Academic Center for Cardio-Circulatory Failure

Last updated: 365 days ago.

To reduce the burden of cardio-circulatory failure for patients and society:

  • To improve our understanding of the pathophysiology and the underlying molecular mechanisms of CCF.
  • To develop diagnostic strategies for both personalized and efficient management of chronic CCF.
  • To develop and implement more effective (tertiary) therapies for CCF.
Academic Center of Excellence

Research Activities

Fundamental, translational, clinical and epidemiological research are all part of the research program within the ACE Cardio-Circulatory Failure. Ongoing research projects include:

  • FP7-MEDIA and CVON-ARENA and CVON-RECONNECT: ongoing (inter-)national Preclinical Research Project Programs of cardiac hypertrophy and failure.
  • EFFECTS: STW project on heart failure diagnosis with ultrasound.
  • Research on inherited cardiomyopathies is performed within national (CVON-DOSIS, Durrer center), and international consortia (SHaRe, NHI-HCMR and Liberty-HCM).
  • 'Parel' Ischemic Heart Disease (IHD): 10th pearl of the 'Pearl String' initiative.
  • Rijnmond Heartfailure/Cardiomyopathy Registry: Registry to improve the quality of care and perform multicenter trials in heart failure.
  • CTMM-TRIUMPH and Bio-SHIFT: national biobanking of plasma of patients hospitalized for acute or chronic CCF.
  • EUROMACS: international database of patients receiving LVADs.
  • Heart Biobanking: national biobanking initiative of hearts of patients undergoing cardiac transplantation.
  • IGeneTrain: international consortium to study the relation between donor and acceptor match and long-term outcome (connection with ACE Transplantation).
  • 'Heart Failure and 4D Flow' and 'Heart Failure in 4D': ZonMw projects with Medical Delta partners.
  • ELSO: Database of patients undergoing ECLS.
  • Micro-CEUS-AKI: Contrast enhanced ultrasound echo (CEUS) identifies microcirculatory alterations underlying Acute Kidney Injury following CCF. The majority of these projects are highly translational in nature, encompassing at least two out of four aspects (fundamental, translational, clinical and/or epidemiological) of research. Importantly, one of our PI's is Scientific Co-Director of the Netherlands Heart Institute ensuring an excellent national and international embedding of our ACE.

Type of

Collaborations

National (CVON-DOSIS, CVON-RECONNECT, CVON-EFFECTS, Durrer center), and international consortia (Wellcome Trust, SHaRe, NHI-HCMR and Liberty-HCM).

Educational

Contributions

The ACE provides education in Junior Med School, and the Bachelor and Master phase of the Medicine Program. The aetiology, pathogenesis, pathophysiology and clinical aspects of CCF are taught.

Two minors are developed for the Bachelor phase: cardiovascular diseases (general), and congenital heart disease. The ACE is involved in the Erasmus MC Master Clinical Research, and students who embark on research in the field of cardiovascular diseases are supervised by our staff. The ACE is - via the department of Cardiology - represented in the Advisory Board of this Master. The training of our PhD students is embedded in the cardiovascular research school COEUR. In addition, methodological courses are offered within the NIHES. Our teachers play an active role in the corresponding educational programs. They also contribute to the so-called 'Papendal' PhD courses on cardiovascular (patho)physiology.

Our medical specialists and researchers offer specialized courses in several ACE-related areas. Furthermore, the ACE plays an active international role in education through proctoring. Several international conferences are organized by members of the ACE. The collaboration within Medical Delta is expected to be increasingly important. Professors within the ACE also hold a chair at TU Delft. Finally, the director of the Cardiovascular Institute of Education (CvOI) of the Dutch Society of Cardiology (NVVC) is connected to our ACE.

