Jeroen J Bax

Leiden University Medical Centre, Leyden, South Holland, Netherlands

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Publications (725)4728.24 Total impact

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    ABSTRACT: The adipokine omentin is highly and selectively expressed in visceral adipose tissue and its circulating levels are decreased in obesity and type 2 diabetes mellitus (T2DM). In this study, we assessed the relationships between plasma omentin levels and cardiometabolic variables in T2DM men and age-matched overweight healthy controls. Next, only in the T2DM men, the effects of 24-wk treatment with pioglitazone or metformin on plasma omentin levels were investigated.
    11/2015; 9(3):109-109. DOI:10.1007/s12467-011-0052-1
  • Victoria Delgado, Jeroen J Bax
    Heart (British Cardiac Society) 05/2015; DOI:10.1136/heartjnl-2015-307885 · 6.02 Impact Factor
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    ABSTRACT: We studied hemodynamic consequences of myocardial bridging and its relation to coronary atherosclerosis. Myocardial bridging is seen as intramural course by computed tomography angiography (CTA) or systolic compression by invasive coronary angiography. Segments with myocardial bridging are in previous studies closely associated with proximal atherosclerotic plaques. We prospectively studied 100 patients 63 ± 7 years of age with intermediate likelihood of coronary artery disease. Segments with superficial (>1 mm) or deep (>2 mm) intramural course were identified using CTA. Myocardial perfusion was studied by 15-Oxygen water positron emission tomography and systolic compression by invasive coronary angiography. Myocardial bridging was detected in 34 (34%) patients in 48 different vascular segments. Of these, 24 (50%) were deep and systolic compression was present in 14 (29%). In patients without obstructive coronary artery disease, myocardial stress perfusion distal to myocardial bridging was comparable with remote control regions (3.3 ± 0.9 ml/g/min vs. 3.3 ± 0.7 ml/g/min, n = 24, p = 0.88). Stress perfusion was comparable in segments with and without systolic compression (3.0 ± 0.9 vs. 2.7 ± 1.0 ml/g/min, p = 0.43). Atherosclerotic plaques were more frequent in proximal (71%) than myocardial bridging (7%) or distal (21%) segments. The presence of atherosclerosis and the average number of plaques were comparable in coronary arteries with and without myocardial bridging (73% vs. 60%, p = 0.14 and 2.0 ± 1.7 vs. 1.5 ± 1.6, p = 0.06). Median Agatston coronary calcium score was not elevated in vessels with myocardial bridge (15 [0, 129] vs. 50 [0, 241], p = 0.21). Myocardial bridging of coronary arteries is common on CTA, but only approximately one-third of these show systolic compression. Myocardial bridging is not associated with reduced myocardial perfusion during vasodilator stress. Atherosclerosis is located predominantly proximal to myocardial bridging but atherosclerotic burden and presence of vulnerable plaques were comparable. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
    JACC. Cardiovascular imaging 05/2015; DOI:10.1016/j.jcmg.2015.04.001 · 6.99 Impact Factor
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    ABSTRACT: Coronary computed tomography angiography (CTA) describes several features of coronary plaques, i.e. location, severity, and composition. Integrated CTA scores are able to identify individual patterns of higher risk. We sought to test whether circulating biomarkers related with metabolism and inflammation could predict high risk coronary anatomy at CTA in patients with stable chest pain. We evaluated a panel of 17 biomarkers in 429 patients (60.3 ± 0.4 years, 268 males) with stable chest pain who underwent coronary CTA having been enrolled in the Evaluation of Integrated Cardiac Imaging (EVINCI) study. The individual CTA risk score was calculated combining plaque extent, severity, composition, and location. The presence and distribution of non-calcified, mixed and calcified plaques were analyzed in each patient. After adjustment for age, sex and medical treatment, high-density lipoprotein (HDL) cholesterol, leptin, and interleukin-6 (IL-6) were independent predictors of CTA risk score at multivariate analysis (P = 0.050, 0.002, and 0.007, respectively). Integrating these biomarkers with common clinical variables, a model was developed which showed a better discriminating ability than the Framingham Risk Score and the Euro-SCORE in identifying the patients with higher CTA risk score (area under the receiver-operating characteristics curve = 0.81, 0.63 and 0.71, respectively, P < 0.001). These three biomarkers were significantly altered in patients with mixed or non-calcified plaques. In patients with stable chest pain, low HDL cholesterol, low leptin and high IL-6 are independent predictors of high risk coronary anatomy as defined by an integrated CTA risk score. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Atherosclerosis 05/2015; 241(1):55-61. DOI:10.1016/j.atherosclerosis.2015.04.811 · 3.97 Impact Factor
