Publications by authors named "Marije Vis"
Background: Concomitant coronary artery disease (CAD) is highly prevalent in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). The optimal treatment strategy for CAD is a topic of debate. An initial conservative strategy for CAD in patients undergoing TAVI may be favorable as multiple studies have failed to show an evident beneficial effect of percutaneous coronary intervention (PCI) on mortality after TAVI.
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- Lipoprotein(a) [Lp(a)] is associated with increased risk for atherosclerotic cardiovascular disease (ASCVD), but there are gaps in its measurement among cardiologists according to current guidelines.
- The review presents four clinical cases showing the link between elevated Lp(a) levels and coronary artery disease (CAD), supported by consensus statements from leading heart organizations.
- Emphasizing routine Lp(a) measurement can help identify high-risk patients, guiding more aggressive treatment and tailored care in catheterization settings, while ongoing clinical trials explore Lp(a)-lowering therapies.
Article Synopsis
- Federated learning (FL) is a technique that allows hospitals to develop predictive models without sharing patient records, but it may affect model performance negatively compared to centralized methods.
- The study evaluated four strategies for predicting 30-day mortality in patients undergoing transcatheter aortic valve implantation (TAVI), including centralized learning and various federated approaches.
- The results showed that federated approaches delivered similar predictive performance in terms of the area under the curve (AUC) and calibration, suggesting that FL can be a practical option for developing clinical prediction models.
Low muscle quality on a procedural computed tomography scan assessed with deep learning as a practical useful predictor of mortality in patients with severe aortic valve stenosis.
Clin Nutr ESPEN
October 2024
Article Synopsis
- Accurate diagnosis of sarcopenia involves assessing muscle quality, specifically how much fat is infiltrated in muscle tissue, which is crucial for predicting mortality in TAVI patients.
- The study analyzed CT scans from 1199 patients who underwent TAVI between 2010 and 2020, employing deep learning algorithms to measure skeletal muscle density (SMD) and intermuscular adipose tissue (IMAT).
- Results indicated that low muscle quality, identified through both low SMD and high IMAT, significantly correlates with increased mortality risk, suggesting that muscle quality metrics are valuable predictors of health outcomes post-TAVI.
The incidence of aortic valve stenosis (AoS) increases with age, and once diagnosed, symptomatic severe AoS has a yearly mortality rate of 25%. AoS is diagnosed with transthoracic echocardiography (TTE), however, this gold standard is time consuming and operator and acoustic window dependent. As AoS affects the arterial blood pressure waveform, AoS-specific waveform features might serve as a diagnostic tool.
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- International guidelines recommend assessing frailty before Transcatheter Aortic Valve Implantation (TAVI), but there's no standard method to do so; this study used the Edmonton Frail Scale (EFS) to evaluate frailty status in patients.
- In a study of 357 TAVI patients, higher EFS scores (indicating greater frailty) were linked to longer hospital stays and increased mortality rates within 30 days to 4 years post-procedure.
- The findings suggest that the EFS is an effective tool for identifying frailty in TAVI patients and could guide clinical decisions to improve patient outcomes and reduce the risk of complications.
Article Synopsis
- Patients with non-obstructive lipid-rich plaques (LRPs) are at a high risk for future health issues, prompting the exploration of a new treatment strategy involving a paclitaxel-eluting drug-coated balloon (PE-DCB).
- This pilot study focuses on assessing the safety and effectiveness of PE-DCB treatment on non-culprit LRPs, aiming to reduce the lipid core burden over a 9-month follow-up period through advanced imaging techniques (IVUS and NIRS).
- Outcomes will be measured based on changes in lipid core burden, clinical events, and various cardiac parameters, with ongoing follow-up extending to one year to evaluate long-term safety and effectiveness.
