The clinical research of the Department of Cardiology is centered around patients with coronary artery disease and cardiomyopathy. All non-invasive imaging modalities are available, including PET, and play an important role in each of the four research categories, often used to guide the interventional procedures. An increasing number of the research topics has ramifications with other clinical disciplines and with the pre-clinical research groups of the VU University Medical Center.
Research categories
Research in this category concentrates on patients with
angina pectoris . The first aim is to detect and assess the severity of
coronary artery disease (CAD) and the atherosclerotic burden using non-invasive imaging techniques (coronary MDCT and MRI) in combination with invasive techniques (Intravascular Ultrasound with Virtual Histology and Optical Coherence Tomography). The second aim is to assess the localisation and quantify the severity of ischemia caused by CAD, again using non-invasive imaging techniques (PET and hybrid PET/CT, MRI, echocardiography) and invasive catheter-based methods (FFR, CFR). Addressing the role of microcirculatory dysfunction is becoming an increasingly important part of the assessment. Additionally PET methods allows to study molecular pathways of metabolism and energy expenditure. New treatment strategies are studied to induce angiogenesis, including ultrasound shockwave therapy. Experimental work concentrates on the effects of the interaction between ultrasound micro-bubbles and the cell membrane, aiming at future clinical implementation for cell-targeted drug delivery.
Here the focus is on clinical research in patients with
acute coronary syndromes (ACS) . Novel treatment strategies are pursued on top of optimal medical therapy to decrease reperfusion injury and the no-reflow response in primary PCI of acute myocardial infarction in order to spare myocardial muscle, to restore left ventricular dysfunction, and to reduce the risk of adverse remodelling. These treatments include anti-thrombotic, anti-inflammatory, anti-apoptotic, and cellular therapies. MRI plays an important role in monitoring the effects of these therapies by assessing microvascular obstruction, left ventricular myocardial function and adverse remodelling as surrogate endpoints for long term prognosis.
Currently the main focus in this category is on patients with
hypertrophic cardiomyopathy and in patients with diastolic dysfunction (heart failure with preserved ejection fraction). Research in hypertrophic cardiomyopathy concentrates on diagnosis, risk prediction, and evolution of the disease in genetic carriers of disease mutations who have not yet expressed hypertrophy on ECG or non-invasive imaging. Experimental work is done to search for treatment options that may prevent the development of hypertrophy. Research in patients with
heart failure and preserved ejection fraction is directed at refining strategies to assess diastolic dysfunction and at improving drug therapy. To this purpose non-invasive imaging modalities such as echocardiography and MRI are being combined with invasive pressure-volume assessments and endomyocardial biopsies in selected cases. Studies in patients with dilated cardiomyopathy are anticipated in the near future.
Patients with a reduced left ventricular ejection resulting from coronary artery disease are the subject of research in this category. The aim is to improve their quality of life and survival by restoring LV function and reducing life threatening arrhythmias. The emphasis is on correctly selecting the patients who will respond to revascularization by PCI or CABG, or to cardiac resynchronization therapy by implantion of a biventricular pacing device. For both categories assessment of myocardial viability and specific molecular activation pathways using echocardiography, MRI and PET plays a pivotal role to predict a successful response to therapy. Also, surgical procedures may be optimized with respect to ischemic mitral regurgitation. Accurately predicting response to therapy will avoid that a patient is unnecessarily exposed to the procedural risk of an intervention and it may also save costs.
The following research fellows are working at the department of Cardiology.
