Publications by authors named "Ralf W Sprengers"
Article Synopsis
- Researchers investigated the effectiveness of AI-QCT in predicting long-term heart-related events in patients with suspected coronary artery disease, analyzing 536 patients over a median follow-up of 10.3 years.
- The study found that patients with higher atherosclerotic plaque burden identified by AI-QCT faced significantly increased risks for major adverse cardiac events (MACE), with certain stages showing more than 4-fold higher risk.
- Incorporating AI-QCT data enhanced the predictive power of existing clinical risk factors and coronary artery calcium scoring models, demonstrating its value in assessing heart disease risk.
Article Synopsis
- Patients with prior coronary artery bypass grafting (CABG) often need further treatment due to issues like advanced age and bypass graft failure, yet there's a lack of studies comparing the effectiveness of treating native arteries versus bypass grafts.
- The PROCTOR trial is a multicenter study involving 584 participants with saphenous vein graft failure, aiming to compare outcomes of PCI on native vessels versus grafts, focusing on major health events over three years.
- This study is significant as it's the first major trial comparing PCI strategies in patients experiencing SVG failure post-CABG, providing insights into better treatment options.
Article Synopsis
- Chest CT (ULDCT) was evaluated against chest X-ray (CXR) to see which better impacts health outcomes for patients with suspected lung disease in the emergency department.
- A randomized clinical trial included 2418 patients, measuring their health status 28 days later using a specific health score, along with hospital admission rates and lengths of stay.
- Results showed that while ULDCT provided slightly better health scores and found more incidental issues, overall short-term health and admissions were similar to those using CXR, suggesting ULDCT isn't necessary for routine use in these cases.
Article Synopsis
- This study evaluated the effectiveness of a new tool, called the FFR planner, which uses CT scans to predict the benefits of a heart procedure called percutaneous coronary intervention (PCI) compared to traditional invasive measurements.
- It was conducted on 56 patients, analyzing FFR readings (a measure of blood flow) before and after PCI, showing that the FFR planner has some correlation with post-PCI FFR outcomes, although it was not perfectly accurate.
- The findings suggest that while the FFR planner is useful for planning PCI, further advancements in the technology are necessary for it to be fully reliable in clinical settings.
Background: Quantification of ventricular performance requires a comprehensive metric which is manageable for patient care and clinical trials. Ejection fraction (EF) has been embraced as an attractive candidate. However, being a dimensionless ratio, EF has serious limitations.
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- - The pressure-volume relationships of the heart are key to understanding cardiac function, allowing for the analysis of factors like ventricular volume and cardiac health through tools like the ventricular volume regulation graph (VRG).
- - Noninvasive techniques can assess cardiac volumes and pressures, while factors such as age, intrinsic cardiac diseases, and vascular abnormalities affect these measurements, with noted differences between sexes in left ventricular volume.
- - This review highlights the importance of recognizing sex-specific differences in cardiac function, particularly in the context of ejection fraction and exercise interventions, and their implications for various patient populations.
Article Synopsis
- This study aimed to evaluate the significance of high or immeasurable ankle-brachial index (ABI) levels for predicting major amputations and amputation-free survival (AFS) in patients suffering from critical limb ischemia (CLI).
- Researchers analyzed data from two trials involving patients with obstructive arterial disease, categorizing them based on ABI levels (low, intermediate, high/immeasurable) and comparing amputation and survival rates across these groups.
- Results revealed that patients with high/immeasurable ABI had much higher rates of major amputations (52.1%) and very low AFS (5.0%), indicating that this ABI category is a strong predictor of poor outcomes,
Objective: Although never assessed prospectively, diabetes mellitus (DM) is assumed to negatively affect the outcomes of critical limb ischemia (CLI). DM was highly prevalent in two recently conducted randomized controlled trials in CLI patients, the PADI (Percutaneous Transluminal Balloon Angioplasty [PTA] and Drug Eluting Stents for Infrapopliteal Lesions in Critical Limb Ischemia) and JUVENTAS (Rejuvenating Endothelial Progenitor Cells via Transcutaneous Intra-Arterial Supplementation) trials. To determine the implications of DM in a population of patients with infrapopliteal CLI, clinical outcomes were compared in patients with and without DM.
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- Bone marrow (BM) transplantations are essential for treating blood-related diseases, and recent interest has shifted towards using BM-derived cells in regenerative medicine.
- This study investigates how the diameter of the needle used for BM aspiration affects the cell density of the harvested BM aspirate.
- Results show that a larger 8-gauge needle yields significantly higher quantities of white blood cells (WBC) and CD34(+) hematopoietic cells (HPC) compared to a smaller 15-gauge needle, suggesting that larger needles may improve transplant efficiency.
Article Synopsis
- Patients with severe limb ischemia, who can't undergo traditional treatment, were tested for a new therapy involving bone marrow-derived cells to see if it could prevent major amputations.
- The JUVENTAS trial involved 160 participants receiving either the cell therapy or placebo, but after 6 months, there was no significant difference in amputation rates between the two groups.
- Secondary outcomes, like quality of life and pain levels, improved for both groups during follow-up, showing benefits of the treatment were not evident when compared to the placebo.
Background: Critical Limb Ischemia (CLI) is the most advanced stage of peripheral arterial disease and is usually treated with bypass surgery or endovascular revascularization. However, a considerable proportion of CLI patients are not eligible to these treatment strategies and amputation is often the only option left. In the past decade, research has focused on bone marrow (BM)-derived cell-based strategies that aim at neovascularization to improve limb perfusion.
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- Critical limb ischemia (CLI) is linked to lower blood flow in the legs and an impaired ability to develop new blood vessels, likely due to issues with bone marrow-derived endothelial progenitor cells (EPCs).
- In a study involving 101 CLI patients and healthy controls, it was found that CLI patients had higher levels of markers indicating endothelial injury and inflammation, but lower levels of EPCs and bone marrow stem cells associated with blood vessel growth.
- The findings suggest that inflammation may lead to a depletion of stem cells in the bone marrow, hindering the body's ability to repair blood vessels despite the presence of endothelial injury.
Objective: To provide a solid baseline reference for quality of life (QoL) in patients with no-option critical limb ischemia (CLI). CLI is associated with surgery, endovascular interventions, hospitalization, and a poor prognosis. An increasing number of clinical trials are, therefore, investigating new treatment strategies (eg, therapeutic neovascularization) in patients with CLI.
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- * Autologous bone marrow-derived cell therapy shows potential for treating CLI, but there hasn't been sufficient evidence of its lasting effectiveness.
- * The JUVENTAS trial is investigating the efficacy of repeated intra-arterial bone marrow mononuclear cell infusions in 110 to 160 CLI patients, aiming to reduce the need for major amputations within 6 months.
Article Synopsis
- Patients with peripheral arterial disease (PAD) face a high risk of serious cardiovascular events like heart attacks and strokes, so it's crucial to manage their cardiovascular risk factors effectively.
- Researchers developed a prediction model using data from 800 PAD patients to identify those at the highest risk for secondary cardiovascular issues, using various health indicators.
- The model stratifies patients into four risk categories, revealing that factors like age, blood pressure, and smoking status significantly predict the likelihood of experiencing a cardiovascular event over time.
Objective: To provide a review on progenitor cell therapy for critical limb ischemia.
Summary Background Data: Critical limb ischemia is estimated to develop in 500 to 1000 individuals per million persons per year and has a major impact on the quality of life. Despite recent advances in surgical and radiologic vascular procedures, a large number of patients ( approximately 40%) are not eligible for these revascularization procedures.