Kietselaer, Bas L J H

BACKGROUND: Transcatheter mitral valve-in-valve replacement is an established therapy for intermediate and high-risk patients with degenerated bioprostheses, but restricted transcatheter valve (THV) expansion within rigid surgical frames and elevated gradients have raised durability concerns. This study aimed to evaluate midterm outcomes of mitral valve-in-valve patients according to THV expansion and sizing strategy. METHODS: Patients who underwent mitral valve-in-valve with balloon-expandable valves at Mayo Clinic Rochester between 2014 and 2023 were retrospectively analyzed. THV expansion (inflow, waist, outflow) was measured from procedural fluoroscopy and indexed to nominal size, with zero indicating expansion to nominal dimensions. Median index values were used as subgroup cutoffs to compare the incidence of the primary composite outcome of all-cause mortality, heart failure readmission, and valve reintervention. RESULTS: The analysis included 80 patients with a median follow-up of 2.5 years. A total of 53 (66%) valves were underexpanded across all 3 sizes, with median inflow, waist, and outflow expansion indices of −10.2, −16.2, and −3.2, respectively. Across all indices, THV expansion closer to nominal size was associated with lower rates of the primary outcome ( P <0.05). Greater expansion correlated with a larger mitral valve area and lower transvalvular mean gradient. Oversized THVs were significantly less expanded and had a higher incidence of the primary composite outcome compared with recommended-size THVs ( P =0.02). CONCLUSIONS: THV underexpansion in degenerated mitral bioprostheses is common and associated with elevated gradients and worse midterm outcomes. Further research is warranted to define THV expansion targets and improve outcomes following mitral valve-in-valve intervention.

Objective Despite promising outcomes from pilot initiatives, the transition to widespread adoption and upscaling of eHealth solutions in the hospital context remains challenging. This study aims to explore the barriers and facilitators influencing the implementation of eCoaches from the perspective of professionals. Methods A qualitative research design was employed, involving individual semi-structured interviews with management and healthcare professionals ( n = 10) who were involved with an eCoach either for heart failure (HF) or inflammatory bowel disease (IBD). Both eCoaches supported remote monitoring, advisory, educational, and interactive care activities. Interview topics were guided by the Consolidated Framework for Implementation Research (CFIR), including the original five domains and the added domain Patients′ needs and Resources. Data were analyzed thematically. Results Barriers and facilitators were identified across all CFIR domains: eCoach design and licensing costs (Intervention Characteristics); financial compensation (Outer Setting); integration into care pathways, Information and Communication Technology (ICT) infrastructure, team dynamics, and task reallocation (Inner Setting); intrinsic motivation, beliefs, and competencies of professionals (Characteristics of Individuals); patient resources and digital literacy (Patients’ Needs and Resources); and availability of evidence and management information (Process of Implementation). Conclusion This study underscores the complex nature of implementing eCoaches within the hospital setting, where barriers and facilitators span multiple interrelated domains. To overcome “pilotitis” and achieve the sustainable integration of blended care for patients with chronic conditions, comprehensive implementation strategies that concurrently address all relevant domains are essential. By illuminating the experiences of healthcare professionals, this study offers actionable insights to guide the design, implementation, and upscaling of eCoaches and related eHealth technologies.

