Publications by authors named "Robbert de Winter"
Deferral of routine percutaneous coronary intervention in patients undergoing transcatheter aortic valve implantation: rationale and design of the PRO-TAVI trial: the PRO-TAVI trial: rationale and design.
Am Heart J
December 2024
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.
View Article and Find Full Text PDFPatients undergoing percutaneous coronary intervention (PCI) to the left main (LM) coronary artery in the setting of acute coronary syndrome (ACS) were not adequately studied in the era of modern PCI. We investigated early and long-term outcomes of these patients, especially those with a true LM bifurcation stenosis. The Left Main Intervention in Acute Coronary Syndrome (LIMACS) is a multicenter registry that enrolled patients undergoing PCI to unprotected LM disease in the setting of ACS using a drug-eluting stent.
View Article and Find Full Text PDFPercutaneous Pulmonary Valve Implantation With Self-Expanding Valves for Carcinoid Heart Diseases.
Catheter Cardiovasc Interv
November 2024
Article Synopsis
Lipoprotein(a) in interventional cardiology: identifying patients at highest risk of recurrent cardiovascular events through early recognition - a case based review.
Expert Rev Cardiovasc Ther
August 2024
Article Synopsis
- 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
- About 25% of the population has a patent foramen ovale (PFO), which is usually asymptomatic, but it can sometimes cause right-to-left shunt (RLS)-mediated hypoxaemia, a rare condition.
- In a case involving a 73-year-old woman, her oxygen levels significantly improved from 87% to 98% after undergoing percutaneous PFO closure due to her progressive difficulty breathing.
- While most PFOs don't cause problems, RLS-mediated hypoxaemia can occur even in older adults, and percutaneous closure is a safe and effective treatment that provides quick relief.
Persistence of residual shunt at 6 and 12 months after transoesophageal echocardiography-guided percutaneous closure of a patent foramen ovale for cryptogenic stroke.
Heart
September 2024
Article Synopsis
- Young patients with cryptogenic stroke and a patent foramen ovale (PFO) sometimes receive device closure to prevent future strokes, but about 25% may still have a residual right-to-left shunt after 6 months.
- In a study of 227 patients, it was found that at 6 months post-closure, 72.7% had no shunt, while the rest had varying degrees of residual shunt.
- By 12 months, many of these residual shunts had either diminished or closed completely, indicating that while residual shunts are common at 6 months, most are small and tend to close over time.
Article Synopsis
- A routine invasive strategy is normally recommended for high-risk patients with non-ST-elevation acute coronary syndromes (NSTE-ACS), but patients with a history of coronary artery bypass graft (CABG) surgery were not included in significant trials informing these guidelines.
- A systematic review and meta-analysis evaluating 11 randomized controlled trials (RCTs) was performed to analyze outcomes such as mortality and hospitalization among patients with prior CABG receiving either routine invasive or conservative treatment for NSTE-ACS.
- The findings indicate that a routine invasive strategy does not offer any benefits over conservative treatment in terms of all-cause mortality, cardiac mortality, myocardial infarction, or cardiac-related hospitalization for patients with prior CABG.
Background: Multisystem inflammatory syndrome in children is an inflammatory syndrome related to severe acute respiratory syndrome coronavirus 2 with a high risk of cardiovascular complications (vasoplegia, cardiac shock). We investigated the cardiac outcomes in multisystem inflammatory syndrome in children, focusing on the identification of predictors for late cardiac function impairment.
Methods: Clinical characteristics, conventional echocardiography (left ventricle ejection fraction, fractional shortening), 4-chamber left ventricular global longitudinal strain, and cardiac MRI of multisystem inflammatory syndrome in children patients (n = 48) were collected during admission, 6 weeks, 6 months, >12-≤18 months, and >18-≤24 months post-onset.
Background: The Apple Watch has the capability to record a lead 1 electrocardiogram (ECG) and can identify and report atrial fibrillation. The use for detecting myocardial ischaemia is not endorsed by Apple but is documented in this case.
Case Summary: A 76-year-old man made a lead 1 ECG with his Apple Watch immediately after exercising on a cross trainer.
Background: We aimed to identify patients with subphenotypes of postacute coronary syndrome (ACS) using repeated measurements of high-sensitivity cardiac troponin T, N-terminal pro-B-type natriuretic peptide, high-sensitivity C-reactive protein, and growth differentiation factor 15 in the year after the index admission, and to investigate their association with long-term mortality risk.
Methods And Results: BIOMArCS (BIOMarker Study to Identify the Acute Risk of a Coronary Syndrome) was an observational study of patients with ACS, who underwent high-frequency blood sampling for 1 year. Biomarkers were measured in a median of 16 repeated samples per individual.
Article Synopsis
- 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.
Background: The Amplatzer™ Trevisio™ Intravascular Delivery System (Trevisio DS; Abbott Laboratories, Chicago, IL, USA) facilitates the delivery of Amplatzer™ Occluders and features an ultraflexible tip, which improves assessment of occluder position before release.
