Characterization of the right ventricle : embryonic development, noninvasive imaging and electrocardiography

The aim of this thesis was to further characterize the right ventricle within three different fields of cardiovascular research: 1. Embryonic development, 2: Non-invasive right ventricular imaging, 3: Right ventricular electrocardiography. In part I, several aspects of embryonic development, relevant for normal right ventricular morphology and function are investigated. In chapter 2, a novel concept for normal development of the right ventricular outflow tract is introduced. In chapter 3, the potential relevance of epicardium-derived cells for the difference between left and right ventricular morphology is discussed. Non-invasive imaging techniques are evaluated in part II. In chapter 4, the use of conventional semi-quantitative measurement of right ventricular function in patients with transposition of the great arteries is analyzed. The relevance of abnormal response to stress, measured with cardiovascular magnetic resonance imaging, is investigated in chapter 5. Chapters 6-8 demonstrate how strain measurement can be used in various types of (suspected) right ventricular disease. In part III, both conventional electrocardiography as well as computerized vectorcardiography is described in patients with right v entricular disease. A case-study of conventional electrocardiographic assessment of right ventricular pressure overload is provided in chapter 9. The prognostic value of QRS duration in patients with tetralogy of Fallot who undergo pulmonary valve replacement, is demonstrated in chapter 10. Chapter 11 and 12 discuss the application of ECG-derived vectorcardiography in normal subjects and suspected pulmonary arterial hypertension patientsNederlandse Hartstichting, Rijnland Zorggroep, Pfizer, MSD, Astellas, Servier, Biotronik, Bayer, Boehringer Ingelheim, ActelionUBL - phd migration 201

Program/Abstract #110 will be presented as scheduled, but the abstract cannot be published due to lack of license agreement between authors and publisher.

Background Since it was anticipated that the need for doctors would increase due to demographic changes, the number of positions for medical specialty training programs has increased from the year 2000 onwards. However, the number of permanent positions for young cardiologists did not follow that trend leading to concerns about future employment. Therefore, the aim of the current study was to assess short-term career perspectives of young cardiologists in the Netherlands. Methods All cardiologists who ended their training between 1 January 2011 and 31 December 2014 were invited to fill in a questionnaire about their first employment status and were followed yearly until the participant had a permanent position. The timespan between the end of training and the moment of permanent employment was assessed. Furthermore, the association between professional profile and short-term career perspectives was investigated. Results The observed unemployment was 1.6% and lasted less than a year in all cases. Of the participants, 77% started their career with a temporary contract; within four years this was 7%. Of young cardiologists, 46% started their career as a fellow and 24% as an attending physician. A total of 29% of male cardiologists started their career with a permanent contract as compared with 12% of females (p = 0.01). Within two years this difference was no longer observed. Conclusions Unemployment is low among young cardiologists. Most cardiologists start their career with a temporary contract. The time to a permanent contract is slightly longer for female cardiologists as compared with males

Expectations and perceived barriers to widespread implementation of e-Health in cardiology practice: Results from a national survey in the Netherlands

Introduction Expectations of physicians concerning e-Health and perceived barriers to implementation in clinical practice are scarcely reported in the literature. The purpose of this study was to assess these aspects of cardiovascular e-Health.Methods A survey was sent to members of the Netherlands Society of Cardiology. In total, the questionnaire contained 30 questions about five topics: personal use of smartphones, digital communication between respondents and patients, current e-Health implementation in clinical practice, expectations about e-Health and perceived barriers for e-Health implementation. Age, personal use of smartphones and professional environment were noted as baseline characteristics.Results In total, 255 respondents filled out the questionnaire (response rate 25%); 89.4% of respondents indicated that they considered e-Health to be clinically beneficial, improving patient satisfaction (90.2%), but also that it will increase the workload (83.9%). Age was a negative predictor and personal use of smartphones was a positive predictor of having high expectations. Lack of reimbursement was identified by 66.7% of respondents as a barrier to e-Health implementation, as well as a lack of reliable devices (52.9%) and a lack of data integration with electronic medical records (EMRs) (69.4%).Conclusion Cardiologists are in general positive about the possibilities of e-Health implementation in routine clinical care; however, they identify deficient data integration into the EMR, reimbursement issues and lack of reliable devices as major barriers. Age and personal use of smartphones are predictors of expectations of e-Health, but the professional working environment is not.Cardiolog