Patient

Care Activities

The full spectrum of heart failure is covered by this ACE ranging from NYHA class I to NYHA class IV patients and those with a predisposition (i.e. comorbidities or genetic predisposition) to develop heart failure.
The main activities within this ACE include:

• Tertiary care of patients with end-stage heart failure, including left ventricular assist devices (LVAD) and cardiac transplantation.
• Tertiary care of patients with acute circulatory shock; including a spectrum of short term circulatory support devices bridging of these patients towards recovery or LVAD/cardiac transplantation. Erasmus MC is currently the only C
• The NFU-approved expertise center "Center for inherited cardiovascular diseases" is part of this ACE. This expertise center is a tertiary referral center for patients and families with inherited cardiomyopathies (hypertrophic cardiomyopathy, dilated cardiomyopathy, non-compaction cardiomyopathy and restrictive cardiomyopathy). In the Erasmus MC all diagnostic (including genetic testing) and (non-) invasive treatment options for cardiomyopathy patients are available and decisions are made in a multidisciplinary team. Both clinical and preclinical research is performed to further unravel the pathophysiology of inherited cardiomyopathies.
• Monitoring of heart failure patients in the Rijnmond Heart Failure / Cardiomyopathy Registry
• CCF is currently under consideration for participation in the Erasmus MC progema 'Value Based Health Care'. Patient management involves the departments of Cardiology, Intensive Care, Internal Medicine, Immunology, Clinical Genetics, Clinical Pathology and Cardio-Thoracic Surgery.

Societal Relevance to Research, Education and Patient Care

The NFU center for inherited cardiovascular disease is actively involved in the development of national and international guidelines as well as developing patient information tools in collaboration with the Heart and Vessel group. Each research group contributes to guidelines for formulation and development of curricula and standard care criteria by participating in various national platforms. Members of the ACE advise the Zorginstituut on diagnostic strategies in Cardio-Circulatory Failure.

The ACE contributes through the CardioVascular Onderwijsinstituut (CVOI) to the cardiology core curriculum and plenary training of cardiology residents and cardiologists. The ESC clinical management guidelines contain a significant number of citations in which one or more (former) ErasmusMC faculty participated.

Viability of Research, Education and Patient Care

Each of the research groups have internal meetings for exchange of ideas. Traditionally exchange of ideas and interaction of researchers is provided by COEUR. In the future, meetings may be held on an ACE level in addition to, or as an alternative to, the internal and COEUR meetings.

PhD students starting international career: David A. Liem (UCLA, California, USA). ACE members organize and participate in international symposia and workshops, including

  1. the biennial European Society of Cardiology basic and translational science congress 'Frontiers of Cardiovascular Biology',
  2. the Annual 'European Symposium on Contrast Imaging',
  3. 'International symposium on Biomarkers in Clinical Cardiology'.
  4. Annual international symposium on intensive care and emergency medicine. ACE members participate in international working groups and other interest groups, including the ESC Working Group of 'Coronary Pathophysiology and Microcirculation'.

