Hubert W Vliegen

Publications (108)593.1 Total impact

• Article: Complications of pacemaker therapy in adults with congenital heart disease: A multicenter study.

  Petra Opić, Matthijs van Kranenburg, Sing-Chien Yap, Arie P van Dijk, Werner Budts, Hubert W Vliegen, Lieselot van Erven, Anil Can, Gulhan Sahin, Dominic A M J Theuns, Maarten Witsenburg, Jolien W Roos-Hesselink
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  ABSTRACT: BACKGROUND: This study aims to investigate indications and complications of permanent cardiac pacing in adults with congenital heart disease (CHD). METHODS AND RESULTS: Two-hundred and seventy-four CHD patients were identified who underwent permanent pacemaker implantation between 1972 and 2009. The indication for pacing was acquired sinus node or AV node conduction disease (63%), sinus node or AV node conduction disease after cardiac surgery (28%), and drug/arrhythmia-related indications (9%). Patients with complex CHD received a pacemaker at younger age (23 versus 31years, p<0.0001) and more often received an epicardial pacing system (51% versus 23%, p<0.0001) compared to those with simple or moderate CHD. Twenty-nine patients (10.6%) had a periprocedural complication during the primary pacemaker implantation (general population: 5.2%). The most common acute complications were lead dysfunction (4.0%), bleeding (2.6%), pocket infection (1.5%) and pneumothorax (1.5%). During a median follow-up of 12years, pacemaker-related complications requiring intervention occurred in 95 patients (34.6%). The most common late pacemaker-related complications included lead failure (24.8%), pacemaker dysfunction/early battery depletion (5.1%), pacemaker migration (4.7%) and erosion (4.7%). Pacemaker implantation at younger age (<18years) was an independent predictor of late pacemaker-related complication (adjusted hazard ratio 1.68, 95% confidence interval 1.07 to 2.63, p=0.023). CONCLUSIONS: The risk of periprocedural complications seems higher in the CHD population compared to the general population and more than one-third of CHD patients encountered a pacemaker-related complication during long-term follow-up. This risk increases for those who receive a pacemaker at younger age.
  International journal of cardiology 05/2013; · 7.08 Impact Factor
• Article: Illness perceptions of adults with congenital heart disease and their predictive value for quality of life two years later.

  Dounya Schoormans, Barbara Jm Mulder, Joost P van Melle, Petronella G Pieper, Arie Pj van Dijk, Gertjan Tj Sieswerda, Mariët S Hulsbergen-Zwarts, Thijs Hwm Plokker, Leo Gh Brunninkhuis, Hubert W Vliegen, Mirjam Ag Sprangers
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  ABSTRACT: Background:To improve patients' quality of life (QoL) we need to identify modifiable determinants, such as illness perceptions. Patients' illness perceptions are known to regulate emotional responses and health-behaviour. Illness perceptions comprise several components: consequences, control, coherence, changeability and emotional representations.Aims:To examine (a) the relation between patient characteristics and illness perceptions, and (b) the independent predictive value of illness perceptions for future QoL.Methods:A longitudinal study in 845 patients with congenital heart disease was conducted. Patients completed three questionnaires: the IPQ-R (illness perceptions) and two years later the SF-36 and TAAQOL-CHD (QoL). Linear regression analyses were performed relating illness perceptions to patient characteristics (sex, age, disease complexity and functional status) and QoL.Results:Patients with a complex defect or poor functional status reported poor illness perceptions. Independent of patient characteristics, poor illness perceptions (i.e. a strong belief that the illness has severe consequences; a weak belief that you have a coherent illness understanding and that the illness can be controlled by treatment; and a strong belief that the illness is changeable and causes negative emotions) were predictive of future QoL.Conclusion:Illness perceptions independently predict QoL, suggesting that QoL may be improved by altering patients' beliefs about their illness. For example, increasing patients' knowledge regarding their disease and informing them about treatment opportunities may enhance their QoL.
  European journal of cardiovascular nursing: journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology 03/2013;
• Article: Impact of bosentan on exercise capacity in adults after the Fontan procedure: a randomized controlled trial.

