Mark Schuuring

University of Twente | UT

Guideline-directed medical therapy (GDMT) has clear benefits on morbidity and mortality in patients with heart failure; however, GDMT use remains low. In the multicenter, open-label, investigator-initiated ADMINISTER trial, patients (n = 150) diagnosed with heart failure and reduced ejection fraction (HFrEF) were randomized (1:1) to receive usual c...

Heart failure with preserved ejection fraction (HFpEF) represents an increasingly common cardiovascular condition, now accounting for almost one-half of all heart failure (HF) cases. 1 As the prevalence continues to increase, efficient risk stratification and personalized care is needed. 2 However, predicting clinical outcomes in these patients is...

Aims To describe the clinical practice and educational preparation of heart failure (HF) nurses across Europe and determine the key differences between countries. Methods and results A survey tool was developed, in English, by the Heart Failure Association Patient Care committee of the European Society of Cardiology (ESC). It was translated into e...

Aims This study aimed to validate the machine learning-based Global Registry of Acute Coronary Events (GRACE) 3.0 score and PRAISE (Prediction of Adverse Events following an Acute Coronary Syndrome) in patients with acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI) for predicting mortality. Methods and results Dat...

Purpose: Interpreting echocardiographic exams requires substantial manual interaction as videos lack scan-plane information and have inconsistent image quality, ranging from clinically relevant to unrecognizable. Thus, a manual prerequisite step for analysis is to select the appropriate views that showcase both the target anatomy and optimal image...

The 2021 European Society of Cardiology guideline on diagnosis and treatment of acute and chronic heart failure (HF) and the 2023 Focused Update include recommendations on the pharmacotherapy for patients with New York Heart Association (NYHA) class II–IV HF with reduced ejection fraction. However, multinational data from the EVOLUTION HF study fou...

Purpose: Interpreting echocardiographic exams requires substantial manual interaction as videos lack scan-plane information and have inconsistent image quality, ranging from clinically relevant to unrecognizable. Thus, a manual prerequisite step for analysis is to select the appropriate views that showcase both the target anatomy and optimal image...

Cardiac imaging plays a pivotal role in the diagnosis and management of cardiovascular diseases. In the burgeoning landscape of digital technology and social media platforms, it becomes essential for cardiac imagers to know how to effectively increase the visibility and the impact of their activity. With the availability of social sites like X (for...

The European Society of Cardiology guidelines for the management of adult congenital heart disease patients recommend screening for arrhythmias and bradycardias in symptomatic patients, often being done by means of an ambulatory 24–48-hour Holter or implantable loop recorder (ILR). However, nowadays non-invasive instruments, such as patches, smartw...

Purposeof Review Guideline-directed medical therapy (GDMT) underuse is common in heart failure (HF) patients. Digital solutions have the potential to support medical professionals to optimize GDMT prescriptions in a growing HF population. We aimed to review current literature on the effectiveness of digital solutions on optimization of GDMT prescri...

Aims The European Society of Cardiology guidelines recommend risk stratification with limited clinical parameters such as left ventricular (LV) function in patients with chronic coronary syndrome (CCS). Machine learning (ML) methods enable analysis of complex datasets including transthoracic echocardiography (TTE) studies. We aimed to evaluate the...

Aims Many heart failure (HF) patients do not receive optimal guideline‐directed medical therapy (GDMT) despite clear benefit on morbidity and mortality outcomes. Digital consults (DCs) have the potential to improve efficiency on GDMT optimization to serve the growing HF population. The investigator‐initiated ADMINISTER trial was designed as a pragm...

Introduction Work related injury is common in medical sonographers. A robotic arm designed to assist in a (transthoracic echocardiography) TTE might be a useful alternative to alleviate the muscle strain of sonographers. Purpose In this study the feasibility and safety of a robotic device intended to improve the ergonomics of TTE is tested. Metho...

Smart devices such as smartphones and smart-watches are increasingly used for digital healthsolutions to manage diseases and track healthgoals.1 The expansion of digital health solutions andthe number of vendors emerged particularly duringthe COVID-19 pandemic.2-4 Benefit of these solutionsis often expected through increased health aware-ness, pati...

