ABSTRACTS
Abstracts of the Scientific Meeting of the Netherlands Society of Cardiology (NWC)
Sessions Session I
21-22 April 2005, Hotel Okura, Amsterdam Acute Coronary Syndromes/Congenital Heart Disease Voorzitters: Mw. A.H.E.M. Maas, C.A. Visser
13.30 - 13.45 uur
INFARCT SIZE REDUCTION IN ACUTE MYOCARDIAL INFARCTION AFTER OPTIMUM REPERFUSION THERAPY AS ASSESSED BY CONTRAST ENHANCED CMR Robin Nijveldt±, Aernout M. Beek', Mark B.M. Hofman2, Victor A.W.M. Umans3, Paul R. Algra4, Cees. A. Visserl, Albert C. van Rossum'. ') Cardiology Dept. VU University Medical Center Amsterdam, 2) Clinical Physics & Informatics VU University Medical Center, Adam, 3) Cardiology Dept. Medical Center Alkmaar Alkmaar, 4) Radiology Dept. Medical Center Alkmaar, Alkmaar.
Objectives: We sought to determine the change in infarct size by delayed contrast enhanced cardiovascular magnetic resonance imaging (ce-CMR) in a homogenous patient group with acute myocardial infarction (AMI) that received optimum treatment. Background: The effect of new treatment strategies after AMI, such as stem cell therapy, can be precisely evaluated by ce-CMR. However, it Is unknown to which extent ce-CMR infarct size changes over time in a homogenous group of optimally treated patients. Methods: 23 patients treated with primary percutaneous intervention with stent implantation, followed by optimum medical treatment (including abciximab and clopidogrel) underwent ce-CMR on a 1.5T MR scanner 15 minutes after 0.2 mmol/kg gadoliniumDTPA, within 7 days and at 3 months. Data acquisition was performed in short axis views covering the whole left ventricle.
Resuits: Mean total infarct size decreased from 25.3 ± 18.7 g at baseline to 19.3 ± 16.7 g at follow-up (p < 0.001, see figure). The percentage of infarct size reduction was 20.9 ± 29.6 %. Conclusions: Total infarct size reduces over time by approximately 20 % in patients optimally treated for AMI.
Acute Coronary Syndromes/Congenital Heart Disease Voorzitters: Mw. A.H.E.M. Maas, C.A. Visser
13.45 - 14.00 uur
CHARACTERISTICS AND MORTALITY IN PATIENTS WITH ACUTE CORONARY SYNDROME WHO WERE NOT INCLUDED IN A CLINICAL TRIAL S Rasoul, S Yokota, JP Ottervanger, MI de Boer, AHEM Maas, E Kolkman, AWJ van t Hof, on behalf of the Zwolle Myocardial Infarction Study Group, Isala Klinieken, Zwolle. Background: Guidelines are mainly based upon outcome of randomised controlled clinical trials (RCT). However, patients included in these trials may not reflect daily clinical practice. In our hospital, all patients with acute coronary syndrome (ACS) are eligible for inclusion in one of our ongoing clinical trials. To asses differences between patients who were included or not in a RCT, we evaluated all patients with a discharge diagnose of ACS during the study period.
Methods: Retrospectively, individual patient data from all patients with a discharge diagnosis of ACS, either ST-elevation myocardial infarction (STEMI) or non- ST-elevation myocardlal infarction (nonSTEMI) between Jan 2001 and Jan 2002 were evaluated. Follow-up data were obtained until December 2004. Results: 824 patients were admitted with an ACS: 583 with STEMI and 241 with a non-STEMI. Total mortality at 3-year follow up was 12.6% for STEMI and 20.1% for non-STEMI. 455 (78%) patients with STEMI and 128 (53%) with non-STEMI were included in one of the ongoing clinical trials (P 20 weeks of gestation) pregnancy (n=48, 26 women, 48 children) were obtained.
