Proefschriften 2011

T.AhmedInnovative therapies for optimizing outcomes of coronary artery disease

Tarek. A.N. Ahmed

Promotores: Prof. Dr. J.W. Jukema, Prof. Dr. M.J. Schalij

15 december 2011

This thesis aimed to evaluate the importance of combined pharmacological and mechanical adjunctive therapies for optimization of outcomes of primary percutaneous coronary intervention (PPCI) in the setting of ST-elevation myocardial infarction (STEMI), and to assess the predictors of large thrombus burden among STEMI patients and to what extent that would influence the outcomes and the pre-hospital triage of these patients. Furthermore, a special focus was granted on the clinical performance of biodegradable-polymer drug eluting stents (DES) comparing the incidence of definite stent thrombosis (DST) and target lesion revascularization (TLR); a) between biodegradable-polymer biolimus, sirolimus and paclitaxel DES, and b) between biodegradable-polymer DES and permanent polymer DES. We also discussed the recently emerging drugs for coronary artery disease, with special focus on antiplatelets, antithrombotics and antidyslipidemics. Finally, we provided an overview of post-stenting problems of in-stent restenosis and late stent malapposition.

N.AjmoneIncremental value of advanced cardiac imaging modalities for diagnosis and patient management

Focus on real-time three-dimensional echocardiography and magnetic resonance imaging

Nina Ajmone Marsan

Promotores: Prof. Dr. J.J. Bax, Prof. Dr. M.J. Schalij
3 november 2011

The objectives of this thesis were to investigate the incremental value of advanced

cardiac imaging modalities, and in particular of real-timethree-dimensional echocardiography (RT3DE), myocardial deformation imresynchronization therapy (CRT, Part IA). Different 3D measures of LV dyssynchrony, based on the full volume approach (Figure) or on the tri-plane approach were applied to improve candidate selection for CRT and to predict favorable response after implantation. In Part IB, RT3DE was applied in patients with atrial fibrillation or heart failure for the quantification of left atrium volume and for the assessment of different left atrial functions (conduit, active and reservoir function).aging, contrast-enhanced echocardiography and magnetic resonance imaging (CMR), for diagnosis and patient management in different cardiac disease. In Part I, the use of RT3DE for quantification of left ventricular (LV) volumes and function and for the assessment of LV dyssynchrony was explored in heart failure patients undergoing cardiac

vanderHulstAdvanced echocardiography and cardiac magnetic resonance in congenital heart disease

Insights in right ventricular mechanics and clinical implications

Annelies van der Hulst

Promotores: Prof. Dr. N.A. Blom, Prof. Dr. J.J. Bax, Prof. Dr. A. de Roos

20 oktober 2011

The first part of this thesis aimed to characterize ventricular mechanics and performance with advanced echocardiographic imaging techniques in patients with congenital heart disease (CHD), with particular focus on the right ventricle (RV). The second part of the thesis aimed to investigate the role of advanced cardiac magnetic resonance (CMR) techniques to characterize RV mechanics in CHD patients. CMR plays an increasing role during clinical follow-up of CHD patients, especially those with complex CHD. The prediction of clinical outcome is an important goal of clinical studies on cardiac imaging techniques. The last part of this thesis focused on the prediction of clinical outcome of CHD patients with the use of conventional and advanced echocardiographic techniques.

Douwepons(Epi)genetic Factor in Vascular Disease

Douwe Pons

Promotor: Prof. Dr. J.W. Jukema

22 september 2011

This thesis examines the impact of genetic and epigenetic factors on several aspects of vascular disease. Part 1 has addressed the influence of genetic variation in genes involved in the different processes that lead to the occurrence of adverse events after percutaneous coronary intervention (PCI), mainly restenosis after bare metal stent (BMS) placement, but also late acquired stent malapposition (LASM) after implantation of a drug-eluting stent (DES). The role of a relatively new area of research, which we refer to as 'epigenetic epidemiology' in restenosis and other aspects of coronary heart disease has been discussed in part 2.