ABSTRACT Objective Pre‐eclampsia complicates up to 8% of pregnancies and is associated with increased risk of ischemic cardiac and cerebral disease, which may be prevented through management of cardiovascular risk when early disease stages are detected. This meta‐analysis aimed to determine the prevalence of clinical and subclinical atherosclerosis in women after pre‐eclamptic vs non‐pre‐eclamptic pregnancy with advancing maternal age. Methods A systematic search of the literature was conducted in PubMed, Embase and Web of Science for studies reporting on the prevalence of atherosclerosis in women with a previous pre‐eclamptic pregnancy and those with a previous uncomplicated pregnancy. Any systemic atherosclerosis documented using ultrasound or computed tomography was included. Random‐effects meta‐analysis was used to compute the odds ratio (OR) with 95% CI for the association between pre‐eclampsia and the presence of atherosclerosis. Subgroup analysis was conducted according to average maternal age at evaluation. Results A total of 11 articles were included (13 217 participants). The average maternal age at evaluation ranged from 32 to 60 years. Within this age range, the pooled OR for the presence of atherosclerotic plaque after pre‐eclampsia was 1.57 (95% CI, 1.39–1.78). The pooled OR of developing atherosclerotic plaque after a pre‐eclamptic vs non‐pre‐eclamptic pregnancy increased gradually with advancing maternal age. The OR was not significant in the 30–39‐year‐old group (0.64 (95% CI, 0.10–4.15)), but the odds of finding an atherosclerotic plaque were significantly increased after pre‐eclamptic pregnancy in the 40–49‐year‐old group (OR, 1.59 (95% CI, 1.34–1.89)) and 50–60‐year‐old group (OR, 2.00 (95% CI, 1.30–3.08)). At any given age, the percentage plaque prevalence in formerly pre‐eclamptic women was roughly equal to that seen 10 years later in women with a previous non‐pre‐eclamptic pregnancy. Conclusions Women with a previous pre‐eclamptic pregnancy exhibit atherosclerosis more frequently and approximately 10 years earlier compared with women with a previous non‐pre‐eclamptic pregnancy. Targeted primary prevention is required to reduce morbidity and mortality from premature cardiovascular disease in women after pre‐eclampsia. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Background Low-dose colchicine (0.5 mg once daily) reduces the risk of major cardiovascular events in coronary disease, but its mechanism of action is not yet fully understood. We investigated whether low-dose colchicine is associated with changes in pericoronary inflammation and plaque composition in patients with chronic coronary disease. Methods We performed a cross-sectional, nationwide, subanalysis of the Low-Dose Colchicine 2 Trial (LoDoCo2, n=5522). CT angiography studies were performed in 151 participants randomised to colchicine or placebo after a median treatment duration of 28.2 months. Pericoronary adipose tissue (PCAT) attenuation measurements around proximal coronary artery segments and quantitative plaque analysis for the entire coronary tree were performed using artificial intelligence-enabled plaque analysis software. Results Median PCAT attenuation was not significantly different between the two groups (−79.5 Hounsfield units (HU) for colchicine versus −78.7 HU for placebo, p=0.236). Participants assigned to colchicine had a higher volume (169.6 mm 3 vs 113.1 mm 3 , p=0.041) and burden (9.6% vs 7.0%, p=0.035) of calcified plaque, and higher volume of dense calcified plaque (192.8 mm 3 vs 144.3 mm 3 , p=0.048) compared with placebo, independent of statin therapy. Colchicine treatment was associated with a lower burden of low-attenuation plaque in participants on a low-intensity statin, but not in those on a high-intensity statin (p interaction =0.037). Conclusions Pericoronary inflammation did not differ among participants who received low-dose colchicine compared with placebo. Low-dose colchicine was associated with a higher volume of calcified plaque, particularly dense calcified plaque, which is considered a feature of plaque stability.

Objective To explore associations between general health-related problems and subclinical coronary artery disease (CAD), determined by CT coronary calcium score (CT-CCS), in a general population. Design A cross-sectional design. Setting This study was performed in a prospective population-based cohort, examining the health and health-related behaviour of individuals living in the Northern Netherlands. Participants The initial cohort comprised 6763 participants ≥45 years of age who underwent CT-scanning. Participants were included for the current analysis if they filled in three validated questionnaires (Symptomatic Checklist-90, Research and Development Survey-36 and Reviving the Early Diagnosis of CardioVascular Diseases questionnaire (RED-CVD)) and did not have a history of cardiovascular disease. The final analysis included 6530 participants. Primary outcome measure Backward-stepwise and forward-stepwise logistic regression analyses were performed to determine associations between general health-related problems and subclinical CAD (CCS≥100 and ≥300). Results The median age was 53 years (25th, 75th percentile: 48, 58); 57% were women. CRCS≥100 was found in 1236 (19%) participants, 437 (12%) in women and 799 (29%) men and CCS≥300 in 643 (9.9%) participants of which 180 (4.8%) were women and 463 (16.6%) men. In univariate analysis, in women the expectation of health to worsen (OR=1.13, 95% CI: 1.05 to 1.21), and in men reduced exercise intolerance (OR=1.14, 95% CI: 1.06 to 1.23) were associated with CCS≥100. The total RED-CVD score in women (OR=1.06, (95% CI: 1.05 to 1.08) and men (OR=1.07, 95% CI: 1.06 to 1.09), and in men also reduced exercise intolerance (OR=1.15, 95% CI: 1.06 to 1.25) and headache (OR=0.55, 95% CI: 0.38 to 0.79) were associated with CCS≥300. In multivariate analyses, only general health expectation in women was still significantly associated with subclinical CAD (CCS≥300) (OR=1.92, 95% CI: 1.56 to 2.37). Conclusion Only a few general health-related problems were associated with the presence of subclinical CAD in the general population, however, these problems showed no strong association. Therefore, using health-related symptoms does not seem useful to pre-select for CT-CCS. Trial registration number CCMO Register, NL17981.042.07 and NL58592.042.16.

