Papers by marc Vanderheyden
European Heart Journal, Oct 1, 2019
European Heart Journal, Oct 1, 2019
Background Revascularization decisions regarding left main (LM) coronary stenoses are often very ... more Background Revascularization decisions regarding left main (LM) coronary stenoses are often very challenging. Non-invasive tests can yield false negative results. On the other hand, some technical aspects of fractional flow reserve (FFR) measurement, as well as the interpretation of their results, are less codified than for other coronary segments. Purpose To investigate the 10-year clinical outcome of patients with isolated angiographically intermediate LM coronary stenosis in whom the treatment strategy was based on Fractional Flow Reserve (FFR) measurements. Methods From 1999 to 2009 we included 96 patients with isolated intermediate LM coronary disease (DS% 30–70%) evaluated with FFR measurement. When FFR was >0.80, patients were deferred to medical therapy (Deferral-group, n=71). When FFR was ≤0.8, surgical revascularization therapy was proposed (Revascularization-group, n=25). Death, the occurrence of myocardial infarction (MI) and the need for target vessel revascularization (TVR) were evaluated in both groups. Results There were no significant differences in clinical characteristics between the 2 groups. Mean DS% was 35% in the Deferral-group and 43% in the Revascularization-group (p<0.01). Average FFR was 0.88 in the Deferral-group and 0.71 in the Revascularization-group (p<0.01). In the latter, the 10-year survival estimate was 72% while it was 77% in the Deferral group (HR [95% CI]: 1.28 [0.53–3.10]; p=NS). No difference was found between the 2 groups in terms of MI (4.5% vs. 1.6%; HR [95% CI]: 3.5 [0.22–56.0]; p=NS) or TVR (9% vs. 12%; HR [95% CI]: 0.94 [0.20–4.43]; p=NS). Conclusions The use of FFR to defer revascularization in patients with non-significant isolated LM stenosis is safe and is associated with favourable clinical outcome at 10 years.
Circulation-cardiovascular Interventions, Nov 1, 2020
Background: During fractional flow reserve (FFR) measurement, the simple presence of the guiding ... more Background: During fractional flow reserve (FFR) measurement, the simple presence of the guiding catheter (GC) within the coronary ostium might create artificial ostial stenosis, affecting the hyperemic flow. We aimed to investigate whether selective GC engagement of the coronary ostium might impede hyperemic flow, and therefore impact FFR measurements and related clinical decision-making. Methods: In the DISENGAGE (Determination of Fractional Flow Reserve in Intermediate Coronary Stenosis With Guiding Catheter Disengagement) registry, FFR was prospectively measured twice (with GC engaged [FFR eng ] and disengaged [FFR dis ]) in 202 intermediate stenoses of 173 patients. We assessed (1) whether ΔFFR eng –FFR dis was significantly different from the intrinsic variability of repeated FFR measurements (test-retest repeatability); (2) whether the extent of ΔFFR eng –FFR dis could be clinically significant and therefore able to impact clinical decision-making; and (3) whether ΔFFR eng –FFR dis related to the stenosis location, that is, proximal and middle versus distal coronary segments. Results: Overall, FFR significantly changed after GC disengagement: FFR eng 0.84±0.08 versus FFR dis 0.80±0.09, P <0.001. Particularly, in 38 stenoses (19%) with FFR values in the 0.81 to 0.85 range, GC disengagement was associated with a shift from above to below the 0.80 clinical cutoff, resulting into a change of the treatment strategy from medical therapy to percutaneous coronary intervention. The impact of GC disengagement was significantly more pronounced with stenoses located in proximal and middle as compared with distal coronary segments (ΔFFR eng –FFR dis , proximal and middle 0.04±0.03 versus distal segments 0.03±0.03; P =0.042). Conclusions: GC disengagement results in a shift of FFR values from above to below the clinical cutoff FFR value of 0.80 in 1 out of 5 measurements. This occurs mostly when the stenosis is located in proximal and middle coronary segments and the FFR value is close to the cutoff value.
International Journal of Cardiology, 2021
European Heart Journal, Aug 16, 2019
Fractional flow reserve (FFR) has never been investigated in patients with reduced ejection fract... more Fractional flow reserve (FFR) has never been investigated in patients with reduced ejection fraction and associated coronary artery disease (CAD). We evaluated the impact of FFR on the management strategies of these patients and related outcomes.