Background: Various mortality prediction models for Transcatheter Aortic Valve Implantation (TAVI) have been developed in the past years. The effect of time on the performance of such models, however, is unclear given the improvements in the procedure and changes in patient selection, potentially jeopardizing the usefulness of the prediction models in clinical practice. We aim to explore how time affects the performance and stability of different types of prediction models of 30-day mortality after TAVI.
View Article and Find Full Text PDFObjectives: To illustrate in-depth validation of prediction models developed on multicenter data.
Methods: For each hospital in a multicenter registry, we evaluated predictive performance of a 30-day mortality prediction model for transcatheter aortic valve implantation (TAVI) using the Netherlands heart registration (NHR) dataset. We measured discrimination and calibration per hospital in a leave-center-out analysis (LCOA).
Article Synopsis
- This study investigates the use of ticagrelor or prasugrel as a monotherapy right after PCI in patients with NSTE-ACS, offering an alternative to traditional dual antiplatelet therapy.
- Out of 125 enrolled patients, 75 were eligible and 93.3% received monotherapy, with low rates of major ischemic events and bleeding complications within 6 months.
- Findings suggest that this monotherapy approach is feasible and generally safe, indicating the need for further randomized trials to compare it with current treatment methods.
Background: TAVI has shown to result in immediate and sustained hemodynamic alterations and improvement in health-related quality of life (HRQoL), but previous studies have been suboptimal to predict who might benefit from TAVI. The relationship between immediate hemodynamic changes and outcome has not been studied before. This study sought to assess whether an immediate hemodynamic change, reflecting myocardial contractile reserve, following TAVI is associated with improved HRQoL.
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- Manual muscle mass assessment via CT scans helps identify malnutrition and sarcopenia, but the process is labor-intensive and needs a more efficient automated method.
- This study involved 583 patients undergoing Transcatheter Aortic Valve Replacement (TAVR) to evaluate a deep learning-based method for automatically annotating psoas muscle areas, comparing it to manual analysis.
- Results showed the automated method had good accuracy and reliability, indicating it could be a valuable tool for larger studies on muscle mass without the extensive time commitment of manual analysis.
Machine learning models have been developed for numerous medical prognostic purposes. These models are commonly developed using data from single centers or regional registries. Including data from multiple centers improves robustness and accuracy of prognostic models.
View Article and Find Full Text PDFObjectives: To analyze the effect of percutaneous coronary intervention (PCI) before transcatheter aortic valve replacement (TAVR) on all-cause and cardiovascular mortality after TAVR, differentiating between significant proximal lesions and the non-proximal (residual) lesions.
Methods: An institutional TAVR database was complemented with data on the extent of coronary artery disease (CAD), lesion location, lesion severity, and the location of PCI. Survival analysis was performed to investigate the impact on 6-month and 3-year mortality after TAVR in all patients and in subgroups of patients with significant proximal lesions (>70% diameter stenosis [DS], >50% DS in left main), the non-proximal residual lesions, and in a propensity score matched cohort.
Aims: To assess differences in long-term outcome and functional status of patients with cardiogenic shock (CS) treated by percutaneous mechanical circulatory support (pMCS) and intra-aortic balloon pump (IABP).
Methods And Results: Long-term follow-up of the multicentre, randomized IMPRESS in Severe Shock trial (NTR3450) was performed 5-year after initial randomization. Between 2012 and 2015, a total of 48 patients with severe CS from acute myocardial infarction (AMI) with ST-segment elevation undergoing immediate revascularization were randomized to pMCS by Impella CP (n = 24) or IABP (n = 24).
Article Synopsis
- Cangrelor is the only intravenous P2Y inhibitor used when oral options aren't timely for patients having percutaneous coronary intervention (PCI), mainly in STEMI cases in a Dutch study from 2015 to 2021.
- In a cohort of 146 patients, the 30-day mortality rate was 25.3%, with a low incidence of stent thrombosis (1.7%) and major bleeding (12.5%) reported.
- Notably, cardiac arrest upon presentation was identified as a significant predictor of 30-day mortality, indicating that high-risk patients were effectively managed with cangrelor despite their critical condition.
