Publications by authors named "Jan Piek"
Angina with non-obstructive coronary arteries (ANOCA) is a major cause of chronic coronary syndromes, affecting nearly half of patients with anginal symptoms who undergo invasive coronary angiography. ANOCA may lead to substantial symptom burden, increased risk of adverse cardiac events, increased healthcare utilization due to ongoing symptoms, repeat hospitalizations, and invasive testing. The pathophysiology of ANOCA often involves a variety of coronary disorders, such as coronary microvascular dysfunction, epicardial or microvascular vasospasm and endothelial dysfunction.
View Article and Find Full Text PDFBackground: Approximately one-third of patients with symptomatic severe aortic valve stenosis scheduled for transcatheter aortic valve implantation (TAVI) have some degree of cognitive impairment. The effect of TAVI on cardiac output, cerebral blood flow (CBF), and cognitive functioning has not been systematically studied.
Methods: CAPITA (NCT05481008) is a prospective longitudinal study assessing cerebral and cognitive outcomes in patients that underwent TAVI between August 2020 and October 2022.
Importance: Patients with angina and no obstructive coronary artery disease frequently have coronary vasomotor dysfunction as underlying pathophysiological mechanism, comprising epicardial spasm, microvascular spasm, and/or microcirculatory dysfunction. These endotypes can be diagnosed by invasive coronary function testing which has previously shown to be safe in tertiary and expert centers.
Objective: To determine the prevalence of vasomotor dysfunction in patients with angina and no obstructive coronary artery disease who were clinically referred for a coronary function test (CFT); and assess safety and feasibility of a CFT.
Article Synopsis
- The study evaluates how well epicardial vasomotion and coronary blood flow (CBF) alone can diagnose coronary endothelial dysfunction (CED) in patients with angina and non-obstructive coronary arteries.
- It involved 110 patients undergoing coronary function testing, finding that using epicardial diameter or CBF alone missed significant instances of CED diagnoses.
- The conclusion emphasizes that both parameters are necessary for a comprehensive diagnosis of CED to avoid missing cases related to microvascular and epicardial issues.
Article Synopsis
- In patients with angina but no major coronary blockages (ANOCA), researchers investigated whether measuring hyperaemic microvascular resistance (HMR) using aortic pressure (Pa) is as effective as using distal pressure (Pd).
- Analysis of data from the ILIAS registry showed a strong correlation between HMR calculated with Pa and Pd, especially in patients with functional epicardial lesions rated as non-severe (FFR >0.80).
- The study concluded that while HMR can be accurately determined using aortic pressure in patients with non-severe lesions, significant discrepancies occur when measuring in patients with more severe lesions (FFR <0.80).
Age-related structural remodelling of the coronary circulation.
Catheter Cardiovasc Interv
November 2024
Article Synopsis
- - The study explores how aging affects the structure and function of coronary microvessels in patients with stable angina, without significant blockage in their main coronary arteries.
- - Researchers analyzed data from 165 vessels, finding that older patients (ages 67-77) exhibited lower hyperemic flow velocity, diminished diastolic microvascular conductance (DMVC), and reduced backward expansion wave (BEW) intensity compared to younger groups.
- - Results indicate that aging leads to structural changes in coronary microcirculation, increasing the prevalence of coronary microvascular dysfunction (CMD) among older individuals, which is crucial for understanding heart issues in elderly patients.
Article Synopsis
- * A case study of four VSA patients revealed that all experienced significant coronary vasoconstriction during acetylcholine testing, but their ECGs differed between spontaneous episodes and induced spasms in three out of four cases.
- * The findings indicate that the ECG during spontaneous VSA episodes may not match those seen during acetylcholine-induced spasms, emphasizing the need for ECG monitoring during spontaneous angina to improve diagnosis
Article Synopsis
- The hyperaemic stenosis resistance (HSR) index is a new measure that combines pressure drop and blood flow to provide a better assessment of coronary artery disease severity compared to traditional methods like fractional flow reserve (FFR) and coronary flow reserve (CFR).
- This study analyzed data from 853 patients with chronic coronary syndromes to evaluate HSR's diagnostic and prognostic value, finding it to more accurately identify inducible ischaemia and predict long-term target vessel failure.
- The results suggest HSR can help determine which obstructed vessels may benefit from treatment, reinforcing its potential as a superior tool in clinical practice for managing coronary artery disease.
Attention Deficit Hyperactivity Disorder (ADHD) is characterized by inappropriate levels of activity, impulsivity, and inattention. Developmental Coordination Disorder (DCD) is a condition involving challenges in acquiring and executing motor skills. This cross-sectional study aimed to distinguish motor symptoms between ADHD and ADHD/DCD.