  Mark J Schuuring, Jeroen C Vis, Arie P J van Dijk, Joost P van Melle, Hubert W Vliegen, Petronella G Pieper, Gertjan T Sieswerda, Rianne H A C M de Bruin-Bon, Barbara J M Mulder, Berto J Bouma
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  ABSTRACT: AIMS: An endothelin-1 receptor blocker, shown to be effective in patients with pulmonary arterial hypertension, might decrease pulmonary vascular resistance to increase cardiac filling and consequently improve exercise capacity in Fontan patients. METHODS AND RESULTS: This was a prospective, multicentre randomized open label trial in Fontan patients. One group received bosentan for 6 months. The other group did not receive study medication for the first 3 months, followed by bosentan for 6 months. The primary endpoint was exercise capacity, and secondary endpoints were NT-proBNP level, cardiac output, SF-36 (Short Form-36) quality of life (QoL), and NYHA class. Forty-two adults (median age 29 (range 18-56) years, 52% male, 88% NYHA class I-II) from five tertiary referral centres participated in the study. Ten patients were on diuretics. Ten patients were not motivated to finish the study. Analysis of all 32 patients who finished the study at 6 months of treatment showed that mean peak V'O(2) (24 vs. 25 mL/kg/min), median SQUASH score (6614 vs. 6390), median NT-proBNP (314 vs. 274 ng/L), and mental QoL (50 vs. 51) remained unchanged as compared with baseline (P = NS, for all). After treatment, NYHA class had improved in 6 (19%), was unchanged in 24 (75%), and declined in 2 (6%) patients. Subgroup analysis on age, ventricular morphology, type of Fontan circulation, or baseline NT-proBNP level did not reveal efficacy of bosentan. Six transient adverse effects were reported. CONCLUSION: An increased NT-proBNP level was present in the majority of Fontan patients. Six months of bosentan treatment was not beneficial.Trial registrationNTR1557.
  European Journal of Heart Failure 01/2013; · 4.90 Impact Factor
• Article: The Effect of Valsartan on the Systemic Right Ventricular Function: A Double-Blind Randomized Placebo-Controlled Pilot Trial.

  Teun van der Bom, Michiel M Winter, Berto J Bouma, Maarten Groenink, Hubert W Vliegen, Petronella G Pieper, Arie P J van Dijk, Gertjan T Sieswerda, Jolien W Roos-Hesselink, Aeilko H Zwinderman, Barbara J M Mulder
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  ABSTRACT: BACKGROUND: The role of angiotensin II receptor blockers in patients with a systemic right ventricle has not been elucidated. METHODS AND RESULTS: We conducted a multicenter double blind parallel randomized controlled trial of angiotensin II receptor blocker valsartan 160mg twice daily compared with placebo in patients with a systemic right ventricle due to congenitally or surgically corrected transposition of the great arteries. The primary endpoint was change in right ventricular ejection fraction during three year follow-up, determined by cardiovascular magnetic resonance imaging or in patients with contraindication for MRI multirow detector computed tomography. Secondary endpoints were change in right ventricular volumes and mass, and V'O(2) peak, and quality of life. Primary analyses were done by intention-to-treat. A total of 88 patients (valsartan n=44, placebo n=44) were enrolled in the trial. No serious adverse effects occurred in either group. There was no significant effect of three year valsartan therapy on systemic right ventricular ejection fraction (treatment effect 1.3%, 95%CI -1.3 to 3.9; p=0.34), maximum exercise capacity, and quality of life. There was a larger increase in right ventricular end-diastolic volume (15ml, 95%CI 3ml to 28ml, p<0.01) and mass (8g 95%CI 2g to 14g, p=0.01) in the placebo group than in the valsartan group. CONCLUSIONS: There was no significant treatment effect of valsartan on right ventricular ejection fraction, exercise capacity, or quality of life. Valsartan was associated with a similar frequency of significant clinical events compared with placebo. Small but significant differences between valsartan and placebo were present for change in right ventricular volumes and mass. CLINICAL TRIAL REGISTRATION INFORMATION: http://www.controlled-trials.com; Identifier: ISRCTN52352170.
  Circulation 12/2012; · 14.74 Impact Factor
• Article: Mild Residual Pulmonary Stenosis in Tetralogy of Fallot Reduces Risk of Pulmonary Valve Replacement.

