Patients older than sixty have an elevated risk of having a heart attack during or after noncardiac surgery, although more than two-thirds of this patient group do not have any heart problems at all. The DH&L has investigated myocardial damage after surgery by analysing troponin levels in the blood. This showed that almost 20% of patients have myocardial damage. Patients with an elevated troponin level have a threefold higher risk of dying within one month of surgery. The DH&L is working together with Anesthesiology, Surgery and Epidemiology within the CHASE study group at UMC Utrecht to investigate the cause of this elevated troponin level.

Waes, J.A.R. van, Nathoe, H.M., Graaff, J.C. de, Kemperman, J.T.J.H., Borst, G.J. de, Peelen, L.M., Grobben, R.B., Doevendans, P.A., CHASE investigators, x & Klei, W.A. van (2013). Myocardial injury after non cardiac surgery and its association with short-term mortality. Circulation, 127(23), 2264-2271.

www.umcutrecht.nl/longziekten

Mohamed Hoesein, F.A.A., Wauters, E., Janssens, W., Groen, H.J., Smolonska, J., Wijmenga, C., Postma, D.S., Boezen, H.M., Jong, P.A. de, Decramer, M., Lammers, J.W.J., Lambrechts, D. & Zanen, P. (2013). Variants in the 15q24/25 locus associate with lung function decline in active smokers. PLoS ONE [E], 8(1), e53219.

PhD research at the DH&L shows that smoking cessation has a significant effect on reducing disease progression in COPD, even in heavy smokers.

Thoracic surgeons at the DH&L are undertaking experimental research evaluating an automatic connector (ELANA Clip), which enables keyhole coronary bypass surgery. Groundbreaking results were achieved in 2013. The size of the experimental automatic connector decreased, which has made human application more feasible. Moreover, experimental robot keyhole surgery on animals tested the connector through keyhole surgery for the first time. If the long-term quality of the connector is confirmed in a large-scale experiment in 2014, the first patient is expected to receive actual cardiac keyhole surgery at the UMC Utrecht in 2015.

Stecher, D., Slochteren, F.J. van, Hoefer, I.E., Pasterkamp, G., Tulleken, C.A.F., Herwerden, L.A. van & Buijsrogge, M.P. (2013). The nonocclusive laser-assisted coronary anastomotic connector in an off-pump porcine bypass model. Journal of Thoracic and Cardiovascular Surgery, S0022-5223, 00779-4.

Alongside known genetic risk factors, such as blood pressure, the DH&L as the Principal Investigator in a large consortium study has discovered two new genetic factors related to blood pressure. This has increased the understanding of the underlying mechanisms of blood pressure and may lead to new therapies for patients with hypertension.

Tragante, V., Doevendans, P.A.F.M., Nathoe, H.M., Graaf, Y. van der, Spiering, W., Algra, A., Borst, G.J. de, Moll, F.L., Bakker, P.I.W. de & Asselbergs, F.W. (2013). The impact of susceptibility loci for coronary artery disease on other vascular domains and recurrence risk. European Heart Journal, 34(37), 2896-904.

Researchers at the DH&L are developing a medicine in their laboratory with a highly targeted pharmacological function to block previously untreated ion channels in the heart. After having been tested in preclinical tests and clinical trials, this medicine could be used in the treatment of cardiac arrhythmias.

medisch manager en voorzitter

Divisie Har

H Takanari, L Nalos, A Stary-Weinziger, K de Git, R Varkevisser, T Linder,

MJ Houtman, P de Kort, M Peschar, T de Boer, RR Tidwell, MB Rook, MA Vos, MA van der Heyden. Efficient and specific cardiac Ik1 inhibiton by a new pentamidine analog. Card Res 2013; 99: 203-214.

Medicines to treat cardiac arrhythmias are effective but often associated with unpleasant side effects which prevents their wide-spread use. These medicines include calcium-channel blockers which reduce heart function, making them unsuitable for patients with heart failure. Researchers at the DH&L are investigating a new remedy which focuses specifically on intracellular calcium metabolism.

VJ Bourgonje, MA Vos, S Ozdemir, N Doisne, K Acsai, A Varro, A Sztojkov-Ivanov,

I Zupko, E Rauch, L Kattner, V Bito, M Houtman, R van der Nagel, JD Beekman.

TA van Veen, K Sipido, G Antoons. Combined Na/Ca exchanger and L-type calcium blocker as a potential strategy to suppress arrhythmias and maintain ventricular function. Circ A&E 2013; 6: 371-9.

www.cvon.eu

The Netherlands CardioVascular Research Initiative (CardioVasculair Onderzoek Nederland - CVON) has awarded major subsidies to two studies of the DH&L.

medisch manager en voorzitter

Divisie Hart

Self-regenerative heart valves

Researchers at the DH&L are researching in-situ tissue engineering, a new method that involves the body growing its own new living heart valve. A biodegradable carrier in the shape of a heart valve is implanted into the patient and the patient's own cells from their blood transform into a living heart valve which can grow with the patient and last a lifetime.

Predict

What goes wrong in patients who die of sudden cardiac arrest? The DH&L is participating in a multicenter study performing extensive genetic analysis among people who have died of sudden cardiac arrest and among families who are genetically predisposed to having a cardiac arrest. Doctors being able to more accurately predict which groups of people run a higher risk could help customize healthcare e.g. by using medication or a pacemaker, and this could save lives.

www.eurostars-eureka.eu

The DH&L collaborates with the Biotech companies CardioGenx and Firalis to research methods that can easily and rapidly diagnose ischemia (oxygen shortage in the heart) by investigating gene expression of cells involved in vessel formation around the heart. This joint research project was given Eurostar funding by Eureka's Eurostars Programme.