Jeroen J Bax

Leiden University Medical Centre, Leyden, South Holland, Netherlands

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Publications (797)4901.83 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The study aims (i) to evaluate changes in myocardial ischaemia on single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) after 2 years in a cohort of high-risk patients with diabetes without cardiac symptoms or known coronary artery disease (CAD) and (ii) to assess the value of baseline computed tomography coronary angiography (CTA)-derived coronary atherosclerosis parameters to predict changes in myocardial ischaemia. The population consisted of 100 high-risk patients with diabetes without cardiac symptoms referred for cardiovascular risk stratification. All patients underwent coronary artery calcium (CAC) scoring, CTA, and SPECT MPI. After 2 years of follow-up, SPECT MPI was repeated to evaluate potential progression of ischaemia. In total, 20% of patients presented with ischaemia at baseline. Of these 20 patients, 7 (35%) still had ischaemia at follow-up, whereas 13 (65%) showed resolution and 4 (20%) showed progression of ischaemia at follow-up. Of the 80 patients without ischaemia at baseline, 65 (81%) had a normal MPI at follow-up and 15 patients (19%) presented with new ischaemia. There were no significant differences in the CAC score or the extent, severity, and composition of CAD on CTA between patients with and without ischaemia at baseline. Similarly, no differences could be demonstrated between patients with and without ischaemia at follow-up or between patients with and without progression of ischaemia. The rate of progression of ischaemia in high-risk patients with diabetes without cardiac symptoms is limited. Few patients presented with new ischaemia, whereas some patients showed resolution of ischaemia. Atherosclerosis parameters on CTA were not predictive of new-onset ischaemia or progression of ischaemia. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.
    European Heart Journal – Cardiovascular Imaging 02/2015; · 2.65 Impact Factor
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    ABSTRACT: Changes in mitral valve geometry in patients with significant aortic regurgitation (AR) have not been evaluated. The aim of the present study was to assess the prevalence of significant secondary mitral regurgitation (MR; grade ≥ 2) and the geometric characteristics of the mitral valve in patients with moderate and severe AR (grade ≥ 2) undergoing aortic valve and root surgery. One-hundred twenty patients (mean age, 54 ± 15 years; 65% men) with AR grade ≥ 2 undergoing aortic valve and root surgery were retrospectively evaluated. The presence of MR grade ≥ 2 and geometry of the mitral valve were assessed on preoperative transthoracic echocardiography. Left ventricular (LV) dimensions and mitral valve geometry were compared between patients with MR grade ≥ 2 and patients without. MR grade ≥ 2 was present in 28 patients (23%). Patients with MR grade ≥ 2 had higher European System for Cardiac Operative Risk Evaluation II scores and more often used β-blockers and diuretics than their counterparts. Patients with MR grade ≥ 2 had larger tenting areas (mean, 1.59 ± 0.79 vs 1.25 ± 0.41 cm(2); P = .003), larger inter-papillary muscle distances (mean, 28.4 ± 9.5 vs 24.8 ± 5.2 mm; P = .014), larger left atria (mean, 40.9 ± 13.7 vs 32.0 ± 12.2 mL/m(2); P = .002), and lower LV ejection fractions (mean, 47.3 ± 12.2% vs 54.3 ± 9.3%; P = .002) as compared to patients with MR grade < 2. However, there were no differences in indexed LV volumes. On multivariate logistic regression analysis, LV ejection fraction (odds ratio, 0.94; 95% confidence interval, 0.89-0.99; P = .018) and indexed left atrial volume (odds ratio, 1.05; 95% confidence interval, 1.01-1.10; P = .019) remained independently associated with MR grade ≥ 2 after correcting for tenting area and inter-papillary muscle distance. Among patients with AR grade ≥ 2 undergoing aortic valve and root surgery, the prevalence of MR grade ≥ 2 was 23%. Lower LV ejection fraction and larger left atrial volume were independently associated with MR grade ≥ 2. Copyright © 2015 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.
    Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 02/2015; · 2.98 Impact Factor
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    ABSTRACT: Differences in arrhythmogenic substrate may explain the variable efficacy of implantable cardioverter-defibrillators (ICDs) in primary sudden cardiac death prevention over time after myocardial infarction (MI). Speckle-tracking echocardiography allows the assessment left ventricular (LV) dyssynchrony, which may reflect the electromechanical heterogeneity of myocardial tissue. The aim of the present study was to evaluate the relationship among LV dyssynchrony, age of MI, and their association with the risk for ventricular tachycardia (VT) after MI. A total of 206 patients (median age, 67 years; 87% men) with prior MIs (median MI age, 6.2 years; interquartile range, 0.66-15 years) who underwent programmed electrical stimulation, speckle-tracking echocardiography, and ICD implantation were retrospectively evaluated. LV dyssynchrony was defined as the standard deviation of time to peak longitudinal systolic strain values using speckle-tracking strain echocardiography. LV scar burden was evaluated by the percentage of segments exhibiting scar (defined as an absolute longitudinal strain of magnitude < 4.5%). Patients were followed up for the occurrence of first monomorphic VT requiring ICD therapy (antitachycardia pacing or shock) for a median of 24 months. In total, 75 individuals experienced the primary end point of monomorphic VT. LV dyssynchrony was independently associated with the occurrence of VT at follow-up (hazard ratio per 10-msec increase, 1.12; 95% confidence interval, 1.07-1.18; P < .001), together with nonrevascularization of the infarct-related artery and VT inducibility. Patients with older (>180 months) MIs had a higher likelihood of VT inducibility (88% vs 63%, P = .003) and greater scar burden (14.7 ± 15.8% vs 10.7 ± 11.4%, P = .03) compared with patients with recent (<8 months) MIs. LV dyssynchrony is independently associated with the occurrence of VT after MI. Copyright © 2015 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.
    Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 01/2015; · 2.98 Impact Factor
  • European heart journal. 01/2015;
  • Victoria Delgado, Jeroen J Bax
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    ABSTRACT: Non-invasive cardiac imaging plays a central role in the diagnosis and management of patients with hypertrophic cardiomyopathy. Transthoracic echocardiography is the imaging technique of first choice to evaluate wall thickness, left ventricular systolic and diastolic function, presence of left ventricular outflow tract obstruction, and abnormal mitral anatomy, whereas cardiac magnetic resonance provides additional information on tissue characterization (replacement fibrosis) using late gadolinium enhancement. Nuclear imaging techniques permit also the assessment of left ventricular systolic and diastolic function in patients with hypertrophic cardiomyopathy but are more frequently used to evaluate myocardial ischemia (particularly assessment of microvascular dysfunction using positron emission tomography) and abnormal sympathetic myocardial innervation. This review article provides an overview of the use of nuclear imaging techniques to refine the phenotyping and risk stratification of patients with hypertrophic cardiomyopathy with particular focus on prediction of progression to overt heart failure, detection of myocardial ischemia, and evaluation of the arrhythmogenic substrate and risk of sudden cardiac death.
    Journal of Nuclear Cardiology 12/2014; · 2.65 Impact Factor
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    ABSTRACT: The prognosis of aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) and the changes in AR grade over time remain unclear. This study evaluated the midterm survival associated with AR after TAVI and examined the evolution of AR over time and its effect on cardiac performance. Successful TAVI was performed in 314 patients (age 81 ± 7 years, 36% men). Serial transthoracic echocardiography and clinical assessment were available in 175 patients who survived >12 months. AR was assessed in terms of overall, paravalvular, and intravalvular severity. Significant post-TAVI AR (grade ≥2) was observed in 82 patients (26%), and these patients showed a trend toward reduced survival at 1- (93% vs 91%) and 2-year (89% vs 74%, log-rank p = 0.063) follow-up. Of the 175 patients who survived >12 months, grade ≥2 overall, paravalvular, and intravalvular AR were noted in 47 (27%), 32 (18%), and 8 patients (5%), respectively. Significant overall and paravalvular AR appeared to improve over time, particularly during the first 6 months (p <0.05), whereas intravalvular AR remained unchanged. Although improvements in the echocardiographic parameters were similar among patients with and without significant AR, patients who remained with grade ≥2 AR at 6 months had significantly worse survival than their counterparts at 2 years (80% vs 94%, log-rank p = 0.032). In conclusion, significant overall and paravalvular AR after TAVI appeared to improve over time. Although improvements in the echocardiographic parameters were similar, patients with grade ≥2 AR, both immediately after TAVI and at 6 months, were associated with worse survival. Copyright © 2015 Elsevier Inc. All rights reserved.