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    ABSTRACT: In propensity score-matched patients with severe aortic stenosis treated with surgical aortic valve replacement (AVR) with the 3f Enable sutureless prosthesis (Medtronic, Minneapolis, Minnesota) or transcatheter aortic valve replacement (TAVR), the hemodynamic performance of both valves and mid-term survival of patients were evaluated. Data on hemodynamic performance of surgical sutureless bioprostheses in high operative risk patients with aortic stenosis are scarce. Of 258 patients undergoing TAVR or surgical aortic valve replacement with the 3f Enable valve, 80 (79 ± 5 years of age, 100% men) were included in the current analysis on the basis of propensity score 1:1 matching for baseline clinical and hemodynamic characteristics. All patients had hemodynamic echocardiographic evaluation at baseline and discharge. Mid-term survival was analyzed. Compared with the 3f Enable valve, TAVR prostheses (Edwards SAPIEN XT [Edwards Lifesciences, Irvine, California] and CoreValve [Medtronic]) had larger effective orifice area index (1.00 ± 0.30 cm(2)/m(2) vs. 0.76 ± 0.22 cm(2)/m(2); p < 0.001), lower pressure gradient (8.14 ± 4.21 mm Hg vs. 10.72 ± 4.01 mm Hg; p = 0.006), less frequent prosthesis-patient mismatch (30.0% vs. 67.5%; p = 0.001), and low flow (46.2% vs. 72.5%; p = 0.02), but more frequent aortic regurgitation (87.5% vs. 20.0%; p < 0.001). The presence of prosthesis-patient mismatch was independently associated with a low-flow state at discharge (odds ratio: 4.70; p = 0.004) and independently associated with the use of the sutureless prosthesis (odds ratio: 3.90; p = 0.02). However, the survival of the 2 groups was comparable after 1.5-year (interquartile range: 0.79 to 2.01 years) follow-up (log-rank test, p = 0.95). TAVR prostheses demonstrated better hemodynamics than the 3f Enable valve but a higher incidence of aortic regurgitation. However, these differences did not influence mid-term survival of patients. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
    JACC. Cardiovascular Interventions 04/2015; 8(5):670-7. DOI:10.1016/j.jcin.2014.10.029 · 7.44 Impact Factor
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    ABSTRACT: To develop an alternative method for Vp-assessment using high-temporal velocity-encoded magnetic resonance imaging (VE-MRI). Left ventricular (LV) inflow propagation velocity (Vp) is considered a useful parameter in the complex assessment of LV diastolic function and is measured by Color M-mode echocardiography. A total of 43 patients diagnosed with ischemic heart failure (61 ± 11 years) and 22 healthy volunteers (29 ± 13 years) underwent Color M-mode echocardiography and VE-MRI to assess the inflow velocity through the mitral valve (mean interexamination time 14 days). Temporal resolution of VE-MRI was 10.8-11.8 msec. Local LV inflow velocity was sampled along a 4-cm line starting from the tip of the mitral leaflets and for consecutive sample points the point-in-time was assessed when local velocity exceeded 30 cm/s. From the position-time relation, Vp was calculated by both the difference quotient (Vp-MRI-DQ) as well as from linear regression (Vp-MRI-LR). Good correlation was found between Vp-echo and both Vp-MRI-DQ (r = 0.83, P < 0.001) and Vp-MRI-LR (r = 0.84, P < 0.001). Vp-MRI showed a significant but small underestimation as compared to Vp measured by echocardiography (Vp-MRI-DQ: 5.5 ± 16.2 cm/s, P = 0.008; Vp-MRI-LR: 9.9 ± 15.2 cm/s, P < 0.001). Applying age-related cutoff values for Vp to identify LV impaired relaxation, kappa-agreement with echocardiography was 0.72 (P < 0.001) for Vp-MRI-DQ and 0.69 (P < 0.001) for Vp-MRI-LR. High temporal VE-MRI represents a novel approach to assess Vp, showing good correlation with Color M-mode echocardiography. In healthy subjects and patients with ischemic heart failure, this new method demonstrated good agreement with echocardiography to identify LV impaired relaxation. J. Magn. Reson. Imaging 2015. © 2015 Wiley Periodicals, Inc.
