The primary aim of the ACE is to reduce the burden of ischemic cardiovascular disease for patients and society.
Therefore, the projects performed within the context of the ACE are designed to:
- improve our understanding of the pathophysiology of atherosclerosis, atherosclerotic plaque progression and to prevent acute vascular conditions.
- device strategies for early recognition and effective management of emerging cardiovascular conditions to prevent acute cardiovascular events.
- develop comprehensive diagnostic strategies for both personalized and efficient management of patients with chronic ischemic cardiovascular disease.
- develop and implement more effective and minimally invasive therapies for ischemic cardiovascular disease.
Recent, current and future research in the context of this ACE includes pre-clinical, translational and clinical studies, as well as clinical trials. Examples of research that has been, currently is, or will be conducted within the ACE are listed below:
- CRESCENT 1 and 2 trials: multicenter clinical trials to determine the effectiveness of new cardiac CT approaches to the management of stable chest pain [cardiology/radiology; multicenter].
- IMPACT study (animal/human): computational fluid and solid mechanics to understand the development and disruption of coronary plaques [biomedical engineering/cardiology/radiology].
- SPECIFIC trial: international, multicenter trial to determine the accuracy of dynamic CT myocardial perfusion imaging [cardiology/radiology; multicenter; international].
- BEACON trial: multicenter clinical trials to investigate the value of cardiac CT in the setting of acute chest pain [cardiology/radiology/emergency department; multicenter].
- MACHINE trial: international, technical validation study of machine-based computational fractional flow reserve to assess the hemodynamic CAD severity [cardiology/radiology; multicenter; international].
- Development of new intra-coronary imaging catheters (Heartbeat OCT, IGIT, iMIT) [biomedical engineering/cardiology].
- Imaging atherosclerotic plaque lipidomics in vivo [biomedical engineering/cardiology].
- Coronary tissue characterization in relation to biomechanics in animals and humans (BioCCora, OC3T) [biomedical engineering/cardiology].
- ABSORB and multiple other clinical trials of intra-coronary devices for the treatment of CAD [cardiology/biomedical engineering/radiology; international; multicenter].
- Minimization of infarct size using post-conditioning (PORT) or medication (BIVAL, REDUCE-MVI) [cardiology/biomedical engineering/radiology; international; multicenter].
- COACT trial: randomized controlled trial of early catheterization after out-of-hospital cardiac arrest [cardiology/intensive care; multicenter].
- Large-scale biomarker studies (BIOMARCS) in the context of (the recurrence of) acute coronary syndromes [cardiology/epidemiology; multicenter].
- ERASE RCT of PTA versus exercise training [vascular surgery/rehabilitation medicine; multicenter].
- RAVE study: RCT placebo-controlled (clopidogrel vs placebo on top of ascal) for vascular patients with subclinical troponin release after surgery and normal coronary cath.
- PETS study: RCT liberal transfusions vs conservative for patients with pre-surgical, subclinical myocardial injury.
- Studies on pathophysiology, diagnosis and treatment of cardiovascular disease in women (CREW consortium)[cardiology/gynaecology/epidemiology/radiology/internal medicine; national consortium on gender specific translational research]
- BigMedilytics (big data in cardiology)
- BIOMArCS-AAA (predictive value of serum biomarkers in abdominal aortic aneurysms)[cardiology/vascular surgery]
- BIOMArCS-PREVENT (predictive value of serum biomarkers for the occurrence of cardiovascular disease in 'healthy' population)[cardiology]
- Pearl Ischemic Heart Disease (as part of NFU 'Parelsnoer' initiatief)[cardiology]
- Clinical trials on antiplatelet strategies following percutaneous coronary intervention (e.g. GLOBAL-LEADERS)
The ACE provides education in the bachelor and master phase of the medicine program. The etiology, pathogenesis and clinical aspects of ACE-specific diseases are taught. The ACE also contributes to the Clinical Technology program in both the bachelor and master phase. Furthermore, the ACE organizes two so-called minor programs for the Bachelor phase: Cardiovascular Diseases and Clinical Technology.
