• No results found

Hemodynamic folluw-up after heart failure surgery : systolic and diastolic function Brinke, E.A. ten

N/A
N/A
Protected

Academic year: 2021

Share "Hemodynamic folluw-up after heart failure surgery : systolic and diastolic function Brinke, E.A. ten"

Copied!
7
0
0

Bezig met laden.... (Bekijk nu de volledige tekst)

Hele tekst

(1)

Hemodynamic folluw-up after heart failure surgery : systolic and diastolic function

Brinke, E.A. ten

Citation

Brinke, E. A. ten. (2011, September 29). Hemodynamic folluw-up after heart failure surgery : systolic and diastolic function. Retrieved from

https://hdl.handle.net/1887/17886

Version: Corrected Publisher’s Version

License: Licence agreement concerning inclusion of doctoral thesis in the Institutional Repository of the University of Leiden

Downloaded from: https://hdl.handle.net/1887/17886

Note: To cite this publication please use the final published version (if

applicable).

(2)

&+$37(5

%5,()&20081,&$7,21

%DOORRQVL]LQJLQVXUJLFDO

YHQWULFXODUUHVWRUDWLRQZKDW

YROXPHDUHZHWDUJHWLQJ"

(OOHQ$WHQ%ULQNH 5REHUW-.ODXW]

3DXO6WHHQGLMN

-7KRUDF&DUGLRYDVF6XUJ-XO  

(3)
(4)



