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Eric Boersma

Publications and source records attributed to Eric Boersma.

At least 73 records · Page 4Linked to original sources
PubMed2005

Comparison of effectiveness of cardiac resynchronization therapy in patients <70 versus > or =70 years of age.

In the present study, the effects of cardiac resynchronization therapy (CRT) in elderly patients were evaluated. The study included 170 consecutive patients whose clinical and echocardiographic improvements were evaluated after 6 months of follow-up. Survival was evaluated up to 2 years. The effects of CRT in elderly patients (age > or =70 years) were compared with those in younger patients (age <70 years).

Age Factors↗
PubMed2005

The spectrum of adult congenital heart disease in Europe: morbidity and mortality in a 5 year follow-up period. The Euro Heart Survey on adult congenital heart disease.

AIMS: To describe clinical and demographic characteristics at baseline of a European cohort of adults with congenital heart disease (CHD) and to assess mortality and morbidity in a 5 year follow-up period. METHODS AND RESULTS: Data collected as part of the Euro Heart Survey on adult CHD was analysed. This entailed information transcribed from the files of 4110 patients diagnosed with one of eight congenital heart conditions ('defects'), who consecutively visited the outpatient clinics of one of the participating centres in 1998. The patients were included retrospectively and followed until the end of 2003 for a median follow-up of 5.1 years. Notwithstanding their overall relatively good functional class and low mortality over the follow-up period, a considerable proportion of the patients had a history of endocarditis, arrhythmias, or vascular events. There were major differences between the eight defects, both in morbidity and regarding specific characteristics. Outcomes were worst in cyanotic defects and in the Fontan circulation, but a considerable proportion of the other patients also suffer from cardiac symptoms. In particular, arrhythmias are common. CONCLUSION: The spectrum of adult CHD in Europe emerging from this survey is one of a predominantly young population with substantial morbidity but relatively low mortality in a 5 year period.

Adolescent↗
PubMed2005

Tirofiban and sirolimus-eluting stent vs abciximab and bare-metal stent for acute myocardial infarction: a randomized trial.

CONTEXT: Bare-metal stenting with abciximab pretreatment is currently considered a reasonable reperfusion strategy for acute ST-segment elevation myocardial infarction (STEMI). Sirolimus-eluting stents significantly reduce the need for target-vessel revascularization (TVR) vs bare-metal stents but substantially increase procedural costs. At current European list prices, the use of tirofiban instead of abciximab would absorb the difference in cost between stenting with sirolimus-eluting vs bare-metal stents. OBJECTIVE: To evaluate the clinical and angiographic impact of single high-dose bolus tirofiban plus sirolimus-eluting stenting vs abciximab plus bare-metal stenting in patients with STEMI. DESIGN, SETTING, AND PATIENTS: Prospective, single-blind, randomized controlled study (Single High Dose Bolus Tirofiban and Sirolimus Eluting Stent vs Abciximab and Bare Metal Stent in Myocardial Infarction [STRATEGY]) of 175 patients (median age, 63 [interquartile range, 55-72] years) presenting to a single referral center in Italy with STEMI or presumed new left bundle-branch block and randomized between March 6, 2003, and April 23, 2004. INTERVENTION: Single high-dose bolus tirofiban regimen plus sirolimus-eluting stenting (n = 87) vs standard-dose abciximab plus bare-metal stenting (n = 88). MAIN OUTCOME MEASURES: The primary end point was a composite of death, nonfatal myocardial infarction, stroke, or binary restenosis at 8 months. Secondary outcomes included freedom, at day 30 and month 8, from major cardiac or cerebrovascular adverse events (composite of death, reinfarction, stroke, and repeat TVR). RESULTS: Cumulatively, 14 of 74 patients (19%; 95% confidence interval [CI], 10%-28%) in the tirofiban plus sirolimus-eluting stent group and 37 of 74 patients (50%; 95% CI, 44%-56%) in the abciximab plus bare-metal stent group reached the primary end point (hazard ratio, 0.33; 95% CI, 0.18-0.60; P<.001 [P<.001 by Fischer exact test]). The cumulative incidence of death, reinfarction, stroke, or TVR was significantly lower in the tirofiban plus sirolimus-eluting stent group (18%) vs the abciximab plus bare-metal stent group (32%) (hazard ratio, 0.53; 95% CI, 0.28-0.92; P = .04), predominantly reflecting a reduction in the need for TVR. Binary restenosis was present in 6 of 67 (9%; 95% CI, 2%-16%) and 24 of 66 (36%; 95% CI, 26%-46%) patients in the tirofiban plus sirolimus-eluting stent and abciximab plus bare-metal stent groups, respectively (P = .002). CONCLUSION: Tirofiban-supported sirolimus-eluting stenting of infarcted arteries holds promise for improving outcomes while limiting health care expenditure in patients with myocardial infarction undergoing primary intervention.