    The American Journal of Cardiology 12/2014; · 3.43 Impact Factor
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    ABSTRACT: Limited data exist on the risk of developing cardiac sarcoidosis (CS) and/or adverse events in sarcoidosis patients. Using LV global longitudinal strain (GLS), an emerging sensitive parameter of LV function, we evaluated the prevalence of subclinical cardiac dysfunction in sarcoidosis and investigated whether LVGLS predicts adverse outcomes in this population. A total of 130 patients with proven sarcoidosis undergoing echocardiography at our referral centre were identified. Following exclusion of those with evidence of CS (n = 14) or other pre-existing structural heart disease (n = 16), 100 patients (55 ± 13 years, 48% male, 90% pulmonary involvement) and 100 age- and gender-matched controls were included. LVGLS was measured by speckle-tracking analysis. The primary endpoint was a composite of all-cause mortality, heart failure hospitalization, device implantation, new arrhythmias, or future development of CS on advanced cardiac imaging modalities. LVGLS was significantly impaired in sarcoidosis patients compared with controls (-17.3 ± 2.5 vs. -20.0 ± 1.6%, P < 0.001). Overall, 27 patients (27%) reached the endpoint during a median follow-up of 35 months. On Cox proportional hazards model analysis, abnormal 24-h Holter, larger LV end-diastolic diameters, and more impaired LVGLS were significantly associated with the endpoint; however, only LVGLS remained independently associated on multivariate analysis [hazard ratio (HR) 1.4, 95% confidence interval (CI) 1.1-1.7, P = 0.006]. Patients with LVGLS less than -17.3% were significantly more likely to be free of the primary endpoint (log-rank P = 0.01). LVGLS is impaired in sarcoidosis patients, suggesting subclinical cardiac dysfunction despite the absence of conventional evidence of cardiac disease, and is independently associated with occurrence of cardiac events and/or development of CS. © 2014 The Authors. European Journal of Heart Failure © 2014 European Society of Cardiology.
    European Journal of Heart Failure 11/2014; · 6.58 Impact Factor
  • 11/2014; 10(7):884-6.
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    ABSTRACT: Imaging identifies patients with high-risk phenotype among the general population with atrial fibrillation, such as the presence of structural and valvular heart disease, which are both related to adverse outcome. Imaging is also potentially important for prediction of success of catheter ablation. Specifically, patients with larger left atrial size, reduced left atrial function and increased left atrial fibrosis content are more likely to experience atrial fibrillation recurrences after ablation. Routine and advanced echocardiographic imaging techniques and multi-detector row computed tomography and magnetic resonance imaging can provide detailed information. Currently, imaging techniques are not able to predict success on an individual basis, but it does permit identification of patients with high versus low risk of atrial fibrillation recurrence after ablation. Finally, imaging can be performed after ablation to demonstrate beneficial effects of restoration of sinus rhythm, including left atrial reverse remodelling and improvement in left atrial or ventricular function. All these issues are discussed in the current review. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
    Heart (British Cardiac Society) 11/2014; · 6.02 Impact Factor
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    ABSTRACT: Objectives: To determine the implications of stable coverage of the coronary ostia by the Edwards SAPIEN valve frame in terms of myocardial ischemia and subsequent percutaneous coronary intervention (PCI), following transcatheter aortic valve implantation (TAVI). Background: Edwards SAPIEN frame is frequently deployed relatively higher than recommended and may overlap the coronary ostia. Methods: A total of 142 patients (age 81±7 years, male 49%) treated with Edwards SAPIEN valve and with multi-detector row computed tomography at 1 month follow-up were evaluated. The position of the frame in relation to the coronary ostia was assessed. Levels of troponin T were measured 12-24 hours after TAVI. PCI events at follow-up were recorded. Results: The left coronary ostium was fully covered in 3 (2.1%) patients and the right coronary ostium in 11 (7.7%). There were no differences in troponin T levels between patients with fully covered ostia vs. patients with partly or non-covered ostia (0.24 (0.13-0.50) μg/L vs. 0.35 (0.15-0.55) μg/L, respectively; p=0.377). At 30±15 months follow up, 10(7%) patients underwent successful PCI. Rate of subsequent PCI was similar between patients with any covered ostium and patients with non-covered ostia (4 (7.8%) vs. 6 (6.5%), p=0.780, respectively). Conclusions: Full overlap of the coronary ostia by Edwards SAPIEN frame is infrequent and in most cases does not limit subsequent PCI. © 2014 Wiley Periodicals, Inc.