Key and relevant publications of the last five years

  • SC Yap, FRamjankhan, Rahat Muslem, Nicolaas de Jonge, Hans J. Kirkels, Corinne Sakir Akin, Olivier C. Manintveld, Ozcan Birim, Tamas Szili-Torok, Kadir Caliskan. Ventricular Arrhythmias in Patients with a Continuous-Flow Left Ventricular Assist Device. JACC 2016;68(3):323-325.
  • Soliman OII, Akin S, Muslem R, Boersma E, Manintveld OC, Krabatsch T, Gummert JF, de By TMMH, Bogers AJJC, Zijlstra F, Mohacsi P, Caliskan K; EUROMACS Investigators. Derivation and Validation of a Novel Right-Sided Heart Failure Model After Implantation of Continuous Flow Left Ventricular Assist Devices: The EUROMACS (European Registry for Patients with Mechanical Circulatory Support) Right-Sided Heart Failure Risk Score. Circulation. 2018;137(9):891-906
  • Haak A, Vegas-Sanchez-Ferrero G, Mulder HW, Ren B, Kirisli HA, Metz C, van Burken G, van Stralen M, Pluim JP, van der Steen AF, et al: Segmentation of multiple heart cavities in 3-D transesophageal ultrasound images. IEEE Trans Ultrason Ferroelectr Freq Control 2015, 62:1179-1189.
  • Vellinga NA, Boerma EC, …. …Tijssen JG, Bakker J, Ince C; microSOAP Study Group.International study on microcirculatory shock occurrence in acutely ill patients. Crit Care Med. 2015;43:48-56.
  • Vriesendorp PA, Schinkel AF, Liebregts M, Theuns DA, van Cleemput J, Ten Cate FJ, Willems R, Michels M. Validation of the 2014 European Society of Cardiology guidelines risk prediction model for the primary prevention of sudden cardiac death in hypertrophic cardiomyopathy. Circ Arrhythm Electrophysiol. 2015;8:829-35.
  • International Genetics & Translational Research in Transplantation Network (iGeneTRAiN). Design and Implementation of the International Genetics and Translational Research in Transplantation Network. Transplantation. 2015;99:2401-12
  • Vriesendorp PA, Liebregts M, Steggerda RC, Schinkel AF, Willems R, Ten Cate FJ, van Cleemput J, Ten Berg JM, Michels M. Long-term outcomes after medical and invasive treatment in patients with hypertrophic cardiomyopathy. JACC Heart Fail. 2014;2:630-6.
  • Sorop O, Heinonen I, van Kranenburg M, van de Wouw J, de Beer VJ, Nguyen ITN, Octavia Y, van Duin RWB, Stam K, van Geuns RJ, Wielopolski PA, Krestin GP, van den Meiracker AH, Verjans R, van Bilsen M, Danser AHJ, Paulus WJ, Cheng C, Linke WA, Joles JA, Verhaar MC, van der Velden J, Merkus D, Duncker DJ. Multiple common comorbidities produce left ventricular diastolic dysfunction associated with coronary microvascular dysfunction, oxidative stress, and myocardial stiffening. Cardiovasc Res. 2018;114(7):954-964.
  • Guven G, Brankovic M, Constantinescu AA, Brugts JJ, Hesselink DA, Akin S, Struijs A, Birim O, Ince C, Manintveld OC, Caliskan K. Preoperative right heart hemodynamics predict postoperative acute kidney injury after heart transplantation. Intensive Care Med. 2018;44(5):588-597.
  • van Boven N, Kardys I, van Vark LC, Akkerhuis KM, de Ronde MWJ, Khan MAF, Merkus D, Liu Z, Voors AA, Asselbergs FW, van den Bos EJ, Boersma E, Hillege H, Duncker DJ, Pinto YM, Postmus D. Serially measured circulating microRNAs and adverse clinical outcomes in patients with acute heart failure. Eur J Heart Fail. 2018;20(1):89-96.
  • van Vark LC, Lesman-Leegte I, Baart SJ, Postmus D, Pinto YM, Orsel JG, Westenbrink BD, Brunner-la Rocca HP, van Miltenburg AJM, Boersma E, Hillege HL, Akkerhuis KM; TRIUMPH Investigators. Prognostic Value of Serial ST2 Measurements in Patients With Acute Heart Failure. J Am Coll Cardiol. 2017;70(19):2378-2388.

PhD theses of the last five years

  • Pieter Vriesendorp. Improving outcomes in hypertrophic cardiomyopathy. 2016
  • Jin Ming Cheng. Coronary Artery Disease: from Atherosclerosis to Cardiogenic Shock. 2015
  • Andre Uitterdijk. Experimental Approaches to Acute Myocardial Infarction. 2015
  • A. Haak. Augmenting Electrophysiology Interventions with Advanced 3D Transesophageal Echocardiography. 2015
  • ME van Genderingen. Peripheral perfusion in relation to systemic hemodynamics and its importance in critically ill patients. 2015
  • P. Kruizinga. Acoustic images of the carotid artery. 2015
  • Linda Battes. Advanced Methods for Clinical Outcome Prediction in Acquired Heart Disease. 2014
  • Erik Buijs. Critically ill children and the microcirculation. 2014
  • Nick van Boven. Improving risk assessment in acquired heart disease: biomarkers and beyond. 2017
  • Mieke van den Heuvel. Endothelial dysfunction in cardiovascular disease. 2018

Non-scientific publications related to the ACE

Principal coordinator(s)