Publications by authors named "Tim van de Hoef"
Background: Pulmonary embolism is an important cause of preventable mortality. Treatment strategies depend on risk stratification. High-risk patients, and some intermediate-high-risk patients, require urgent reperfusion therapy.
View Article and Find Full Text PDFBackground: Patients with refractory angina are often ineligible for revascularization and have poor quality of life despite optimal medical therapy. The coronary sinus (CS) Reducer (Shockwave Medical Inc) was safe and effective in the treatment of refractory angina in the COSIRA (Coronary Sinus Reducer for Treatment of Refractory Angina) randomized sham-controlled trial.
Objectives: This study sought to perform the primary endpoint analysis of the complete REDUCER-I (An Observational Study of the Neovasc Reducer System) study cohort.
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).
Computed tomography-derived fractional flow reserve (CT-FFR) enhances the specificity of coronary computed tomography angiography (CCTA) to that of the most specific non-invasive imaging techniques, while maintaining high sensitivity in stable coronary artery disease (CAD). As gatekeeper for invasive coronary angiography (ICA), use of CT-FFR results in a significant reduction of negative ICA procedures and associated costs and complications, without increasing cardiovascular events. It is expected that CT-FFR algorithms will continue to improve, regarding accuracy and generalisability, and that introduction of new features will allow further treatment guidance and reduced invasive diagnostic testing.
View Article and Find Full Text PDFAge-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.
Coronary vasomotor dysfunction, an important underlying cause of angina and nonobstructive coronary arteries (ANOCA), encompassing coronary vasospasm, coronary endothelial dysfunction, and/or coronary microvascular dysfunction, is clinically assessed by invasive coronary function testing (ICFT). As ICFT imposes a high burden on patients and carries risks, developing noninvasive alternatives is important. We evaluated whether coronary vasomotor dysfunction is a component of systemic microvascular endothelial and smooth muscle dysfunction and can be detected using laser speckle contrast analysis (LASCA).
View Article and Find Full Text PDFThe Diagnostic Value of ECG Characteristics for Vasospastic and Microvascular Angina: A Systematic Review.
Ann Noninvasive Electrocardiol
September 2024
Article Synopsis
- Coronary vascular dysfunction, more common in women with non-obstructive angina, includes vasospastic angina (VSA) and microvascular angina (MVA), with invasive tests being the standard but burdensome for patients.
- This study reviewed ECG characteristics linked to VSA and MVA by analyzing 30 relevant publications, revealing that repolarization changes are significant predictors for both conditions, but diagnostic evaluations in studies are scarce.
- Only a few studies stratified results by sex, indicating that while ECG could aid in noninvasive diagnosis and risk assessment, more targeted research is needed to fully understand its efficacy and potential sex differences.
Article Synopsis
- Angina with Non-Obstructed Coronary Arteries (ANOCA) is linked to abnormal blood vessel responses, and reduced myocardial blood volume (MBV) may contribute to this condition and be related to insulin resistance.
- A study compared MBV in ANOCA patients with healthy controls while testing coronary function, which revealed issues like vasospasm and coronary microvascular dysfunction in some ANOCA patients.
- Results showed that ANOCA patients had significantly lower MBV levels at various stress tests and exhibited signs of metabolic insulin resistance, but insulin did not change heart blood flow in the short term.
Association Between Coronary Artery Spasm and Atherosclerotic Disease.
JACC Cardiovasc Imaging
July 2024
In at least one-half of the patients with angina or ischemia and nonobstructive coronary arteries undergoing coronary function testing, coronary artery spasm (CAS) is detected. CAS is associated with an adverse prognosis regarding recurrent complaints and ischemic events. Current treatment options are mainly focused on the complaints, not on the underlying pathophysiological process.
View Article and Find Full Text PDFArticle 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.
Coronary 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 PDFFractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are invasive techniques used to evaluate the hemodynamic significance of coronary artery stenosis. These methods have been validated through perfusion imaging and clinical trials. New invasive pressure ratios that do not require hyperemia have recently emerged, and it is essential to confirm their diagnostic efficacy.
View Article and Find Full Text PDFBackground: Coronary vasomotor dysfunction (CVDys) comprises coronary vasospasm (CVS) and/or coronary microvascular dysfunction (CMD) and is highly prevalent in patients with angina and non-obstructive coronary artery disease (ANOCA). Invasive coronary function testing (CFT) to diagnose CVDys is becoming more common, enabling pathophysiologic research of CVDys. This study aims to explore the electrophysiological characteristics of ANOCA patients with CVDys.
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.
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.
Background: Coronary flow capacity (CFC) is a measure that integrates hyperemic myocardial blood flow and coronary flow reserve to quantify the pathophysiological impact of coronary artery disease on vasodilator capacity. This study explores the prognostic value of modified CFC derived from [O]HO positron emission tomography perfusion imaging.
Methods: Quantitative rest/stress perfusion measurements were obtained from 1300 patients with known or suspected coronary artery disease.