    11/2014;
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    ABSTRACT: Recently, it has been hypothesized that mitral leaflet remodelling may play a role in the pathophysiology of functional mitral regurgitation (FMR). We investigated the characteristics, determinants, and relation of mitral leaflet remodelling to FMR severity.
    European Heart Journal – Cardiovascular Imaging 11/2014; · 2.65 Impact Factor
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    ABSTRACT: A bedside-available transcatheter aortic valve implantation (TAVI)-dedicated prognostic risk score is an unmet clinical need. We aimed to develop such a risk score predicting 1-year mortality post-TAVI and to compare it with the performance of the logistic EuroSCORE (LES) I and LES-II and the Society of Thoracic Surgeons' (STS) score. Baseline variables of 511 consecutive patients who underwent TAVI that were independently associated with 1-year mortality post-TAVI were included in the "TAVI2-SCORe." Discrimination and calibration abilities of the novel score were assessed and compared with surgical risk scores. One-year mortality was 17.0% (n = 80 of 471). Porcelain thoracic aorta (hazard ratio [HR] 2.56), anemia (HR 2.03), left ventricular dysfunction (HR 1.98), recent myocardial infarction (HR 3.78), male sex (HR 1.81), critical aortic valve stenosis (HR 2.46), old age (HR 1.68), and renal dysfunction (HR 1.76) formed the TAVI2-SCORe (all p <0.05). According to the number of points assigned (1 for each variable and 2 for infarction), patients were stratified into 5 risk categories: 0, 1 (HR 2.6), 2 (HR 3.6), 3 (HR 10.5), and ≥4 (HR 17.6). TAVI2-SCORe showed better discrimination ability (Harrells' C statistic 0.715) compared with LES-I, LES-II, and STS score (0.609, 0.633, and 0.50, respectively). Cumulative 1-year survival rate was 54% versus 88% for patients with TAVI2-SCORE ≥3 versus <3 points, respectively (p <0.001). Contrary to surgical risk scores, there was no significant difference between observed and expected 1-year mortality for all TAVI2-SCORe risk strata (all p >0.05, Hosmer-Lemeshow statistic 0.304), suggesting superior calibration performance. In conclusion, the TAVI2-SCORe is an accurate, simple, and bedside-available score predicting 1-year mortality post-TAVI, outperforming conventional surgical risk scores for this end point. Copyright © 2014 Elsevier Inc. All rights reserved.
    The American Journal of Cardiology 10/2014; · 3.43 Impact Factor
  • Journal of Nuclear Cardiology 10/2014; · 2.65 Impact Factor
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    ABSTRACT: Left ventricular (LV) reverse remodeling after aortic valve replacement (AVR) for aortic regurgitation (AR) is associated with superior prognosis. The outcomes of valve-sparing aortic root replacement techniques on LV performance have not been compared with LV reverse remodeling in AVR. The present evaluation compared the extent of long-term LV reverse remodeling in patients with aortic root pathology and/or AR who underwent aortic valve repair (AVr) with patients who underwent AVR.