Journal of the American Heart Association, Oct 4, 2022
Background Deferring revascularization in patients with nonsignificant stenoses based on fraction... more Background Deferring revascularization in patients with nonsignificant stenoses based on fractional flow reserve (FFR) is associated with favorable clinical outcomes up to 15 years. Whether this holds true in patients with reduced left ventricular ejection fraction is unclear. We aimed to investigate whether FFR provides adjunctive clinical benefit compared with coronary angiography in deferring revascularization of patients with intermediate coronary stenoses and reduced left ventricular ejection fraction. Methods and Results Consecutive patients with reduced left ventricular ejection fraction (≤50%) undergoing coronary angiography between 2002 and 2010 were screened. We included patients with at least 1 intermediate coronary stenosis (diameter stenosis ≥40%) in whom revascularization was deferred based either on angiography plus FFR (FFR guided) or angiography alone (angiography guided). The primary end point was the cumulative incidence of all‐cause death at 10 years. The secondary end point (incidence of major adverse cardiovascular and cerebrovascular events) was a composite of all‐cause death, myocardial infarction, any revascularization, and stroke. A total of 840 patients were included (206 in the FFR‐guided group and 634 in the angiography‐guided group). Median follow‐up was 7 years (interquartile range, 3.22–11.08 years). After 1:1 propensity‐score matching, baseline characteristics between the 2 groups were similar. All‐cause death was significantly lower in the FFR‐guided group compared with the angiography‐guided group (94 [45.6%] versus 119 [57.8%]; hazard ratio [HR], 0.65 [95% CI, 0.49–0.85]; P <0.01). The rate of major adverse cardiovascular and cerebrovascular events was lower in the FFR‐guided group (123 [59.7%] versus 139 [67.5%]; HR, 0.75 [95% CI, 0.59–0.95]; P =0.02). Conclusions In patients with reduced left ventricular ejection fraction, deferring revascularization of intermediate coronary stenoses based on FFR is associated with a lower incidence of death and major adverse cardiovascular and cerebrovascular events at 10 years.
European Heart Journal, Nov 1, 2020
Journal of the American College of Cardiology, Nov 1, 2021
Eurointervention, Jun 1, 2020
AIM Significant platelet activation after long stented coronary segments has been associated with... more AIM Significant platelet activation after long stented coronary segments has been associated with peri-procedural microvascular impairment and myonecrosis. In long lesions treated either with everolimus-eluting bioresorbable vascular scaffold (BVS) or everolimus-eluting stent (EES), we investigated (a) procedure-related microvascular impairment, and (b) relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomized 1:1 either to BVS or EES. Primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Peri-procedural myonecrosis was assessed by high sensitivity-cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer™. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of Δ cIMR (p= 0,04). Hs-ADP was not different between the 2 groups at different time points. Hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or peri-procedural myonecrosis.
European Heart Journal Supplements, Dec 1, 2021
Aims: Deferring percutaneous coronary intervention (PCI) in patients with nonsignificant stenoses... more Aims: Deferring percutaneous coronary intervention (PCI) in patients with nonsignificant stenoses based on fractional flow reserve (FFR) is associated with favourable clinical outcomes up to 15 years. Whether this holds true in patients with reduced left ventricular ejection fraction (LVEF) is unclear. To investigate whether
European Journal of Cardio-Thoracic Surgery, Oct 13, 2017
OBJECTIVES: To investigate whether and in which patients with catheter-derived low pressure gradi... more OBJECTIVES: To investigate whether and in which patients with catheter-derived low pressure gradient (PG, <40 mmHg) severe (aortic valve area < _ 1 cm 2) aortic stenosis and preserved left ventricular ejection fraction, early aortic valve replacement (AVR) might improve survival. METHODS: We investigated a total of 506 consecutive patients (age 75 ± 9 years, 58% men) with either moderate aortic stenosis (MAS) or severe aortic stenosis (SAS) and preserved left ventricular ejection fraction (> _50%) as defined at catheterization. Propensity score matching was used to select matched pairs of patients with and without AVR in each group. A 100% complete follow-up of all cause death was obtained after a median of 6.6 years (interquartile range 3.4-8.8 years). RESULTS: There were 62 (12%) patients with MAS, 119 (24%) patients with SAS and low (<40 mmHg) PG and 325 (64%) patients with SAS and high PG. Significantly less patients with MAS and low-gradient SAS underwent AVR compared to patients with high gradient SAS (58% vs 60% vs 83%, P < 0.001). In propensity score-matched patients, AVR was independently associated with a decrease in all-cause mortality in all groups (P < 0.05) regardless of the PG, stroke volume or aortic valve area. CONCLUSIONS: The present data indicate a that AVR improves survival in SAS regardless of the gradient and flow. This advocates an 'early-AVR' rather than a 'watchful waiting' strategy.
