Although substantial progress has been made in the pathophysiology and management of the post-thr... more Although substantial progress has been made in the pathophysiology and management of the post-thrombotic syndrome (PTS), several aspects still need clarification. Among them, the incidence and severity of PTS in the real world, the risk factors for its development, the value of patient’s self-evaluation, and the ability to identify patients at risk for severe PTS. Eligible participants (n = 1107) with proximal deep-vein thrombosis (DVT) from the global GARFIELD-VTE registry underwent conventional physician’s evaluation for PTS 36 months after diagnosis of their DVT using the Villalta score. In addition, 856 patients completed a Villalta questionnaire at 24 months. Variable selection was performed using stepwise algorithm, and predictors of severe PTS were incorporated into a multivariable risk model. The optimistic adjusted c-index was calculated using bootstrapping techniques. Over 36-months, 27.8% of patients developed incident PTS (mild in 18.7%, moderate in 5.7%, severe in 3.4%)...
Pulmonary disease in liver cirrhosis and portal hypertension (PH) constitutes a challenging clini... more Pulmonary disease in liver cirrhosis and portal hypertension (PH) constitutes a challenging clinical scenario and may have important implications with regard to prognosis, liver transplantation (LT) candidacy, and post‐LT outcome. Pre‐LT evaluation should include adequate screening for pulmonary diseases that may occur concomitantly with liver disease as well as for those that may arise as a complication of end‐stage liver disease and PH, given that either may jeopardize safe LT and successful outcome. It is key to discriminate those patients who would benefit from LT, especially pulmonary disorders that have been reported to resolve post‐LT and are considered “pulmonary indications” for transplant, from those who are at increased mortality risk and in whom LT is contraindicated. In conclusion, in this article, we review the impact of several pulmonary disorders, including cystic fibrosis, alpha 1‐antitrypsin deficiency, hereditary hemorrhagic telangiectasia, sarcoidosis, coronavirus disease 2019, asthma, chronic obstructive pulmonary disease, pulmonary nodules, interstitial lung disease, hepatic hydrothorax, hepatopulmonary syndrome, and portopulmonary hypertension, on post‐LT survival, as well as the reciprocal impact of LT on the evolution of lung function.
Venous thromboembolism (VTE) is common in cancer patients and is an important cause of morbidity ... more Venous thromboembolism (VTE) is common in cancer patients and is an important cause of morbidity and mortality. The Global Anticoagulant Registry in the FIELD (GARFIELD)–VTE (ClinicalTrials.gov: NCT02155491) is a prospective, observational study of 10,684 patients with objectively diagnosed VTE from 415 sites in 28 countries. We compared baseline characteristics, VTE treatment patterns, and 1-year outcomes (mortality, recurrent VTE and major bleeding) in 1075 patients with active cancer, 674 patients with a history of cancer, and 8935 patients without cancer. Patients with active cancer and history of cancer were older than cancer-free patients, with median ages of 64.8, 68.9, and 58.4 years, respectively. The most common sites of active cancer were lung (14.5%), colorectal (11.0%), breast (10.6%), and gynaecological (10.3%). Active cancer patients had a higher incidence of upper limb and vena cava thrombosis than cancer-free patients (9.0% vs 4.8% and 5.1% vs 1.4%, respectively), and were more likely to receive parenteral anticoagulation as monotherapy than cancer-free patients (57.8% vs 12.1%), and less likely to receive DOACs (14.2% vs 50.6%). Rates of death, recurrent VTE, and major bleeding were higher in active cancer patients than in cancer-free patients, with hazard ratios (95% confidence intervals) of 14.2 (12.1–16.6), 1.6 (1.2–2.0) and 3.8 (2.9–5.0), respectively. VTE was the second most common cause of death in patients with active cancer or history of cancer. In patients with VTE, those with active cancer are at higher risk of death, recurrence, and major bleeding than those without cancer.