    Journal of Cardiac Surgery 10/2014; · 0.89 Impact Factor
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    ABSTRACT: The prognostic implications of flow, assessed by stroke volume index (SVi), and left ventricular (LV) global longitudinal strain on survival of patients with low-gradient severe aortic stenosis (AS) and preserved LV ejection fraction are debated. The aim of this study was to evaluate the impact of flow and LV global longitudinal strain on survival in these patients treated with aortic valve replacement (AVR). Patients with low-gradient severe AS with preserved LV ejection fraction treated with AVR (n = 134, mean age 76 ± 10 years, 50% men) were included in the present study. Aortic valve hemodynamics and LV function were assessed with 2-dimensional, Doppler and speckle-tracking echocardiography before AVR. Patients were dichotomized on the basis of low (SVi ≤35 ml/m(2)) or normal (SVi >35 ml/m(2)) flow and impaired (>-15%) or more preserved (≤-15%) global longitudinal strain. The end point was all-cause mortality. During a median follow-up period of 1.8 years (interquartile range 0.5 to 3) after AVR, 26 patients (19.4%) died. Survival was better for patients with SVi >35 ml/m(2) or global longitudinal strain ≤-15% compared with those with SVi ≤35 ml/m(2) or global longitudinal strain >-15% (log-rank p = 0.01). Atrial fibrillation (hazard ratio 5.40, 95% confidence interval 1.81 to 16.07, p = 0.002) and chronic kidney disease (hazard ratio 3.67, 95% confidence interval 1.49 to 9.06, p = 0.005) were the clinical variables independently associated with all-cause mortality. The addition of global longitudinal strain (chi-square = 19.87, p = 0.029, C-statistic = 0.74) or SVi (chi-square = 29.62, p <0.001, C-statistic = 0.80) to a baseline model including atrial fibrillation and chronic kidney disease (chi-square = 14.52, C-statistic = 0.68) improved risk stratification of these patients. In conclusion, flow and LV global longitudinal strain are independently associated with survival after AVR in patients with low-gradient severe AS with preserved LV ejection fraction. Copyright © 2014 Elsevier Inc. All rights reserved.
    The American Journal of Cardiology 09/2014; 114(12):1875-1881. · 3.43 Impact Factor
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    ABSTRACT: The presence of a left dominant coronary artery system is associated with worse outcome after ST-segment elevation myocardial infarction (STEMI) compared with right dominance or a balanced coronary artery system. However, the association between coronary arterial dominance and left ventricular (LV) function at follow-up after STEMI is unclear. The present study aimed at evaluating the relation between coronary arterial dominance and LV ejection fraction (LVEF) shortly after STEMI and at 12-month follow-up. A total of 741 patients with STEMI (mean age 60 ± 11 years and 77% men) were evaluated with 2-dimentional echocardiography within 48 hours of admission (baseline) and at 12-month follow-up after STEMI. Coronary arterial dominance was assessed on the angiographic images obtained during primary percutaneous coronary intervention. A right, left, and balanced dominant coronary artery system was noted in 640 (86%), 58 (8%), and 43 (6%) patients, respectively. At baseline, significant difference in LV function was observed, with slightly lower LVEF in patients with a left dominant coronary artery system (LVEF 45 ± 8% vs 48 ± 9% and 50 ± 9%, for left dominant, right dominant, and balanced coronary artery system respectively, p = 0.03). However, at 12-month follow-up no differences in LV function or volumes were observed among the different coronary arterial dominance groups. In conclusion, patients with a left dominant coronary artery system had lower LVEF early after STEMI. At 12-month follow-up, differences in LVEF were no longer present among the different coronary arterial dominance groups.
