Papers by peter gheeraert
Journal of the American College of Cardiology, 2000
The study intended to compare the acute coronary anatomy of patients with acute myocardial infarc... more The study intended to compare the acute coronary anatomy of patients with acute myocardial infarction (AMI) complicated by out-of-hospital ventricular fibrillation (VF) versus patients with AMI without this complication. BACKGROUND More than half of the deaths associated with AMI occur out of the hospital and within 1 h of symptom onset. The angiographic determinants of out-of-hospital VF in patients with AMI have not been investigated in detail. Acute coronary angiographic findings of 72 consecutive patients with AMI complicated by out-of-hospital VF were compared with findings from 144 matched patients with AMI without this complication. Patients with an acute occlusion of the left anterior descending coronary artery (LAD) or left circumflex coronary artery (LCx) had a higher risk for out-of-hospital VF compared with patients with an acute occlusion of the right coronary artery (RCA) (odds ratio and 95% confidence interval, respectively, 4.82 [2.35 to 9.92] and 4. 92 [2.34 to 10.39]). With regard to extent of coronary artery disease (CAD), the location of the culprit lesion in the coronary arteries (proximal vs. mid or distal), the flow in the infarct related artery (IRA), the presence or absence of collaterals to the IRA and chronic occlusions, there were no differences between the two groups. CONCLUSIONS Acute myocardial infarction due to occlusion in the left coronary artery (LCA) is associated with greater risk for out-of-hospital VF compared to the RCA. The location of occlusion within LCA (LAD, LCx, proximal or distal), amount of myocardium at risk for necrosis and extent of CAD are not related to out-of-hospital VF. (
Acta Cardiologica, Jun 18, 2018
A 65-year-old asymptomatic male presented for a routine cardiac screening examination. His medica... more A 65-year-old asymptomatic male presented for a routine cardiac screening examination. His medical history mentioned recurrent bacterial prostatitis, for which intravenous antibiotic therapy with temocillin was administered via a peripherally inserted central catheter (PICC) six months earlier in another centre. Clinical examination showed no abnormalities. Transthoracic echocardiography revealed an echogenic structure in the right atrium extending to the right ventricle through the tricuspid valve (Figure 1). Subsequently, a transesophageal echocardiography was performed for further differentiation. This confirmed the presence of a guide wire extending from the superior caval vein to the right atrium and looping through the tricuspid valve into the right ventricle and back (Figure 2). Retrieval of the wire was done successfully by the interventional cardiologist, with a basket helical catheter via transfemoral venous approach (Figures 3 and 4). PICCs are non-tunnelled catheters which are inserted via a peripheral vein of the arm and guided further centrally using the Seldinger technique [1]. They allow for administration of long-term intravenous therapies. The most important PICC-related complications include
Journal of the American College of Cardiology, Nov 1, 2001
Zwolle, the Netherlands The goal of this study was to evaluate the effect of preconditioning on o... more Zwolle, the Netherlands The goal of this study was to evaluate the effect of preconditioning on out-of-hospital ventricular fibrillation (VF) in patients with acute myocardial infarction (AMI). BACKGROUND More than half of the deaths associated with AMI occur out of the hospital and within 1 h of symptom onset. In humans, preinfarction angina (PA), which can serve as a surrogate marker for preconditioning, reduces infarct size, but the protective effect against out-ofhospital VF has not been investigated. Preinfarction angina status and acute coronary angiographic findings of 72 consecutive patients with AMI complicated by out-of-hospital VF were compared with 144 matched controls without this complication. Preinfarction angina is associated with a lower risk for VF (odds ratio [OR]: 0.40, 95% confidence interval [CI]: 0.18 to 0.88). In patients with acute occlusion of the left coronary artery (LCA) (n ϭ 136), the risk reduction is pronounced (OR: 0.25, 95% CI: 0.10 to 0.66), whereas, in patients with acute occlusion of the right coronary artery (RCA) (n ϭ 67), the protective effect of PA on VF was not observed (OR: 2.25, 95% CI: 0.45 to 11.22). Subgroup and multivariate analyses show that the protective effect is independent of cardiovascular risk factors, preinfarction treatment with beta-adrenergic blocking agents or aspirin, the presence of collaterals or residual antegrade flow or the extent of coronary artery disease. CONCLUSIONS Preinfarction angina protects against out-of-hospital VF in patients with acute occlusion of the LCA. This protection is independent of risk factors or coronary anatomy. A larger study is needed to examine the apparently different effect in patients with acute occlusion of the RCA. (
International Journal of Cardiology, Dec 1, 2005
There are scarce and sometimes contradictory data about ventricular fibrillation (VF) during the ... more There are scarce and sometimes contradictory data about ventricular fibrillation (VF) during the acute phase of MI. In-hospital VF most often occurs with inferior MI, when treated with fibrinolytics. Out-of-hospital VF seems to be associated with anterior MI. We studied characteristics of patients with VF during reperfusion therapy by primary angioplasty (PCI) versus patients with VF before PCI. From January 1995 until December 2001, we treated 2826 patients for acute MI and reviewed clinical records of all patients who developed VF and classified the patients according to the first episode of VF: either before or during the angioplasty procedure. VF developed in 219 (8%) patients. Patients with VF during reperfusion therapy (n=74, 3%) were older (p=0.03), more frequently female (0.04), less often had heart failure (p=0.04), when compared with patient with VF before PCI (n=145, 5%). Patients with VF during PCI experienced more often preinfarction angina (p=0.009) and suffered more often from inferior MI (p=0.001), when compared with patients with VF before PCI. Patients with early VF before reperfusion have different characteristics when compared with patients with VF during reperfusion. Infarct location is a major determinant of timing of VF, when both groups are compared (p<0.001).