Background The European Society of Cardiology 2019 Guidelines on chronic coronary syndrome (CCS) recommend echocardiographic measurement of the left ventricular function for risk stratification in all patients with CCS. Whereas CCS and valvular heart disease (VHD) share common pathophysiological pathways and risk factors, data on the impact of VHD...

Funding Acknowledgements Type of funding sources: None. Introduction Injury to the left circumflex artery (LCA) occurs in an estimated 2.7% of patients undergoing mitral valve (MV) surgery. The average distance from the LCA to the MV varies substantially between patients but is on average 3.1 ± 1.3mm. In unfavorable anatomical variations, a 3D pri...

Funding Acknowledgements Type of funding sources: None. Introduction Echocardiographic left ventricular (LV) global longitudinal strain (GLS) may be used to detect subclinical ventricular dysfunction in patients who have received cardiotoxic chemotherapy. However, in some persons participating in recreational sports, GLS at rest may be lower than...

Background The European Society of Cardiology (ESC) guidelines for the management of adult congenital heart disease (ACHD) recommend screening in patients at risk for arrhythmic events. However, the optimal mode of detection is unknown. Methods Baseline and follow-up data of symptomatic ACHD patients who received an implantable loop recorder (ILR)...

Background Various electrocardiogram (ECG)-based devices are available for home monitoring, but the reliability in adults with CHD is unknown. Therefore, we determined the accuracy of different ECG-based devices compared to the standard 12-lead ECG in adult CHD. Methods and results This is a single-centre, prospective, cross-sectional study in 176...

Digital health technology is receiving increasing attention in cardiology. The rise of accessibility of digital health tools including wearable technologies and smart phone applications used in medical practice has created a new era in healthcare. The coronavirus pandemic has provided a new impetus for changes in delivering medical assistance acros...

The role of subclinical atrial fibrillation as a cause of cryptogenic stroke is unambiguously established. Long-term electrocardiogram (ECG) monitoring remains the sole method for determining its presence following a negative initial workup. This position paper of the European Society of Cardiology Working Group on e-Cardiology first presents the d...

Purpose of Review Artificial intelligence (AI) applications in (interventional) cardiology continue to emerge. This review summarizes the current state and future perspectives of AI for automated imaging analysis in invasive coronary angiography (ICA). Recent Findings Recently, 12 studies on AI for automated imaging analysis In ICA have been publi...

Funding Acknowledgements Type of funding sources: None. Introduction The most recent European Society of Cardiology guideline on coronary syndromes recommends echocardiography in all patients with suspected coronary artery disease (CAD). Whereas left ventricular function (LVF) is recognized as an important determinant of major adverse cardiovascul...

Introduction Left ventricular function (LVF) is a well-known recognized predictor of major adverse cardiovascular events (MACE) in patients with coronary artery disease (CAD) and is recommended in all CAD patients by the guidelines of the European Society of Cardiology. As non-obstructive CAD is more common among women, the predictive value of LVF...

Background Video consultation (VC) has been scaled up at our academic centre attempting to facilitate and accommodate patient-provider interaction in times of social distancing during the recent and ongoing COVID-19 pandemic. Objectives This study evaluates qualitative outcomes with data insights from the electronic health record, to contrast sati...

Introduction: Echocardiography is widely used because of its portability, high temporal resolution, absence of radiation, and due to the low-costs. Over the past years, echocardiography has been recommended by the European Society of Cardiology in most cardiac diseases for both diagnostic and prognostic purposes. These recommendations have led to a...

Commercially available health technologies such as smartphones and smartwatches, activity trackers and eHealth applications, commonly referred to as wearables, are increasingly available and used both in the leisure and healthcare sector for pulse and fitness/activity tracking. The aim of the Position Paper is to identify specific barriers and know...

Patients with congenital heart disease (CHD) are a vulnerable subgroup of cardiac patients. These patients have a high morbidity and high mortality rate. As the number of patients with CHD keeps growing, while also getting older, new tools for the care and follow-up of these vulnerable patients are warranted. eHealth has an enormous potential to re...