Results: Cardiovascular events complicated almost 40% of completed pregnancies. In particular postpartum persistence of pregnancy associated NYHA class deterioration (n= 11, mainly patients with residual ASD; p=0.049) and deterioration of preexisting left (n=8) fright (n=6) AV-valvar regurgitation were frequently recorded. Additional cardiac complications were arrhythmias (n=9, in 6 of them associated with a history of arrhythmia; p=0.005) and symptomatic heart failure (n=1). Non cardiac events were more common in patients with complete than in those with partial AVSD (p=0.009). Congenital heart disease (CHD) recurred in 6 children (12%): AVSD (n=4, including 3 with left sided hypoplasia), patent ductus arteriosus (n=1) and ASD (n=1). In addition to 1 foetal demise, two children with left-sided hypoplasia died within the first year postpartum (offspring mortality 6.3%). Conclusion: Pregnancy is not always well tolerated in women with AVSD, predominantly due to high incidences of NYHA class deterioration, worsening of pre-existing AV-valvar regurgitation and offspring mortality (primarily recurrence of complex CHD). Complete AVSD patients and those with (residual) left AV valve regurgitation or ASD prior to pregnancy appear to be at greater risk for complications.
Abstracts
Sessions Session 11 Electrofysiology/Cardiomyopathy
13.30 - 13.45 uur
Voorzitters: Mw. I.C. van Gelder, A. A. Wilde
Electrofysiology/Cardiomyopathy Voorzitters: Mw. I.C. van Gelder, A. A. Wilde
13.45 - 14.00 uur
DO ELDERLY PATIENTS BENEFIT FROM CARDIAC RESYNCHRONIZATION THERAPY? G.B.Bleeker S.G.Molhoek, H.F.Verwey, E.R.Holman, M.C.Wijffels, P.Steendijk, E.E.van der Wall, M.J.Schalij, J.J.Bax. Leiden University Medical Center, Lelden, The Netherlands.
RATE VERSUS RHYTHM CONTROL IN PATIENTS YOUNGER THAN 65 YEARS WITH PERSISTENT ATRIAL FIBRILLATION - DATA OF THE RACE
Introduction: Cardiac resynchronization therapy (CRT) improves clinical symptoms, exercise capacity and systolic performance in patients with heart failure. The effect of CRT in elderly patients is unknown, and was evaluated in the current study.
Introduction: Large trials have demonstrated that rate control is an acceptable alternative to rhythm control. However, it is unknown whether this
Methods: A total of 170 consecutive patients with severe heart failure (New York Heart Association Class III-IV), LV ejection fraction 120 ms, and left bundle branch block received a CRT device. At baseline and 6 months after implantation clinical and echocardiographic parameters were evaluated. Patients with an improvement of 2 1 NYHA class were considered responders. The effects in elderly patients (270 years) were compared to results in younger patients (
Abstracts of the Scientific Meeting of the Netherlands Society of Cardiology (NWC)
Sessions Session I
21-22 April 2005, Hotel Okura, Amsterdam Acute Coronary Syndromes/Congenital Heart Disease Voorzitters: Mw. A.H.E.M. Maas, C.A. Visser
13.30 - 13.45 uur
INFARCT SIZE REDUCTION IN ACUTE MYOCARDIAL INFARCTION AFTER OPTIMUM REPERFUSION THERAPY AS ASSESSED BY CONTRAST ENHANCED CMR Robin Nijveldt±, Aernout M. Beek', Mark B.M. Hofman2, Victor A.W.M. Umans3, Paul R. Algra4, Cees. A. Visserl, Albert C. van Rossum'. ') Cardiology Dept. VU University Medical Center Amsterdam, 2) Clinical Physics & Informatics VU University Medical Center, Adam, 3) Cardiology Dept. Medical Center Alkmaar Alkmaar, 4) Radiology Dept. Medical Center Alkmaar, Alkmaar.
Objectives: We sought to determine the change in infarct size by delayed contrast enhanced cardiovascular magnetic resonance imaging (ce-CMR) in a homogenous patient group with acute myocardial infarction (AMI) that received optimum treatment. Background: The effect of new treatment strategies after AMI, such as stem cell therapy, can be precisely evaluated by ce-CMR. However, it Is unknown to which extent ce-CMR infarct size changes over time in a homogenous group of optimally treated patients. Methods: 23 patients treated with primary percutaneous intervention with stent implantation, followed by optimum medical treatment (including abciximab and clopidogrel) underwent ce-CMR on a 1.5T MR scanner 15 minutes after 0.2 mmol/kg gadoliniumDTPA, within 7 days and at 3 months. Data acquisition was performed in short axis views covering the whole left ventricle.
Resuits: Mean total infarct size decreased from 25.3 ± 18.7 g at baseline to 19.3 ± 16.7 g at follow-up (p < 0.001, see figure). The percentage of infarct size reduction was 20.9 ± 29.6 %. Conclusions: Total infarct size reduces over time by approximately 20 % in patients optimally treated for AMI.