J.AtaryAcute Myocardial Infarction Treatment

From Prehospital care to Secondary Prevention

Jael Z. Atary

Promotores: Prof.dr. M.J. Schalij, Prof.dr. E.E. van der Wall

22 september 2011


This thesis shows that consistent implementation of a structured regional treatment and prevention program for acute myocardial infarction patients is feasible when healthprofessionals of various disciplines collaborate. In chapter 3 results of the randomized MISSION!-intervention study demonstrates that safety of SES is comparable to BMS three years after the index event, in terms of death, stent thrombosis and nonfatal recurrent MI. In chapter 4 an effort was made to relate plaque characteristics at stent edges to clinical outcome at 9 months postPCI in 40 AMI patients by utilizing virtual histology intravascular ultrasound imaging (VH-IVUS). In the study presented in chapter 5, a strategy of adjunctive thrombus aspiration before primary PCI in AMI patients in combination with early abciximab administration, was associated with a significant improvement in post-procedural ST segment resolution and with a lower mortality at one year follow-up. In chapter 6 it was shown that the majority of occlusions occur in the proximal parts of the LAD and RCA with worse post-procedural LV function in particular for LAD and LCX culprit lesions. The study shows that plaques in the proximal parts of the LAD and RCA are more prone to rupture. Chapter 7 aimed to provide more insight into the clinical profile, treatment delays, medication compliance and 12 month outcome of treatment in the elderly AMI patient population (>75 years). The study presented in chapter 8 investigated clinical relevance of resting heat rate in post AMI patients who were treated with primary percutaneous intervention and relatively preserved LV-function. Chapter 9 aimed to assess the number of patients in daily clinical practice that meets criteria for implantation of an ICM following AMI when treated according to an aggressive treatment protocol. Findings of the study described in chapter 10 suggest the properties of the baseline stimulation threshold may be used clinically as an indicator of chronic changes caused by ischemic heart disease which increase the risk of arrhythmic event requiring ICD therapy and risk of mortality. Chapter 11 aimed to provide more long-term data on the characteritics of recurrent atrial tachyarrhythmias after ablation of post-operative tachyarrhythmias in 53 patients with congenital heart defects. The final chapter aimed to provide more insight into long-term outcome of cavotricuspid isthmus ablation in terms of atrial flutter recurrence and particularly in terms of atrial fibrillation occurrence.

J.vanWerkhoven aangepastCardiovascular Computed Tomography for Diagnosis and Risk Stratification of Coronary Artery Disease

Jaap .M. van Werkhoven

Promotores: Prof.dr. J.J. Bax; Prof.dr. J.W. Jukema; Prof.dr. A. de Roos
23 juni 2011

In part 1 of the thesis the value of CTA for diagnosis of CAD, and its relationship to existing diagnostic imaging modalities is described. In the second part the value of CTA for risk stratification is evaluated; in addition, the prognostic value of CTA is compared to other non-invasive imaging techniques used for risk stratification. In part 3 the potential future perspectives of CTA imaging are discussed. In addition to non-invasive coronary angiography and LV volume and function assessment, CTA also has the potential to assess myocardial perfusion imaging

bergheanuNew insights in mechanism, diagnosis and treatment of myocardial infarction

Sandrin. C. Bergheanu

Promotores: Prof. Dr. J.W. Jukema, Prof. Dr. F.R. Rosendael

21 april 2011

This thesis aimed to present new molecular and genetic findings in the pathology and diagnosis of acute myocardial infarction. Furthermore, a special focus was granted on the current invasive treatment ofmyocardial infarction. Here, new aspects were investigated inrelation to a) the role of IVUS in preventing late stent thrombosis, and b) differences in coronary plaque composition, as assessed with IVUS – Virtual Histology, after drug-eluting versus bare-metal stent implantation. Finally, the influence of the stent type as well as the patient's genetic profile were investigated in relation to the occurrence of post-stenting complications.