%DOORRQVL]LQJLQVXUJLFDOYHQWULFXODUUHVWRUDWLRQ

&+$37(5

,1752'8&7,21

6XUJLFDOYHQWULFXODUUHVWRUDWLRQ 695 E\HQGRYHQWULFXODUFLUFXODUSDWFKSODVW\ZDVGH

VFULEHGE\'RUDQGFROOHDJXHVDVDQHZDSSURDFKWRWUHDWSDWLHQWVZLWKOHIWYHQWULFXODU

/9  DQHXU\VP 2YHU WLPH WKLV WHFKQLTXH ZDV RSWLPL]HG DQG RQH RI WKH LQJUHGLHQWV

ZKLFKPRVWFHQWHUVFXUUHQWO\XVHLVDQLQWUDYHQWULFXODUEDOORRQWRVWDQGDUGL]HYROXPH

DQGVKDSHRIWKHUHVLGXDOFDYLW\'XULQJ695WKH/9LVRSHQHGWKURXJKWKHLQIDUFWDQGDQ

HQGRFDUGLDOHQFLUFOLQJVXWXUH )RQWDQVWLWFK LVSODFHGDWWKHWUDQVLWLRQDO]RQHEHWZHHQ

VFDUUHGDQGQRUPDOWLVVXH1H[WWKHEDOORRQLVLQWURGXFHGLQWRWKH/9DQGÀOOHGZLWK

WRP/VDOLQHSHUVTXDUHPHWHURIERG\VXUIDFHDUHD7KH)RQWDQVWLWFKLVWLJKWHQHGWR

DSSUR[LPDWHWKHYHQWULFXODUZDOOWRWKHEDOORRQDQGWKHUHVLGXDORULÀFHLVFORVHGZLWKD

SDWFK6XEVHTXHQWO\WKHH[FOXGHGVFDUWLVVXHLVFORVHGRYHUWKHSDWFKWRHQVXUHKHPR

VWDVLV7KHJXLGLQJSULQFLSOHEHKLQGWKLVRSHUDWLRQLVWKHFRQFHSWWKDW695UHGXFHVZDOO

VWUHVV DFFRUGLQJWR/DSODFH·VODZ OHDGLQJWRUHGXFHGR[\JHQGHPDQGDQGLPSURYHG

IXQFWLRQRIWKHKHDOWK\UHPRWHP\RFDUGLXP7KHEDOORRQWHFKQLTXHLVJHQHUDOO\FRQVLG

HUHGWRSURGXFHPRUHFRQVLVWHQWDQGPRUHSUHGLFWDEOHUHVXOWVZLWKLPSURYHGFOLQLFDO

RXWFRPH2QHRIWKHÀUVWSDSHUVWRGHVFULEHEDOORRQVL]LQJPHQWLRQHGWKDWWKHEDOORRQ

ZDVLQÁDWHGWRFKHFNWKDWWKH¶QHZ/9GLDVWROLFYROXPH·ZDVEHWZHHQDQGP/P ,QDUHFHQW¶([SHUW&RPPHQWDU\·'RUHWDOUHSRUWHGDWLJKWHUUDQJHRIWRP/P DQGH[SODLQHGWKDWWKHEDOORRQVKRXOGKHOSWRDYRLGH[FHVVLYHYROXPHUHGXFWLRQZKLFK

PLJKWFDXVHLPSDLUHGGLDVWROLFIXQFWLRQDQGUHVWULFWLYHFDUGLRP\RSDWK\7KHWHFKQLTXH

LVUHIHUUHGWRDV¶GLDVWROLFYROXPHEDOORRQVL]LQJ·EXWWKHEDVLVIRUVHOHFWLQJWKLVVSHFLÀF

WDUJHW YROXPH UDQJH ZDV QRW H[SOLFLWO\ PHQWLRQHG 7R SXW WKH YDOXHV LQ SHUVSHFWLYH

UHFHQW05,VWXGLHVLQGLFDWHDQRUPDO('9,RI”P/PLQPHQDQG”P/PLQ

ZRPHQZLWKUHVSHFWLYHO\”P/PDQG”P/PIRULQGH[HGHQGV\VWROLFYROXPH

(69, )XUWKHUPRUHDLQFUHDVHLQ('9,DIWHUP\RFDUGLDOLQIDUFWLRQLVFRQVLGHUHG

WR LQGLFDWH UHPRGHOLQJ DQG DQ (69, !P/P LV DVVRFLDWHG ZLWK DGYDQFHG KHDUW

IDLOXUH7KXV LI RQH DVVXPHV WKDW EDOORRQ YROXPH SUHGLFWV SRVWVXUJHU\ HQGGLDVWROLF

YROXPH ('9  HYHQ EDOORRQ LQÁDWLRQ WR P/P ZRXOG VHHP WRR VPDOO +RZHYHU D

GLUHFWFRUUHVSRQGHQFHZLWKWKHUHVXOWLQJLQYLYR('9PD\QRWEHH[SHFWHG)LUVWWKH

FRPSOLDQFHRIWKHDUUHVWHGKHDUWGXULQJVXUJHU\ZLOOGLIIHUIURPWKHFRPSOLDQFHRIWKH

EHDWLQJKHDUWDIWHUVXUJHU\6HFRQGHYHQLIWKH\ZHUHWKHVDPHWKH('9RIWKHEHDWLQJ

KHDUWVWURQJO\GHSHQGVRQÀOOLQJSUHVVXUHDQGLWLVXQFOHDUKRZPXFKWKHDUUHVWHGKHDUW

LVSUHORDGHGZKHQWKHVXUJHRQWLJKWHQVWKH)RQWDQVWLWFK

&OLQLFDOVXPPDU\

7R LQYHVWLJDWH WKLV LVVXH ZH FRPSLOHG SRVW695 /9 YROXPHV IURP VWXGLHV WKDW XVHG

EDOORRQVL]LQJ 7DEOH :HIRFXVHGRQVWXGLHVUHSRUWLQJYDOXHVREWDLQHGZLWKLQWKH

(5)