  Annelies E van der Hulst, Marije G Hylkema, Hubert W Vliegen, Victoria Delgado, Mark G Hazekamp, Marry E B Rijlaarsdam, Eduard R Holman, Nico A Blom, Arno A W Roest
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  ABSTRACT: BACKGROUND: Current surgical strategies that aim at preventing pulmonary regurgitation in patients with corrected tetralogy of Fallot (cToF) may result in a certain grade of residual pulmonary stenosis (PS). The clinical implications of a postoperative residual PS in cToF patients remain unclear. Pulmonary valve replacement (PVR) is frequently needed during follow-up of cToF patients. The aim of the current study was to determine the role of residual PS in the need for PVR during follow-up in cToF patients. METHODS: cToF patients were included if clinical follow-up after primary surgical correction had taken place for a minimum of 5 years. Patient characteristics, surgical factors, and postoperative factors were reviewed, with a special focus on the transpulmonic systolic gradient. Cox proportional hazards regression analysis was performed to identify predictors of PVR. RESULTS: Of 171 cToF patients, 71 (41.5%) underwent PVR after 24.2 years (interquartile range, 16.8-31.6 years). Year of birth, older age at corrective operation, and patch use significantly predicted PVR during follow-up. By contrast, a mild residual PS in cToF patients (peak systolic gradient, 15-30 mm Hg) independently reduced the risk of PVR, as compared with patients without PS (hazard ratio, 0.47; p = 0.02) and with moderate-to-severe PS (hazard ratio, 0.35; p = 0.01). CONCLUSIONS: In addition to the known risks factors for PVR, a postoperative mild residual PS reduces the risk of PVR during follow-up of cToF patients. This finding provides clinical evidence for a conservative PS relief during correction of ToF.
  The Annals of thoracic surgery 09/2012; · 3.74 Impact Factor
• Article: Impaired cardiac reserve in asymptomatic patients with moderate pulmonary restenosis late after relief of severe pulmonary stenosis: Evidence for diastolic dysfunction.

  Soha Romeih, Nico A Blom, Mart N Van der Plas, Anje M Spijkerboer, Arno A W Roest, Hubert W Vliegen, Barbara J M Mulder, Maarten Groenink
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  ABSTRACT: BACKGROUND: Patients with moderate pulmonary valve restenosis late after relief of severe pulmonary stenosis (PS) may show decreased exercise tolerance. To elucidate the mechanism of decreased exercise tolerance, we evaluated cardiac response to physical and pharmacological stress in these patients and compared results with those of patients with native moderate PS. METHODS: Twenty asymptomatic patients with moderate PS were divided into 2 groups: Group I (late after relief of severe PS, n=9), and Group II (no previous intervention, n=11). All patients underwent an exercise test, dobutamine stress (DS) MRI, and delayed contrast enhanced MRI. The response to physical and pharmacological stress was compared between both groups. RESULTS: Group I showed impaired exercise capacity compared to Group II (VO(2)max=72.8%±3.5% vs. 102.5%±16.3%, p<0.001). During DS-MRI, RV-SV increased in Group II, but not in Group I (+13±8ml, -5±8ml, p<0.001). RV end-diastolic volume decreased significantly in Group I patients (p=0.006) while it did not significantly change in Group II patients. The amount of RV-SV increase (∆ RV-SV) correlated negatively with the period of moderate PS existence and the current PG in Group I (r=-0.82, p=0.007, and r=-0.68, p=0.04, respectively) but not in Group II (r=0.45, p=0.1, and r=0.40, p=0.2, respectively). Furthermore, ∆ RV-SV correlated negatively with the PG before valvuloplasty (r=-0.76, p=0.02). CONCLUSION: Impaired exercise capacity in patients with moderate pulmonary restenosis after relief of severe PS is probably caused by inability to increase RV-SV. Disturbed RV filling properties, worsening in time, might play a role.
  International journal of cardiology 08/2012; · 7.08 Impact Factor
• Article: Prognostic value of right ventricular longitudinal peak systolic strain in patients with pulmonary hypertension.

  Marlieke L A Haeck, Roderick W C Scherptong, Nina Ajmone Marsan, Eduard R Holman, Martin J Schalij, Jeroen J Bax, Hubert W Vliegen, Victoria Delgado
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  ABSTRACT: Background- Right ventricular (RV) function is an important prognostic marker in patients with pulmonary hypertension. The present evaluation assessed the prognostic value of RV longitudinal peak systolic strain (LPSS) in patients with pulmonary hypertension. Methods and Results- A total of 150 patients with pulmonary hypertension of different etiologies (mean age, 59±15 years; 37.3% male) were evaluated. RV fractional area change and tricuspid annular plane systolic excursion index were evaluated with 2-dimensional echocardiography. RV LPSS was assessed with speckle-tracking echocardiography. The patient population was categorized according to a RV LPSS value of -19%. Among several clinical and echocardiographic parameters, the significant determinants of all-cause mortality were evaluated. There were no significant differences in age, sex, pulmonary hypertension cause and left ventricular ejection fraction between patients with RV LPSS <-19% and patients with RV LPSS ≥-19%. However, patients with RV LPSS ≥-19% had significantly worse New York Heart Association functional class (2.7±0.6 versus 2.3±0.8; P=0.003) and lower tricuspid annular plane systolic excursion (16±4 mm versus 18±3 mm; P<0.001) than their counterparts. During a median follow-up of 2.6 years, 37 patients died. RV LPSS was a significant determinant of all-cause mortality (HR, 3.40; 95% CI, 1.19-9.72; P=0.02). Conclusions- In patients with pulmonary hypertension, RV LPSS is significantly associated with all-cause mortality. RV LPSS may be a valuable parameter for risk stratification of these patients. Future studies are needed to confirm these results in the pulmonary hypertension subgroups.
  Circulation Cardiovascular Imaging 08/2012; 5(5):628-36. · 5.94 Impact Factor
• Article: Rates and determinants of progressive aortic valve dysfunction in aortic coarctation.