Acute Coronary Syndromes/Congenital Heart Disease Voorzitters: Mw. A.H.E.M. Maas, C.A. Visser
13.45 - 14.00 uur
CHARACTERISTICS AND MORTALITY IN PATIENTS WITH ACUTE CORONARY SYNDROME WHO WERE NOT INCLUDED IN A CLINICAL TRIAL S Rasoul, S Yokota, JP Ottervanger, MI de Boer, AHEM Maas, E Kolkman, AWJ van t Hof, on behalf of the Zwolle Myocardial Infarction Study Group, Isala Klinieken, Zwolle. Background: Guidelines are mainly based upon outcome of randomised controlled clinical trials (RCT). However, patients included in these trials may not reflect daily clinical practice. In our hospital, all patients with acute coronary syndrome (ACS) are eligible for inclusion in one of our ongoing clinical trials. To asses differences between patients who were included or not in a RCT, we evaluated all patients with a discharge diagnose of ACS during the study period.
Methods: Retrospectively, individual patient data from all patients with a discharge diagnosis of ACS, either ST-elevation myocardial infarction (STEMI) or non- ST-elevation myocardlal infarction (nonSTEMI) between Jan 2001 and Jan 2002 were evaluated. Follow-up data were obtained until December 2004. Results: 824 patients were admitted with an ACS: 583 with STEMI and 241 with a non-STEMI. Total mortality at 3-year follow up was 12.6% for STEMI and 20.1% for non-STEMI. 455 (78%) patients with STEMI and 128 (53%) with non-STEMI were included in one of the ongoing clinical trials (P 20 weeks of gestation) pregnancy (n=48, 26 women, 48 children) were obtained.
Results: Cardiovascular events complicated almost 40% of completed pregnancies. In particular postpartum persistence of pregnancy associated NYHA class deterioration (n= 11, mainly patients with residual ASD; p=0.049) and deterioration of preexisting left (n=8) fright (n=6) AV-valvar regurgitation were frequently recorded. Additional cardiac complications were arrhythmias (n=9, in 6 of them associated with a history of arrhythmia; p=0.005) and symptomatic heart failure (n=1). Non cardiac events were more common in patients with complete than in those with partial AVSD (p=0.009). Congenital heart disease (CHD) recurred in 6 children (12%): AVSD (n=4, including 3 with left sided hypoplasia), patent ductus arteriosus (n=1) and ASD (n=1). In addition to 1 foetal demise, two children with left-sided hypoplasia died within the first year postpartum (offspring mortality 6.3%). Conclusion: Pregnancy is not always well tolerated in women with AVSD, predominantly due to high incidences of NYHA class deterioration, worsening of pre-existing AV-valvar regurgitation and offspring mortality (primarily recurrence of complex CHD). Complete AVSD patients and those with (residual) left AV valve regurgitation or ASD prior to pregnancy appear to be at greater risk for complications.
Abstracts
Sessions Session 11 Electrofysiology/Cardiomyopathy
13.30 - 13.45 uur
Voorzitters: Mw. I.C. van Gelder, A. A. Wilde
Electrofysiology/Cardiomyopathy Voorzitters: Mw. I.C. van Gelder, A. A. Wilde
13.45 - 14.00 uur
DO ELDERLY PATIENTS BENEFIT FROM CARDIAC RESYNCHRONIZATION THERAPY? G.B.Bleeker S.G.Molhoek, H.F.Verwey, E.R.Holman, M.C.Wijffels, P.Steendijk, E.E.van der Wall, M.J.Schalij, J.J.Bax. Leiden University Medical Center, Lelden, The Netherlands.
RATE VERSUS RHYTHM CONTROL IN PATIENTS YOUNGER THAN 65 YEARS WITH PERSISTENT ATRIAL FIBRILLATION - DATA OF THE RACE
Introduction: Cardiac resynchronization therapy (CRT) improves clinical symptoms, exercise capacity and systolic performance in patients with heart failure. The effect of CRT in elderly patients is unknown, and was evaluated in the current study.
Introduction: Large trials have demonstrated that rate control is an acceptable alternative to rhythm control. However, it is unknown whether this
Methods: A total of 170 consecutive patients with severe heart failure (New York Heart Association Class III-IV), LV ejection fraction 120 ms, and left bundle branch block received a CRT device. At baseline and 6 months after implantation clinical and echocardiographic parameters were evaluated. Patients with an improvement of 2 1 NYHA class were considered responders. The effects in elderly patients (270 years) were compared to results in younger patients (