Background The growing availability of mobile phones increases the popularity of portable telemonitoring devices. An atrial fibrillation diagnosis can be reached with a recording of 30s on such telemonitoring devices. However, current commercially available automatic algorithms still require approval by experts. Purpose In this research we aimed t...

Background: Type D personality has been previously shown to increase the risk for mortality in patients with acquired heart disease. Objective: We aimed to compare mortality in adult patients with congenital heart disease (CHD) with and without type D. Methods: Survival was assessed using prospective data from the Dutch national Congenital Cor...

Background Mobile health (mHealth) can improve quality of care and empower cardiac patients. However, large-scale adoption is still lacking, as several challenges continue to be encountered in daily practice. We aimed to explore the mHealth experiences and challenges in cardiac patients, healthcare professionals, healthcare managers and information...

Background: Despite the increase in use and high expectations of digital health solutions, scientific evidence about the effectiveness of electronic health (eHealth) and other aspects such as usability and accuracy is lagging behind. eHealth solutions are complex interventions, which require a wide array of evaluation approaches that are capable of...

Background 22q11.2 Deletion syndrome (22q11.2DS) is common in patients with tetralogy of Fallot (TOF) or pulmonary atresia with ventricular septal defect (PA/VSD) and is associated with worse outcomes in children. Whether this impaired prognosis is also translated into adulthood is unknown, as data in adult patients are limited. We aimed to compare...

An 80-year-old man with a history of atrial fibrillation developed heart failure in 3 days. Soon after ad-mission he went into cardiogenic shock. Electrocardiography demonstrated inferoposterior ischaemia. Transthoracic echocardiography demon-strated an anterolateral papillary muscle (APM) rupture, which was confirmed by transoesophagealechocardiog...

Background: Adults with congenital heart disease (ACHD) often suffer from deterioration related to cardiac arrhythmias, hypertension (HT) or heart failure (HF), frequently occurring between planned visits. Mobile health (mHealth) could improve management through remote monitoring by enabling swift therapeutic response and detecting new diagnoses....

Purpose Mobile health (mHealth) could improve the outcome of grown-up patients with congenital heart disease (GUCH) and reduce their emergency care utilisation. Inappropriate use of mHealth, however, can lead to data overload for professionals and unnecessary data collection for patients, increasing the burden for both. We aimed to determine the cl...

Introduction: Cardiac rehabilitation is aimed at risk factor modification and improving quality of life. eHealth has a couple of potential benefits to improve this aim. The primary purpose of this review is to summarize available literature for eHealth strategies that have been investigated in randomized controlled trials in post-myocardial infarct...

Background Arrhythmias and heart failure are common and invalidating sequelae in adult patients with congenital heart disease (CHD). Mobile health (m-Health) enables daily monitoring and a timely response that might prevent deterioration. We present an observational prospective registry to evaluate feasibility of an m‑Health telemonitoring program...

Background: Scarce data on crowdfunding report a maximal funding of €10.000,-, and state that research is needed to attract attention of larger granting organizations. The aims of this project were 1) to fund an eHealth study in grown-up congenital heart disease (GUCH) patients 2) to contemplate on critical success factors. Methods: After peer revi...

Introduction: Mobile health (mHealth), an advanced form of eHealth is expected to drastically change the field of traditional healthcare in the near future as wearables and mobile applications are rapidly increasing in number. The majority of patients with congenital heart disease (CHD) now reach adulthood and this relative young patient population...

Right ventricular (RV) failure is frequently encountered in the intensive care unit. This clinical syndrome may be difficult to diagnose and treat. RV failure is commonly characterised by oedema, elevated jugular venous pressure, hypotension and in worse cases shock or multi-organ failure. High-risk patients include those with cardiac surgery, ARDS...

Background Adult patients with pulmonary arterial hypertension due to congenital heart disease (PAH-CHD) suffer from high mortality. This underlines the importance of adequate risk stratification to guide treatment decisions. Several baseline parameters are associated with mortality, however, their prognostic value may weaken after years of follow-...