PubMed, May 1, 2023
Objectives: This study aimed to assess discordance between results of instantaneous wave-free rat... more Objectives: This study aimed to assess discordance between results of instantaneous wave-free ratio (iFR), fractional flow reserve (FFR), and intravascular ultrasound (IVUS) in intermediate left main coronary (LM) lesions, and its impact on clinical decision making and outcome. Methods: We enrolled 250 patients with a 40%-80% LM stenosis in a prospective, multicenter registry. These patients underwent both iFR and FFR measurements. Of these, 86 underwent IVUS and assessment of the minimal lumen area (MLA), with a 6 mm2 cutoff for significance. Results: Isolated LM disease was recognized in 95 patients (38.0%), while 155 patients (62.0%) had both LM disease and downstream disease. In 53.2% of iFR+ and 56.7% of FFR+ LM lesions, the measurement was positive in only one daughter vessel. iFR/FFR discordance occurred in 25.0% of patients with isolated LM disease and 36.2% of patients with concomitant downstream disease (P=.049). In patients with isolated LM disease, discordance was significantly more common in the left anterior descending artery and younger age was an independent predictor of iFR-/FFR+ discordance. iFR/MLA and FFR/MLA discordance occurred in 37.0% and 29.4%, respectively. Within 1 year of follow-up, major cardiac adverse events (MACE) occurred in 8.5% and 9.7% (P=.763) of patients whose LM lesion was deferred or revascularized, respectively. Discordance was not an independent predictor of MACE. Conclusions: Current methods of estimating LM lesion significance often yield discrepant findings, complicating therapeutic decision-making.
Page 1. Ventricular Fibrillation During Acute Myocardial Infarction: From Patient and Infarction ... more Page 1. Ventricular Fibrillation During Acute Myocardial Infarction: From Patient and Infarction Characteristics to Risk Factors and Risk Estimates. Page 2. 2 Cover: Leonardo da Vinci (in Quaderni dÁnatomia IV, Anatomisch Museum Utrecht). ...
Revue Medicale De Bruxelles, 1997
Local treatments of leg ulcers require necrotic tissues destruction and preventing and reducing s... more Local treatments of leg ulcers require necrotic tissues destruction and preventing and reducing surinfection with local antiseptics. Local and general antibiotherapy are proposed in defined circumstances. Choice of local dressings are dependent on necrosis, degree of exsudation, global cost and compliance of the patient.
Revista Española de Cardiología (English Edition), 2014
Journal of Nuclear Cardiology, 1999
Peri-operative myocardial infarction (MI) is a major cause of mortality and morbidity following p... more Peri-operative myocardial infarction (MI) is a major cause of mortality and morbidity following peripheral vascular surgery. Recently the efficacy of stress perfusion imaging to assess these patients has been questioned. This study aimed to prospectively determine the value of clinical assessment, electrocardiographic assessment, blood pool ventriculography and dipyridamole thallium scintigraphy in predicting peri-operative MI in sequential unselected patients(n=298). Stress-redistribution gated planar perfusion scans were performed followed by gated blood pool ventriculography. Patients were screened for a peri-operative MI by daily CK-MB isoenzymes and ECGs. Thallium scans were reported semiqnantitatively, independently on two occasions to yield global stress defect and a reversibility indices. Left and right ventricular ejection fractions (LVEF,RVEF) were obtained from the blood pool ventriculograms. There were 21 patients vcho sustained a perioperative MI. The occurrence of a peri-operative MI was associated with reversibility score (12 versus 6, p<.000I,Mann,Whitney). Additionally, LVEF was significantly lower in patients in those with events (3 I+10.5 versus 38+_11.7,p<.02), but there was no difference in RVEF. There were 25 patients with a moderate or large reversible defect of whom 3 had events, giving a sensitivity of 14% and a specificity of 95%. Multivariate analysis showed reversibility index to be the most powerful predictor ofperi-operative ML In conclusion stress T120t scintigraphy is the investigation of choice in pre-operative risk stratification.