BackgroundAn increasing number of older patients are hospitalised. Prognostic uncertainty causes ... more BackgroundAn increasing number of older patients are hospitalised. Prognostic uncertainty causes hospital doctors to be reluctant to make the switch from cure to care. The Supportive and Palliative Care Indicators Tool (SPICT) has not been validated for prognostication in an older hospitalised population.AimTo validate SPICT as a prognostic tool for risk of dying within one year in older hospitalised patients.DesignProspective multicentre study. Premorbid SPICT and 1-year survival and survival time were assessed.Setting/participantsPatients 75 years and older admitted at acute geriatric (n=209) and cardiology units (CUs) (n=249) of four hospitals.ResultsIn total, 59.3% (124/209) was SPICT identified on acute geriatric vs 40.6% (101/249) on CUs (p<0.001). SPICT-identified patients in CUs reported more functional needs and more symptoms compared to SPICT non-identified patients. On acute geriatric units, SPICT-identified patients reported more functional needs only.The HR of dying ...
Background: Pulmonary arterial hypertension (PAH) associated with congenital heart disease (CHD) ... more Background: Pulmonary arterial hypertension (PAH) associated with congenital heart disease (CHD) usually results from a systemic-to-pulmonary shunt. Eisenmenger's syndrome (ES) is characterised by ...
Heart transplantation in patients with Marfan syndrome is challenging and raises concerns with re... more Heart transplantation in patients with Marfan syndrome is challenging and raises concerns with regards to the haemodynamic and immunosuppressive-induced effects on the inherently fragile aorta. Most aortic events following transplantation reported so far in the literature occurred in patients with pre-existent distal aortic dissection. We report a case of successful orthotopic heart transplantation in a patient with Marfan syndrome that was complicated by late-onset type B dissection in pre-existing mild and stable distal aortic dilation. Serial aortic imaging revealed progressive growth at the level of the descending thoracic aorta. An open thoracoabdominal aortic repair procedure was successfully performed 6 months after the transplantation.
International Journal of Physiology Pathophysiology and Pharmacology, 2014
Heart failure is the final common pathway for most forms of heart disease, and is characterized b... more Heart failure is the final common pathway for most forms of heart disease, and is characterized by a reduced energy status. Myocardial oxygen consumption (MV02) is closely related to the main determinants of systolic function (heart rate, pressure and contractility). The aim of the study was to compare myocardial blood flow, metabolism and mechanical efficiency in rapid pacing induced heart failure in dogs. 5 dogs were paced for 3 weeks at 240 bpm, with regular follow up of hemodynamic characteristics. Coronary blood flow and oxidative metabolism were evaluated with [(15)O] water and [(11)C]acetate clearance respectively, in baseline conditions (B) and after 3 weeks of rapid pacing (3 wk RP) using positron emission tomography. Three weeks of rapid pacing in a dog model resulted in a severely depressed left ventricular function (LV dP/dtmax 3698 ± 314 mmHg (B) vs. 1365 ± 103 mmHg (3 wk RP)). On the contrary myocardial blood flow 1.29 ± 0.11 ml/min/g (B) vs. 1.05 ± 0.07 ml/min/g (3 wk RP) and oxidative metabolism 0.178 ± 0.1 min(-1) (B) vs. 0.161 ± 0.1 min(-1) (3 wk RP) remained essentially unchanged, indicating a reduced efficiency and a change in O2 utilization. Heart failure induced by rapid ventricular pacing in dogs provokes a clearly reduced mechanical efficiency, illustrating the occurrence of a metabolic remodeling in heart failure induced by rapid pacing.
Rapid pacing (RP) is a regularly used model to induce heart failure in dogs. The aim of the study... more Rapid pacing (RP) is a regularly used model to induce heart failure in dogs. The aim of the study was to evaluate Ca(2+) handling, left ventricular (LV) contractile response during Ca(2+) administration compared to exercise, as well as oxygen consumption and mechanical efficiency after 48 hours (hrs) of RP. 53 mongrel dogs were instrumented to measure LV pressure, LV fractional shortening, regional wall thickening and coronary blood flow. Contractile reserve was measured with isoproterenol and intravenous (IV) Ca(2+) administration. To assess the function of the sarcoplasmic reticulum (SR) post extrasystolic potentiation (PESP) and SR Ca(2+) uptake were measured. A graded treadmill test was performed in baseline and after RP (n=14). In a separate group of animals (n=5) myocardial performance and oxygen consumption was measured using a wide range of loading conditions. LV contractility was significantly decreased upon cessation of pacing. The contractile response to isoproterenol was blunted compared to a preserved response to IV Ca(2+) . PESP was slightly increased after RP. Maximal velocity (Vmax ) of SR Ca(2+) uptake was unchanged. Contractile response during exercise is attenuated after RP. External work is reduced, whereas oxygen consumption is preserved, provoking a reduced mechanical efficiency. 48 hrs RP provokes a reversible LV dysfunction, while the SR-function and response to exogenous Ca(2+) are preserved. This is compatible with an intracellular functional remodelling to counteract Ca(2+) overload provoked by RP. LV dysfunction is accompanied by a reduced contractile reserve but an unchanged oxygen consumption, illustrating an alteration in oxygen utilization. This article is protected by copyright. All rights reserved.