Abciximab↗
PubMed2005

Optimizing the prediction of perioperative mortality in vascular surgery by using a customized probability model.

BACKGROUND: Accurately assessing the probability of perioperative mortality can be useful in preoperative risk assessment and management. This study aimed to revise and customize the revised cardiac risk (Lee) index to estimate the probability of perioperative all-cause mortality in patients undergoing noncardiac vascular surgery. METHODS: We studied 2310 patients (mean age, 67.8 +/- 11.3 years; 1747 males) who underwent acute or elective major noncardiac vascular surgery between January 1, 1991, and December 31, 2000, at the Erasmus Medical Center, Rotterdam, the Netherlands. A total of 1537 patients were assigned for model development, in which the associations between predictor variables and mortality occurring within 30 days after surgery were identified to modify the Lee index, which was then evaluated in a validation cohort of 773 patients. RESULTS: The perioperative mortality rates were similar in the development (n = 103 [6.7%]) and validation (n = 50 [6.5%]) populations. The customized risk-prediction model for perioperative mortality identified type of vascular surgery, ischemic heart disease, congestive heart failure, previous stroke, hypertension, renal dysfunction, and chronic pulmonary disease as being associated with increased risk, whereas beta-blocker and statin use were associated with a lower risk of mortality. The performance of the customized index had excellent discriminative ability in both derivation and validation populations (concordance statistic, 0.88 and 0.85, respectively). CONCLUSIONS: The customized index provides more detailed information than the Lee index about the type of vascular procedure, clinical risk factors, and concomitant medication use. The customized probability model can be a useful tool to estimate the risk of perioperative all-cause mortality and facilitate subsequent treatment strategies.

Aged↗
PubMed2005

Which parameters on magnetic resonance imaging determine Q waves on the electrocardiogram?

Studies have demonstrated that patients with Q-wave infarctions on the electrocardiogram (ECG) frequently have nontransmural scar formation, whereas non-Q-wave infarctions may have transmural scars. The precise pathophysiologic substrate that underlies Q waves remains unclear. Magnetic resonance imaging (MRI) is the preferred technique to evaluate patients who have infarction because information can be obtained on function, contractile reserve (viability), and scar tissue. Consecutive patients (n = 69) who had coronary artery disease and a history of myocardial infarction underwent MRI; the protocol included MRI at rest, small-dose dobutamine MRI, and contrast-enhanced MRI. Parameters included left ventricular ejection fraction, left ventricular volumes, end-diastolic wall thickness and contractile reserve in the infarct region, transmurality and spatial extent of scar tissue, total scar score, and quantified percent left ventricular scar tissue. MRI data were related to the presence/absence of Q waves on the ECG. Q waves were present in 39 patients (57%). Univariate analysis identified transmurality, spatial extent, total scar score, and quantified percent scar tissue as predictors of Q waves. Multivariate analysis demonstrated that quantified percent scar tissue was the single best predictor of Q waves on the ECG. A cut-off value of 17% infarcted tissue of the left ventricle yielded a sensitivity and specificity of 90% to predict the presence/absence of Q waves. When quantified percent scar tissue was removed from the model, spatial extent of infarction was the best predictor. Thus, Q waves on the ECG correlate best with quantified percent scar tissue on contrast-enhanced MR images.