Background We aimed to identify patients with subphenotypes of postacute coronary syndrome (ACS) using repeated measurements of high‐sensitivity cardiac troponin T, N‐terminal pro‐B‐type natriuretic peptide, high‐sensitivity C‐reactive protein, and growth differentiation factor 15 in the year after the index admission, and to investigate their association with long‐term mortality risk. Methods and Results BIOMArCS (BIOMarker Study to Identify the Acute Risk of a Coronary Syndrome) was an observational study of patients with ACS, who underwent high‐frequency blood sampling for 1 year. Biomarkers were measured in a median of 16 repeated samples per individual. Cluster analysis was performed to identify biomarker‐based subphenotypes in 723 patients without a repeat ACS in the first year. Patients with a repeat ACS (N=36) were considered a separate cluster. Differences in all‐cause death were evaluated using accelerated failure time models (median follow‐up, 9.1 years; 141 deaths). Three biomarker‐based clusters were identified: cluster 1 showed low and stable biomarker concentrations, cluster 2 had elevated concentrations that subsequently decreased, and cluster 3 showed persistently elevated concentrations. The temporal biomarker patterns of patients in cluster 3 were similar to those with a repeat ACS during the first year. Clusters 1 and 2 had a similar and favorable long‐term mortality risk. Cluster 3 had the highest mortality risk. The adjusted survival time ratio was 0.64 (95% CI, 0.44–0.93; P =0.018) compared with cluster 1, and 0.71 (95% CI, 0.39–1.32; P =0.281) compared with patients with a repeat ACS. Conclusions Patients with subphenotypes of post‐ACS with different all‐cause mortality risks during long‐term follow‐up can be identified on the basis of repeatedly measured cardiovascular biomarkers. Patients with persistently elevated biomarkers have the worst outcomes, regardless of whether they experienced a repeat ACS in the first year.

Abstract OBJECTIVES Prehabilitation through a digital platform could preoperatively improve the physical and mental fitness of patients undergoing cardiothoracic surgery, thereby improving treatment outcomes. This study aimed to describe the reasons and predictors of non-participation in a personalized digital prehabilitation care trial (Digital Cardiac Counseling randomized controlled trial) for patients undergoing elective cardiothoracic surgery. METHODS Adult patients scheduled for elective cardiothoracic surgery at the Maastricht University Medical Center+ were approached to participate in a digital prehabilitation care trial, in which patients were informed about their care pathway, monitored for symptom progression and screened for preoperative modifiable risk factors. Baseline characteristics of all eligible patients and reasons of non-participation were registered prospectively. Predictors of non-participation were determined using logistic regression. RESULTS Between May 2020 and August 2022, 815 patients were eligible for participation; 421 (52%) did not participate in the personalized digital prehabilitation care trial. Reasons for non-participation were ‘lack of internet access or insufficient digital skills’ (32%), ‘wishing no participation’ (39%) and ‘other reasons’ (30%; e.g. vision or hearing impairments, analphabetism, language barriers). Independent predictors of non-participation were age [odds ratio (OR) 1.024 (1.003–1.046), P = 0.024], socioeconomic status [OR 0.267 (0.133–0.536), P &lt; 0.001], current smoker [OR 1.823 (1.124–2.954), P = 0.015] and EuroSCORE II [OR 1.160 (1.042–1.292), P = 0.007]. CONCLUSIONS Half of the eligible patients did not participate in a personalized digital prehabilitation care trial. Non-participants were vulnerable patients, with a more unfavourable risk profile and more modifiable risk factors, who could potentially benefit the most from prehabilitation.

Abstract Aims Evidence regarding the role of serial measurements of biomarkers for risk assessment in post-acute coronary syndrome (ACS) patients is limited. The aim was to explore the prognostic value of four, serially measured biomarkers in a large, real-world cohort of post-ACS patients. Methods and results BIOMArCS is a prospective, multi-centre, observational study in 844 post-ACS patients in whom 12 218 blood samples (median 17 per patient) were obtained during 1-year follow-up. The longitudinal patterns of high-sensitivity cardiac troponin T (hs-cTnT), N-terminal-pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hs-CRP), and growth differentiation factor 15 (GDF-15) were analysed in relation to the primary endpoint (PE) of cardiovascular mortality and recurrent ACS using multivariable joint models. Median age was 63 years, 78% were men and the PE was reached by 45 patients. The average biomarker levels were systematically higher in PE compared with PE-free patients. After adjustment for 6-month post-discharge Global Registry of Acute Coronary Events score, 1 standard deviation increase in log[hs-cTnT] was associated with a 61% increased risk of the PE [hazard ratio (HR) 1.61, 95% confidence interval (CI) 1.02–2.44, P = 0.045], while for log[GDF-15] this was 81% (HR 1.81, 95% CI 1.28–2.70, P = 0.001). These associations remained significant after multivariable adjustment, while NT-proBNP and hs-CRP were not. Furthermore, GDF-15 level showed an increasing trend prior to the PE (Structured Graphical Abstract). Conclusion Longitudinally measured hs-cTnT and GDF-15 concentrations provide prognostic value in the risk assessment of clinically stabilized patients post-ACS. Clinical Trial Registration The Netherlands Trial Register. Currently available at URL https://trialsearch.who.int/; Unique Identifiers: NTR1698 and NTR1106.