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Drs. W.P. Brouwer Research fellow cardiology |
Research subject Since mid 2008, my scientific field of interest is focused on the existence and pathogenesis of hypertrophy in the genetic heart disease ‘hypertrophic cardiomyopathy’ (HCM). In order to detect new tiny pieces of the complicated puzzle resembling HCM, I investigate both humans and mice with the use of cardiac magnetic resonance imaging. Hopefully, my research will generate important new information and contribute to the initiation of adequate causative treatment of patients. |
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Drs. S. de Haan Research fellow cardiology |
Research subject
The number of patients with ischemic cardiomyopathy implanted with a implantable cardioverter defibrillator (ICD) because of primary prevention is steadily increasing worldwide. A substantial portion of these patients, however, never receive ICD therapy because of a life threatening ventricular tachyarrhythmia. Nonetheless, these patients are at risk of inappropriate shocks and implantation related complications. These issues warrant a further refinement of selection criteria for ICD implantation to select those patients who are most likely to benefit from this treatment modality. |
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Drs. S.A. Kleijn Research fellow cardiology |
Research subject Cardiac resynchronization therapy (CRT) has demonstrated sustained clinical benefit in selected patients with drug-refractory heart failure. However, when determining patient eligibility for CRT with current selection criteria, approximately 30% of patients do not respond to this therapy. A major challenge lies in reducing the number of nonresponders to this invasive and expensive therapy. Toward a better understanding of the response to CRT, we use novel cardiovascular imaging techniques such as real-time three-dimensional echocardiography to investigate the relative importance of mechanical dyssynchrony, scar tissue, and left ventricular lead placement as determinants of response to CRT. By identifying the underlying mechanisms we hope to comprehend and address non-response and be able to better determine the most likely responders to CRT . |
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Drs. J. Slikkerveer Research fellow cardiology |
Research subject My name is Jeroen Slikkerveer and I work as a PhD student at the cardiology department of the VU university medical center. My main research subject is the therapeutic application of ultrasound. In the Sonolysis study we study a new treatment method for acute myocardial infarction using a combination of thrombolytics, microbubbles and ultrasound. Furthermore, in the Shockwave study we are treating end stage coronary artery disease patients with ischemic cardiomyopathy using high intensity ultrasound shockwaves. The application of these waves on the heart creates the release of different chemical compounds, like VEGF and NO, which causes local vasodilation and angiogenesis. |
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Drs. J.G.J. Groothuis Research fellow cardiology |
Research subject
MA gnetic
R esonance and
C t in suspected
C oronary artery disease: the MARCC study. |
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Drs. G.J. de Roest Research fellow cardiology |
Research subject The benefits of Cardiac Resynchronization Therapy (CRT) as treatment for drug refractory end-stage heart failure patients with conduction delay are well established. However, a substantial fraction of patients do not show clinical benefit (~30%) or reverse remodeling (~50%) in response to the therapy. Response to the therapy is based on improving cardiac pump function by stimulating both ventricles of the heart. Achieving this response is partly dependent on lead localization, yet also partly not well understood. Characterization of pump function, its improvement during pacing and optimal lead location can however be assessed comprehensively by pressure-volume loops using invasive conductance catheter measurements. Therefore my research topic is unraveling the response to CRT and determining individual optimal lead locations in end stage heart failure patients treated with CRT. |
ICaR-VU
The Institute for Cardiovascular Research of the Vrije Universiteit of Amsterdam (ICaR-VU) was founded in 1992 on basis of the Dutch University Education Act (WW) of 1986. In 1992 the Research School of Cardiovascular Diseases Maastricht-Amsterdam (CARMA), consisting of the Cardiovascular Research Institute Maastricht (CARIM) and the ICaR-VU, was formally recognized by the Royal Dutch Academy of Sciences (KNAW). The recognition of the Research School was officially renewed for another period of five years in July 1997, and again in July 2002. Since May 1998 the ICaR-VU formally collaborates with TNO-PG Leiden. All research projects should ultimately contribute to two research themes (Heart & Vessels). The institute stimulates research in these themes and provides quality control of the research projects.
ICIN
The ICIN (Interuniversitair Cardiologisch Instituut Nederland) is an alliance of the 8 university cardiology departments in the Netherlands. Together we stimulate, co-ordinate and execute scientific research in the field of cardiovascular diseases.
Below you find a link to all publications by our current sfaff members, listed in PubMed
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