PubMed, Dec 1, 1993
A 28-year-old renal transplant patient developed a shock due to an acute bleeding from his right ... more A 28-year-old renal transplant patient developed a shock due to an acute bleeding from his right native kidney. An urgent nephrectomy was performed. Macroscopic and histological examination revealed a pyelocaliceal diverticulum as the cause of the hemorrhage. This rare event must be taken into account in every case of an unexplained acute renal bleeding.
European heart journal, Oct 21, 2022
In this study, we compare the diagnostic accuracy of a standard 12-lead electrocardiogram (ECG) w... more In this study, we compare the diagnostic accuracy of a standard 12-lead electrocardiogram (ECG) with a novel 13-lead ECG derived from a self-applicable 3-lead ECG recorded with the right exploratory left foot (RELF) device. The 13th lead is a novel age and sex orthonormalized computed ST (ASO-ST) lead to increase the sensitivity for detecting ischaemia during acute coronary artery occlusion. Methods and results A database of simultaneously recorded 12-lead ECGs and RELF recordings from 110 patients undergoing coronary angioplasty and 30 healthy subjects was used. Five cardiologists scored the learning data set and five other cardiologists scored the validation data set. In addition, the presence of non-ischaemic ECG abnormalities was compared. The accuracy for detection of myocardial supply ischaemia with the derived 12 leads was comparable with that of the standard 12-lead ECG (P = 0.126). By adding the ASO-ST lead, the accuracy increased to 77.4% [95% confidence interval (CI): 72.4-82.3; P < 0.001], which was attributed to a higher sensitivity of 81.9% (95% CI: 74.8-89.1) for the RELF 13-lead ECG compared with a sensitivity of 76.8% (95% CI: 71.9-81.7; P < 0.001) for the 12-lead ECG. There was no significant difference in the diagnosis of non-ischaemic ECG abnormalities, except for Q-waves that were more frequently detected on the standard ECG compared with the derived ECG (25.9 vs. 13.8%; P < 0.001). Conclusion A self-applicable and easy-to-use 3-lead RELF device can compute a 12-lead ECG plus an ischaemia-specific 13th lead that is, compared with the standard 12-lead ECG, more accurate for the visual diagnosis of myocardial supply ischaemia by cardiologists.
Journal of Electrocardiology, Mar 1, 2020
Background: New onset electrocardiographic (ECG) changes after transcatheter aortic valve replace... more Background: New onset electrocardiographic (ECG) changes after transcatheter aortic valve replacement (TAVR) are used to assess the risk for late atrioventricular block. However, the time of ECG evaluation remains controversial. We aimed to compare the time course and dynamics of new onset ECG changes according to valve design in balloon-(BEV) and self-expandable (SEV) TAVR. Methods and results: This single center study enrolled 133 consecutive TAVR patients (28.6% SEV, 71.4% BEV). Patients with pre-existent permanent pacemaker implant (PPMI), procedural death or incomplete ECG registration were excluded. Standard 12-lead ECG was performed before the procedure, at 1, 24, 48 and 120 h and 1 month. In BEV patients, no significant PR prolongation occurred, whereas in SEV patients the PR interval prolonged significantly with 33.7 ± 22.0 ms (p b 0.001, compared to pre-TAVR) but only after 48 h after TAVR. Widening of QRS duration was comparable among both BEV and SEV patients (6.7 ± 21.5 versus 17.0 ± 26.9 ms, p = 0.061) and occurred immediately after TAVR. New-onset left bundle branch block was seen in 18.5% of BEV and 30.8% of SEV patients (p = 0.120) and occurred within 24 h after TAVR in both groups. Late PPMI (N24 h after TAVR) was higher in SEV compared to BEV patients (15.3% versus 1.5%, p = 0.008). Conclusion: Self-expandable valves cause more impairment in atrioventricular conduction with a delayed time course compared to balloon expandable valves. This might explain the higher pacemaker need beyond 24 h after TAVR. Our findings suggest that patients with self-expandable valves require at least 48 h ECG monitoring post TAVR.
