Publications by authors named "Yolande Appelman"
Aims: A genotype-guided P2Y12-inhibitor de-escalation strategy, switching acute coronary syndrome (ACS) patients without a CYP2C19 loss-of-function allele from ticagrelor or prasugrel to clopidogrel, has shown to reduce bleeding risk without affecting effectivity of therapy by increasing ischemic risk. We estimated the cost-effectiveness of this personalized approach compared to standard dual antiplatelet therapy (DAPT; aspirin plus ticagrelor/prasugrel) in the Netherlands.
Methods And Results: We developed a one-year decision tree based on results of the FORCE-ACS registry, comparing a cohort of ACS patients who underwent genotyping with a cohort of ACS patients treated with standard DAPT.
Article Synopsis
- The study investigates the frequency and reasons for changes in ticagrelor treatment among patients with acute coronary syndrome (ACS), revealing that many patients discontinue it prematurely.
- Data from over 4,200 patients showed that 26.7% had physician-recommended discontinuations and 20.1% had alterations in their treatment within a year.
- Treatment interruptions and disruptions significantly increased the risk of serious heart-related issues, while discontinuation and alterations did not show the same level of risk.
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
- The 2023 European Society of Cardiology guidelines for acute coronary syndrome emphasize updated management strategies for better clinical outcomes.
- The review highlights specific practices in the Netherlands, such as pre-treatment protocols and antiplatelet agent strategies tailored to patient needs.
- It also covers the importance of risk scoring and the logistical aspects of scheduling coronary angiography to improve patient care efficiency.
Article Synopsis
- The study investigated whether using CYP2C19 genetic testing to guide medication choices improves outcomes for patients with acute coronary syndrome (ACS) compared to standard treatment.
- Out of 5,321 ACS patients, those who were genotyped and had their medications tailored showed significantly lower bleeding rates while maintaining a similar risk of ischemic events compared to those on standard therapy.
- The findings suggest that a personalized approach to antiplatelet therapy based on genetic markers can enhance safety without compromising efficacy in managing ACS.
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.
Background: Older people less frequently receive invasive coronary angiography (ICA) for NSTEMI than younger patients. We describe care, ICA data, and in-hospital and 30-day outcomes of NSTEMI by age in a contemporary and geographically diverse cohort.
Methods: Prospective cohort study including 2947 patients with NSTEMI from 287 centres in 59 countries, stratified by age (≥75 years, n = 761).
Objectives: We sought to investigate the impact of sex on myocardial perfusion changes following chronic total coronary occlusion (CTO) percutaneous coronary intervention (PCI) as measured by [O]HO positron-emission tomography (PET) perfusion imaging.
Background: CTO PCI has been associated with an increase in myocardial perfusion, yet females are less likely to undergo revascularization. As such, data on the impact of sex on myocardial perfusion following CTO PCI is scarce.
Purpose: Hodgkin lymphoma (HL) survivors are at increased risk of cardiovascular disease (CVD) due to former lymphoma treatment. In 2013, cardiovascular screening for 5-year HL survivors according to national guidelines was implemented in Dutch survivorship clinics. We aim to assess the following: (1) adherence to screening guidelines and (2) the yield of (risk factors for) CVD in the screening program.
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- The National Health Insurance (NHI) was introduced in Indonesia in 2014, leading to a significant increase in the number of patients with acute coronary syndrome (ACS) receiving hospital care, as seen in a study comparing pre- and post-NHI implementation data.
- The study found that NHI users skyrocketed from 20.1% to 95.6%, and ACS admissions increased over threefold, with more patients receiving invasive treatments for heart conditions.
- Notably, there was a 50.8% reduction in in-hospital mortality rates among ACS patients after NHI implementation, suggesting that universal health coverage may greatly enhance cardiovascular care and patient outcomes in Indonesia.
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 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.
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- 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.
Diabetes mellitus and presentation, care and outcomes of patients with NSTEMI: the Association for Acute Cardiovascular Care-European Association of Percutaneous Cardiovascular Interventions EURObservational Research Programme NSTEMI Registry of the European Society of Cardiology.
Eur Heart J Qual Care Clin Outcomes
December 2024
Aims: Diabetes mellitus (diabetes) is common amongst patients with non-ST-segment elevation myocardial infarction (NSTEMI). We describe presentation, care, and outcomes of patients admitted with NSTEMI by diabetes status.
Methods And Results: Prospective cohort study including 2928 patients (1104 with prior diabetes, 1824 without) admitted to hospital with NSTEMI from 287 centres in 59 countries.
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.
Aims: Women have historically been disadvantaged in terms of care and outcomes for non-ST-segment elevation myocardial infarction (NSTEMI). We describe patterns of presentation, care, and outcomes for NSTEMI by sex in a contemporary and geographically diverse cohort.
Methods And Results: Prospective cohort study including 2947 patients (907 women, 2040 men) with Type I NSTEMI from 287 centres in 59 countries, stratified by sex.
One-year follow-up of patients treated with single antiplatelet therapy directly after percutaneous coronary intervention for non-ST-segment elevation acute coronary syndrome.
Eur Heart J Open
September 2023
Graphical AbstractClinical outcomes and treatment adherence during 12 months follow-up. *Second bleeding event in same patient. PCI, percutaneous coronary intervention; TVR, target vessel revascularization.
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- 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.
Purpose: We sought to assess the impact of coronary revascularization on myocardial perfusion and fractional flow reserve (FFR) in patients without a cardiac history, with prior myocardial infarction (MI) or non-MI percutaneous coronary intervention (PCI). Furthermore, we studied the impact of scar tissue.
Methods: Symptomatic patients underwent [O]HO positron emission tomography (PET) and FFR before and after revascularization.
Sex differences in prevalence and outcomes of the different endotypes of chronic coronary syndrome in symptomatic patients undergoing invasive coronary angiography: Insights from the global ILIAS invasive coronary physiology registry.
Atherosclerosis
November 2023
Background And Aims: The management of chronic coronary syndrome (CCS) is informed by studies predominantly including men. This study investigated the relationship between patients sex and different endotypes of CCS, including sex-specific clinical outcomes.
Methods: In patients with CCS undergoing coronary angiography, invasive Fractional Flow Reserve (FFR) and Coronary Flow Reserve (CFR) were measured.
Objective: Patients with acute coronary syndrome (ACS) remain at high risk for recurrent ischaemic and bleeding events during follow-up. Our study aimed to quantify and compare the impact of these adverse events on quality of life (QoL).
Methods: Data from patients with ACS prospectively enrolled in the FORCE-ACS registry between January 2015 and December 2019 were used for this study.