&KDSWHU



ÀUVW\HDUDIWHU695WROLPLWSRVVLEOHFRQIRXQGLQJHIIHFWVRIODWHUHPRGHOLQJ7ZR

ODUJHVFDOHVWXGLHV5(6725(DQG67,&+ZHUHQRWLQFOXGHGLQ7DEOHEHFDXVHLWZDV

QRWFOHDUZKHWKHUDEDOORRQZDVFRQVLVWHQWO\XVHGLQDOOSDUWLFLSDWLQJFHQWHUV+RZHYHU

SRVW695(69,ZDV”P/PLQ5(6725(DQGP/PLQ67,&+,QWHUHVWLQJO\SRVW

695('9,DQG(69,ZHUHUHODWLYHO\VLPLODUEHWZHHQVWXGLHVVXJJHVWLQJWKDWWKHEDOORRQ

KHOSV WR VWDQGDUGL]H UHVXOWV )XUWKHUPRUH RYHUDOO PHDQ ('9, ZDV ”P/P DQG

PHDQ(69,ZDV”P/PLQGLFDWLQJWKDWHQGV\VWROLFYROXPH (69 UDWKHUWKDQ('9

FRUUHVSRQGHGZLWKWKHYROXPHRIWKHEDOORRQ

',6&866,21

2XUUHVXOWVSXWLQWRTXHVWLRQWKHXVHRIWKHWHUP¶GLDVWROLFYROXPHVL]LQJ·7KLVÀQGLQJ

PD\LQGLFDWHWKDWWKHVWLIIQHVVRIWKHDUUHVWHGKHDUWLVKLJKHUWKDQWKHGLDVWROLFVWLIIQHVV

RIWKHEHDWLQJKHDUW$QDOWHUQDWLYHH[SODQDWLRQFRXOGEHWKDWZKHQWKH/9LVFORVHGRYHU

WKHEDOORRQWKLVLVGRQHZLWKYHU\OLPLWHGVWUHWFKLQJRIWKHPXVFOHDQGWKXVUHSUHVHQWV

DUHOD[HGEXWXQORDGHGFRQGLWLRQLQZKLFKFDVHWKHYROXPHPD\EHFORVHWRWKH¶LQYLYR·

(69+RZHYHUWKHFRUUHVSRQGHQFHFRXOGEHIXOO\FRLQFLGHQWDODQGDTXDQWLWDWLYHUHOD

WLRQVKLSEHWZHHQEDOORRQYROXPHDQGSRVW695YHQWULFXODUYROXPH HLWKHU('9RU(69  FDQRQO\EHUHOLDEO\GHWHUPLQHGIURPVWXGLHVZLWKPXOWLSOHEDOORRQVL]HVZKLFKFXUUHQWO\

DUHQRWDYDLODEOH$OWKRXJKLWVHHPVSODXVLEOHWKDWXVLQJDODUJHUEDOORRQZRXOGUHVXOWLQ

DODUJHUSRVW695('9,DQG(69,WKLVHIIHFWKDVQRW\HWEHHQHVWDEOLVKHG

$SDUWIURPWKHSRVVLEOHDGYDQWDJHRIPRUHVWDQGDUGL]HGUHVXOWVDFRPPRQFRQFHUQ

ZLWK695LVWKHSRWHQWLDOULVNRIFUHDWLQJGLDVWROLFG\VIXQFWLRQDQGLWLVOLNHO\WKDWWKH

EDOORRQPHWKRGPD\KHOSWRDYRLGFUHDWLQJWRRVPDOO/9FKDPEHUV+RZHYHUZKHWKHU

7DEOH/9YROXPHVSUHDQGSRVW695

$XWKRU \HDU 3DWLHQWV )ROORZXS ,PDJLQJ 3UH695 3RVW695

Q ('9, (69, ('9, (69,

P/P P/P P/P P/P

%RYp    PR HFKRFDUGLRJUDSK\ ” ” ” ”

'RU    PR 05, ” ” ” ”

&DVWHOYHFFKLR    DWGLVFKDUJH HFKRFDUGLRJUDSK\ ” ” ” ”

'DUGDV    PR HFKRFDUGLRJUDSK\ ” ” ” ”

0HQLFDQWL    G HFKRFDUGLRJUDSK\ ” ” ” ”

7XOQHU    PR HFKRFDUGLRJUDSK\ ” ” ” ”

'L'RQDWR    G DQJLRJUDSK\ ” ” ” ”