  Paul Luijendijk, Arnaud W J M Stevens, Rianne H A C M de Bruin-Bon, S Matthijs Boekholdt, Joris W J Vriend, Hubert W Vliegen, Berto J Bouma, Barbara J M Mulder
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  ABSTRACT: PURPOSE: Aortic valve dysfunction is common in coarctation patients(CoA). Bicuspid aortic valve (BAV) in CoA is associated with aortic valve stenosis (AS), aortic valve regurgitation (AR), and ascending aortic dilatation. The aim of this study was to evaluate the progression of and predictors for aortic valve dysfunction in CoA. METHODS: 96 CoA patients prospectively underwent echocardiography twice between 2001 and 2010. AS was defined as an aortic valve gradient ≥20mmHg, AR as none/minor, or moderate/severe. Aortic dilatation as an ascending aortic diameter ≥37mm. RESULTS: All patients (median age 28.0years, range 17-61years; male 57%) were followed with a median follow-up of 7.0years. Sixty patients (63%) had BAV. At baseline 10 patients had AS (10%, 9 BAV), 6 patients AR (6%, 3 BAV) and 11 patients aortic dilatation (11%, 11 BAV). At follow-up 15 patients had AS (15%, 13 BAV) and 12 patients AR. (13%, 8 BAV). Median AS progression was 1.1mmHg/5years (range - 13-28). Determinants for AS at follow-up were age (ß=0.20, P=0.01), aortic dilatation (ß=4.6, P=0.03), and baseline aortic valve gradient (ß=0.93, P<0.001). BAV was predictive for AR. (ß=0.91, P=0.049). CONCLUSION: Progression of AS in adult CoA patients is mild in this young population. Older age, aortic dilatation and the baseline aortic valve gradient are determinants for AS at follow-up. BAV is predictive for AR. These findings point towards a common embryological pathway of both valvular and aortic disease in CoA.
  International journal of cardiology 08/2012; · 7.08 Impact Factor
• Article: Exercise capacity and ventricular function in patients treated for isolated pulmonary valve stenosis or tetralogy of Fallot.

  Saskia E Luijnenburg, Wilfred B de Koning, Soha Romeih, Jochem van den Berg, Hubert W Vliegen, Barbara J M Mulder, Willem A Helbing
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  ABSTRACT: We hypothesized 1) that long-term ventricular outcome and exercise capacity would be better in patients with isolated pulmonary valve stenosis (PS) treated with balloon pulmonary valvuloplasty (BPV) than in patients operated for tetralogy of Fallot (TOF), and 2) that ventricular outcome and exercise capacity would not be different in PS patients and healthy controls. We included 21 PS patients after BPV (16.2 ± 5.2 years) and 21 patients operated for TOF (16.6 ± 5.6 years), matching them for gender, age at treatment, and age at study. Patients underwent cardiovascular magnetic resonance (CMR) imaging, exercise testing, 12-lead ECG and 24-hour Holter monitoring for assessment of right ventricular (RV) size and function, pulmonary regurgitation (PR), exercise capacity and electrocardiographic status. Healthy controls for CMR imaging and exercise testing were matched for gender and age at study. RV volumes and PR percentage were significantly larger in TOF patients than in PS patients; biventricular ejection fraction (EF) was not different. PR was mild in most PS patients. RV end-systolic volume was significantly larger in PS patients than in healthy controls; RVEF was significantly lower. Both patient groups had similar exercise test results. Peak workload and VO(2) max. were significantly lower in PS patients than in healthy controls. Longstanding mild PR in PS patients can lead to an enlarged RV, reduced RV function and reduced exercise capacity. Despite more PR and larger RV volumes in TOF patients, exercise capacity and biventricular function are similar in both patient groups.
  International journal of cardiology 07/2012; 158(3):359-63. · 7.08 Impact Factor
• Article: Serial follow-up of biventricular function, exercise capacity and NT-proBNP measurements in repaired tetralogy of Fallot: is there a role for MR stress imaging?

