[Dyspnoea].

Dyspnoea is an important and common symptom in patients with pulmonary or cardiovascular disease. It is a vital signal that we all can experience, for instance during heavy exercise, but it can also be an expression of a variety of diseases. In this updated educational article, we provide an answer to 10 questions on the causes of dyspnoea and the effectiveness of various diagnostic and therapeutic strategies.

[The treatment of stable coronary artery disease: always optimal medical therapy, coronary revascularization only on indication].

No trial or meta-analysis in patients with stable coronary artery disease, normal left ventricular function and without left main stenosis, has shown that adding revascularization to optimal medical therapy (OMT) decreases hard endpoints: myocardial infarction (MI) and overall mortality. However, Navarese concludes that OMT with elective revascularization reduces "cardiac" mortality, and is associated with a reduction in spontaneous MI. His meta-analysis is biased by a less hard primary endpoint "cardiac mortality" (often poorly defined and/or not independently assessed), exclusion of revascularisation-related MI and inclusion of vintage trials without platelet aggregation inhibitors, statins or PCIs.

[Stable angina pectoris deserves better treatment].

In the Netherlands, the burden of coronary artery disease is higher than that of any other disease. The healthcare costs amount to approximately 2.3 billion per year.

[Treatment of mitral regurgitation with the MitraClip].

The consideration for treatment of mitral regurgitation is dependent on its underlying cause: degenerative or functional. The percutaneous MitraClip treatment is mostly suitable for patients with severe, symptomatic mitral regurgitation and additional risk factors, who therefore do not qualify for surgical treatment but still have a life expectancy of more than one year. The MitraClip treatment has undergone technical improvements in the past ten years and has a low rate of periprocedural and postprocedural complications.

[Dyspnoea].

Dyspnoea is an important and common symptom in patients with pulmonary or cardiovascular disease. It is a vital signal that we all can experience, for instance during heavy exercise, but it can also be an expression of a variety of diseases. In this educational article, we provide an answer to 10 questions on the causes of dyspnoea and the effectiveness of various diagnostic and therapeutic strategies.

Diagnostic evaluation and treatment strategy in patients with suspected prosthetic heart valve dysfunction: The incremental value of MDCT.

Background: In patients with suspected prosthetic heart valve (PHV) dysfunction, routine evaluation echocardiography and fluoroscopy may provide unsatisfactory results for identifying the cause of dysfunction. This study assessed the value of MDCT as a routine, complementary imaging modality in suspected PHV-dysfunction for diagnosing the cause of PHV dysfunction and proposing a treatment strategy.

Methods: Patients with suspected PHV dysfunction were prospectively recruited.

[Estimation of the jugular venous pressure].

Estimation of jugular venous pressure (JVP) is valuable for the differentiation between dyspnoea of cardiac or pulmonary origin, and for determining the cause of oedema. JVP assessments are useful for evaluation of treatment of right ventricular failure. The correlation between non-invasive JVP and invasive measurement of the central venous pressure (CVP) is remarkably better than previously reported.

Baseline MDCT findings after prosthetic heart valve implantation provide important complementary information to echocardiography for follow-up purposes.

Objectives: Recent studies have proposed additional multidetector-row CT (MDCT) for prosthetic heart valve (PHV) dysfunction. References to discriminate physiological from pathological conditions early after implantation are lacking. We present baseline MDCT findings of PHVs 6 weeks post implantation.

Are novel non-invasive imaging techniques needed in patients with suspected prosthetic heart valve endocarditis? A systematic review and meta-analysis.

Objectives: Multimodal non-invasive imaging plays a key role in establishing a diagnosis of PHV endocarditis. The objective of this study was to provide a systematic review of the literature and meta-analysis of the diagnostic accuracy of TTE, TEE, and MDCT in patients with (suspected) PHV endocarditis.

Methods: Studies published between 1985 and 2013 were identified via search and cross-reference of PubMed/Embase databases.

Percutaneous mitral valve repair preserves right ventricular function.

Background: Chronic mitral regurgitation (MR) often leads to diminished right ventricular (RV) function due to long-standing pressure and volume overload. Surgical intervention often adds to the preexisting RV dysfunction. Percutaneous mitral valve (MV) repair can reduce MR, but to what extent this affects the right ventricle is unknown.