    Journal of Magnetic Resonance Imaging 04/2015; DOI:10.1002/jmri.24905 · 2.79 Impact Factor
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    ABSTRACT: Despite considerable improvements in the medical management of patients with myocardial infarction (MI), patients with large MI still have substantial risk to develop heart failure. In the early post MI setting, implantable cardioverter defibrillators have reduced arrhythmic deaths but have no impact on overall mortality. Hence, additional interventions are required to further reduce the overall morbidity and mortality of patients with large MI. The pacing remodeling prevention therapy (PRomPT) trial is designed to study the effects of peri-infarct pacing in preventing adverse post-MI remodeling. Up to 250 subjects with a peak creatine phosphokinase (CPK) > 3000 U/L (or a troponin T (TnT) > 10 mcg/L) at time of MI will be randomized to either dual-site or single-site biventricular pacing with the LV lead implanted in a peri-infarct region or a non-implanted control. Those randomized to a device will be blinded to the pacing mode, however randomization to a device or control cannot be blinded. Subjects randomized to pacing will have the device implanted within 10 days of MI. The primary objective is to assess the change in left ventricular end diastolic volume (LVEDV) from baseline to 18 months. Secondary objectives are to assess changes in clinical and mechanistic parameters between the groups, including rates of hospitalization for heart failure and cardiovascular events, the incidence of sudden cardiac death and all-cause mortality, NYHA functional class, 6 minute walking distance, and quality of life CONCLUSIONS: The PRomPT trial will provide important evidence regarding the potential of peri-infarct pacing to interrupt adverse remodeling in patients with large MI. Copyright © 2015 Elsevier Inc. All rights reserved.
    Journal of cardiac failure 03/2015; DOI:10.1016/j.cardfail.2015.03.005 · 3.07 Impact Factor
  • Jeroen J Bax, Victoria Delgado
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    ABSTRACT: Chronic heart failure is a major public-health problem with a high prevalence, complex treatment, and high mortality. A careful and comprehensive analysis is needed to provide optimal (and personalized) therapy to heart failure patients. The main 4 non-invasive imaging techniques (echocardiography, magnetic resonance imaging, multi-detector-computed tomography, and nuclear imaging) provide information on cardiovascular anatomy and function, which form the basis of the assessment of the pathophysiology underlying heart failure. The selection of imaging modalities depends on the information that is needed for the clinical management of the patients: (1) underlying etiology (ischemic vs non-ischemic); (2) in ischemic patients, need for revascularization should be evaluated (myocardial ischemia/viability?); (3) left ventricular function and shape assessment; (4) presence of significant secondary mitral regurgitation; (5) device therapy with cardiac resynchronization therapy and/or implantable cardiac defibrillator (risk of sudden cardiac death). This review is dedicated to assessment of myocardial viability, however "isolated assessment of myocardial viability" may be clinically not meaningful and should be considered among all those different variables. This complete information will enable personalized treatment of the patient with ischemic heart failure.