  Saskia E Luijnenburg, Jochem van den Berg, Adriaan Moelker, Jolien W Roos-Hesselink, Ad JJC Bogers, Yolanda B de Rijke, Barbara JM Mulder, Hubert W Vliegen, Willem A Helbing
  Journal of Cardiovascular Magnetic Resonance 05/2012; 13:1-2. · 3.72 Impact Factor
• Article: Right ventricular longitudinal peak systolic strain measurements from the subcostal view in patients with suspected pulmonary hypertension: a feasibility study.

  Marlieke L A Haeck, Roderick W C Scherptong, M Louisa Antoni, Nina Ajmone Marsan, Hubert W Vliegen, Eduard R Holman, Martin J Schalij, Jeroen J Bax, Victoria Delgado
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  ABSTRACT: The assessment of right ventricular (RV) function with two-dimensional echocardiography can be challenging in patients with pulmonary hypertension, especially in those with chronic pulmonary disease. The aim of the present study was to evaluate the feasibility of measuring RV longitudinal peak systolic strain (LPSS) in the echocardiographic subcostal view in patients with suspected pulmonary hypertension. A total of 179 patients evaluated for pulmonary hypertension were included (85 with systemic disorder, 64 with pulmonary disease, and 30 with RV dilatation and dysfunction). Additionally, 30 normal controls were evaluated. The feasibility of RV LPSS speckle-tracking measurements in the apical four-chamber view and in the subcostal view was evaluated. Furthermore, the RV LPSS speckle-tracking measurements performed in these two echocardiographic views were compared. The feasibility of RV LPSS in the subcostal view was 95.3%, 92.2%, 93.3%, and 93.3% in patients with systemic disorder, with pulmonary disease, with RV dilatation and dysfunction, and controls, respectively. In comparison, the feasibility of RV LPSS in the apical four-chamber view was 92.9%, 82.8%, 90%, and 93.3% in each group, respectively. Bland-Altman analysis showed good agreement between measurements in both echocardiographic views (systemic disorder: mean bias, -0.14; pulmonary disease: mean bias, 0.28; RV dilatation and dysfunction: mean bias, 0.3; and normal controls: mean bias, -0.14). The subcostal view provides a good alternative for RV strain assessment in patients who are evaluated for pulmonary hypertension. This measurement may be a valuable surrogate of RV function in patients with challenging apical windows.
  Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 04/2012; 25(6):674-81. · 2.98 Impact Factor
• Source

  Available from: Saskia E Luijnenburg

  Article: Intra-observer and interobserver variability of biventricular function, volumes and mass in patients with congenital heart disease measured by CMR imaging

  Saskia E. Luijnenburg, Daniëlle Robbers-Visser, Adriaan Moelker, Hubert W. Vliegen, Barbara J. M. Mulder, Willem A. Helbing
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  ABSTRACT: Cardiovascular magnetic resonance (CMR) imaging provides highly accurate measurements of biventricular volumes and mass and is frequently used in the follow-up of patients with acquired and congenital heart disease (CHD). Data on reproducibility are limited in patients with CHD, while measurements should be reproducible, since CMR imaging has a main contribution to decision making and timing of (re)interventions. The aim of this study was to assess intra-observer and interobserver variability of biventricular function, volumes and mass in a heterogeneous group of patients with CHD using CMR imaging. Thirty-five patients with CHD (7–62years) were included in this study. A short axis set was acquired using a steady-state free precession pulse sequence. Intra-observer and interobserver variability was assessed for left ventricular (LV) and right ventricular (RV) volumes, function and mass by calculating the coefficient of variability. Intra-observer variability was between 2.9 and 6.8% and interobserver variability was between 3.9 and 10.2%. Overall, variations were smallest for biventricular end-diastolic volume and highest for biventricular end-systolic volume. Intra-observer and interobserver variability of biventricular parameters assessed by CMR imaging is good for a heterogeneous group of patients with CHD. CMR imaging is an accurate and reproducible method and should allow adequate assessment of changes in ventricular size and global ventricular function.
  The International Journal of Cardiovascular Imaging 04/2012; 26(1):57-64. · 2.29 Impact Factor
• Article: Relation of prolonged tissue Doppler imaging-derived atrial conduction time to atrial arrhythmia in adult patients with congenital heart disease.

