http://repub.eur.nl/res/aut/25054/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/34992/ 2012-01-15T00:00:00Z The risk scores developed for the prediction of an adverse outcome in patients after ST-segment elevation myocardial infarction (STEMI) have mostly addressed patients treated with thrombolysis and evaluated solely all-cause mortality as the primary end point. Primary percutaneous coronary intervention in patients with STEMI has improved the outcome significantly and might have changed the relative contribution of different risk factors. Our patient population included 1,484 consecutive patients admitted with STEMI who had undergone primary percutaneous coronary intervention. The clinical, angiographic, and echocardiographic data obtained during hospitalization were used to derive a risk score for the prediction of short-term (30-day) and long-term (1- and 4-year) cardiovascular mortality and hospitalization for heart failure. During a median follow-up of 30 months, 87 patients (6%) died from cardiovascular mortality or were hospitalized for heart failure. Multivariate Cox regression analyses identified age <70 years, Killip class <2, diabetes, left anterior descending coronary artery as the culprit vessel, 3-vessel disease, peak cardiac troponin T level <3.5 μg/L, left ventricular ejection fraction ≤40%, and heart rate at discharge <70 beats/min as relevant factors for the construction of the risk score. The discriminatory power of the model as assessed using the areas under the receiver operating characteristic curves was good (0.84, 0.83, and 0.81 at 30 days and 1 and 4 years, respectively), and the patients could be allocated to low-, intermediate-, or high-risk categories with an event rate of 1%, 6%, and 24%, respectively. In conclusion, the current risk model demonstrates for the first time that 8 parameters readily available during the hospitalization of patients with STEMI treated with primary percutaneous coronary intervention can accurately stratify patients at long-term follow-up (≤4 years after the index infarction) into low-, intermediate-, and high-risk categories. http://repub.eur.nl/res/pub/33672/ 2011-06-01T00:00:00Z AimsTo identify changes in multidirectional strain and strain rate (SR) in patients with aortic stenosis (AS).Methods and resultsA total of 420 patients (age 66.1 ± 14.5 years, 60.7 men) with aortic sclerosis, mild, moderate, and severe AS with preserved left ventricular (LV) ejection fraction [(EF), <50] were included. Multidirectional strain and SR imaging were performed by two-dimensional speckle tracking. Patients were more likely to be older (P < 0.001) and at a worse New York Heart Association functional class (P < 0.001) with increasing AS severity. There was a progressive stepwise impairment in longitudinal, circumferential, and radial strain and SR with increasing AS severity (all P < 0.001). The myocardial dysfunction appeared to start in the subendocardium with mild AS, to mid-wall dysfunction with moderate AS, and eventually transmural dysfunction with severe AS. Aortic valve area, as a measure of AS severity, was an independent determinant of multidirectional strain and SR on multiple linear regressions.ConclusionsPatients with AS have evidence of subclinical myocardial dysfunction early in the disease process despite normal LVEF. The myocardial dysfunction appeared to start in the subendocardium and progressed to transmural dysfunction with increasing AS severity. Symptomatic moderate and severe AS patients had more impaired multidirectional myocardial functions compared with asymptomatic patients. http://repub.eur.nl/res/pub/34684/ 2011-03-01T00:00:00Z Background-The present substudy of a recently published randomized trial aimed to investigate the effect of intramyocardial bone marrow cell injection on diastolic function in patients with chronic myocardial ischemia. Methods and Results-In a total of 50 patients, diastolic function was evaluated before and 3 months after bone marrow cell injection using standard echocardiography and strain analysis. In addition, MRI-derived transmitral flow measurements were obtained in a subset of 36 patients. Left ventricular ejection fraction increased from 50±5% to 54±7% in the bone marrow cell group, which was a significant improvement as compared with the placebo group (52±5% versus 51±7%, P=0.001). Filling pressure estimate E/E