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 NIHES. Furthermore, MSc and Bsc level students and interns frequently perform technical projects related to ischemic heart disease and experimental imaging technology under the supervision of ACE members.
Our teachers play an active role in the corresponding educational programs. Members of this ACE are involved in and participate in a variety of educational programs, international courses and conferences, both national (e.g. course on basic quantitative methods for data analysis as part of NIHES program) and international (European Society of Cardiology, American College of Cardiology, American Heart Association, Transcatheter Cardiovascular Therapeutics, EuroPCR). One of the members of the ACE provides an annual course on advanced training in clinical research design and protocol development at the Peking University Clinical Research Institute. Furthermore, several international conferences and courses are organized by members of the ACE (e.g. Optics in Cardiology, Vulnerable Plaque Meeting (VPM)). The ACE also plays an active international role in education through proctoring.
Over the past years, fellows and PhD students of many nationalities have worked within the ACE (Japan, Kenya, Italy, Romania, India, Egypt, Morocco, Iran, USA, China).
Societal Relevance to Research, Education and Patient Care
Despite substantial improvements in diagnosis and management, ischemic cardiovascular disease remains one of the leading causes of morbidity and mortality in the Western World. In general, during the last 40 years, the departments that contribute to this ACE have exerted major influences on many fields of cardiovascular medicine, from imaging to intervention, from mechanistic clinically-oriented research to the foundations of modern evidence-based treatment of ischemic cardiovascular (heart) disease.
The ACE and its members have participated in the development of different international clinical management guidelines, such as:
- SCCT Guidelines for the Interpretation and Reporting of Coronary CT Angiography
- ESC Guidelines for the management of acute ST-elevation myocardial infarction
- The 2014 ESC/EACTS Guidelines on myocardial revascularization
The 5 most relevant ESC clinical management guidelines on different aspects of ischemic cardiovascular disease contain over 200 citations, in which one or more (former) ACE member participated as faculty.
Members of this ACE are involved and participate in a variety of educational programs, international courses and conferences, both national and international. They are regularly invited as speakers at various prestigious international conferences (annual congresses of the European Society of Cardiology, American College of Cardiology, American Heart Association, Transcatheter Cardiovascular Therapeutics, EuroPCR). For the EuroPCR conference, the Department of Cardiology provides broadcasting of so-called life-case treatment of patients with ischemic heart disease during the conference. Furthermore, several international conferences and courses are organized by members of the ACE (e.g. Optics in Cardiology, Vulnerable Plaque Meeting (VPM)). The ACE also plays an active international role in education through proctoring in other countries.
Furthermore, a member of the ACE has led the creation of the EACVI (European Society of Cardiology) educational core curriculum on cardiac CT. Members of the ACE advise the Zorginstituut on diagnostic strategies in ischemic heart disease. The ACE contributes through the cardiovascular onderwijsinstituut (CVOI) to the cardiology core curriculum and plenary training of cardiology residents and cardiologists.
One of the research programs within the ACE focuses on a topic that is important, as well as controversial in our society, namely gender specific translational research on the pathophysiology, diagnosis and treatment of cardiovascular disease in women (national CREW consortium).
The collaborating departments that constitute this ACE have made significant and substantial contributions to the management and treatment of people with or suspected of ischemic cardiovascular disease. Recent examples include:
- Randomized trials that have focussed on detailed comparisons between percutaneous treatment (i.e. PCI with stenting) and coronary artery bypass grafting for the treatment of ischemic heart disease. These studies result in an improved personalized approach to these patients.
- Studies on new intracoronary catheters that can detect plaque composition will contribute to therapy guidance in percutaneous treatment of ischemic heart disease.
- Innovations in CT-FFR (fractional flow reserve) research will be used for therapy planning and guidance.
- Contribution to the health care system in the city of Rotterdam by implementing research on the utilization of e-transfer of ECGs through the www in the ambulances for improving early recognition and diagnosis of ST-elevation myocardial infarction in the larger Rotterdam-Rijnmond region. This collaboration with the Ambulance Service Rotterdam-Rijnmond has resulted in improved management of patients with ST-elevation myocardial infarction.
