TweeSteden Hospital

Tilburg, Netherlands

TweeSteden Hospital

Tilburg, Netherlands
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Van Den Branden B.J.L.,St Antonius Hospital | Rahel B.M.,Viecuri Hospital | Laarman G.J.,Tweesteden Hospital | Slagboom T.,Onze Lieve Vrouwe Gasthuis | And 3 more authors.
EuroIntervention | Year: 2012

Aims: The aim of this study was to examine the five-year clinical outcome in patients enrolled in the Primary Stenting of Totally Occluded Native Coronary Arteries II (PRISON II) study. Methods and results: Patients with totally occluded coronary arteries were randomised to either sirolimus-eluting stent (SES, n=100) or bare metal stent (BMS, n=100) implantation. At five years, patients in the SES group had significantly lower rates of target lesion revascularisation (12% vs. 30%, p=0.001), target vessel revascularisation (17% vs. 34%, p=0.009) and major adverse cardiac events (12% vs. 36%, p<0.001). There were no significant differences in death and myocardial infarction. Eight (8%) cases of stent thrombosis (seven definite and one probable; one early, one late, and six very late) were noticed in the SES group versus three cases (3%, one definite and two possible; all very late) in the BMS group (p=0.21). Conclusions: The results of the present study show that the documented superior short-term angiographic and clinical results of SES in patients with total coronary occlusions are maintained during long-term 5-year follow-up as compared with BMS. On the other hand, there is a trend to a higher stent thrombosis rate in the SES group. © Europa Edition 2012. All rights reserved.


Vink M.A.,Onze Lieve Vrouwe Gasthuis | Dirksen M.T.,Onze Lieve Vrouwe Gasthuis | Suttorp M.J.,St Antonius Hospital | Tijssen J.G.P.,University of Amsterdam | And 5 more authors.
JACC: Cardiovascular Interventions | Year: 2011

Objectives The purpose of this study was to evaluate the long-term outcomes of the PASSION (Paclitaxel-Eluting Versus Conventional Stent in Myocardial Infarction with ST-Segment Elevation) trial. Background In primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction (STEMI), the use of drug-eluting stents (DES) is still controversial. Several randomized controlled trials of DES, compared with bare-metal stents (BMS), with short-term follow-up showed a reduction in target lesion revascularization (TLR), but no differences in rates of cardiac death or recurrent myocardial infarction. Moreover, the occurrence of (very) late stent thrombosis (ST) continues to be of major concern, and, therefore, long-term follow-up results are needed. Methods We randomly assigned 619 patients presenting with STEMI to a paclitaxel-eluting stent (PES) or the similar BMS. The primary end point was the composite of cardiac death, recurrent myocardial infarction, or TLR. We performed clinical follow-up at 5 years. Results At 5 years, the occurrence of the composite of cardiac death, recurrent myocardial infarction, or TLR was comparable at 18.6% versus 21.8% in PES and BMS, respectively (hazard ratio [HR]: 0.82, 95% confidence interval [CI]: 0.58 to 1.18, p = 0.28). The incidence of definite or probable ST was 12 (4.2%) in the PES group and 10 (3.4%) in the BMS group (HR: 1.19, 95% CI: 0.51 to 276, p = 0.68). Conclusions In the present analysis of PES compared with BMS in primary percutaneous coronary intervention for STEMI, no significant difference in major adverse cardiac events was observed. In addition, no difference in the incidence of definite or probable ST was seen, although very late ST was almost exclusively seen after the use of PES. (Paclitaxel-Eluting Versus Conventional Stent in Myocardial Infarction with ST-Segment Elevation [PASSION]; ISRCTN65027270) © 2011 American College of Cardiology Foundation.


Goedee H.S.,St Elisabeth Hospital | Brekelmans G.J.F.,St Elisabeth Hospital | van Asseldonk J.T.H.,TweeSteden Hospital | Beekman R.,Atrium Medical | And 2 more authors.
European Journal of Neurology | Year: 2013