/9/HIWYHQWULFOH6956XUJLFDO9HQWULFXODU5HVWRUDWLRQ('9,HQGGLDVWROLFYROXPHLQGH[(69,HQG

V\VWROLFYROXPHLQGH[05,PDJQHWLFUHVRQDQFHLPDJLQJ 5HSRUWHGDEVROXWH/9YROXPHVZHUHLQ

GH[HGXVLQJDQDYHUDJHYDOXHIRUERG\VXUIDFHDUHDP

(6)



%DOORRQVL]LQJLQVXUJLFDOYHQWULFXODUUHVWRUDWLRQ

&+$37(5

WKHEDOORRQPHWKRGFDQEHHIIHFWLYHO\XVHGWRWDUJHWDVSHFLÀFSRVW695/9YROXPHDQG

VXEVHTXHQWO\ZKHWKHUDGDSWLQJSRVW695/9YROXPHDFWXDOO\KHOSVWRLPSURYHRXWFRPH

QHHGVWREHHVWDEOLVKHGLQIXWXUHVWXGLHV

(7)

&KDSWHU



5()(5(1&(6

  'RU96DDE0&RVWH3HWDO/HIWYHQWULFXODUDQHXU\VPDQHZVXUJLFDODSSURDFK7KRUDF&DUGLRYDVF

6XUJ

  'RU9&LYDLD)$OH[DQGUHVFX&HWDO7KHSRVWP\RFDUGLDOLQIDUFWLRQVFDUUHGYHQWULFOHDQGFRQJHV

WLYHKHDUWIDLOXUHWKHSUHHPLQHQFHRIPDJQHWLFUHVRQDQFHLPDJLQJIRUSUHRSHUDWLYHLQWUDRSHUD

WLYHDQGSRVWRSHUDWLYHDVVHVVPHQW-7KRUDF&DUGLRYDVF6XUJ

  'RU96DEDWLHU00RQWLJOLR)HWDO(QGRYHQWULFXODUSDWFKUHFRQVWUXFWLRQLQODUJHLVFKHPLFZDOO

PRWLRQDEQRUPDOLWLHV-&DUG6XUJ

  1DWRUL 6 /DL 6 )LQQ -3HW DO &DUGLRYDVFXODU IXQFWLRQ LQ PXOWLHWKQLF VWXG\ RI DWKHURVFOHURVLV

QRUPDOYDOXHVE\DJHVH[DQGHWKQLFLW\$-5$P-5RHQWJHQRO66

  0DQQDHUWV+)YDQGHU+HLGH-$.DPS2HWDO(DUO\LGHQWLÀFDWLRQRIOHIWYHQWULFXODUUHPRGHOOLQJ

DIWHUP\RFDUGLDOLQIDUFWLRQDVVHVVHGE\WUDQVWKRUDFLF'HFKRFDUGLRJUDSK\(XU+HDUW-



  :KLWH+'1RUULV50%URZQ0$HWDO/HIWYHQWULFXODUHQGV\VWROLFYROXPHDVWKHPDMRUGHWHUPL

QDQWRIVXUYLYDODIWHUUHFRYHU\IURPP\RFDUGLDOLQIDUFWLRQ&LUFXODWLRQ

  %RYp 7 9DQ %< 9DQGHQSODV *HW DO 6KRUWWHUP V\VWROLF DQG GLDVWROLF YHQWULFXODU SHUIRUPDQFH

DIWHUVXUJLFDOYHQWULFXODUUHVWRUDWLRQIRUGLODWHGLVFKHPLFFDUGLRP\RSDWK\(XU-&DUGLRWKRUDF6XUJ



  &DVWHOYHFFKLR60HQLFDQWL/5DQXFFL0HWDO,PSDFWRIVXUJLFDOYHQWULFXODUUHVWRUDWLRQRQGLDVWROLF

IXQFWLRQLPSOLFDWLRQVRIVKDSHDQGUHVLGXDOYHQWULFXODUVL]H$QQ7KRUDF6XUJ

  'DUGDV363LWVLV$$0H]LOLV1(HWDO/HIWDWULDOIXQFWLRQDQGZRUNDIWHUVXUJLFDOYHQWULFXODUUHVWR