    The American Journal of Cardiology 09/2014; · 3.43 Impact Factor
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    ABSTRACT: Right ventricular (RV) function after ST-segment elevation myocardial infarction (STEMI) has important prognostic implications. However, the changes in RV function over time after STEMI and the incidence of RV remodeling remain unknown. The present study evaluated changes in RV dimensions and function in contemporary patients with first STEMI and assessed the independent determinants of RV dysfunction at follow-up. Patients with first STEMI (n = 940, 60 ± 11 years, 77% men) treated with primary percutaneous coronary intervention underwent echocardiography at baseline and 6- and 12-month follow-up. The prevalence of RV dysfunction (tricuspid annular plane systolic excursion [TAPSE] ≤15 mm) decreased significantly at 6 months follow-up (from 15% to 8%, p <0.001) and the incidence of RV remodeling (increase in RV end-diastolic area [RVEDA] ≥20%) was observed in 200 patients (25%). Absolute changes in RVEDA were independently associated with absolute changes in wall motion score index and left ventricular (LV) remodeling (p <0.001 for both parameters), whereas absolute changes in TAPSE were independently related with absolute changes in wall motion score index and mitral regurgitation grade (p <0.001 for both parameters). Independent correlates of RV dysfunction at 6 months follow-up were multivessel coronary disease (odds ratio [OR] 2.13), peak cardiac troponin T (OR 1.05), angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers use (OR 0.27), baseline LV ejection fraction (OR 0.96) and baseline TAPSE (OR 0.88). In conclusion, despite the non-negligible incidence of RV remodeling in patients with first STEMI, RV function improves early after STEMI. Multivessel coronary disease, infarct size, baseline LV ejection fraction and TAPSE and the nonuse of angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers are independent determinants of RV dysfunction.
    The American Journal of Cardiology 08/2014; · 3.43 Impact Factor
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    ABSTRACT: Potentially, Agatston coronary artery calcium (CAC) score could be calculated on contrast computed tomography coronary angiography (CTA). This will make a separate non-contrast CT scan superfluous. This study aims to assess the performance of a novel fully automatic algorithm to detect and quantify the Agatston CAC score in contrast CTA images. From a clinical registry, 20 patients were randomly selected for each CAC category (i.e. 0, 1-99, 100-399, 400-999, ≥1,000). The Agatston CAC score on non-contrast CT was calculated manually, while the novel algorithm was used to automatically detect and quantify Agatston CAC score in contrast CTA images. The resulting Agatston CAC scores were validated against the non-contrast images. A total of 100 patients (60 ± 11 years, 63 men) were included. The median CAC score on non-contrast CT was 145 (IQR 5-760), whereas the contrast CTA CAC score was 170 (IQR 23-594) (P = 0.004). The automatically computed CAC score showed a high correlation (R = 0.949; P < 0.001) and intra-class correlation (R = 0.863; P < 0.001) with non-contrast CT CAC score. Moreover, agreement within CAC categories was good (κ 0.588). Fully automatic detection of Agatston CAC score on contrast CTA is feasible and showed high correlation with non-contrast CT CAC score. This could imply a radiation dose reduction and time saving by omitting the non-contrast scan.
    The International Journal of Cardiovascular Imaging 08/2014; · 2.32 Impact Factor
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    ABSTRACT: Although pericardial effusion (PE) early after transcatheter aortic valve implantation (TAVI) has been reported in few registries, late PE at follow-up remains unexplored. Particularly, after transapical TAVI, diagnosis of PE with transthoracic echocardiography (TTE) may be challenging. The present evaluation assessed the incidence of PE early after TAVI and at 1 month follow-up using TTE and multi-detector computed tomography (MDCT). The agreement between TTE and MDCT to diagnose the presence and severity of PE at 1 month follow-up was evaluated. Overall 293 patients undergoing TAVI were included. Pre-discharge TTE was performed in all patients. At 1 month, repeat TTE was performed in 234 patients and additional MDCT evaluation in 143 patients. Pre-discharge small and moderate PE was observed in 74.1 and 4.1 % of patients, respectively, whereas significant PE was diagnosed in 8 (2.7 %) patients without differences between procedural access: 1.6 versus 3.6 % for transfemoral and transapical respectively, p = 0.474. At 1 month new-onset moderate PE was noted in 6 (2.5 %) patients all of who underwent transapical TAVI. MDCT and TTE disagreed on the grade of PE in 38 patients. Importantly, one patient with small PE on TTE was considered having moderate PE and two patients with small and moderate PE were considered having large PE. Also, two patients with moderate PE on echocardiography were considered small PE on MDCT. In conclusions, significant PE early after TAVI is infrequent. The prevalence of small and moderate PE remains stable at 1 month follow-up. MDCT refines the diagnosis of significant PE.