Clinical, laboratory and electrodiagnostic studies are the mainstay in the diagnosis of polyneuropathy. An accurate etiological diagnosis is of paramount importance to provide the appropriate treatment, prognosis and genetic counselling. High resolution sonography of the peripheral nervous system allows nerves to be readily visualized and to assess their morphology. Ultrasonography has brought pathophysiological insights and substantially added to diagnostic accuracy and treatment decisions amongst mononeuropathies. In this study the literature on its clinical application in polyneuropathy is reviewed. Several polyneuropathies have been studied by means of ultrasound: Charcot-Marie-Tooth, hereditary neuropathy with liability to pressure palsies, chronic inflammatory demyelinating polyneuropathy, Guillain-Barré syndrome, multifocal motor neuropathy, paraneoplastic polyneuropathy, leprosy and diabetic neuropathy. The most prominent reported pathological changes were nerve enlargement, increased hypo-echogenicity and increased intraneural vascularization. Sonography revealed intriguingly different patterns of nerve enlargement between inflammatory neuropathies and axonal and inherited polyneuropathies. However, many studies concerned case reports or case series and showed methodological shortcomings. Further prospective studies with standardized protocols for nerve sonography and clinical and electrodiagnostic testing are needed to determine the role of nerve sonography in inherited and acquired polyneuropathies. © 2013 EFNS.


Van Son J.,University of Tilburg | Nyklicek I.,University of Tilburg | Pop V.J.,University of Tilburg | Blonk M.C.,Catharina Hospital | And 4 more authors.
Diabetes Care | Year: 2013

OBJECTIVE-Emotional distress is common in outpatients with diabetes, affecting ;20- 40% of the patients. The aim of this study was to determine the effectiveness of group therapy with Mindfulness-Based Cognitive Therapy (MBCT), relative to usual care, for patients with diabetes with regard to reducing emotional distress and improving health-related quality of life and glycemic control. RESEARCH DESIGN AND METHODS-In the present randomized controlled trial, 139 outpatients with diabetes (type 1 or type 2) and low levels of emotional well-being were randomized to MBCT (n = 70) or a waiting list group (n = 69). Primary outcomes were perceived stress (Perceived Stress Scale), anxiety and depressive symptoms (Hospital Anxiety and Depression Scale), mood (Profiles of Mood States), and diabetes-specific distress (Problem Areas In Diabetes). Secondary outcomes were health-related quality of life (12-Item Short-Form Health Survey), and glycemic control (HbA1c). Assessments were conducted at baseline and at 4 and 8 weeks of follow-up. RESULTS-Compared with control, MBCT was more effective in reducing stress (P< 0.001, Cohen d = 0.70), depressive symptoms (P = 0.006, d = 0.59), and anxiety (P = 0.019, d = 0.44). In addition, MBCT was more effective in improving quality of life (mental: P = 0.003, d = 0.55; physical: P = 0.032, d = 0.40). We found no significant effect on HbA1c or diabetes-specific distress, although patients with elevated diabetes distress in the MBCT group tended to show a decrease in diabetes distress (P = 0.07, d = 0.70) compared with the control group. CONCLUSIONS-Compared with usual care, MBCT resulted in a reduction of emotional distress and an increase in health-related quality of life in diabetic patients who had lower levels of emotional well-being. © 2013 by the American Diabetes Association.


Kupper N.,University of Tilburg | Widdershoven J.W.,TweeSteden Hospital | Pedersen S.S.,University of Tilburg
Journal of Affective Disorders | Year: 2012

Background: Little is known about whether cognitive/affective depressive symptoms or somatic/affective depressive symptoms are associated with inflammation in heart failure (HF), or that the relation is confounded with disease severity. Aim: To examine the association between depressive symptom dimensions in HF patients with inflammatory markers cross-sectionally and prospectively, while adjusting for appropriate confounders. Results: Consecutive HF patients completed the Beck Depression Inventory at inclusion and at 12 month follow-up. Cytokines were assessed at both occasions. Cross-sectional - multivariate linear regression analysis (n = 110) demonstrated that cognitive/affective depressive symptoms were independently associated with increased levels of sTNFR2 (β = 0.20, p < 0.05) and IL-1ra (β = 0.28, p < 0.01). Somatic/affective depressive symptoms were independently related to sTNFR2 (β = 0.21, p < 0.05). Prospective - (n = 125) the level of cognitive/affective depressive symptoms at inclusion was prospectively associated with increased levels of sTNFR1 and sTNFR2 (β = 0.21 and 0.25 resp. p < 0.05), independent of covariates. Change in somatic/affective depressive symptoms over the 12 month period was associated with sTNFR2 (β = 0.30, p = 0.008). At symptom level, core depressive cognitions such as hopelessness and guilt drove the relation between the sTNF receptors and the cognitive/affective component, while having sleep problems was the most important associate of the somatic/affective dimension. Conclusions: Baseline cognitive/affective depressive symptoms were prospectively associated with sTNFR1 and sTNFR2 in HF patients, while change in somatic/affective depressive symptoms was associated with sTNFR2, independent from clinical and demographic covariates. Further studies are warranted to replicate these findings and to examine the association between depression dimensions, inflammation and prognosis in HF. © 2011 Elsevier B.V. All rights reserved.