    Journal of Nuclear Cardiology 03/2015; 22(2). DOI:10.1007/s12350-015-0096-5 · 2.65 Impact Factor
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    ABSTRACT: The aim of this study was to characterize left ventricular (LV) mechanics in symptomatic and asymptomatic patients with moderate-to-severe or severe aortic regurgitation (AR) and preserved ejection fraction (left ventricular ejection fraction) using two-dimensional speckle tracking echocardiography (2D-STE). The association between baseline LV strain and development of indications for surgery in asymptomatic patients was also evaluated. A total of 129 patients with moderate-to-severe or severe AR and LVEF >50% (age 55 ± 17 years, 64% male, 53% asymptomatic at baseline) were included. Standard echocardiography and 2D-STE were performed at baseline. Compared with asymptomatic patients, symptomatic patients had significantly impaired LV longitudinal (-14.9 ± 3.0 vs. -16.8 ± 2.5%, P < 0.001), circumferential (-17.5 ± 2.9 vs. -19.3 ± 2.8%, P = 0.001), and radial (35.7 ± 12.2 vs. 43.1 ± 14.7%, P = 0.004) strains. Among 49 asymptomatic patients who were followed up, 26 developed indications for surgery (symptoms onset or LVEF ≤50%). These patients had comparable LV volumes, LVEF, and colour Doppler assessments of AR jet at baseline, but more impaired LV longitudinal (P = 0.009) and circumferential (P = 0.017) strains compared with patients who remained asymptomatic. Impaired baseline LV longitudinal (per 1% decrease, HR = 1.21, P = 0.04) or circumferential (per 1% decrease, HR = 1.22, P = 0.04) strain was independently associated with the need for surgery. Multidirectional LV strain was more impaired in symptomatic than in asymptomatic patients with moderate-to-severe or severe AR, despite preserved LVEF. In asymptomatic AR patients, longitudinal and circumferential strains identified patients who would require surgery during follow-up. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email:
    European Heart Journal – Cardiovascular Imaging 03/2015; DOI:10.1093/ehjci/jev019 · 2.65 Impact Factor
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    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:
    European Heart Journal – Cardiovascular Imaging 02/2015; DOI:10.1093/ehjci/jev003 · 2.65 Impact Factor
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    ABSTRACT: QRS fragmentation (fQRS) and prolonged QTc interval on surface ECG are prognostic in various cardiomyopathies other than hypertrophic cardiomyopathy (HCM). The association between fQRS and prolonged QTc duration with occurrence of ventricular tachyarrhythmias or sudden cardiac death (VTA/SCD) in patients with HCM was explored. 195 clinical HCM patients were studied. QTc duration was derived applying Bazett's formula; fQRS was defined as presence of various RSR' patterns, R or S notching and/or >1 additional R wave in any non-aVR lead in patients without pacing or (in)complete bundle branch block. The endpoints comprised SCD, ECG documented sustained VTA (tachycardia or fibrillation) or appropriate implantable cardioverter defibrillator (ICD) therapies [antitachycardia pacing (ATP) or shock] for VTA in ICD recipients [n = 58 (30%)]. QT prolonging drugs recipients were excluded. After a median follow-up of 5.7 years (IQR 2.7-9.1), 26 (13%) patients experienced VTA or SCD. Patients with fQRS in ≥3 territories (inferior, lateral, septal and/or anterior) (p = 0.004) or QTc ≥460 ms (p = 0.009) had worse cumulative survival free of VTA/SCD than patients with fQRS in <3 territories or QTc <460 ms. fQRS in ≥3 territories (ß 4.5, p = 0.020, 95%CI 1.41-14.1) and QTc ≥460 ms (ß 2.7, p = 0.037, 95%CI 1.12-6.33) were independently associated with VTA/SCD. Likelihood ratio test indicated assessment of fQRS and QTc on top of conventional SCD risk factors provides incremental predictive value for VTA/SCD (p = 0.035). Both fQRS in ≥3 territories and QTc duration are associated with VTA/SCD in HCM patients, independently of and incremental to conventional SCD risk factors. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Journal of Cardiovascular Electrophysiology 02/2015; 26(5). DOI:10.1111/jce.12629 · 2.88 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; 28(4). DOI:10.1016/j.echo.2014.12.012 · 3.99 Impact Factor