    The International Journal of Cardiovascular Imaging 08/2014; · 2.32 Impact Factor
  • Nina Ajmone Marsan, Jeroen J Bax
    Journal of Nuclear Cardiology 08/2014; · 2.65 Impact Factor

Publication Stats

25k Citations
4,901.83 Total Impact Points

Institutions

  • 1997–2015
    • Leiden University Medical Centre
      • Department of Cardiology
      Leyden, South Holland, Netherlands
  • 2013
    • Université de Montréal
      Montréal, Quebec, Canada
  • 2011
    • Princess Alexandra Hospital (Queensland Health)
      Brisbane, Queensland, Australia
    • University of Ferrara
      Ferrare, Emilia-Romagna, Italy
  • 2009–2011
    • VU University Medical Center
      • Department of Nuclear Medicine and PET Research
      Amsterdamo, North Holland, Netherlands
    • Marshfield Clinic
      Marshfield, Wisconsin, United States
  • 2005–2011
    • Leiden University
      Leyden, South Holland, Netherlands
    • University of Milan
      • Department of Health Science - DISS
      Milano, Lombardy, Italy
  • 2000–2011
    • Erasmus MC
      • • Department of Anesthesiology
      • • Department of Cardiology
      Rotterdam, South Holland, Netherlands
    • University of Manitoba
      Winnipeg, Manitoba, Canada
    • Mayo Foundation for Medical Education and Research
      Rochester, Michigan, United States
  • 2010
    • Yale-New Haven Hospital
      New Haven, Connecticut, United States
    • Brigham and Women's Hospital
      • Center for Brain Mind Medicine
      Boston, MA, United States
  • 2008–2010
    • Emory University
      • Department of Radiology
      Atlanta, GA, United States
    • University of Tuebingen
      • Department of Internal Medicine
      Tübingen, Baden-Wuerttemberg, Germany
    • Frederiksberg Hospital
      Фредериксберг, Capital Region, Denmark
    • Johns Hopkins Medicine
      • Division of Cardiology
      Baltimore, MD, United States
    • Fondazione Salvatore Maugeri IRCCS
      Ticinum, Lombardy, Italy
    • Aarhus University Hospital
      Aarhus, Central Jutland, Denmark
  • 1997–2010
    • Erasmus Universiteit Rotterdam
      • • Department of Anesthesiology
      • • Department of Cardiology
      Rotterdam, South Holland, Netherlands
  • 2005–2008
    • The Chinese University of Hong Kong
      • Department of Medicine and Therapeutics
      Hong Kong, Hong Kong
  • 2006
    • HagaZiekenhuis van Den Haag
      's-Gravenhage, South Holland, Netherlands
    • Universitair Medisch Centrum Groningen
      • Department of Nuclear Medicine and Molecular Imaging
      Groningen, Groningen, Netherlands
  • 2004–2006
    • University of Nebraska Medical Center
      • • Department of Internal Medicine
      • • Division of Cardiology
      Omaha, Nebraska, United States
  • 2002–2006
    • University of Antwerp
      • Faculty of Medicine
      Antwerpen, Flanders, Belgium
  • 2004–2005
    • Catholic University of the Sacred Heart
      Milano, Lombardy, Italy
  • 2003–2005
    • Ospedale Maggiore Carlo Alberto Pizzardi di Bologna
      • Department of Cardiology
      Bologna, Emilia-Romagna, Italy
    • University of Nebraska at Omaha
      • Department of Internal Medicine
      Omaha, NE, United States
    • University of California, Los Angeles
      • Department of Medicine
      Los Angeles, California, United States
  • 1998
    • Academisch Medisch Centrum Universiteit van Amsterdam
      Amsterdamo, North Holland, Netherlands
  • 1996
    • Medisch Centrum Alkmaar
      • Department of Cardiology
      Alkmaar, North Holland, Netherlands
  • 1995
    • VU University Amsterdam
      • Department of Cardiology
      Amsterdam, North Holland, Netherlands