Aged↗
PubMed2005

The clinical characteristics and investigations planned in patients with stable angina presenting to cardiologists in Europe: from the Euro Heart Survey of Stable Angina.

AIMS: The Euro Heart Survey of Stable Angina set out to prospectively study the presentation and management of patients with stable angina as first seen by a cardiologist in Europe, with particular reference to adherence to existing guidelines and regional variability in patient presentation and initial assessment. METHODS AND RESULTS: Consecutive outpatients with a clinical diagnosis by a cardiologist of stable angina were enrolled in the study and 3779 patients were included in the analysis. The average age was 61 years and 58% were male. The majority of patients (88%) had mild to moderate angina, CCS class I or II. Despite a high prevalence of recognized risk factors, 27% did not have cholesterol and 33% did not have glucose measured within 4 weeks of assessment. The resting ECG was abnormal in 41% of patients. An exercise ECG was performed or planned as part of initial investigation in 76% of patients and 18% had a stress imaging test such as perfusion scanning or stress echo. A coronary angiogram was performed or planned in 41%, and 64% had an echo. The time from assessment to investigation varied widely, particularly for angiography. One in 10 patients had neither any form of stress test nor angiography, with marked regional variation. Availability of invasive facilities increased the likelihood of both non-invasive and invasive investigations. Those with more severe symptoms or longer duration of symptoms or a positive non-invasive test were more likely to have angiography. In multivariable analysis, a positive stress test was the strongest predictor of the use of angiography, associated with a six-fold increase in the likelihood of invasive investigation. However, gender and availability of facilities were also predictive. CONCLUSION: Considerable variation in features at presentation and use of investigations has been identified in the stable angina population in Europe. The evaluation of biochemical cardiovascular risk factors was suboptimal. Overall rates of non-invasive investigation for angina and the clinical appropriateness of factors predictive of the use of invasive investigation were broadly in line with guidelines. However, the influence of access to facilities, and marked international variation in rates and timing of investigation suggest that factors unrelated to clinical need are also influential in the management of patients with stable angina.

Aged↗
PubMed2005

The initial management of stable angina in Europe, from the Euro Heart Survey: a description of pharmacological management and revascularization strategies initiated within the first month of presentation to a cardiologist in the Euro Heart Survey of Stable Angina.

AIMS: In order to assess adherence to guidelines and international variability in management, the Euro Heart Survey of Newly Presenting Angina prospectively studied medical therapy, percutaneous coronary intervention (PCI), and surgery in patients with new-onset stable angina in Europe. METHODS AND RESULTS: Consecutive patients, 3779 in total, with a clinical diagnosis of stable angina by a cardiologist were enrolled. After initial assessment by a cardiologist, 78% were treated with aspirin, 48% with a statin, and 67% with a beta-blocker. ACE-inhibitors were prescribed by the cardiologist in 37% overall. Revascularization rates were low, with only 501 (13%) patients having PCI or coronary bypass surgery performed or planned. However, when restricted to patients with coronary disease documented within 4 weeks of assessment, over 50% had revascularization performed or planned. Among other factors, the national rate of angiography and availability of invasive facilities significantly predicted the likelihood of revascularization, OR 2.4 and 2.0, respectively. CONCLUSION: This survey shows a shortfall between guidelines and practice with regard to the use of evidence-based drug therapy and evidence that revascularization rates are strongly influenced by non-clinical, in addition to clinical, factors.

Analysis of Variance↗
PubMed2005

Recovery of left ventricular function after primary angioplasty for acute myocardial infarction.