  • European Heart Journal 01/2015; DOI:10.1093/eurheartj/ehu481 · 14.72 Impact Factor
  • 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; 22(3). DOI:10.1007/s12350-014-0054-7 · 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; 115(5). DOI:10.1016/j.amjcard.2014.12.018 · 3.43 Impact Factor
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    ABSTRACT: In this chapter of Tools and Techniques Clinical, 3D transoesophageal echocardiography for selecting and guiding in percutaneous mitral valve repair using MitraClip (R) is discussed. The following is a summarised overview of this technique. The complete, unabridged version with images is available online at:
    EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 11/2014; 10(7):884-6. DOI:10.4244/EIJV10I7A150 · 3.76 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.MethodsA 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 hr after TAVI. PCI events at follow-up were recorded.ResultsThe left coronary ostium was fully covered in three (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 versus patients with partly or non-covered ostia (0.24 (0.13-0.50) μg/L versus 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.
    Catheterization and Cardiovascular Interventions 11/2014; 85(3). DOI:10.1002/ccd.25718 · 2.40 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; DOI:10.1016/j.amjcard.2014.10.029 · 3.43 Impact Factor
  • Journal of Nuclear Cardiology 10/2014; 21(6). DOI:10.1007/s12350-014-0013-3 · 2.65 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. DOI:10.1016/j.amjcard.2014.09.030 · 3.43 Impact Factor

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25k Citations
4,728.24 Total Impact Points


  • 1997–2015
    • Leiden University Medical Centre
      • Department of Cardiology
      Leyden, South Holland, Netherlands
  • 2003–2014
    • Leiden University
      Leyden, South Holland, Netherlands
    • University of California, Los Angeles
      Los Ángeles, California, United States
  • 2013
    • Université de Montréal
      Montréal, Quebec, Canada
  • 2010
    • Emory University
      • Department of Radiology
      Atlanta, GA, United States
  • 1997–2010
    • Erasmus Universiteit Rotterdam
      • • Department of Anesthesiology
      • • Department of Cardiology
      Rotterdam, South Holland, Netherlands
  • 2006–2009
    • Marshfield Clinic
      Marshfield, Wisconsin, United States
    • HagaZiekenhuis van Den Haag
      's-Gravenhage, South Holland, Netherlands
  • 2008
    • Frederiksberg Hospital
      Фредериксберг, Capital Region, Denmark
    • The Chinese University of Hong Kong
      • Department of Medicine and Therapeutics
      Hong Kong, Hong Kong
    • Johns Hopkins Medicine
      • Division of Cardiology
      Baltimore, MD, United States
    • Aarhus University Hospital
      Aarhus, Central Jutland, Denmark
  • 2000–2008
    • 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
  • 2007
    • University of Toronto
      Toronto, Ontario, Canada
  • 1999–2007
    • VU University Amsterdam
      Amsterdamo, North Holland, Netherlands
  • 2004
    • University of Nebraska Medical Center
      • Department of Internal Medicine
      Omaha, Nebraska, United States
    • Catholic University of the Sacred Heart
      Milano, Lombardy, Italy
    • Sacred Heart University
      Феърфилд, Connecticut, United States
  • 2002
    • Cardiovascular Research Foundation
      New York, New York, United States
  • 1998
    • Academisch Medisch Centrum Universiteit van Amsterdam
      Amsterdamo, North Holland, Netherlands
  • 1996
    • Medisch Centrum Alkmaar
      • Department of Cardiology
      Alkmaar, North Holland, Netherlands
  • 1995–1996
    • University of Amsterdam
      • Department of Cardiology
      Amsterdamo, North Holland, Netherlands