Esc Heart Failure, Nov 1, 2021
AimsWe investigated the prognostic relevance of serpin peptidase inhibitor, clade A member 3 (SER... more AimsWe investigated the prognostic relevance of serpin peptidase inhibitor, clade A member 3 (SERPINA3) in patients admitted with a de novo or worsened heart failure (HF).Methods and resultsIn the first stage, 83 HF‐related left ventricular (LV) transcripts were examined in patients with congestive cardiomyopathy (CCMP, n = 44) who died within 5 years and compared with age‐matched and haemodynamically matched CCMP survivors (n = 39) and controls with normal LV function (n = 17). Among 14 differentially expressed transcripts, myocardial gene and circulating SERPINA3 levels were up‐regulated in non‐survivors vs. survivors (2.40 ± 3.66 vs. 0.36 ± 0.22 units, P &lt; 0.01 and 334.7 ± 138.7 vs. 228.2 ± 83.1 μg/mL, P &lt; 0.01, respectively). While no significant transmyocardial gradient was detected, cytokine stimulation of human endothelial cells induced SERPINA3 secretion. In an independent validation cohort with a de novo or worsened HF (n = 387), circulating SERPINA3 levels &gt; 316 μg/mL were associated with increased all‐cause mortality {hazard ratio [HR] [95% confidence interval (CI)]: 2.4 [1.5–3.9], P = 0.0002} and its composite with unplanned cardiovascular readmission [HR (95% CI): 2.0 (1.2–3.3), P = 0.004]. Patients with elevated SERPINA3 levels and elevated either N‐terminal pro brain natriuretic peptide or ST2 showed worse freedom from both endpoints. In a multivariate analysis, including established clinical risk factors, SERPINA3 remained independent predictor of all‐cause mortality together with age, gender, ST2, glomerular filtration, and pulmonary capillary wedge pressure.ConclusionIn patients with a de novo or worsened HF, increased SERPINA3 levels &gt; 316 μg/mL are associated with increased mortality or unplanned cardiac readmission. Elevated SERPINA3 levels on top of established clinical predictors appear to identify a subgroup of HF patients at higher mortality risk. Prospective studies should further validate its value in prognostic stratification of HF.
Circulation: Cardiovascular Interventions, 2020
Background: In diabetic patients with multivessel coronary artery disease, coronary artery bypass... more Background: In diabetic patients with multivessel coronary artery disease, coronary artery bypass grafting (CABG) has shown long-term benefits over percutaneous coronary intervention (PCI). Physiology-guided PCI has shown to improve clinical outcomes in multivessel coronary artery disease, though its impact in diabetic patients has never been investigated. We evaluated long-term clinical outcomes of diabetic patients with multivessel coronary artery disease treated with fractional flow reserve (FFR)–guided PCI compared with CABG. Methods: From 2010 to 2018, 4622 diabetic patients undergoing coronary angiography were screened for inclusion. The inclusion criterion was the presence of at least 2-vessel disease defined as with diameter stenosis ≥50%, in which at least 1 intermediate stenosis (diameter stenosis, 30%–70%) was treated or deferred according to FFR. Inverse probability of treatment weighting analysis was used to account for baseline differences with a contemporary cohort of...
Circulation, 2016
Introduction: The role of aortic valve replacement (AVR) in patients with low gradient moderate t... more Introduction: The role of aortic valve replacement (AVR) in patients with low gradient moderate to severe aortic stenosis (AS) (AVA ≤ 1.5 cm2) or high gradient moderate AS (AVA between 1-1.5 cm2), ...
JACC: Cardiovascular Interventions, 2020
OBJECTIVES The aim of this study was to compare clinical outcomes of different bifurcation percut... more OBJECTIVES The aim of this study was to compare clinical outcomes of different bifurcation percutaneous coronary intervention (PCI) techniques. BACKGROUND Despite several randomized trials, the optimal PCI technique for bifurcation lesions remains a matter of debate. Provisional stenting has been recommended as the default technique for most bifurcation lesions. Emerging data support double-kissing crush (DK-crush) as a 2-stent technique. METHODS PubMed and Scopus were searched for randomized controlled trials comparing PCI bifurcation techniques for coronary bifurcation lesions. Outcomes of interest were major adverse cardiovascular events (MACE). Secondary outcomes of interest were cardiac death, myocardial infarction, target vessel or lesion revascularization, and stent thrombosis. Summary odds ratios (ORs) were estimated using Bayesian network meta-analysis. RESULTS Twenty-one randomized controlled trials including 5,711 patients treated using 5 bifurcation PCI techniques were included. Investigated techniques were provisional stenting, T stenting/T and protrusion, crush, culotte, and DK-crush. Median follow-up duration was 12 months (interquartile range: 9 to 36 months). When all techniques were considered, patients treated using the DK-crush technique had less occurrence of MACE (OR: 0.39; 95% credible interval: 0.26 to 0.55) compared with those treated using provisional stenting, driven by a reduction in target lesion revascularization (OR: 0.36; 95% credible interval: 0.22 to 0.57). No differences were found in cardiac death, myocardial infarction, or stent thrombosis among analyzed PCI techniques. No differences in MACE were observed among provisional stenting, culotte, T stenting/T and protrusion, and crush. In non-left main bifurcations, DK-crush reduced MACE (OR: 0.42; 95% credible interval: 0.24 to 0.66). CONCLUSIONS In this network meta-analysis, DK-crush was associated with fewer MACE, driven by lower rates of repeat revascularization, whereas no significant differences among techniques were observed for cardiac death, myocardial infarction, and stent thrombosis. A clinical benefit of 2-stent techniques was observed over provisional stenting in bifurcation with side branch lesion length ≥10 mm.