AIMS: To study recovery of segmental wall thickening (SWT), ejection fraction (EF), and end-systolic volume (ESV) after acute myocardial infarction (AMI) in patients who underwent primary stenting with drug-eluting stents. Additionally, to evaluate the predictive value of magnetic resonance imaging (MRI)-based myocardial perfusion and delayed enhancement (DE) imaging. METHODS AND RESULTS: Twenty-two patients underwent cine-MRI, first-pass perfusion, and DE imaging 5 days after successful placement of a drug-eluting stent in the infarct-related coronary artery. Regional myocardial perfusion and the transmural extent of DE were evaluated. A per patient perfusion score was calculated and consisted of a summation of all segmental scores. Myocardial infarct size was quantified by measuring the volume of DE. At 5 months after AMI, cine-MRI was performed and SWT, EF, and ESV were quantified. EF increased from 48+/-11 to 55+/-9% (P<0.01). SWT at 5 months was inversely related to baseline segmental DE scores (P<0.001) and segmental perfusion scores (P<0.001). EF and ESV at 5 months were related to acute infarct size (R(2)=0.65; P<0.001 and R(2)=0.78; P<0.001, respectively) and the calculated perfusion score (R(2)=0.23; P=0.02 and R(2)=0.14; P=0.09, respectively) at baseline. CONCLUSION: Marked recovery of left ventricular function was observed in patients receiving a drug-eluting stent for AMI. DE imaging appears to be a better prognosticator than perfusion imaging.

Analysis of Variance↗
PubMed2005

Impact of body mass index on the outcome of patients with multivessel disease randomized to either coronary artery bypass grafting or stenting in the ARTS trial: The obesity paradox II?

The effect of body mass index (BMI) on outcomes after coronary artery revascularization remains controversial. We studied 1,203 patients who had multivessel coronary artery disease and underwent stenting (n = 599) or coronary artery bypass grafting (CABG; n = 604) in the Arterial Revascularization Therapies Study. Patients were assigned to 1 of 3 groups according to BMI: <25, 25 to 30, and >30 kg/m(2). At 3-year follow-up, the incidence of death, cerebrovascular events, or myocardial infarction was similar for these BMI categories regardless of the revascularization technique used. Rates of repeat revascularization procedures were significantly higher among patients who had been randomized to stenting but were similar across BMI groups. For patients who had been randomized to undergo CABG, there was a significant decrease in repeat revascularization procedures in obese patients (p = 0.03). Among patients who underwent stenting, BMI had no effect on the 3-year combined end point of rate of major adverse cardiac or cerebrovascular events. Among patients who underwent CABG, major adverse cardiac or cerebrovascular event rates were significantly lower for patients who were obese (11%) or overweight (16%) compared with patients who had a normal BMI (24%; p = 0.008). Thus, in a large cohort of patients who had multivessel coronary artery disease and underwent surgical or percutaneous revascularization, BMI had no effect on 3-year outcome of those who underwent stenting. Conversely, among patients who underwent CABG, those who were overweight or obese had a significantly better outcome than did those who had a normal BMI with regard to survival without major adverse cardiac or cerebrovascular events, mainly due to lower rates of repeat revascularization procedures.

Angioplasty, Balloon, Coronary↗
PubMed2005

Cardiac multidetector-row computed tomography in patients with unstable angina.

Ideally, information on coronary artery stenosis and left ventricular (LV) function is obtained in patients who have unstable angina to allow optimal risk stratification. The value of multidetector-row computed tomography (MDCT) was evaluated for a simultaneous assessment of coronary artery disease and global/regional LV function using a single acquisition. Twenty-five patients who had unstable angina underwent a single multidetector-row computed tomographic acquisition using a 4-slice multidetector-row computed tomographic system. Based on retrospective electrocardiographic gating, images and cine movies were reconstructed, which allowed 2 independent observers to analyze the 9 major coronary artery segments and global/regional LV function. Conventional angiography (with quantitative analysis) and echocardiography served as standards of reference, which were performed </=2 +/- 2.7 days and </=3 hours, respectively, after multidetector-row computed tomographic investigations. Sensitivity, specificity, positive and negative predictive values, and correlations were calculated. Of 225 coronary artery segments, 182 (81%) were assessable by MDCT. Significant (>/=50%) coronary artery stenosis was detected with sensitivities, specificities, and positive and negative predictive values of 95%, 91%, 85%, and 97% for observer 1 and 89%, 87%, 79%, and 94% for observer 2, respectively; the interobserver kappa value was 0.73. MDCT showed excellent agreement with echocardiography for regional wall motion (90%; kappa = 0.88) and LV ejection fraction (correlation 0.95%, mean difference 0.7 +/- 3.9). Thus, MDCT can simultaneously assess coronary artery disease and LV function in patients who have unstable angina. High accuracies in excluding significant coronary artery disease and in confirming normal LV function were observed, suggesting potential clinical use for screening of patients who present with symptoms of unstable angina.