A 44-year-old woman with a history of pulmonary embolism and abdominal echinococcosis complained of sudden thoracic pain and shortness of breath. A D-dimer of 77.5 mg/l (reference ≤0.5 mg/l) was found. Chest CT scan revealed obstruction of the right lower and middle lobe pulmonary artery (PA). Anticoagulation therapy was initiated for the presumed...

Objective Many adults with congenital heart disease (CHD) are affected lifelong by cardiac events, particularly arrhythmias and heart failure. Despite the care provided, the cardiac event rate remains high. Mobile health (mHealth) brings opportunities to enhance daily monitoring and hence timely response in an attempt to improve outcome. However, i...

A 72-year-old Slovakian woman was referred to our Heart Center for aortic valve replacement because of severe aortic stenosis. Her medical history revealed arthralgia and bilateral hip replacement. She reported shortness of breath on exertion. Physical examination revealed aortic valve stenosis. Besides a mild anemia (hemoglobin 7.6 mmol/L), the re...

BACKGROUND: Advanced treatment of pulmonary arterial hypertension (PAH) in congenital heart disease (CHD) is increasingly applied worldwide following the-mainly Western world based-international PAH-CHD guidelines. However, studies comparing clinical presentation and outcome after the initiation of PAH-specific treatment are lacking. We aimed to an...

Background: Adults with pulmonary arterial hypertension due to congenital heart disease (PAH-CHD) have a poor prognosis. Identifying patients with a high risk for clinical events and death is important because their prognosis can be improved by intensifying their treatment. Cystatin C, a novel cardiac biomarker, correlates with right ventricular d...

Background: Decrease in quality of life (QoL) in left-sided heart failure precedes poor survival, which can be reversed with exercise training. We investigated whether QoL is associated with mortality in pulmonary arterial hypertension due to congenital heart disease (PAH-CHD) patients. Methods: In this observational study, PAH-CHD adults referr...

Purpose: Patients with congenital heart disease (CHD) often undergo right-sided surgery, and contribution of the right ventricle (RV) to their cardiac pump function is essential. We aimed to identify determinants of adverse outcome after cardiac surgery. Methods: 503 consecutive adults (56% male, median age 36 years) with CHD operated between Janua...

AimsAn 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 resultsThis was a prospective, multicentre randomized open label trial in Fontan patients. On...

Objective Pulmonary arterial hypertension due to congenital heart disease (CHD-PAH) has a poor prognosis. We sought to determine whether the biomarker high-sensitivity troponin T (hsTnT) measured on routine visit at the outpatient clinic is associated with prognosis. PatientsConsecutive adult CHD-PAH (86% Eisenmenger syndrome) patients referred for...

Identification of adults with congenital heart disease (CHD) who were lost to cardiological follow-up. Cross-sectional study. Adults with CHD and not under cardiological follow-up were asked via a nationwide publicity campaign to contact the CONCOR (CONgenital CORvitia) project group. A total of 593 patients with mild (85%) to moderate-severe (15%)...

IntroductionPulmonary arterial hypertension (PAH) is a progressivedisease with poor survival. PAH is classified by the 2009updated clinical classification of pulmonary hypertensionand a major subgroup is PAH due to congenital heartdisease (CHD) with systemic-to-pulmonary shunt [1]. Thisshunting may lead to extensive histological changes in thedista...

Pulmonary arterial hypertension (PAH) is a severe, progressive disease, which can present idiopathically or secondary to conditions such as systemic sclerosis or congenital heart disease (CHD) [1]. In the setting of CHD-PAH a systemic-to-pulmonary shunt and increased volume overload ultimately lead to adaptations of pulmonary vasculature and endoth...

Introduction: Pulmonary arterial hypertension (PAH) in patients with congenital heart disease (CHD) usually has a homogeneous pressure distribution. More rarely, complex CHD patients have segmental PAH. This is often post-surgically. The characteristics of these patients and their responsiveness to specific pulmonary vasodilator therapy have not b...