"Level Crossroads" A Venous Graft Compressing a Left Internal Mammary Graft Presenting as Myocardial Infarction

Cardiolog

"Level Crossroads" A Venous Graft Compressing a Left Internal Mammary Graft Presenting as Myocardial Infarction

Cardiolog

Prognostic value of right ventricular longitudinal peak systolic strain in patients with pulmonary hypertension

BACKGROUND Right ventricular (RV) function is an important prognostic marker in patients with pulmonary hypertension. The present evaluation assessed the prognostic value of RV longitudinal peak systolic strain (LPSS) in patients with pulmonary hypertension. METHODS AND RESULTS A total of 150 patients with pulmonary hypertension of different etiologies (mean age, 59±15 years; 37.3% male) were evaluated. RV fractional area change and tricuspid annular plane systolic excursion index were evaluated with 2-dimensional echocardiography. RV LPSS was assessed with speckle-tracking echocardiography. The patient population was categorized according to a RV LPSS value of -19%. Among several clinical and echocardiographic parameters, the significant determinants of all-cause mortality were evaluated. There were no significant differences in age, sex, pulmonary hypertension cause and left ventricular ejection fraction between patients with RV LPSS <-19% and patients with RV LPSS ≥-19%. However, patients with RV LPSS ≥-19% had significantly worse New York Heart Association functional class (2.7±0.6 versus 2.3±0.8; P=0.003) and lower tricuspid annular plane systolic excursion (16±4 mm versus 18±3 mm; P<0.001) than their counterparts. During a median follow-up of 2.6 years, 37 patients died. RV LPSS was a significant determinant of all-cause mortality (HR, 3.40; 95% CI, 1.19-9.72; P=0.02). CONCLUSIONS In patients with pulmonary hypertension, RV LPSS is significantly associated with all-cause mortality. RV LPSS may be a valuable parameter for risk stratification of these patients. Future studies are needed to confirm these results in the pulmonary hypertension subgroups.Cardiolog

Detection of elevated pulmonary pressures by the ECG-derived ventricular gradient: A comparison of conversion matrices in patients with suspected pulmonary hypertension

Cardiolog

Development of a patient-oriented hololens application to illustrate the function of medication after myocardial infarction

Aims: Statin treatment is one of the hallmarks of secondary prevention after myocardial infarction. Adherence to statins tends to be difficult and can be improved by patient education. Novel technologies such as mixed reality (MR) expand the possibilities to support this process. To assess if an MR medication-application supports patient education focused on function of statins after myocardial infarction. Methods and results: A human-centred design-approach was used to develop an MR statin tool for Microsoft HoloLens™. Twenty-two myocardial infarction patients were enrolled; 12 tested the application, 10 patients were controls. Clinical, demographic, and qualitative data were obtained. All patients performed a test on statin knowledge. To test if patients with a higher tendency to become involved in virtual environments affected test outcome in the intervention group, validated Presence- and Immersive Tendency Questionnaires (PQ and ITQ) were used. Twenty-two myocardial infarction patients (ST-elevation myocardial infarction, 18/22, 82%) completed the study. Ten out of 12 (83%) patients in the intervention group improved their statin knowledge by using the MR application (median 8 points, IQR 8). Test improvement was mainly the result of increased understanding of statin mechanisms in the body and secondary preventive effects. A high tendency to get involved and focused in virtual environments was moderately positive correlated with better test improvement (r = 0.57, P &lt; 0.05). The median post-test score in the control group was poor (median 6 points, IQR 4). Conclusions: An MR statin education application can be applied effectively in myocardial infarction patients to explain statin function and importance.Applied Ergonomics and Desig

Biventricular Performance in Patients with Marfan Syndrome without Significant Valvular Disease: Comparison to Normal Subjects and Longitudinal Follow-Up

Ventricular Dysfunction & Heart Failur