  Annelies E van der Hulst, Arno A W Roest, Eduard R Holman, Hubert W Vliegen, Mark G Hazekamp, Jeroen J Bax, Nico A Blom, Victoria Delgado
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  ABSTRACT: Atrial arrhythmia (AA) is common in adult patients with congenital heart disease (CHD). To enable the prevention of AA or its complications, timely identification of adult patients with CHD at risk of AA is crucial. Long total atrial activation times have been related to AA. Tissue Doppler imaging (TDI) permits noninvasive evaluation of the total atrial conduction time (PA-TDI duration). The present study evaluated the association between the PA-TDI duration and the development of AA in adult patients with CHD. A total of 223 adult patients with CHD were followed up for the occurrence of AA after PA-TDI duration assessment. The PA-TDI duration was defined as the interval from the onset of the P wave on the electrocardiogram to the peak of the A' wave at the lateral atrial wall on TDI tracings. Among the various clinical and echocardiographic parameters, the association between the PA-TDI duration and AA occurrence was investigated. The median follow-up was 39 months (interquartile range 21 to 57). A PA-TDI duration of ≥126 ms was associated with AA during follow-up (log-rank, p <0.001). On multivariate analysis, a PA-TDI duration >126 ms (hazard ratio 2.25, 95% confidence interval 1.21 to 4.19) and history of AA (hazard ratio 4.89, 95% confidence interval 2.75 to 8.71) were independently associated with the occurrence of AA. In conclusion, PA-TDI duration and a history of AA were independently associated with the occurrence of AA in adult patients with CHD. The PA-TDI duration is a useful tool to identify patients with CHD at risk of AA during follow-up.
  The American journal of cardiology 03/2012; 109(12):1792-6. · 3.58 Impact Factor
• Article: Patients with a congenital heart defect and Type D personality feel functionally more impaired, report a poorer health status and quality of life, but use less healthcare.

  Dounya Schoormans, Barbara Jm Mulder, Joost P van Melle, Els G Pieper, Arie Pj van Dijk, Gert-Jan Tj Sieswerda, Mariët S Hulsbergen-Zwarts, Thijs Hwm Plokker, Leo Gh Brunninkhuis, Hubert W Vliegen, Mirjam Ag Sprangers
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  ABSTRACT: Background: Type D personality, characterized by high levels of negative affectivity and social inhibition, is related to mortality, morbidity, poor health status, quality of life (QoL) and less healthcare utilization in various cardiovascular patient groups. To date, studies in patients with congenital heart disease (CHD) are lacking. Aims: (1) To examine the prevalence of Type D personality in CHD patients; (2) to compare Type D to non-Type D patients with regard to disease severity, functional status, health status and QoL; and (3) to examine the extent to which Type D personality is independently related to healthcare utilization. Methods: A total of 1109 adult CHD patients were included in a questionnaire survey. Due to missing data, 302 patients were excluded. Results: The prevalence of Type D personality was 20.4%. Type D patients reported a poorer functional status, health status and QoL than non-Type D patients (p<0.05). Type D patients reported less healthcare use than non-Type D patients (primary and cardiac outpatient healthcare: adjusted OR=0.56, 95% CI=0.35-0.90; inpatient healthcare: adjusted OR=0.38, 95% CI=0.17-0.83). Results of a post-hoc analysis showed a high prevalence of Type D personality in patients with a poor functional status who did not consult their cardiologist. Conclusion: Type D patients report a poorer functional status, health status and QoL, but less healthcare utilization. In clinical practice, patients should be screened for Type D personality, since social inhibition may prevent them from contacting a healthcare provider in the event of symptom aggravation.
  European journal of cardiovascular nursing: journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology 03/2012; 11(3):349-55.
• Article: Abnormal right atrial and right ventricular diastolic function relate to impaired clinical condition in patients operated for tetralogy of Fallot.

  Saskia E Luijnenburg, Rosanne E Peters, Rob J van der Geest, Adriaan Moelker, Jolien W Roos-Hesselink, Yolanda B de Rijke, Barbara J M Mulder, Hubert W Vliegen, Willem A Helbing
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  ABSTRACT: BACKGROUND: Atrial enlargement may reflect ventricular diastolic dysfunction. Although patients with tetralogy of Fallot (TOF) have been studied extensively, little is known about atrial size and function. We assessed bi-atrial size and function in patients after TOF repair, and related them to biventricular systolic and diastolic function, and clinical parameters. METHODS: 51 Patients (21±8years) and 30 healthy controls (31±7years) were included and underwent magnetic resonance imaging to assess bi-atrial and biventricular size, systolic and diastolic function. Patients also underwent exercise testing, and N-terminal prohormone brain natriuretic peptide (NT-proBNP) assessment. RESULTS: In patients, right atrial (RA) minimal volume (34±8ml/m(2) vs. 28±8ml/m(2), p=0.001) and late emptying fraction were increased; RA early emptying fraction was decreased. Patients had longer right ventricular (RV) deceleration time (0.24±0.10 vs. 0.13±0.04, p<0.001), reflecting impaired RV relaxation, and larger RV volumes. Patients with end-diastolic forward flow (EDFF) had larger RA and RV size, abnormal RA emptying, higher NT-proBNP levels, higher VE/VCO(2) slope (ventilatory response to carbon dioxide production), and the most abnormal LV diastolic function (impaired compliance). Patients with abnormal RA emptying (reservoir function <30% and pump function >24%) had higher NT-proBNP levels and worse exercise capacity. RA minimal volume was associated with RV end-diastolic volume (r=0.35, p=0.013). CONCLUSIONS: In TOF patients with moderate RV dilatation, abnormal bi-atrial function and biventricular diastolic dysfunction are common. Abnormal RA emptying was associated with signs of impaired clinical condition, as was the presence of EDFF. These parameters, together with RA enlargement, could serve as useful markers for clinically relevant RV diastolic dysfunction.
  International journal of cardiology 03/2012; · 7.08 Impact Factor
• Article: Increased risk for ascending aortic dilatation in patients with complex compared to simple aortic coarctation.