We describe the case of a 23-year-old man with incessant atrial tachycardia complicated with tach... more We describe the case of a 23-year-old man with incessant atrial tachycardia complicated with tachycardiomyopathy. Transseptal ablation of the arrhythmia focus, located between the ostia of the left and right inferior vena pulmonalis, resulted in a restoration of normal sinus rhythm and a complete regression of the signs of tachycardiomyopathy.
The aim of this study was 1) to investigate the validity of repeated estimations of blood flow us... more The aim of this study was 1) to investigate the validity of repeated estimations of blood flow using colored microspheres (CMS) and 2) to develop and validate a method that permits four consecutive estimations in the same animal using nonradiolabeled microspheres (NRMS). Several mixtures of different types of microspheres were injected in dogs, with each mixture containing the radiolabeled microspheres (RMS; labeled with 113Sn) with either three CMS, four CMS, or three CMS and one type of fluorescent (crimson labeled) microsphere (FMS). The blood flows estimated with the use of any of the injected microspheres were compared with those measured using the RMS as the &amp;amp;amp;amp;amp;amp;quot;gold standard.&amp;amp;amp;amp;amp;amp;quot; The results were analyzed by 1) regression analysis, 2) variance analysis (ANOVA I), and 3) estimation of the limits of agreement between RMS and NRMS flow rates. The results indicate that simultaneous estimations of blood flow obtained with the use of more than three CMS lack accuracy and reliability. A combination of three types of CMS with crimson-labeled FMS, however, offers the possibility to estimate consecutively four different flow rates in the same animal in an accurate way and with relatively high precision.
Although substantial progress has been made in the pathophysiology and management of the post-thr... more Although substantial progress has been made in the pathophysiology and management of the post-thrombotic syndrome (PTS), several aspects still need clarification. Among them, the incidence and severity of PTS in the real world, the risk factors for its development, the value of patient’s self-evaluation, and the ability to identify patients at risk for severe PTS. Eligible participants (n = 1107) with proximal deep-vein thrombosis (DVT) from the global GARFIELD-VTE registry underwent conventional physician’s evaluation for PTS 36 months after diagnosis of their DVT using the Villalta score. In addition, 856 patients completed a Villalta questionnaire at 24 months. Variable selection was performed using stepwise algorithm, and predictors of severe PTS were incorporated into a multivariable risk model. The optimistic adjusted c-index was calculated using bootstrapping techniques. Over 36-months, 27.8% of patients developed incident PTS (mild in 18.7%, moderate in 5.7%, severe in 3.4%)...
Pulmonary disease in liver cirrhosis and portal hypertension (PH) constitutes a challenging clini... more Pulmonary disease in liver cirrhosis and portal hypertension (PH) constitutes a challenging clinical scenario and may have important implications with regard to prognosis, liver transplantation (LT) candidacy, and post‐LT outcome. Pre‐LT evaluation should include adequate screening for pulmonary diseases that may occur concomitantly with liver disease as well as for those that may arise as a complication of end‐stage liver disease and PH, given that either may jeopardize safe LT and successful outcome. It is key to discriminate those patients who would benefit from LT, especially pulmonary disorders that have been reported to resolve post‐LT and are considered “pulmonary indications” for transplant, from those who are at increased mortality risk and in whom LT is contraindicated. In conclusion, in this article, we review the impact of several pulmonary disorders, including cystic fibrosis, alpha 1‐antitrypsin deficiency, hereditary hemorrhagic telangiectasia, sarcoidosis, coronavirus disease 2019, asthma, chronic obstructive pulmonary disease, pulmonary nodules, interstitial lung disease, hepatic hydrothorax, hepatopulmonary syndrome, and portopulmonary hypertension, on post‐LT survival, as well as the reciprocal impact of LT on the evolution of lung function.