Viability of Research, Education and Patient Care
As ischemic cardiovascular disease remains one of the leading causes of morbidity and mortality in the Western World despite the substantial improvements that have been achieved over the past decades, further research and innovations are pivotal to increase our understanding on the pathophysiology of ischemic cardiovascular disease to improve patient care. The ACE provides an excellent platform for further research, education and improvements in patient care. The ACE enables to create a shared research agenda to direct joint study programs and grant writing, as well as to collaborate with external partners at the level of the ACE.
Members of the ACE are leading scientists in their fields, publishing in top ranking journals (N Engl J Med, Lancet, JAMA, Eur Heart J, Circulation, J Am Coll Cardiol) both in basic and clinical science. The ACE also includes some of the world leading experts in their fields. The list of students that have completed their PhD is extensive. Our PhD students present their work at international conferences. The foreign PhD students constitute a substantial portion of the total number of PhD students. After returning, the majority of these international PhD students have a successful career in research or medicine in their country of origin.
The ACE has resulted in new collaborative efforts within the ACE, among which:
- The development of new intravascular catheters (collaboration Cardiology-Biomedical Engineering).
- Studies on relationship between atherosclerosis in coronary and carotid arteries (Cardiology-Radiology).
- studies on personalized treatment of ischemic heart disease (Cardiology-Thoracic Surgery).
- studies on serum biomarkers in abdominal aortic aneurysms (Epidemiology/Cardiology-Vascular Surgery).
The ACE has also contributed to new, external collaborative efforts, among which:
- Collaboration with iMIT, a large consortium (including TU Delft, Erasmus MC, AMC, VUMC, LUMC and 15 companies) for the development of new minimal invasive devices.
- Collaboration with Sanquin Bloodbank for the new BIOMArCS-PREVENT project
- Collaboration with the ACE Cardio-Circulatory Failure on studies in patients that include both ischemic heart disease and heart failure (e.g. Bio-SHIFT, TRIUMPH and Pearl Ischemic Heart Disease)
- National collaboration with departments of Cardiology, Gynaecology and Epidemiology of both the Erasmus MC and other academic centers within the CREW consortium on gender specific translational research in cardiovascualr disease.
The collaboration within the ACE has provided good opportunities for acquiring external funding, among which:
- a VENI grant for the development of new catheters to guide PCI (Wang)
- a VICI grant for one of the leading investigators (Van Soest) for studies on spectroscopy of atherosclerosis.
- Funding of new research programs within the Medical Delta
- Funding of the BIOMArCS-PREVENT project
Key and relevant publications of the last five years
- Dedic A, et al. Coronary CT Angiography for Suspected ACS in the Era of High-Sensitivity Troponins: Randomized Multicenter Study. J Am Coll Cardiol. 2016 Jan 5;67(1):16-26.
- Lubbers M, et al. Calcium imaging and selective computed tomography angiography in comparison to functional testing for suspected coronary artery disease: the multicentre, randomized CRESCENT trial. Eur Heart J. 2016;37(15):1232-43.
- Schrauwen JT, et al. Functional and anatomical measures for outflow boundary conditions in atherosclerotic coronary bifurcations. J Biomech. 2015 Nov 28.
- Kok AM, et al. Peak cap stress calculations in coronary atherosclerotic plaques with an incomplete necrotic core geometry. Biomed Eng Online. 2016;15(1):48.
- Fakhry, et al. Endovascular Revascularization and Supervised Exercise for Peripheral Artery Disease and Intermittent Claudication A Randomized Clinical Trial. JAMA. 2015;314(18):1936-1944.
- Ultee KHJ, et al. Coronary revascularization induces a shift from cardiac toward noncardiac mortality without improving survival in vascular surgery patients. JVS 2015Jun;61(6):1543-9.
- Iqbal J, et al. Optimal medical therapy improves clinical outcomes in patients undergoing revascularization with percutaneous coronary intervention or coronary artery bypass grafting: insights from the Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) trial at the 5-year follow-up. Circulation. 2015 Apr 7;131(14):1269-77.
- Nauta ST, et al. Sex-related trends in mortality in hospitalized men and women after myocardial infarction between 1985 and 2008: equal benefit for women and men. Circulation. 2012 Oct 30;126(18):2184-9.