  Paul Luijendijk, Rutger J Franken, Joris W J Vriend, Aeilko H Zwinderman, Hubert W Vliegen, Michiel M Winter, Maarten Groenink, Berto J Bouma, Barbara J M Mulder
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  ABSTRACT: AIMS: Aortic coarctation (CoA) occurs as a "simple" isolated disorder, and in a more "complex" form, combined with associated congenital cardiac abnormalities. Long term outcome of all CoA patients may be complicated by dilatation of the thoracic aorta. The aim of this study was to quantify progressive aortic dilatation, and identify determinants for progressive aortic dilatation. METHODS AND RESULTS: Cardiovascular Magnetic Resonance Imaging (CMR) and echocardiographic data of 93 CoA patients were analyzed retrospectively on the progression, and determinants, of progressive thoracic aortic dilatation. Outcome of simple- versus complex CoA patients were compared. 93 CoA patients (mean age 39±12years, male 59%) were followed with CMR (follow-up 5.3±1.8years). Twenty-eight patients were classified as simple- and 68 as complex CoA. The mean progression rate of thoracic aortic dilatation was highest in the ascending aorta with 2.2±2.0mm/5years (range 0-7.2mm/5years). History of VSD (β=1.77, P=0.004) and an increased left ventricular mass index (β=0.02, P=0.04) were associated with progressive ascending aortic dilatation. Complex CoA patients show an increased progression rate compared to simple CoA patients with 2.4mm/5years versus 1.5mm/5years respectively. (P=0.03). CONCLUSION: Adult post-coarctectomy patients show an increased mean progression rate of ascending aortic dilatation with 2.2mm/5years. The progression rate of ascending aortic dilatation is increased in complex CoA patients, as compared to simple CoA patients. These findings point towards a more comprehensive genetic subset of patients with an increased risk for progressive ascending aortic dilatation.
  International journal of cardiology 02/2012; · 7.08 Impact Factor
• Source

  Available from: Jolien W Roos-Hesselink

  Article: Psychosocial impact of implantable cardioverter defibrillators (ICD) in young adults with Tetralogy of Fallot.

  Petra Opić, Elisabeth M W J Utens, Philip Moons, Dominic A M J Theuns, Arie P J van Dijk, Elke S Hoendermis, Hubert W Vliegen, Natasja M S de Groot, Maarten Witsenburg, Martin Schalij, Jolien W Roos-Hesselink
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  ABSTRACT: To investigate the psychosocial impact of having an implantable cardioverter defibrillator (ICD) in adults with Tetralogy of Fallot (ToF). Included were 26 ToF-patients with an ICD (age 44 ± 12 years), and two control groups consisting of 28 ToF-patients without an ICD (age 40 ± 10 years) and a group of 35 ICD-patients of older age without ToF (age 72.0 ± 8 years). This last control group was chosen to represent the "older general ICD population" with acquired heart disease seen at the out-patient clinic. Psychosocial functioning encompassed daily functioning, subjective health status, quality of life, anxiety, depression, coping and social support. ToF-patients with ICD showed diminished psychosocial functioning in comparison to ToF-patients without ICD. This was reflected by diminished subjectively perceived physical functioning (p = 0.01), general health perception (p < 0.01) and a lower satisfaction with life (p = 0.02). In comparison to older ICD-patients, ToF-patients with ICD showed less satisfaction with life (p = 0.03), experienced more anxiety (p = 0.01) and showed less favourable coping styles, although physical functioning was better for ToF-patients with ICD than for older ICD-patients (p = 0.01). More inappropriate shocks were found in ToF-patients with ICD compared to the older ICD-patients. In patients with ToF, ICD implantation had a major impact on psychosocial functioning which should be taken into account when considering ICD implantation in these young patients. To help improve psychosocial functioning, psychological counselling attuned to the specific needs of these patients may be useful.
  Clinical Research in Cardiology 02/2012; 101(7):509-19. · 2.95 Impact Factor
• Article: Bi-atrial function and its relation with biventricular function and clinical parameters in patients operated for tetralogy of Fallot.