Venous thromboembolism (VTE) is common in cancer patients and is an important cause of morbidity ... more Venous thromboembolism (VTE) is common in cancer patients and is an important cause of morbidity and mortality. The Global Anticoagulant Registry in the FIELD (GARFIELD)–VTE (ClinicalTrials.gov: NCT02155491) is a prospective, observational study of 10,684 patients with objectively diagnosed VTE from 415 sites in 28 countries. We compared baseline characteristics, VTE treatment patterns, and 1-year outcomes (mortality, recurrent VTE and major bleeding) in 1075 patients with active cancer, 674 patients with a history of cancer, and 8935 patients without cancer. Patients with active cancer and history of cancer were older than cancer-free patients, with median ages of 64.8, 68.9, and 58.4 years, respectively. The most common sites of active cancer were lung (14.5%), colorectal (11.0%), breast (10.6%), and gynaecological (10.3%). Active cancer patients had a higher incidence of upper limb and vena cava thrombosis than cancer-free patients (9.0% vs 4.8% and 5.1% vs 1.4%, respectively), and were more likely to receive parenteral anticoagulation as monotherapy than cancer-free patients (57.8% vs 12.1%), and less likely to receive DOACs (14.2% vs 50.6%). Rates of death, recurrent VTE, and major bleeding were higher in active cancer patients than in cancer-free patients, with hazard ratios (95% confidence intervals) of 14.2 (12.1–16.6), 1.6 (1.2–2.0) and 3.8 (2.9–5.0), respectively. VTE was the second most common cause of death in patients with active cancer or history of cancer. In patients with VTE, those with active cancer are at higher risk of death, recurrence, and major bleeding than those without cancer.
BackgroundAn increasing number of older patients are hospitalised. Prognostic uncertainty causes ... more BackgroundAn increasing number of older patients are hospitalised. Prognostic uncertainty causes hospital doctors to be reluctant to make the switch from cure to care. The Supportive and Palliative Care Indicators Tool (SPICT) has not been validated for prognostication in an older hospitalised population.AimTo validate SPICT as a prognostic tool for risk of dying within one year in older hospitalised patients.DesignProspective multicentre study. Premorbid SPICT and 1-year survival and survival time were assessed.Setting/participantsPatients 75 years and older admitted at acute geriatric (n=209) and cardiology units (CUs) (n=249) of four hospitals.ResultsIn total, 59.3% (124/209) was SPICT identified on acute geriatric vs 40.6% (101/249) on CUs (p<0.001). SPICT-identified patients in CUs reported more functional needs and more symptoms compared to SPICT non-identified patients. On acute geriatric units, SPICT-identified patients reported more functional needs only.The HR of dying ...
Background: Pulmonary arterial hypertension (PAH) associated with congenital heart disease (CHD) ... more Background: Pulmonary arterial hypertension (PAH) associated with congenital heart disease (CHD) usually results from a systemic-to-pulmonary shunt. Eisenmenger's syndrome (ES) is characterised by ...
Heart transplantation in patients with Marfan syndrome is challenging and raises concerns with re... more Heart transplantation in patients with Marfan syndrome is challenging and raises concerns with regards to the haemodynamic and immunosuppressive-induced effects on the inherently fragile aorta. Most aortic events following transplantation reported so far in the literature occurred in patients with pre-existent distal aortic dissection. We report a case of successful orthotopic heart transplantation in a patient with Marfan syndrome that was complicated by late-onset type B dissection in pre-existing mild and stable distal aortic dilation. Serial aortic imaging revealed progressive growth at the level of the descending thoracic aorta. An open thoracoabdominal aortic repair procedure was successfully performed 6 months after the transplantation.