ratio improved from 14±5 at baseline to 12±4 at 3 months in the bone marrow cell group, whereas no improvement was observed in the placebo group (13±4 versus 13±5). The improvement in E/E' ratio was significantly larger in the bone marrow cell group (P=0.008). Furthermore, the E/A peak flow ratio as assessed by MRI showed a significant increase in the bone marrow cell group as compared with the placebo group (+0.16±0.25 versus-0.04±0.21, P=0.01), which was mainly related to an increase in the early (E) peak flow rate in the bone marrow cell group (from 407±96 mL/s to 468±110 mL/s, P=0.009 as compared with the placebo group). Conclusions-The current study demonstrates that intramyocardial bone marrow cell injection is associated with a beneficial effect on myocardial relaxation and filling pressures in patients with chronic myocardial ischemia. http://repub.eur.nl/res/pub/21085/ 2010-08-01T00:00:00Z Aims The purpose of the present study was to assess the evolution of left ventricular (LV) function after acute myocardial infarction (AMI) using global longitudinal peak systolic strain (GLPSS) during 1 year follow-up. In addition, patients were divided in groups with early, late, or no improvement of LV function and predictors of recovery of LV function were established. Methods and results A total of 341 patients with AMI were evaluated. Two-dimensional echocardiography was performed at baseline, 3, 6, and 12 months. At baseline, LV function was assessed with traditional parameters and GLPSS. Global longitudinal peak systolic strain was re-assessed at 3, 6, and 12 months. Improvement of LV function was based on GLPSS and was observed in 72 of the patients. No differences were observed between patients with early and late improvement. The left anterior descending coronary artery as culprit vessel, peak cardiac troponin T level, diastolic function, and baseline GLPSS were identified as independent predictors of recovery of LV function. Conclusion Improvement of LV systolic function occurred in the majority of patients during follow-up. Global longitudinal peak systolic strain, left anterior descending coronary artery as culprit vessel, peak cardiac troponin T level, and diastolic function were independent predictors of recovery of LV function. Quantification of GLPSS may be of important value for the prediction of recovery of LV function in patients after AMI. http://repub.eur.nl/res/pub/21169/ 2010-07-15T00:00:00Z Patients who develop new-onset atrial fibrillation (AF) after acute myocardial infarction (AMI) show an increased risk for adverse events and mortality during follow-up. Recently, a novel noninvasive echocardiographic method has been validated for the estimation of total atrial activation time using tissue Doppler imaging of the atria (PA-TDI duration). PA-TDI duration has shown to be independently predictive of new-onset AF. However, whether PA-TDI duration provides predictive value for new-onset AF in patients after AMI has not been evaluated. Consecutive patients admitted with AMIs and treated with primary percutaneous coronary intervention underwent echocardiography <48 hours after admission. All patients were followed at the outpatient clinic for <1 year. During follow-up, 12-lead electrocardiography and Holter monitoring were performed regularly, and the development of new-onset AF was noted. Baseline echocardiography was performed to assess left ventricular and left atrial (LA) function. LA performance was quantified with LA volumes, function, and PA-TDI duration. A total of 613 patients were evaluated. LA maximal volume (hazard ratio 1.07, 95% confidence interval 1.04 to 1.11), the total LA ejection fraction (hazard ratio 0.96, 95% confidence interval 0.93 to 0.99) and PA-TDI duration (hazard ratio 1.05, 95% confidence interval 1.04 to 1.06) were univariate predictors of new-onset AF. After multivariate analysis, LA maximal volume and PA-TDI duration independently predicted new-onset AF. Furthermore, PA-TDI duration provided incremental prognostic value to traditional clinical and echocardiographic parameters for the prediction of new-onset AF. In conclusion, PA-TDI duration is a simple measurement that provides important value for the prediction of new-onset AF in patients after AMI. http://repub.eur.nl/res/pub/20673/ 2010-07-01T00:00:00Z Aims Recently, strain and strain rate have been introduced as novel parameters