- Cheng JM, et al. In vivo detection of high-risk coronary plaques by radiofrequency intravascular ultrasound and cardiovascular outcome: results of the Atheroremo-IVUS study. Eur Heart J 2014; 35 (10): 639-647.
- Oemrawsingh RM, et al. Near-Infrared Spectroscopy Predicts Cardiovascular Outcome in Patients With Coronary Artery Disease. J Am Coll Cardiol 2014; 64 (23): 2510-2518.
- Appelman Y, et al. Sex differences in cardiovascular risk factors and disease prevention. Atherosclerosis 2015; 241(1): 211-218.
- Camenzind E, et al. Modifying effect of dual antiplatelet therapy on incidence of stent thrombosis according to implanted drug-eluting stent type. Eur Heart J 2014; 35 (29): 1932-1948.
- Wijns W, et al. Endeavour zotarolimus-eluting stent reduces stent thrombosis and improves clinical outcomes compared with cypher sirolimus-eluting stent: 4-year results of the PROTECT randomized trial. Eur Heart J 2014; 35(40): 2812-2820.
- Wu M, et al. Real-time volumetric lipid imaging in vivo by intravascular photoacoustics at 20 frames per second. Biomedical Optics Express 2017;8(2): 943-953.
- Villiger M, et al. Coronary Plaque Microstructure and Composition Modify Optical Polarization: A New Endogenous Contrast Mechanism for Optical Frequency Domain Imaging. JACC Cardiovasc Imaging 2017; https://doi.org/10.1016/j.jcmg.2017.09.023.
- Bourantas, et al. Hybrid intravascular imaging: recent advances, technical considerations, and current applications in the study of plaque pathophysiology. Eur Heart J 2017; 38(6): 400-412.
- Karanasos A, et al. OCT Assessment of the Long-Term Vascular Healing Response 5 Years After Everolimus-Eluting Bioresorbable Vascular Scaffold. J Am Coll Cardiol 2014; 64(22): 2343-2356.
- Gnanadesigan M, et al. Optical coherence tomography attenuation imaging for lipid core detection: an ex-vivo validation study. Int J Cardiovasc Imaging 2017; 33(1): 5-11.
- Van der Sijde JN, et al. Safety of optical coherence tomography in daily practice: a comparison with intravascular ultrasound. Eur Heart J Cardiovasc Imaging 2017; 18(4): 467-474.
- Van Soest G, et al. Intravascular imaging for characterization of coronary atherosclerosis. Current Opinion in Biomedical Engineering 2017; 3: 1-12.
- Van Soest G, et al. Photonics in cardiovascular medicine. Nat Photon 2015; 9(10): 626-629.
- Wang T, et al. Heartbeat OCT and motion-free 3D in vivo coronary artery microscopy. JACC: Cardiovascular Imaging 2016; 9(5): 622-623.
- Van der Heiden K, et al. The effects of stenting on shear stress: relevance to endothelial injury and repair. Cardiovasc Res. 2013 Jul 15;99(2):269-75.
- Kwak BR, et al. Biomechanical factors in atherosclerosis: mechanisms and clinical implications. Eur Heart J. 2014 Sep 17. Review.
- Evans PC, et al. Biomechanics in vascular biology and cardiovascular disease. Thromb Haemost. 2016 Mar;115(3):465-6.
- Thondapu V, et al. Endothelial shear stress 5 years after implantation of a coronary bioresorbable scaffold. Eur Heart J. 2018 May 7;39(18):1602-1609. doi: 10.1093/eurheartj/ehx81
- Stone GW, et al. Everolimus-Eluting Stents or Bypass Surgery for Left Main Coronary Artery Disease. N Engl J Med. 2016;375(23):2223-2235.
- Vranckx P, et al. Ticagrelor plus aspirin for 1 month, followed by ticagrelor monotherapy for 23 months vs aspirin plus clopidogrel or ticagrelor for 12 months, followed by aspirin monotherapy for 12 months after implantation of a drug-eluting stent: a multicentre, open-label, randomised superiority trial. Lancet 2018; 392 (10151): 940-949.