Pelle A.J.,University of Tilburg | Pedersen S.S.,University of Tilburg | Schiffer A.A.,Tweesteden Hospital | Szabo B.,St Elisabeth Hospital | And 2 more authors.
Circulation: Heart Failure | Year: 2010

Background: Depression, anxiety, and type D ("distressed") personality (tendency to experience negative emotions paired with social inhibition) have been associated with poor prognosis in coronary heart disease, but little is known about their role in chronic heart failure. Therefore, we investigated whether these indicators of psychological distress are associated with mortality in chronic heart failure. Method and Results: Consecutive outpatients with chronic heart failure (n=641; 74.3% men; mean age, 66.6±10.0 years) filled out a 4-item questionnaire to assess mixed symptoms of anxiety and depression and the 14-item type D scale. End points were defined as all-cause and cardiac mortality. After a mean follow-up of 37.6±15.6 months, 123 deaths (76 due to cardiac cause) were recorded. Cumulative hazard functions for elevated anxiety/depression symptoms differed marginally for all-cause (P=0.06), but not cardiac, mortality (P=0.43); type D personality was associated with neither all-cause mortality (P=0.63) nor cardiac mortality (P=0.87). In multivariable analyses, neither elevated anxiety/depression symptoms nor type D personality was associated with all-cause mortality (hazard ratio [HR] = 1.18; 95% CI, 0.76 to 1.84; P=0.45 and HR=1.09; 95% CI, 0.67 to 1.77; P=0.73, respectively) or cardiac mortality (HR=1.13; 95% CI, 0.63 to 2.04; P=0.65 and HR=1.16; 95% CI, 0.62 to 2.18; P=0.67). In secondary analyses, a 1-point increase in anxiety/depression (range, 0 to 16) was associated with an 8% increase in risk for all-cause mortality (HR=1.08; 95% CI, 1.01 to 1.15; P=0.02). Conclusions: Neither elevated anxiety/depression symptoms nor type D personality was associated with an increased risk for all-cause or cardiac mortality. Future studies with adequate power and a longer follow-up duration are needed to further elucidate the role of psychological distress in chronic heart failure. © 2010 American Heart Association, Inc.


Lockefeer J.P.M.,TweeSteden Hospital | De Vries J.,University of Tilburg | De Vries J.,St Elisabeth Hospital
Psycho-Oncology | Year: 2013

Background Depressive symptoms, fatigue, and low sleep quality are common symptoms during and after breast cancer (BC) treatment. In the present study, the relationship between trait anxiety and these symptoms in a long follow-up period was examined. Methods This was a prospective study. Participants, composed of 163 women with BC and 224 women with benign breast problems (BBPs), completed questionnaires on depressive symptoms, fatigue, and sleep quality before diagnosis and 1, 3, 6, 12, and 24 months after diagnosis (BBP group) or surgical treatment (BC group). In addition, patients completed a questionnaire on trait anxiety before diagnosis. Results and Conclusions Trait anxiety was the most significant predictor for depressive symptoms (p < 0.001) and lower sleep quality (p = 0.040) at 2-year follow-up. For fatigue, fatigue at baseline and trait anxiety together was the most important predictor (p < 0.001). Linear mixed model analyses showed that there was an interaction effect of time with trait anxiety and with diagnosis for depressive symptoms (p = 0.001 and p < 0.001) and fatigue (p = 0.004 and p < 0.001). There was no interaction effect of time with trait anxiety or diagnosis for sleep quality (p = 0.055 and p = 0.225). Together with diagnosis, trait anxiety was an important determinant of depressive symptoms, fatigue, and low sleep quality following diagnosis of BBP or BC and seemed to be a common factor in these persisting symptoms. Copyright © 2012 John Wiley & Sons, Ltd.


