Publications by authors named "Tom Adriaenssens"
Background: The evaluation of myocardial ischemia in patients with aortic valve stenosis (AS) with concomitant coronary artery disease (CAD) and possible microvascular dysfunction (MVD) is challenging because fractional flow reserve (FFR) and the resting full-cycle ratio (RFR) have not been validated in this clinical setting.
Objectives: The objectives of this study in patients with AS and CAD were: 1) to describe the relationship between hyperemic and resting indexes; 2) to investigate the acute and long-term effects of aortic valve replacement (AVR) on epicardial indexes and microvascular function; 3) to assess the impact of these changes on clinical decision making; and 4) to determine FFR/RFR ischemia cutoff points in AS.
Methods: In this prospective multicentric study, we performed serial measurements of FFR and RFR and evaluated MVD by means of coronary flow reserve, the index of microvascular resistance, and microvascular resistance reserve in patients with severe AS and intermediate to severe CAD before and 6 months after AVR.
Article Synopsis
- * In a trial with 858 patients, results showed no significant difference in major complications between those who continued anticoagulation (16.5% experienced primary outcomes) and those who interrupted it (14.8%).
- * Continuation of anticoagulation led to higher incidences of major bleeding (31.1% vs. 21.3%), suggesting that interrupting anticoagulation is safer in this patient population undergoing TAVI.
Association of vessel fractional flow reserve (vFFR) with luminal obstruction and plaque characteristics as detected by optical coherence tomography (OCT) in patients with NSTE-ACS: the FAST OCT study.
Eur Heart J Cardiovasc Imaging
December 2024
Aims: There is a paucity of data on the performance of angiography-derived vessel fractional flow reserve (vFFR) in coronary artery lesions of patients presenting with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Optical coherence tomography (OCT) allows for visualization of lumen dimensions and plaque integrity with high resolution. The aim of this study was to define the association between vFFR and OCT findings in intermediate coronary artery lesions in patients presenting with NSTE-ACS.
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- The optimal management of patients with atrial fibrillation (AF) requiring oral anticoagulation (OAC) during percutaneous coronary intervention (PCI) is debated, with current guidelines suggesting a temporary triple therapy regimen that includes aspirin, which raises bleeding risks.
- A new study, the WOEST-3 trial, seeks to compare a 30-day dual antiplatelet therapy (DAPT) strategy that temporarily omits OAC against guideline-directed therapy post-PCI for AF patients, aiming to reduce bleeding without sacrificing efficacy.
- With a sample of 2,000 patients, the trial will evaluate the rates of major bleeding and adverse ischemic events, making it the first randomized controlled trial to explore the omission of OAC
Aims: Decision-makers still predominantly focus on the perspective of non-patient stakeholders, which may deviate from the unique perspective of heart failure (HF) patients. To enhance patient-centred decision-making, there is a need for more patient-based evidence derived directly from the patients themselves. Hence, this study aimed to understand (i) HF patients' unmet medical needs and preferred treatment outcomes; (ii) patients' risk tolerance; and (iii) their information needs, uncertainties and satisfaction towards HF treatment.
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- - TAVI with the SAPIEN 3 device has demonstrated significant clinical advantages over traditional surgical aortic valve replacement (SAVR) for low-risk patients, as shown by the PARTNER 3 trial.
- - The cost-utility analysis, tailored for Belgium, found that TAVI could lead to savings of €3,013 per patient, despite higher initial costs due to reduced follow-up expenses like rehabilitation and rehospitalization.
- - Overall, the findings suggest that TAVI offers a beneficial and cost-effective alternative for low-risk patients with severe symptomatic aortic stenosis in Belgium, outpacing SAVR in both quality of life and financial outcomes.
We aimed to develop a large animal model of subcoronary aortic stenosis (AS) to study intracoronary and microcirculatory hemodynamics. A total of three surgical techniques inducing AS were evaluated in 12 sheep. Suturing the leaflets together around a dilator ( = 2) did not result in severe AS.
View Article and Find Full Text PDFResearch Question: Can a strategy for scoring oocyte quality, based on cumulus cell (CC) gene expression, prioritize oocytes with the highest implantation potential, while limiting the number of embryos to be processed in culture and the number of supernumerary embryos to be vitrified?
Design: An interventional, blinded, prospective cohort study was retrospectively analyzed. In the original study, patients underwent a fresh Day3 single embryo transfer with embryos ranked based on morphology and CC gene expression (Aurora Test). The additional ranking of the embryos with the Aurora Test resulted in significant higher clinical pregnancy and live birth rates.
Background: Impella™ is increasingly used in cardiogenic shock. However, thromboembolic and bleeding events are frequent during percutaneous mechanical circulatory support (pMCS).
Objective: Therefore, we aimed to explore the optimal anticoagulation regime for pMCS to prevent thromboembolism and bleedings.
Aims: Sutureless aortic valve replacement (SU-AVR) and transcatheter aortic valve implantation (TAVI) are both viable therapeutic interventions for aortic stenosis in elderly patients. Meta-analyses show similar all-cause mortality for both techniques albeit with a different pattern of adverse effects. This study means to compare costs and, to a lesser extent, clinical outcomes of both techniques.