Cardiac computed tomography angiography results in diagnostic and therapeutic change in prosthetic heart valve endocarditis.

Echocardiography may miss prosthetic heart valve (PHV) endocarditis which advocates for novel imaging techniques to improve diagnostic accuracy and patient outcome. The purpose of this study was to determine the complementary diagnostic value of cardiac computed tomography angiography (CTA) to the clinical routine workup including transthoracic and transesophageal echocardiography (TTE/TEE) in patients with suspected PHV endocarditis and its impact on patient treatment. A diagnostic prospective cross-sectional study was chosen as design.

Differentiation of thrombus from pannus as the cause of acquired mechanical prosthetic heart valve obstruction by non-invasive imaging: a review of the literature.

Aims: For acquired mechanical prosthetic heart valve (PHV) obstruction and suspicion on thrombosis, recently updated European Society of Cardiology guidelines advocate the confirmation of thrombus by transthoracic echocardiography, transesophageal echocardiography (TEE), and fluoroscopy. However, no evidence-based diagnostic algorithm is available for correct thrombus detection, although this is clinically important as fibrinolysis is contraindicated in non-thrombotic obstruction (isolated pannus). Here, we performed a review of the literature in order to propose a diagnostic algorithm.

Coronary artery assessment by multidetector computed tomography in patients with prosthetic heart valves.

Objectives: Patients with prosthetic heart valves may require assessment for coronary artery disease. We assessed whether valve artefacts hamper coronary artery assessment by multidetector CT.

Methods: ECG-gated or -triggered CT angiograms were selected from our PACS archive based on the presence of prosthetic heart valves.

[Chagas disease in the Netherlands: an estimate of the number of patients].

A total of 8-10 million persons are infected worldwide with Trypanosoma cruzi, the causative parasite of Chagas disease, most of whom are inhabitants of Latin America. Due to the increased migration of peoples, Chagas disease has been on the uprise outside Latin America, including in Europe. The course of Chagas, also called American trypanosomiasis, runs in 2 phases: an acute phase lasting approximately 2 months, and a chronic phase in which symptoms may appear years after infection.

Two cases of cardiac arteriovenous malformation complicated by a local angioproliferative process.

Vascular malformations of the heart are extremely rare with only a few cases of the arteriovenous type of vascular malformation (AVM) reported. We investigated the pathology of two additional cases, which were complicated by the occurrence of a local vasoproliferative response of immature but benign vessels. We suppose that the mass forming effect of this vasoproliferative response, which has also been reported recently as a complication of congenital AVM elsewhere in the body, has significantly contributed to the onset of symptoms and ultimate death of both patients.

Right ventricular dysfunction is an independent predictor for mortality in ST-elevation myocardial infarction patients presenting with cardiogenic shock on admission.

Aims: Despite improvement in prognosis for ST-elevation myocardial infarction (STEMI) patients, mortality remains high in STEMI patients presenting with cardiogenic shock (CS). Right ventricular (RV) dysfunction is an established independent predictor for adverse prognosis in STEMI patients without CS. The purpose of our study was to determine the prognostic value of RV dysfunction on admission in STEMI patients presenting in CS.

[Perioperative suspension of anticoagulants: practical recommendations].

If patients being treated with anticoagulants need to undergo an operation then physicians need to consider whether to suspend the use of this medication or to allow its use to be continued. Suspending the use of anticoagulants increases the risk of thrombosis, whereas continued use may cause bleeding complications. No evidence-based scientific research has been carried out regarding best practice for the perioperative use of anticoagulants.

Health-related quality of life and posttraumatic stress disorder among survivors of left-sided native valve endocarditis.

Background: The long-term prognosis of endocarditis is described primarily in relation to clinical outcome measures-for example, such complications as cerebrovascular accident, cardiac failure, need for cardiac surgery, relapse rate, and mortality. To our knowledge, to date, no studies have examined the health-related quality of life and the prevalence of long-term persistence of physical symptoms for survivors of left-sided native valve endocarditis.

Methods: We conducted a prospective follow-up study of patients treated for left-sided native valve endocarditis from 1 November 2000 through 31 October 2003 in 23 hospitals in the Netherlands.