- Head SJ et al. Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data. Lancet. 2018;391(10124):939-948
PhD theses of the last five years
- J van der Slegt: Periferal Vascular Surgery, an appraisal of various clinical outcome measures (2016)
- Tianshi Wang: Heartbeat OCT (2015)
- Yoshinobu Onuma: Bioresorbable scaffolds in CAD (2014).
- Alexia Rossi: Quantification in Non invasive Cardiac Imaging: CT and MR (2013).
- Salvatore Brugaletta: Imaging techniques for the assessment of atherosclerosis, intracoronary devices and vessel response after metallic or polymeric scaffold implantation (2013).
- Lisan Neefjes: CT Coronary Angiography to Detect CAD: Low-dose Protocols in High-risk Individuals (2013).
- Krista Jansen: Intravascular Photoacoustics (2013)
- Tessa S.S. Genders (cum laude): Diagnostic Imaging Strategies for Patients with Suspected Coronary Artery Disease (2012).
- Linda Battes: Advanced methods for clinical outcome prediction in acquired heart disease (2014)
- Cihan Simsek: Long-term results of permanent and bioresorbable scaffolds in the treatment of coronary artery disease (2014)
- Jin Ming Cheng: Coronary Artery Disease: from atherosclerosis to cardiogenic shock (2015)
- Sanneke de Boer: Innovations to improve characterisation and prognostication of patients undergoing percutaneous coronary intervention (2016)
- Sjoerd T. Nauta: Myocardial infarction - Temporal trends over the past three decades (2015)
- Nick van Boven: Improving risk assessment in acquired heart disease: biomarkers, and beyond (2017)
- Jelle Schrauwen: Wall shear stress in coronary arteries (2016)
- Muthukaruppan Gnanadesigan: Intravascular OCT tissue type by automated optical attenuation analysis (2016)
- Min Wu: Real-time intravascular photoacoustics (2017)
- Jovana Janjic: Looking forward with intravascular ultrasound (2018)
- Jiang Ming Fam: Bioresorbable polymer coated metallic stents and fully bioresorbable scaffolds: benefits and limitations in different coronary lesion subsets (2018)
Non-scientific publications related to the ACE
- 'Op een ochtend werd ik wakker’. Over radicale technische en sociale innovatie voor houdbaarheid van de zorg: De Medical Delta. Http://www.medicaldelta.nl/network/professors/ton-van-der-steen.
- Aantal patiënten dat terugkomt na dotteren moet omlaag. Https://www.gezondheidenco.nl/168771/aantal-patienten-dat-terugkomt-na-dotteren-moet-omlaag.
- Aneurysma zit vaak in de familie. Https://www.nd.nl/nieuws/nederland/aneurysma-zit-vaak-in-de-familie.1610444.lynkx.
- "Meer kennis over de specifieke risico's op hart- en vaatziekten bij vrouwen is hard nodig". Https://www.hartstichting.nl/verhalen/meer-kennis-risico-hart-vaatziekten-vrouwen-nodig.
- "Mijn ideaalplaatje is dat het risico op een hartinfarct thuis te meten is". Https://www.hartstichting.nl/verhalen/ideaalplaatje-risico-hartinfarct-thuis-meten.
- 'Thoraxcentrum': dr. James Muller en Prof. Ton van der Steen over plaques meten in de aders. Https://www.youtube.com/watch?v=HSzCCPZkoJs.
- Minder hart- en vaatziekten door mindfulness? Https://steunmijnonderzoek.hartstichting.nl/project/rouwet.
- ‘Ik zag m’n hartslag letterlijk in mijn ogen’. Https://amazingerasmusmc.nl/actueel/ik-zag-mn-hartslag-letterlijk-in-mijn-ogen/.
- ‘Het raakvlak van bio-engineering, computer¬wetenschappen en geneeskunde biedt mooie kansen’. Https://decardioloog.nl/jaargangen/2017/december/hetraakvlakvanbio-engineeringcomputerwetenschappenengeneeskundebiedtmooiekansen.html.
- Supersnelle OCT catheter https://nos.nl/artikel/2023804-supersnelle-camera-verbetert-zorg-hart-en-vaatpatienten.html