  Saskia E Luijnenburg, Rosanne Peters, Rob J van der Geest, Adriaan Moelker, Jolien W Roos-Hesselink, Yolanda B de Rijke, Hubert W Vliegen, Barbara J Mulder, Willem A Helbing
  Journal of Cardiovascular Magnetic Resonance 02/2012; 14 Suppl 1:P124. · 3.72 Impact Factor
• Article: Diagnosis and mortality prediction in pulmonary hypertension: the value of the electrocardiogram-derived ventricular gradient.

  Roderick W C Scherptong, Ivo R Henkens, Gijs F L Kapel, Cees A Swenne, Klaas W van Kralingen, Menno V Huisman, Annemie J M Schuerwegh, Jeroen J Bax, Ernst E van der Wall, Martin J Schalij, Hubert W Vliegen
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  ABSTRACT: The aim of this study was to investigate the use of the electrocardiogram-derived ventricular gradient, projected on the x-axis (VGx), for detection of pulmonary hypertension (PH) and for prediction of all-cause mortality in PH patients. In patients referred for PH screening (n = 216), the VGx was calculated semiautomatically from the electrocardiogram and was defined as abnormal when less than 24 mV · ms. The VGx of PH patients was compared with the VGx of patients without PH. The association between a reduced VGx and mortality was investigated in PH patients. Patients with PH (n = 117) had a significantly reduced VGx: 14 ± 27 vs 45 ± 23 mV · ms, P < .001. Furthermore, a severely reduced VGx (<0 mV · ms) was associated with increased mortality in PH patients: hazard ratio, 1.025 (95% confidence interval, 1.006-1.045; P = .012) per mV·ms VGx decrease. Reduced VGx is associated with the presence of PH and, more importantly, within PH patients, a severely reduced VGx predicts mortality.
  Journal of electrocardiology 01/2012; 45(3):312-8. · 1.08 Impact Factor
• Article: Biventricular performance in patients with marfan syndrome without significant valvular disease: comparison to normal subjects and longitudinal follow-up.

  Roderick W C Scherptong, Hubert W Vliegen, Ernst E van der Wall, Yvonne Hilhorst-Hofstee, Jeroen J Bax, Arthur J Scholte, Victoria Delgado
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  ABSTRACT: The presence and progressive nature of primary myocardial involvement in Marfan syndrome are debated. The aim of this study was to evaluate the clinical relevance of left ventricular (LV) and right ventricular (RV) strain in adult patients with Marfan syndrome without significant valvular disease. Adult patients with Marfan syndrome (n = 50; mean age, 35.2 ± 12.9 years) were followed prospectively. Echocardiography was performed annually and consisted of comprehensive assessment of ventricular and valvular function. Using speckle-tracking imaging, the baseline strain values of the Marfan population were calculated and compared with the values of normal controls. The follow-up evaluations were used to assess changes in ventricular strain. The association between the incidence of adverse events (heart failure, [supra]ventricular arrhythmias, and proximal aorta surgery) and baseline strain values was investigated. Compared with controls, patients with Marfan syndrome had significantly lower peak longitudinal LV strain (-18.9 ± 2.3% vs -20.1 ± 1.9%, P < .01) and RV strain (±26.9 ± 5.2% vs ±29.3 ± 4.25%, P < .01). The absolute changes in LV longitudinal, radial, and circumferential strain and RV longitudinal strain during a median 4 years of follow-up were 0.1 ± 2.8%, 1.12 ± 7.6%, 0.3 ± 3.7%, and 0.9 ± 5.5%, respectively, which was not statistically significant. Cox regression demonstrated that reduced LV or RV strain was not associated with adverse outcome (supraventricular arrhythmias, n = 3; proximal aorta surgery, n = 4). This study suggests that patients with Marfan syndrome show lower ventricular strain and strain rate values compared with healthy controls. However, no relevant changes in LV and RV function occurred during midterm follow-up in patients with Marfan syndrome without valvular disease at baseline. Although ventricular strain and strain rate were mildly reduced in patients with Marfan syndrome, this did not affect outcomes negatively in the present study.
  Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 12/2011; 24(12):1392-1399.e1. · 2.98 Impact Factor