Current prognostic risk scores for transcatheter aortic valve implantation (TAVI) do not benefit yet from modern machine learning techniques, which can improve risk stratification of one-year mortality of patients before TAVI. Despite the advancement of machine learning in healthcare, data sharing regulations are very strict and typically prevent exchanging patient data, without the involvement of ethical committees. A very robust validation approach, including 1300 and 631 patients per center, was performed to validate a machine learning model of one center at the other external center with their data, in a mutual fashion.
View Article and Find Full Text PDFObjectives: Computed tomography angiography (CTA) is performed routinely in the work-up for transcatheter aortic valve implantation (TAVI), and could potentially replace invasive coronary angiography (ICA) to rule out left main (LM) and proximal coronary stenosis. The objectives were to assess the diagnostic yield and accuracy of pre-TAVI CTA to detect LM and proximal coronary stenosis of ≥ 50% and ≥ 70% diameter stenosis (DS).
Methods: The DEPICT CTA database consists of individual patient data from four studies with a retrospective design that analyzed the diagnostic accuracy of pre-TAVI CTA to detect coronary stenosis, as compared with ICA.
Implementation of CT Coronary Angiography as an Alternative to Invasive Coronary Angiography in the Diagnostic Work-Up of Non-Coronary Cardiac Surgery, Cardiomyopathy, Heart Failure and Ventricular Arrhythmias.
J Clin Med
May 2021
To assess the need for additional invasive coronary angiography (CAG) after initial computed tomography coronary angiography (CTCA) in patients awaiting non-coronary cardiac surgery and in patients with cardiomyopathy, heart failure or ventricular arrhythmias, and to determine differences between patients that were referred to initial CTCA or direct CAG, consecutive patients were included between August 2017 and January 2020 and categorized as those referred to initial CTCA (conform protocol), and to direct CAG (non-conform protocol). Out of a total of 415 patients, 78.8% (327 patients, mean age: 57.
View Article and Find Full Text PDFObjectives: The aim of this study was to investigate the online assessment feasibility of aortography using videodensitometry in the catheterization laboratory during transcatheter aortic valve replacement (TAVR).
Background: Quantitative assessment of regurgitation after TAVR through aortography using videodensitometry is simple, reproducible, and validated in vitro, in vivo, in clinical trials, and in "real-world" patients. However, thus far the assessment has been done offline.
Background Despite the availability of guidelines for the performance of transcatheter aortic valve implantation (TAVI), current treatment pathways vary between countries and institutions, which impact on the mean duration of postprocedure hospitalization. Methods and Results This was a prospective, multicenter registry of 502 patients to validate the appropriateness of discharge timing after transfemoral TAVI, using prespecified risk criteria from FAST-TAVI (Feasibility and Safety of Early Discharge After Transfemoral [TF] Transcatheter Aortic Valve Implantation), based on hospital events within 1-year after discharge. The end point-a composite of all-cause mortality, vascular access-related complications, permanent pacemaker implantation, stroke, cardiac rehospitalization, kidney failure, and major bleeding-was reached in 27.
View Article and Find Full Text PDFBackground: In selected patients with an acute myocardial infarction (AMI) complicated by Cardiogenic shock (CS), mechanical circulatory support with Impella may be beneficial, although conclusive evidence is still lacking. Nevertheless, it has been suggested that Impella initiation prior to primary PCI might improve survival.
Objective: To investigate the effect pre-PCI versus immediate post-PCI Impella initiation on short term mortality.
Background: The timing of onset and associated predictors of late new conduction disturbances (CDs) leading to permanent pacemaker implantation (PPI) following transcatheter aortic valve implantation (TAVI) are still unknown, however, essential for an early and safe discharge. This study aimed to investigate the timing of onset and associated predictors of late onset CDs in patients requiring PPI (LCP) following TAVI.
Methods And Results: We performed retrospective analysis of prospectively collected data from five large volume centres in Europe.