Dynamic computer-assisted ST segment monitoring in patients with acute coronary syndromes

Since the first recording of the human electrical activity of the heart by Waller in 1887 1 and the invention of the electrocardiograph by Willem Einthoven in 1902 2 the recording of the electrocardiogram (ECG) has evolved into one of the most important noninvasive diagnostic techniques of today cardiology 3 In particular, the diagnosis of cardiac arrhythmias, myocardial ischemia and myocardial infarction depends on the use of routine ECG recordings. The development of continuous ECG recording techniques such as long term ambulatory ECG recording (Holter) made it also possible to document less frequently occurring cardiac arrhythmias or ischemic events occurring during daily life

Early effects of brain death on kidney injury and outcome after transplantation

In the last decades, kidney transplantation has become the treatment of choice for end-stage renal failure. The main source for donor organs in kidney transplantation has traditionally been heart-beating brain dead patients (donation after brain death, DBD). Due to the persistent shortage of donor organs, however, living (un)related donors and, to a lesser extent, kidneys from non-heart-beating donors have been increasingly accepted for transplantation. Transplantation with well-matched living donor-recipient combinations was known to have superior results compared to those with DBD and NHB donor kidneys. During the past fifteen years it became obvious that fully mismatched living-unrelated grafts also have better survival outcomes than kidneys retrieved from DBD donors with a very reasonable match for HLA antigens. This difference in results cannot be fully attributed to prolonged cold ischemia times in grafts procured from DBD donors, since no significant effect of cold ischemia time on kidney transplantation outcome was seen with preservation times up to 24 hr. Thus, other risk factors must be responsible and should explain the difference in success rates between living and cadaveric kidney transplantation. ... Zie: Chapter 9

Optimizing Non-Invasive Detection of Coronary Artery Disease and Effects of Advanced Interventional Techniques for Patients with Stable Coronary Artery Disease:It is All about Myocardial Perfusion

The aim of this thesis was to (1) further optimize non-invasive detection of hemodynamically significant coronary artery disease (CAD) with coronary computed tomography angiography (CCTA) and myocardial perfusion imaging (MPI) and to examine (2) the effect of implantation of the bioresorbable vascular scaffold (BVS) and (3) chronic total occlusion percutaneous coronary intervention (CTO PCI). Part I showed that angiographic characteristics such as volumetric measures as well as morphological aspects of atherosclerosis as assessed by CCTA are of interest when considering the hemodynamic consequences of atherosclerosis. These findings add to luminal stenosis grading alone and aid in increasing the diagnostic accuracy of CCTA to predict hemodynamically significant CAD determined by invasive FFR. The main results of Part II indicate that implantation of the BVS is feasible however no benefit with regard to myocardial perfusion is observed during hyperemia or cold pressor testing. These findings do not support the use of BVS instead of metallic DES, especially since large randomized trials have illustrated that there is an increased risk in scaffold thrombosis during the first three years. Still, long-term outcome (>3 years) has yet to become available. The results of the studies in Part III indicate that the vast majority of patients with a CTO have significantly impaired myocardial perfusion with great effect of successful CTO PCI on recovery of myocardial perfusion and decrease of ischemic burden. Patient selection for CTO PCI should be based on expected patient benefit rather than lesion complexity