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- Outcomes after heart attacks in women are still not great, and understanding the connection between risk factors and artery plaque types is limited.
- A study of 382 women with acute coronary syndrome showed that younger women (<60 years) mostly had plaque erosion, while older women had different plaque characteristics.
- Risk factors like smoking, diabetes, and high cholesterol affect plaque development, indicating that addressing these issues early, especially in young women, could help prevent worsening heart disease as they age.
Background: The percutaneous treatment of calcified coronary lesions remains challenging and is associated with worse clinical outcomes. In addition, coronary artery calcification is associated with more frequent peri-procedural myocardial infarction.
Study Design And Objectives: The ShOckwave ballooN or Atherectomy with Rotablation in calcified coronary artery lesions (SONAR) study is an investigator-initiated, prospective, randomized, international, multicenter, open label trial (NCT05208749) comparing a lesion preparation strategy with either shockwave intravascular lithotripsy (IVL) or rotational atherectomy (RA) before drug-eluting stent implantation in 170 patients with moderate to severe calcified coronary lesions.
Article Synopsis
- The LEGACY study examines whether stopping aspirin right after PCI for NSTE-ACS and using only P2Y-inhibitor therapy is safer and effective compared to continuing dual antiplatelet therapy (DAPT) for 12 months.
- The research involves 3,090 patients, comparing the incidence of bleeding events between those on aspirin and those who aren’t, while also ensuring no significant increase in serious health issues like heart attacks or strokes.
- This study is groundbreaking as it specifically investigates the effects of immediately omitting aspirin, making it a crucial step in understanding optimal post-PCI treatment options.
Background: Cardiogenic shock (CGS) occurs in 10% of patients presenting with acute myocardial infarction (MI), with in-hospital mortality rates of 40-50% despite revascularisation.
Aims: The EURO SHOCK trial aimed to determine if early use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) could improve outcomes in patients with persistent CGS following primary percutaneous coronary intervention (PPCI).
Methods: This multicentre, pan-European trial randomised patients with persistent CGS 30 minutes after PPCI of the culprit lesion to receive either VA-ECMO or continue with standard therapy.
Left main coronary artery (LMCA) extrinsic compression should be suspected in patients with pulmonary hypertension and angina. Coronary angiography and intracoronary imaging are complementary techniques to confirm the diagnosis and guide therapy. In the largest prospective single-center series, the prevalence of a significant LMCA stenosis >50% due to dilated pulmonary artery-induced extrinsic compression was 6% in the pulmonary arterial hypertension population, and increased to 40% in patients with angina-like symptoms.
View Article and Find Full Text PDFBackground: Aortic stenosis and coronary artery disease (CAD) frequently coincide. However, the management of coexisting CAD in patients undergoing transcatheter aortic valve replacement (TAVR) remains controversial.
Objectives: This study sought to determine whether the presence of CAD, its complexity, and angiography-guided percutaneous coronary intervention (PCI) are associated with outcomes after TAVR.
Introduction: Despite advances in heart failure therapies and percutaneous coronary interventions, survival for cardiogenic shock remains poor. Percutaneous ventricular assist devices (pVAD) are increasingly used, but current evidence remains conflicting. The Impella is an example of such a device, based on a catheter mounted micro-axial continuous flow pump, that has been rapidly adopted in routine practice.
View Article and Find Full Text PDFMetadata analysis of public microarray datasets using bioinformatics tools has been successfully used in several biomedical fields in the search for biomarkers. In reproductive science, there is an urgent need for the establishment of oocyte quality biomarkers that could be used in the clinical environment to increase the chances of successful outcomes in treatment cycles. Adaptive cellular processes observed in cumulus oophorus cells reflect the conditions of the follicular microenvironment and may thus bring relevant information of oocyte's conditions.
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- Recent research reveals that while cardiovascular mortality in women has decreased, the differences in the causes of acute coronary syndromes between sexes are not well-understood.
- A study analyzing 1,368 patients showed that both men and women had similar types of plaque morphology, but significant differences in the mechanisms leading to these conditions emerged with age.
- Specifically, older women exhibited an increasing tendency toward plaque rupture and vulnerability features, unlike their male counterparts, suggesting that age plays a crucial role in the sex-related differences observed.
Article Synopsis
- Optical Coherence Tomography (OCT) has evolved as a key imaging tool over the past two decades, significantly improving our understanding of coronary atherosclerosis and optimizing cardiac interventions.
- Recent advancements in OCT have enabled better identification of plaque pathology and healing processes in patients with acute coronary syndromes, potentially transforming patient management.
- This Review aims to present the latest insights on cardiac OCT, standardizing its clinical application and interpretation among researchers and clinicians globally.
Article Synopsis
- European guidelines now recommend dual antithrombotic therapy (DAT) over triple antithrombotic therapy (TAT) for patients on oral anticoagulants undergoing coronary interventions, focusing on P2Y inhibitors and OAC without aspirin.
- The WOEST 2 registry was conducted to analyze the effectiveness and safety of these therapies in real-world settings, specifically looking at bleeding and thrombotic outcomes after one year.
- Results showed that DAT significantly reduced clinically relevant bleeding risks compared to TAT, while outcomes related to major adverse cardiac and cerebrovascular events were similar between both groups.