View Article and Find Full Text PDFCoronary endothelial dysfunction (CED) and coronary artery spasm (CAS) are causes of angina with no obstructive coronary arteries in patients. Both can be diagnosed by invasive coronary function testing (ICFT) using acetylcholine (ACh). This study aimed to evaluate the diagnostic yield of a 3-minute ACh infusion as compared with a 1-minute ACh bolus injection protocol in testing CED and CAS.
View Article and Find Full Text PDFRecently, a novel method to estimate wedge pressure (P)-corrected minimal microvascular resistance (MR) was introduced. However, this method has not been validated since, and there are some theoretical concerns regarding the impact of different physiological conditions on the derivation of P measurements. This study sought to validate the recently introduced method to estimate P-corrected MR in a Doppler-derived study population and to evaluate the impact of different physiological conditions on the P measurements and the derivation of P-corrected MR.
View Article and Find Full Text PDFAfter myocardial infarction (MI), emergency hematopoiesis produces inflammatory myeloid cells that accelerate atherosclerosis and promote heart failure. Since the balance between glycolysis and mitochondrial metabolism regulates hematopoietic stem cell homeostasis, metabolic cues may influence emergency myelopoiesis. Here, we show in humans and female mice that hematopoietic progenitor cells increase fatty acid metabolism after MI.
View Article and Find Full Text PDFArticle Synopsis
- The microvascular resistance reserve (MRR) is a new index used to evaluate how well the coronary circulation can dilate, particularly in patients with coronary artery disease (CAD), and its assessment may require special considerations for women.
- This study aimed to evaluate how effective the MRR is for diagnosis and prognosis in women compared to men, using data from the ILIAS Registry.
- Results showed that MRR is a significant predictor of major adverse cardiac events (MACE) for both sexes, with similar correlations and cut-off values for predicting outcomes in women and men.
Article Synopsis
- This study evaluates the prognostic value of coronary pressure and flow parameters in patients who did not undergo revascularization due to borderline readings.
- It included 1,971 blood vessels, and found that abnormal pressure and flow metrics significantly predicted long-term risks of target vessel failure (TVF), myocardial infarction (MI), and cardiac death over five years.
- The study concluded that both resting and hyperemic conditions are important independent factors in predicting cardiac events, with their abnormal flow readings providing additional prognostic information.
Cardiac output, cerebral blood flow and cognition in patients with severe aortic valve stenosis undergoing transcatheter aortic valve implantation: design and rationale of the CAPITA study.
Neth Heart J
December 2023
Background: Approximately one-third of patients with symptomatic severe aortic valve stenosis who are scheduled for transcatheter aortic valve implantation (TAVI) have some degree of cognitive impairment. TAVI may have negative cognitive effects due to periprocedural micro-emboli inducing cerebral infarction. On the contrary, TAVI may also have positive cognitive effects due to increases in cardiac output and cerebral blood flow (CBF).
View Article and Find Full Text PDFArticle Synopsis
- Microvascular resistance (MR) is important in assessing patient outcomes after coronary procedures, but its changes and links to target vessel failure (TVF) haven’t been thoroughly studied before.
- This research analyzed data from the ILIAS registry, focusing on the relationship between MR changes and TVF outcomes in post-percutaneous coronary intervention (PCI) patients, involving 295 vessels from 828 patients.
- Findings showed that an increase in MR post-PCI was linked to higher rates of TVF, indicating that patients with less severe baseline conditions might have worse outcomes if MR increases after the procedure.
Background: The pressure-derived parameters fractional flow reserve (FFR) and the emerging instantaneous wave-free ratio (iFR) are the most widely applied invasive coronary physiology indices to guide revascularisation. However, approximately 15-20% of intermediate stenoses show discordant FFR and iFR, and therapeutical consensus is lacking.
Aims: We sought to associate hyperaemic stenosis resistance index, coronary flow reserve (CFR) and coronary flow capacity (CFC) to FFR/iFR discordance.
Article Synopsis
- A study was conducted to evaluate the effectiveness of macitentan, an endothelin-1 receptor inhibitor, in treating patients with angina caused by coronary artery spasm (CAS) who continued to experience symptoms despite standard treatment.
- 28 participants (mainly women, average age 55) were given either macitentan or a placebo for four weeks, followed by a switch, measuring changes in anginal burden during each phase.
- Results showed no significant difference in anginal burden between macitentan and placebo, and the frequency and severity of side effects were similar for both treatments.
Background And Aims: The management of chronic coronary syndrome (CCS) is informed by studies predominantly including men. This study investigated the relationship between patients sex and different endotypes of CCS, including sex-specific clinical outcomes.
Methods: In patients with CCS undergoing coronary angiography, invasive Fractional Flow Reserve (FFR) and Coronary Flow Reserve (CFR) were measured.
Article Synopsis
- * Recent research is focusing on the underlying causes of angina in patients with non-obstructive coronary arteries, highlighting the challenges in diagnosing and treating these conditions.
- * The review aims to offer a thorough understanding of these issues, along with practical management strategies for dealing with angina in patients with non-obstructive coronary artery disease.