UDWLRQLQSRVWP\RFDUGLDOLQIDUFWLRQKHDUWIDLOXUH-$P6RF(FKRFDUGLRJU

  'L'RQDWR07RVR$'RU9HWDO6XUJLFDOYHQWULFXODUUHVWRUDWLRQLPSURYHVPHFKDQLFDOLQWUDYHQ

WULFXODUG\VV\QFKURQ\LQLVFKHPLFFDUGLRP\RSDWK\&LUFXODWLRQ

  0HQLFDQWL/&DVWHOYHFFKLR65DQXFFL0HWDO6XUJLFDOWKHUDS\IRULVFKHPLFKHDUWIDLOXUHVLQJOH

FHQWHUH[SHULHQFHZLWKVXUJLFDODQWHULRUYHQWULFXODUUHVWRUDWLRQ-7KRUDF&DUGLRYDVF6XUJ



  7XOQHU6$%D[--%OHHNHU*%HWDO%HQHÀFLDOKHPRG\QDPLFDQGFOLQLFDOHIIHFWVRIVXUJLFDOYHQ

WULFXODUUHVWRUDWLRQLQSDWLHQWVZLWKLVFKHPLFGLODWHGFDUGLRP\RSDWK\$QQ7KRUDF6XUJ



  $WKDQDVXOHDV&/%XFNEHUJ*'6WDQOH\$:HWDO6XUJLFDOYHQWULFXODUUHVWRUDWLRQLQWKHWUHDWPHQW

RIFRQJHVWLYHKHDUWIDLOXUHGXHWRSRVWLQIDUFWLRQYHQWULFXODUGLODWLRQ-$P&ROO&DUGLRO



  -RQHV5+9HOD]TXH](-0LFKOHU5(HWDO&RURQDU\%\SDVV6XUJHU\ZLWKRUZLWKRXW6XUJLFDO9HQ

WULFXODU5HFRQVWUXFWLRQ1(QJO-0HG

  3DXOXV:-9DQWULPSRQW3-5RXVVHDX0)'LDVWROLFIXQFWLRQRIWKHQRQÀOOLQJKXPDQOHIWYHQWULFOH

-$P&ROO&DUGLRO

Referenties

GERELATEERDE DOCUMENTEN

Er is een waarde van p waarvoor de oppervlakte van PQRS

VWLIIQHVV ZDV VLJQLÀFDQWO\ LQFUHDVHG 7KH IDFW WKDW G3GW 0,1  DQG 7DX GLG QRW

DIWHU P\RFDUGLDO LQIDUFWLRQ DQG LQ  RI WKH SDWLHQWV ZLWK FRQJHVWLYH KHDUW IDLOXUH 

HQGGLDVWROLF ('9  DQG HQGV\VWROLF (69  YROXPHV ZHUH PHDVXUHG DFFRUGLQJ WR WKH. 6LPSVRQ·VELSODQHPHWKRGDQG/9HMHFWLRQIUDFWLRQ () ZDVFDOFXODWHGDV&gt; ('9(69

SURFHGXUH DQG DW  \HDUV· IROORZXS WKH DOOFDXVH PRUWDOLW\ DQG KRVSLWDOL]DWLRQV IRU. +) ZHUH UHFRUGHG )LQDOO\ EDVHOLQH DQG  PRQWKV· IROORZXS FKDQJHV

FDUGLDF (&amp;0 PHWDEROLVP EHIRUH DQG DIWHU 695 ,Q DGGLWLRQ WKH UHODWLRQVKLS

WLPDOLVDWLH YDQ 695 $QDO\VH YDQ GH GHWHUPLQDQWHQ YDQ ODQJHU WHUPLMQ RYHUOHYLQJ

License: Licence agreement concerning inclusion of doctoral thesis in the Institutional Repository of the University of Leiden. Downloaded