abciximab over no abciximab in primary percutaneous coronary intervention (PCI).

Background: Drug-eluting stents (DES) are increasingly used in primary PCI, but the recommendations for use in primary PCI are based on a few randomized controlled trials with selected patients. The usefulness of abciximab in primary PCI is not established.

Right atrial thrombus migrating to the superior vena cava during surgery.

Free-floating right heart thrombi are extremely mobile structures that carry a very high mortality rate. We describe a case of pulmonary embolism with a free-floating right heart thrombus that migrated to the superior vena cava during the institution of cardiopulmonary bypass.

Novel ultrasound contrast agent dilution method for the assessment of ventricular ejection fraction.

Aims: Left ventricular (LV) ejection fraction is an important determinant of prognosis in heart failure. We evaluated the accuracy of a novel algorithm for LV ejection fraction quantification based on indicator dilution curve (IDC) principles using ultrasound contrast as indicator, and compared the results with contrast enhanced biplane LV ejection fraction assessment. Method A diluted ultrasound contrast bolus (SonoVue) was injected intravenously in 31 patients (19 male, age 65 +/- 11) with known or suspected heart disease.

The influence of myocardial scar and dyssynchrony on reverse remodeling in cardiac resynchronization therapy.

Aim: The influence of location and extent of transmural scar and its relation with dyssynchrony in cardiac resynchronization therapy (CRT) was investigated as posterolateral scar tissue has been invoked as a cause of non-response to CRT.

Methods And Results: Fifty-seven patients eligible for CRT were assessed for transmural scar with gadolinium-enhanced MRI and for left ventricular (LV) dyssynchrony with tissue Doppler. After implant, both atrioventricular and interventricular pacing intervals were optimized.

Improvement in diastolic function and left ventricular filling pressure induced by cardiac resynchronization therapy.

Background: Variable results of cardiac resynchronization therapy (CRT) on diastolic function have been described. We investigated 3 and 12 months' effect of CRT on diastolic function and left ventricular (LV) filling pressures and their relation to LV reverse remodeling.

Methods: Fifty-two patients' (36 male, 69 +/- 8 years, QRS duration 170 +/- 29 milliseconds) echo-Doppler was performed before and 3 and 12 months after CRT.

Qualitative observation of left ventricular multiphasic septal motion and septal-to-lateral apical shuffle predicts left ventricular reverse remodeling after cardiac resynchronization therapy.

A multiphasic septal motion and typical septal-to-lateral apical shuffle of the left ventricle can be observed echocardiographically in some patients with left branch bundle block. The relation of both with left ventricular (LV) dyssynchrony according to tissue Doppler and LV reverse remodeling after cardiac resynchronization therapy was investigated. Fifty-three patients (37 men; age 68+/-8 years) with ischemic (n=26) or idiopathic (n=27) cardiomyopathy, baseline QRS duration 171+/-30 ms, LV ejection fraction 21+/-7%, and LV end-diastolic volume 257+/-91 ml were studied.

Relation of isovolumic times after cardiac resynchronization therapy to improvement in exercise capacity.

Isovolumic times (IVTs) comprise a determinant of exercise capacity in cardiomyopathy. We postulated that an increase in exercise capacity after cardiac resynchronization therapy (CRT) might be related to a more efficient cardiac cycle due to decreasing IVTs and increased filling times. According to standard selection criteria, a CRT device was implanted in 52 patients (37 men; 69 +/- 8 years) with a QRS duration of 174 +/- 30 ms.

Peritoneal dialysis in patients with congestive heart failure.

Background: Peritoneal dialysis (PD) may be a useful technique in the treatment of patients with congestive heart failure, both with and without primary end-stage renal disease (ESRD).

Methods: In the treatment of patients with ESRD and congestive heart failure (CHF), PD has theoretical advantages compared with haemodialysis (HD), such as the absence of an arteriovenous fistula and the more gradual fluid removal. In cohort studies, the incidence of heart failure was less as compared with HD, however, randomized studies on this aspect are lacking.

Quantification in echocardiography.

Until recently, more than 2200 Swan Ganz catheters were used annually in the operating rooms (OR) and intensive care unit (ICU) of the Catharina Hospital in Eindhoven, The Netherlands. After cardiologists who were specialists in echocardiography (ECHO) trained anesthesiologists in ECHO, the need for these catheters in cardiac and noncardiac surgery was reduced. Initially intended as a local teaching project, an ECHO teaching compact disk (CD) was produced during the training and distributed later worldwide, thanks to a positive review in a major anesthesiology publication.

Left ventricular pressure-volume measurements in mice: comparison of closed-chest versus open-chest approach.

Objective: We investigated whether in vivo closed-chest left ventricular pressure-volume measurements would yield similar values for LV hemodynamics compared with open-chest PV measurements under several anesthetics.

Methods: The right common carotid of C57Bl/6 mice was cannulated with a combined pressure-conductance catheter and inserted retrogradely into the left ventricle in the closed-chest model. The open-chest model consisted of an abdominal approach involving the opening of the thoracic cavity by transverse opening of the diaphragm and ventricular catheterization by apical stab.

Transesophageal echocardiographic evaluation of tricuspid valve regurgitation during pacemaker and implantable cardioverter defibrillator lead extraction.

Chronically implanted ventricular pacing and defibrillator (ICD) leads can adhere to the tricuspid valve. This study examined the effect of lead extraction, and laser sheath extraction in particular, on tricuspid valve regurgitation. Lead extraction was first tried with traction using limited force followed by a laser sheath if not successful.