Aims: To assess the safety and efficacy of the Trevisio DS for transcatheter closure of patent foramen ovale and atrial septal defect.
Methods: The Amplatzer™ Trevisio™ Intravascular Delivery System Post-Approval Study was a prospective, postmarket, single-arm, multicentre, observational study of the Trevisio DS.
Introduction: Acute mechanical thrombectomy (MT) is the preferred treatment for large vessel occlusion-related stroke. Histopathological research on the obtained occlusive embolic thrombus may provide information regarding the aetiology and pathology of the lesion to predict prognosis and propose possible future acute ischaemic stroke therapy.
Methods: A total of 75 consecutive patients who presented to the Amphia Hospital with acute large vessel occlusion-related stroke and underwent MT were included in the study.
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.
Paravalvular leak (PVL) is a shortcoming that can erode the clinical benefits of transcatheter valve replacement (TAVR) and therefore a readily applicable method (aortography) to quantitate PVL objectively and accurately in the interventional suite is appealing to all operators. The ratio between the areas of the time-density curves in the aorta and left ventricular outflow tract (LVOT-AR) defines the regurgitation fraction (RF). This technique has been validated in a mock circulation; a single injection in diastole was further tested in porcine and ovine models.
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- Increasing survival rates in adults with congenital heart disease (ACHD) lead to complications like arrhythmias and heart failure; therefore, transcatheter valve interventions are emerging as a viable treatment option.
- A study at the Center of Congenital Heart Disease Amsterdam-Leiden analyzed ACHD patients with severe atrioventricular (AV) valve regurgitation who underwent various transcatheter procedures from 2020 to 2022, noting improvements in condition without complications.
- The findings suggest that while transcatheter valve repair can be safe and effective for complex ACHD patients, ongoing collaboration and individualized treatment strategies from a dedicated heart team are crucial for optimizing outcomes and future evaluations are needed to assess long-term results.
Article Synopsis
- Renal sympathetic innervation plays a significant role in managing blood flow and pressure in the kidneys and is relevant for various treatment approaches.
- A study involving 18 patients assessed how static handgrip exercise affects renal arterial pressure and flow, revealing that pressure increased while flow decreased during the exercise.
- These findings suggest that analyzing renal pressure and flow dynamics can help identify patients' sympathetic control levels of kidney perfusion, offering insights for potential therapeutic strategies.
Migraine is a chronic neurovascular disease with a complex, not fully understood pathophysiology with multiple causes. People with migraine suffer from recurrent moderate to severe headache attacks varying from 4 to 72 h. The prevalence of migraine is two to three times higher in women compared with men.
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- Intracoronary acetylcholine (ACh) testing is used to diagnose vasospasm in patients with chest pain and non-obstructive coronary artery disease.
- The study measured flow-recovery time after ACh provocation to assess ischemia, finding that those with equivocal results had similar prolonged flow-recovery times as patients diagnosed with vasospasm.
- The findings suggest that patients with equivocal results experience myocardial ischemia, indicating they could benefit from medical treatment.
Background: NobleStitch EL is a novel suture-based technique used for patent foramen ovale (PFO) closure and an alternative to traditional double-disc devices without the need for antithrombotic therapy. However, successful closure rates are still unknown, and certain anatomies may be unfavorable for successful closure.
Aims: We assessed the efficacy of the NobleStitch EL and sought to identify patient-related anatomical features associated with successful suture-based closure.
Serially measured high-sensitivity cardiac troponin T, N-terminal-pro-B-type natriuretic peptide, high-sensitivity C-reactive protein, and growth differentiation factor 15 for risk assessment after acute coronary syndrome: the BIOMArCS cohort.
Eur Heart J Acute Cardiovasc Care
July 2023
Aims: Evidence regarding the role of serial measurements of biomarkers for risk assessment in post-acute coronary syndrome (ACS) patients is limited. The aim was to explore the prognostic value of four, serially measured biomarkers in a large, real-world cohort of post-ACS patients.
Methods And Results: BIOMArCS is a prospective, multi-centre, observational study in 844 post-ACS patients in whom 12 218 blood samples (median 17 per patient) were obtained during 1-year follow-up.
Article Synopsis
- * It measured SWS changes before and after procedures, finding a significant decrease in strain at treatment sites and a shift of strain to the edges of the devices in both treatment groups.
- * The findings suggest that angiography-based SWS analysis can effectively evaluate the mechanical condition of coronary arteries after treatment, with similar outcomes for both BRS and DES.
Article Synopsis
- - The study aimed to evaluate whether low-dose dobutamine stress echocardiography (DSE) can predict residual mitral regurgitation (MR) after transcatheter edge-to-edge mitral valve repair (TMVR) procedures.
- - Findings showed that among 39 patients, those who experienced an increase in MR during DSE were more likely to have significant residual MR at discharge, highlighting DSE's predictive value.
- - The high sensitivity (100%) and specificity (85%) of DSE make it a powerful tool for guiding clinical decisions post-TMVR, potentially leading to better patient outcomes.