Journal of Electrocardiology, Mar 1, 2016
Background: Delayed medical attendance is a leading cause of death in patients with ST elevation ... more Background: Delayed medical attendance is a leading cause of death in patients with ST elevation myocardial infarction (STEMI). Methods: We aimed to introduce, develop, and validate a novel method (RELF method) for detection of transmural ischemia based on a new and easy-to-use 3-lead configuration and orthonormalization of ST reference vectors (STDV N). The study included 60 patients undergoing coronary artery occlusion (CAO) during balloon inflation and 30 healthy subjects. Results: STDV N was significantly different and an optimal discriminator between CAO patients and healthy subjects (respectively 8.00 ± 4.50 vs. 1.90 ± 0.86 normalized units, p b 0.001). Compared to the 12-lead ECG, the RELF method was sensitive (90 vs. 73%, p = 0.13) and more specific (91 vs. 75%, p b 0.001). Conclusions: The RELF method is highly accurate for early detection of acute occlusion related ischemia and it outperforms the conventional 12-lead ECG criteria for STEMI. This method provides a platform for self-detection of CAO with handheld devices or smart phones.
Journal of Cardiovascular Electrophysiology, Apr 1, 2020
Background: Conduction disorders requiring permanent pacemaker implantation occur frequently afte... more Background: Conduction disorders requiring permanent pacemaker implantation occur frequently after transcatheter aortic valve replacement (TAVR). This multicenter study explored the feasibility and safety of His bundle pacing (HBP) in TAVR patients with a pacemaker indication to correct a TAVR-induced left bundle branch block (LBBB). Methods: Patients qualifying for a permanent pacemaker implant after TAVR were planned for HBP implant. HBP was performed using the Select Secure (3830; Medtronic) pacing lead, delivered through a fixed curve or deflectable sheath (C315HIS or C304; Medtronic).
Journal of the American College of Cardiology, 1998
offset of T). QTDex w=1s the longest minus the shortest exemise QT, Exerose pedusion imag~P~ w~m ... more offset of T). QTDex w=1s the longest minus the shortest exemise QT, Exerose pedusion imag~P~ w~m d~ into 5 segments with each segment scored for th~ lnton~ty of tra¢'er (0-3 t~.alo), Sc0r0s for the 5 IN~,~mts w~m =1~ to DI~ on t~iit ~Of~ Corollary di~sse extent was the number 0f vessels w~h :~ 70% stonos~s, Those wllh ischem~ S,CO,T~ >0 had h~hor mean QTDex than tho~ wtth ischem~ so~res = 0 (45 :t 2~8 vs 33 ~ 2,8 mse¢: p ,~ 0.004), Those wtth ~ witho~ mu~t~essel dl~a~e ~ mean QTDex Inal d~ not diffe~ (45 ¢ 7,3 w 41 • 2~3 mse~ p ~ 0.7~), Both QTL~x (p .~ 0,006) and coronary Cx~t~ W d~0 OT1Dex w~s not (p = 023), Catctu~et-Alth~ both QT[~ ~ the extem of ,~'omnary d~e o~ml=1tO indei~mdemtly ~ tt~ eztent ~ ~hen~a, QTOe= wo.~ not =in i~ I~t¢t~ el the e~,em o~ coreN~ d~ase, The~, QTDe~ relte¢ts a ~ Ol ~ mc~ unrelated to the extem of 11 ;30
Journal of Nuclear Cardiology, Feb 1, 1999
Journal of the American College of Cardiology, Mar 1, 2002
The Annals of Thoracic Surgery, Jul 1, 1993
We report an unusual case of invasive thymoma with intracaval growth into the right atrium. Compu... more We report an unusual case of invasive thymoma with intracaval growth into the right atrium. Computed tomography and venacavography demonstrated this manner of extension of thymoma. The tumor was completely removed by means of cardiopulmonary bypass after four courses of chemotherapy. Multidisciplinary treatment for invasive thymoma with this growth pattern is thought to be useful.
Acta Clinica Belgica, Aug 12, 2016
We present a case of a 71-year-old woman with recurrent stroke episodes due to non-bacterial thro... more We present a case of a 71-year-old woman with recurrent stroke episodes due to non-bacterial thrombotic endocarditis (NBTE) leading to the diagnosis of an early-stage breast carcinoma. NBTE is associated with a variety of inflammatory states, including malignancy. NBTE presents itself with systemic embolization, mostly stroke. Treatment consists of treating the underlying condition and start of systemic anticoagulation therapy. Cardiac surgery is restricted to highly selected cases, since prognosis usually is limited by the neoplasm, which usually is in an advanced stage at time of diagnosis of NBTE. The malignancy usually is diagnosed prior to NBTE. Cases presenting with NBTE leading to the diagnosis of malignancy, however, are rarely reported. To our knowledge, we present the first case leading to the diagnosis of an early-stage breast carcinoma.
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Papers by peter gheeraert