Smith O.R.F.,University of Tilburg | Smith O.R.F.,University of Bergen | Kupper N.,University of Tilburg | Schiffer A.A.,University of Tilburg | And 2 more authors.
Psychosomatic Medicine | Year: 2012

Objective: Somatic symptoms of depression predict mortality in chronic heart failure (CHF), but symptoms of fatigue that are common to both conditions may confound this association. We therefore examined the contribution of fatigue to the association between somatic depression and increased risk of mortality in patients with CHF. Methods: At baseline, 380 consecutive patients with CHF were assessed for symptoms of depression, exertion fatigue, and general fatigue. Demographic and clinical data were obtained from the patients' medical records or the treating cardiologist. The primary end point was mortality after a median follow-up of 2.3 years (range = 0.15-4.76 years). Results: At follow-up, 63 patients (16.6%) had died. Exertion fatigue (hazard ratio [HR] = 1.04, 95% confidence interval [CI] = 1.01-1.06, p = .003), not general fatigue, was associated with an increased risk of mortality in CHF. Multivariate Cox regression analysis revealed that somatic symptoms of depression (HR = 1.41, 95% CI = 1.05-1.88, p = .02) were independently associated with increased mortality risk and that this association could not be explained by exertion fatigue (HR = 1.02, 95% CI = 0.97-1.05, p = .31). Conclusions: The adverse effect of somatic depression on prognosis in CHF was not confounded by exertion fatigue. Behavioral interventions should focus not only on fatigue but also on other somatic manifestations of depression in patients with CHF. Abbreviations: CHF = chronic heart failureLVEF = left ventricular ejection fractionBDI = Beck Depression InventoryPCA = principal components analysis © 2012 by the American Psychosomatic Society.


Kupper N.,University of Tilburg | Denollet J.,University of Tilburg | Widdershoven J.,University of Tilburg | Widdershoven J.,TweeSteden Hospital | Kop W.J.,University of Tilburg
International Journal of Psychophysiology | Year: 2013

Background: The distressed (Type D) personality is associated with adverse coronary heart disease outcomes, but the mechanisms accounting for this association remain to be elucidated. We examined whether myocardial and hemodynamic responses to mental stress are disrupted in Type D patients with chronic heart failure (HF). Methods: Ninety-nine HF patients (mean age 65. ±. 12. years; 75% men) underwent a public speech task, during which heart rate (HR) and blood pressure (BP) were recorded. Type D personality and its components negative affectivity (NA) and social inhibition (SI) were assessed with the DS14. General linear models with repeated measures and logistic regression were used to assess differences in stress response and recovery. Results: Type D personality was associated with a reduced HR response (F1,93=4.31, p<.05) independent of the use of beta adrenergic blocking agents and the presence of atrial fibrillation. There were no differences between HF patients with and without a Type D personality with respect to the BP response. Examining continuous NA and SI scores and their interaction (NA*SI), revealed a significant association of NA*SI with the SBP response (F1,93=4.11, p<.05), independent of BP covariates. Results with respect to HR and DBP responses were comparable to the findings using the dichotomous Type D measure. No significant associations between Type D and recovery patterns were found. Conclusion: HF patients with Type D personality may show an inadequate response to acute social stress, characterized by a blunted HR response. © 2013 Elsevier B.V.


Oldenbeuving A.W.,St Elisabeth Hospital | De Kort P.L.M.,St Elisabeth Hospital | De Kort P.L.M.,TweeSteden Hospital | Jansen B.P.W.,TweeSteden Hospital | And 3 more authors.
Neurology | Year: 2011

Objectives: This prospective cohort study assesses incidence of delirium after stroke. In addition, risk factors during the first week were assessed. Finally, outcome in relation to development of delirium was studied. Methods: A total of 527 consecutive patients with stroke (median age, 72 years; range, 29-96 years) were screened for delirium during the first week after admission. We diagnosed delirium with the Confusion Assessment Method. Cognitive functioning prior to the stroke was assessed with the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Neurologic deficits were assessed with the NIH Stroke Scale. Results: A total of 62 patients with stroke (11.8%) developed delirium during the first week of admission. Independent risk factors were preexisting cognitive decline (odds ratio [OR] for IQCODE above 50: 2.6, 95% confidence interval [CI] 1.2-5.7) and infection (OR 3.4, 95% CI 1.7-6.8). Furthermore, right-sided hemispheric stroke (OR 2.0, 95% CI 1.0-3.0), anterior circulation large-vessel stroke (OR 3.4, 95% CI 1.1-10.2), the highest tertile of the NIH Stroke Scale (OR for highest vs lowest tertile 15.1, 95% CI 3.3-69.0), and brain atrophy (OR for highest versus lowest tertile 2.7, 95% CI 1.1-6.8) increased the risk for delirium. Delirium was associated with a worse outcome in terms of duration of hospitalization, mortality, and functional outcome. CONClusions: Delirium occurs in almost 1 out of every 8 patients with stroke on a stroke unit and is associated with cognitive decline, infection, right-sided hemispheric stroke, anterior circulation large-vessel stroke, stroke severity, and brain atrophy. Delirium after stroke is associated with a worse outcome. © 2011 by AAN Enterprises, Inc. All rights reserved.

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