reflecting left ventricular (LV) function. The purpose of the current study was to assess the prognostic importance of strain and strain rate after acute myocardial infarction (AMI). Methods and results A total of 659 patients after AMI were evaluated. Baseline echocardiography was performed to assess LV function with traditional parameters and strain and strain rate. During follow-up, 51 patients (8) reached the primary endpoint (all-cause mortality) and 142 patients (22) the secondary endpoint (a composite of revascularization, re-infarction, and hospitalization for heart failure). Strain and strain rate were both significantly related with all endpoints. After adjusting for clinical and echocardiographic parameters, strain was independent related to all endpoints and was found to be superior to LV ejection fraction (LVEF) and wall motion score index (WMSI). Patients with global strain and strain rate higher than-15.1 and-1.06 s-1 demonstrated HRs of 4.5 (95 CI 2.1-9.7) and 4.4 (95 CI 2.0-9.5) for all-cause mortality, respectively. Conclusion Strain and strain rate provide strong prognostic information in patients after AMI. These novel parameters were superior to LVEF and WMSI in the risk stratification for long-term outcome. Published on behalf of the European Society of Cardiology. All rights reserved. http://repub.eur.nl/res/pub/28683/ 2010-05-01T00:00:00Z Background-Data on the association between right ventricular (RV) function and adverse events after acute myocardial infarction (AMI) are scarce. The purpose of the current study was to evaluate the relation between RV function and adverse events in patients treated with primary percutaneous coronary intervention for AMI. Methods and Results-Consecutive patients admitted with AMI treated with primary percutaneous coronary intervention underwent echocardiography within 48 hours of admission to assess left ventricular and RV function. RV function was quantified with RV fractional area change (RVFAC), tricuspid annular plane systolic excursion, and RV strain. The end point was defined as a composite of all-cause mortality, reinfarction, and hospitalization for heart failure. All patients (n=621) were followed prospectively, and during a mean follow-up of 24 months, 86 patients reached the composite end point. RVFAC, tricuspid annular plane systolic excursion, and RV strain were all univariable predictors of worse outcome. After multivariable analysis, only RVFAC (hazard ratio, 0.96; 95% CI, 0.92 to 0.99) and RV strain (hazard ratio, 1.08; 95% CI, 1.03 to 1.13) independently predicted the composite end point. In addition, RV strain provided incremental value to clinical information, infarct characteristics, left ventricular function, and RVFAC. Conclusions-RV function provides strong prognostic information in patients treated with primary percutaneous coronary intervention for AMI. http://repub.eur.nl/res/pub/28723/ 2010-01-01T00:00:00Z Background-The extent of viable myocardial tissue is recognized as a major determinant of recovery of left ventricular (LV) function after myocardial infarction. In the current study, the role of global LV strain assessed with novel automated function imaging (AFI) to predict functional recovery after acute infarction was evaluated. Methods and Results-A total of 147 patients (mean age, 61 ±11 years) admitted for acute myocardial infarction were included. All patients underwent 2D echocardiography within 48 hours of admission. Significant relations were observed between baseline AFI global LV strain and peak level of troponin T (r=0.64), peak level of creatine phosphokinase (r=0.62), wall motion score index (r=0.52), and viability index assessed with single-photon emission computed tomography (r=0.79). At 1-year follow-up, LV ejection fraction was reassessed. Patients with absolute improvement in LV ejection fraction ≥5% at 1-year follow-up (n=70; 48%) had a higher (more negative) baseline AFI global LV strain (P<0.0001). Baseline AFI global LV strain was a predictor for change in LV ejection fraction at 1-year follow-up. A cutoff value for baseline AFI global LV strain of-13.7% yielded a sensitivity of 86% and a specificity of 74% to predict LV functional recovery at 1-year follow-up. Conclusions-AFI global LV strain early after acute myocardial infarction reflects myocardial viability and predicts recovery of LV function at 1-year follow-up.