European Heart Journal, 2018
IRR: ischaemic rate ratio; MI: myocardial infarction. Conclusion: Among patients treated with 12 ... more IRR: ischaemic rate ratio; MI: myocardial infarction. Conclusion: Among patients treated with 12 months of DAPT for AMI, new ischaemic events occurred rapidly upon conversion to aspirin monotherapy at 12 months.
European Heart Journal, 2019
Introduction A pulmonary capillary wedge pressure (PCWP) ≥25 mm Hg following volume load or exerc... more Introduction A pulmonary capillary wedge pressure (PCWP) ≥25 mm Hg following volume load or exercise has been proposed as a partition value for detection of HfpEF. However, the hemodynamic response to volume challenge in heart transplant (Tx) recipients has never been studied. Methods 24 heart Tx recipients (age: 65 years) with normal LV function (55±7%) and without rejection and graft vasculopathy underwent right heart catheterization to measure hemodynamic response to volume loading before and after a rapid saline infusion of 7mL/kg over 10 min. PCWP, right atrial pressure (RAP), mean pulmonary artery pressure (AP) were obtained and the PCWP and indexed (i) stroke volume (SV) data were used to construct Starling (SVindex/PCWP) curves. Pts were categorized in those with elevated filling pressures (Group A, n=13 pts) defined by a PCWP ≥15 mm Hg at rest or ≥25 mm Hg following volume loading vs those without (Group B, n=11 pts). Results No difference in age of donor and transplant hea...
International Heart Journal, 2019
This study aimed to examine the relationship between corin expression and circulating brain natri... more This study aimed to examine the relationship between corin expression and circulating brain natriuretic peptide in patients with left ventricular (LV) dysfunction. Circulating levels of B-type natriuretic peptide (BNP) can be an indicator of LV dysfunction. The 32amino-acid BNP is cleaved by corin, a cardiac serine protease, from its108-amino-acid pro-brain natriuretic peptide (proBNP) precursor. This study included 25 patients with idiopathic dilated cardiomyopathy (DCMP) and LV dysfunction and 44 heart transplant recipients with normal LV function who underwent diagnostic left and right heart catheterization. Blood samples were used to determine the ratio of plasma proBNP/BNP levels, and LV endomyocardial biopsies were used to determine the expression of NPPB, which encode BNP and corin, respectively, by quantitative reverse transcription-polymerase chain reaction. Patients with DCMP revealed worse hemodynamic profiles and higher plasma proBNP and BNP levels than those of the transplant recipients. Myocardial NPPB expression was higher and CORIN expression was lower in the DCMP patients than in the transplant recipients. CORIN expression significantly correlated with NPPB expression (r = −0.585; P < 0.001), ejection fraction (EF; r = 0.694; P < 0.01), LV end-diastolic pressure (r = −0.373; P < 0.05), and indexed end-diastolic LV volume (r = −0.452; P < 0.001). In addition, the plasma proBNP/BNP levels inversely correlated with the CORIN expression (r = −0.362; P < 0.005). Decreased myocardial CORIN expression and the corresponding higher levels of circulating unprocessed proBNP in DCMP may partly account for the relative BNP resistance observed in patients with LV dysfunction.
The American journal of cardiology, Jan 15, 2018
Inconsistencies between area (aortic valve area [AVA])-flow-gradient are common during the echoca... more Inconsistencies between area (aortic valve area [AVA])-flow-gradient are common during the echocardiographic assessment of aortic stenosis (AS). This study was conducted to investigate the importance of these inconsistencies and the impact of 3 methods to resolve these inconsistencies. The study population consisted of 327 patients (age: 76.3 ± 8.6 years, 49.5% males) with severe AS (SAS) (AVA ≤ 1 cm) and preserved left ventricular ejection fraction (≥50%). Inconsistent findings between AVA, flow, and mean gradient (MG) were observed in 78 (23.9%) patients with low flow and a high MG, 52 (15.9%) patients with normal flow and a low MG, and 37 (11.3%) patients with a low flow and a low MG. Using stroke volume index by catheterization for AVA recalculation showed the greatest effect to resolve inconsistencies in the low flow and a high MG group (85%). Decreasing the AVA cut-off values for SAS to ≤0.8 cm resulted in a shift from SAS to moderate AS in 36 patients (69%) in the normal flow...
Thrombosis Research, 2017
Uploads
Papers by marc Vanderheyden