International Journal of Physiology Pathophysiology and Pharmacology, 2014
Heart failure is the final common pathway for most forms of heart disease, and is characterized b... more Heart failure is the final common pathway for most forms of heart disease, and is characterized by a reduced energy status. Myocardial oxygen consumption (MV02) is closely related to the main determinants of systolic function (heart rate, pressure and contractility). The aim of the study was to compare myocardial blood flow, metabolism and mechanical efficiency in rapid pacing induced heart failure in dogs. 5 dogs were paced for 3 weeks at 240 bpm, with regular follow up of hemodynamic characteristics. Coronary blood flow and oxidative metabolism were evaluated with [(15)O] water and [(11)C]acetate clearance respectively, in baseline conditions (B) and after 3 weeks of rapid pacing (3 wk RP) using positron emission tomography. Three weeks of rapid pacing in a dog model resulted in a severely depressed left ventricular function (LV dP/dtmax 3698 ± 314 mmHg (B) vs. 1365 ± 103 mmHg (3 wk RP)). On the contrary myocardial blood flow 1.29 ± 0.11 ml/min/g (B) vs. 1.05 ± 0.07 ml/min/g (3 wk RP) and oxidative metabolism 0.178 ± 0.1 min(-1) (B) vs. 0.161 ± 0.1 min(-1) (3 wk RP) remained essentially unchanged, indicating a reduced efficiency and a change in O2 utilization. Heart failure induced by rapid ventricular pacing in dogs provokes a clearly reduced mechanical efficiency, illustrating the occurrence of a metabolic remodeling in heart failure induced by rapid pacing.
Rapid pacing (RP) is a regularly used model to induce heart failure in dogs. The aim of the study... more Rapid pacing (RP) is a regularly used model to induce heart failure in dogs. The aim of the study was to evaluate Ca(2+) handling, left ventricular (LV) contractile response during Ca(2+) administration compared to exercise, as well as oxygen consumption and mechanical efficiency after 48 hours (hrs) of RP. 53 mongrel dogs were instrumented to measure LV pressure, LV fractional shortening, regional wall thickening and coronary blood flow. Contractile reserve was measured with isoproterenol and intravenous (IV) Ca(2+) administration. To assess the function of the sarcoplasmic reticulum (SR) post extrasystolic potentiation (PESP) and SR Ca(2+) uptake were measured. A graded treadmill test was performed in baseline and after RP (n=14). In a separate group of animals (n=5) myocardial performance and oxygen consumption was measured using a wide range of loading conditions. LV contractility was significantly decreased upon cessation of pacing. The contractile response to isoproterenol was blunted compared to a preserved response to IV Ca(2+) . PESP was slightly increased after RP. Maximal velocity (Vmax ) of SR Ca(2+) uptake was unchanged. Contractile response during exercise is attenuated after RP. External work is reduced, whereas oxygen consumption is preserved, provoking a reduced mechanical efficiency. 48 hrs RP provokes a reversible LV dysfunction, while the SR-function and response to exogenous Ca(2+) are preserved. This is compatible with an intracellular functional remodelling to counteract Ca(2+) overload provoked by RP. LV dysfunction is accompanied by a reduced contractile reserve but an unchanged oxygen consumption, illustrating an alteration in oxygen utilization. This article is protected by copyright. All rights reserved.
We describe the case of a 23-year-old man with incessant atrial tachycardia complicated with tach... more We describe the case of a 23-year-old man with incessant atrial tachycardia complicated with tachycardiomyopathy. Transseptal ablation of the arrhythmia focus, located between the ostia of the left and right inferior vena pulmonalis, resulted in a restoration of normal sinus rhythm and a complete regression of the signs of tachycardiomyopathy.
The aim of this study was 1) to investigate the validity of repeated estimations of blood flow us... more The aim of this study was 1) to investigate the validity of repeated estimations of blood flow using colored microspheres (CMS) and 2) to develop and validate a method that permits four consecutive estimations in the same animal using nonradiolabeled microspheres (NRMS). Several mixtures of different types of microspheres were injected in dogs, with each mixture containing the radiolabeled microspheres (RMS; labeled with 113Sn) with either three CMS, four CMS, or three CMS and one type of fluorescent (crimson labeled) microsphere (FMS). The blood flows estimated with the use of any of the injected microspheres were compared with those measured using the RMS as the &amp;amp;amp;amp;amp;amp;quot;gold standard.&amp;amp;amp;amp;amp;amp;quot; The results were analyzed by 1) regression analysis, 2) variance analysis (ANOVA I), and 3) estimation of the limits of agreement between RMS and NRMS flow rates. The results indicate that simultaneous estimations of blood flow obtained with the use of more than three CMS lack accuracy and reliability. A combination of three types of CMS with crimson-labeled FMS, however, offers the possibility to estimate consecutively four different flow rates in the same animal in an accurate way and with relatively high precision.
Uploads
Papers by Michel Pauw