Angina, Unstable↗
PubMed2005

Atrial fibrillation: multi-detector row CT of pulmonary vein anatomy prior to radiofrequency catheter ablation--initial experience.

PURPOSE: To evaluate multi-detector row computed tomographic (CT) depiction of pulmonary veins to provide a road map for radiofrequency catheter ablation. MATERIALS AND METHODS: For patients, institutional review board (IRB) approval was not required, and consent was obtained for treatment. Control subjects were part of an IRB-approved research protocol at the institution, in which they had consented to participate. Multi-detector row CT was performed in 23 patients (17 men, six women; mean age, 48 years +/- 11 [standard deviation]) with atrial fibrillation who were admitted for isolation of pulmonary veins by means of radiofrequency catheter ablation. Pulmonary vein anatomy was evaluated, and diameters of pulmonary vein ostia were measured. To determine the shape of ostia, a venous ostium index was calculated for all veins by dividing anterior-posterior measurements by superior-inferior measurements. Results were compared with those in a control group of 11 patients (eight men, three women; mean age, 56 years +/- 11) without atrial fibrillation. Images were evaluated by two observers in consensus. RESULTS: Pulmonary veins additional to the four main veins were found in seven (30%) of 23 patients. Common ostia of left and right pulmonary veins were detected in 19 (83%) and nine (39%) patients, respectively. Early branching occurred more often with right than with left veins (19 [83%] vs three [13%] cases, P <.05) in both patients and control subjects. Anterior-posterior diameter of ostia was 12.8 mm +/- 3.3 for left veins, 16.2 mm +/- 3.8 for right veins, and 18.8 mm +/- 7.7 and 28.7 mm +/- 5.1 for left and right common ostia, respectively. Ostia of right pulmonary veins were more round than were ostia of left pulmonary veins (venous ostium index in patients, 0.91 +/- 0.21 vs 0.75 +/- 0.17, P <.05; in control subjects, 0.93 +/- 0.12 vs 0.82 +/- 0.17, P <.05). The CT data were used to determine ablation strategy and guide catheters during radiofrequency ablation. CONCLUSION: Multi-detector row CT provides a valuable road map for pulmonary vein anatomy prior to radiofrequency catheter ablation. Variations in number and insertion of pulmonary veins were observed in a considerable number of patients and control subjects.

Adult↗
PubMed2005

Assessment of myocardial viability by nuclear imaging techniques.

The assessment of myocardial viability has become important in the diagnostic and prognostic work up of patients with ischemic cardiomyopathy. Patients with viable myocardium may benefit from revascularization in terms of improvement of function, symptoms, and prognosis. In contrast, patients without viable myocardium do not benefit and should be treated conservatively. Various nuclear imaging techniques are available.

Animals↗
PubMed2005

Association of chronic kidney disease with clinical outcomes after coronary revascularization: the Arterial Revascularization Therapies Study (ARTS).

BACKGROUND: Chronic kidney disease (CKD) is associated with adverse outcomes after coronary artery bypass graft surgery (CABG) and percutaneous coronary interventions (PCI), but it is unclear which of these revascularization strategies is associated with lower risk for morbidity and mortality in this population. In the Arterial Revascularization Therapies Study (ARTS), we compared long-term clinical outcomes after CABG or PCI with multivessel stenting in patients with CKD. METHODS: The ARTS randomly assigned 1205 participants with and without CKD to CABG or PCI with multivessel stenting. We defined CKD as creatinine clearance < or =60 mL/min, estimated by the Cockroft-Gault equation. The primary outcome was the composite of death, myocardial infarction (MI), or stroke; and, a secondary outcome was repeat revascularization. Participants were followed for a mean of 3 years after their intervention. We evaluated whether randomization to CABG or PCI was associated with different outcomes among participants with CKD. RESULTS: Two hundred ninety participants (25%) had CKD at entry into ARTS. One hundred fifty-one received PCI, and 139 received CABG. No difference was observed in the primary endpoint with CABG or PCI among CKD participants (adjusted Hazard Ratio [HR] CABG vs PCI = 0.93; 95% CI 0.54-1.60; P = .97). However, CABG was associated with a reduced risk for repeat revascularization (HR = 0.28; 95% CI 0.14-0.54; P < .01). Compared with participants with normal renal function, CKD was associated with a nearly 2-fold risk for the primary outcome (unadjusted HR = 1.9; 95% CI 1.4-2.7; P < .01). After multivariate adjustment, this association remained significant (HR 1.6; 95% CI 1.1-2.4). CONCLUSIONS: In patients with multivessel CAD and CKD, treatment with CABG or PCI with multivessel stenting led to similar outcomes of death, MI, or stroke, but CABG was associated with decreased repeat revascularizations. When compared with ARTS participants with normal renal function, those with CKD had substantially elevated risk of adverse clinical outcomes after coronary revascularization.

Aged↗
PubMed2005

Applicability of clinical prediction models in acute myocardial infarction: a comparison of traditional and empirical Bayes adjustment methods.

INTRODUCTION: Several clinical prediction models have been developed to predict outcome after acute myocardial infarction. Updating to local circumstances may be required to make such models better applicable. We aimed to compare traditional and empirical Bayes (EB) methods to perform such updating. METHODS: We focused on 16 geographical regions within the GUSTO-I trial, which included 40,830 patients with acute myocardial infarction; of whom, 2851 (7.0%) had died by 30 days. Differences in mortality between regions were studied with traditional adjustment for case mix in logistic regression models and with EB methods. These methods updated predictions for new patients while accounting for the uncertainty in the traditionally estimated mortality differences. RESULTS: The case mix in the regions differed with respect to important predictive characteristics such as age, presence of shock, and anterior infarct location (all P < .001). These differences did not explain regional differences in 30-day mortality, which varied between 80% and 120% with traditional analyses (P < .01). The EB estimates for regional differences were much smaller (between 93% and 107%). CONCLUSIONS: Statistically significant differences in case mix and 30-day mortality were noted between geographical regions. The practical implications of this heterogeneity were, however, limited when model predictions were updated with EB methods.

Bayes Theorem↗
PubMed2005

Perioperative cardiovascular mortality in noncardiac surgery: validation of the Lee cardiac risk index.

PURPOSE: The Lee risk index was developed to predict major cardiac complications in noncardiac surgery. We retrospectively evaluated its ability to predict cardiovascular death in the large cohort of patients who recently underwent noncardiac surgery in our institution. METHODS: The administrative database of the Erasmus MC, Rotterdam, The Netherlands, contains information on 108 593 noncardiac surgical procedures performed from 1991 to 2000. The Lee index assigns 1 point to each of the following characteristics: high-risk surgery, ischemic heart disease, heart failure, cerebrovascular disease, renal insufficiency, and diabetes mellitus. We retrospectively used available information in our database to adapt the Lee index calculated the adapted index for each procedure, and analyzed its relation to cardiovascular death. RESULTS: A total of 1877 patients (1.7%) died perioperatively, including 543 (0.5%) classified as cardiovascular death. The cardiovascular death rates were 0.3% (255/75 352) for Lee Class 1, 0.7% (196/28 892) for Class 2, 1.7% (57/3380) for Class 3, and 3.6% (35/969) for Class 4. The corresponding odds ratios were 1 (reference), 2.0, 5.1, and 11.0, with no overlap for the 95% confidence interval of each class. The C statistic for the prediction of cardiovascular mortality using the Lee index was 0.63. If age and more detailed information regarding the type of surgery was retrospectively added, the C statistic in this exploratory analysis improved to 0.85. CONCLUSION: The adapted Lee index was predictive of cardiovascular mortality in our administrative database, but its simple classification of surgical procedures as high-risk versus not high-risk seems suboptimal. Nevertheless, if the goal is to compare outcomes across hospitals or regions using administrative data, the use of the adapted Lee index, as augmented by age and more detailed classification of type of surgery, is a promising option worthy of prospective testing.

Adult↗