Research An Van Berendoncks

Abstract

Within Western countries, the number of pregnancies and deliveries in women afflicted with acquired, congenital or inherited cardiovascular disease is significantly growing. Unfortunately, maternal heart disease is currently the leading cause of non-obstetric mortality in women during pregnancy, accounting for 33% of pregnancy-related deaths globally. To increase chances of a successful pregnancy with safeguarding maternal and fetal health on the long term, the provision of care by a multidisciplinary pregnancy heart team is recommended by several scientific and professional bodies. These European and American guidelines endorse the establishment of a joint cardio-obstetric outpatient clinic aiming to reduce the risk for adverse pregnancy outcomes. Such a Pregnancy Heart Clinic should integrate several components, including pre-conceptual counselling, perinatal risk assessment, antenatal care and post-partum follow-up. Hence, as the cohort of women of childbearing age with underlying CVD is ever growing, the evaluation of the effectiveness of a cardio-obstetric model of care is urgently needed. Although several guidelines recommend the creation of a Pregnancy Heart Clinic, these recommendations are currently largely eminence-based, urging the provision of empirical evidence as underpinning. To date, little empirical evidence is available on the patient-reported needs, organizational challenges and effectiveness of this care model in terms of feto-maternal outcomes. As maternal cardiovascular mortality and morbidity are to be considered a public health emergency, studies are needed to gain insight into successful strategies on how to create a dedicated clinic that incorporates multiple guideline-recommended components. Hence, this research project primarily aims to develop, implement and evaluate a multidisciplinary integrated care pathway for women with cardiovascular disease before, during and after pregnancy involving relevant stakeholders. To achieve this primary aim, several research objectives will be addressed in a consecutive project pathway. Three main research objectives are proposed. Firstly, we aim to gain insights into the needs, challenges and experiences of women with CVD before and after pregnancy using a qualitative study using semi-structured interviews. Secondly, we will establish a multicentric prospective registry of physiological and psychological outcomes in pregnant women with CVD during the post-partum period (i.e., fourth trimester). As part of this study, we will use a validated, standard set of parameters combining clinical outcomes, patient-reported outcomes and patient-reported experience measurements developed by ICHOM. Thirdly, we will develop an Integrated Care Pathway for women with CVD before, during and after pregnancy using the new European Pathway Association Framework. Furthermore, several scientific bodies propose to set-up a multidisciplinary cardio-obstetrics programs as a strategy to mitigate pregnancy-associated risks, limited data are currently available demonstrating the clinical and patient-reported effectiveness. Therefore, we will investigate the impact of the implementation of an integrated care pathway for women with CVD in terms of maternal, obstetric, fetal and patient-reported outcomes in the short -term post-partum period (i.e., fourth trimester).

Researcher(s)

• Promoter: Goossens Eva
• Co-promoter: Van Berendoncks An
• Fellow: Vanharen Yaël

Research team(s)

• Centre for Research and Innovation in Care (CRIC)

Project type(s)

• Research Project

Abstract

Adults with a congenital heart disease (ACHD) have a lower functional capacity, reduced quality of life and worse prognosis compared to healthy individuals. ACHD and patients with heart failure (HF) induced by other aetiologies share many characteristics, incl. exercise intolerance, right ventricular (RV) dysfunction and increased inflammatory cytokine levels. Among the pathophysiological changes in HF, endothelial dysfunction is highlighted. However, the presence of endothelial dysfunction in ACHD is unknown as literature is limited and conflicting. I hypothesize that coronary microvascular dysfunction (CMD) is important in the pathophysiology of ACHD. I believe that multiple factors incl. genetics, underlying cardiac abnormality, history of cardiac surgery and RV overload, further aggravated by classical acquired risk factors (including overweight, hypertension and sedentary lifestyle), alter shear stress and promote systemic inflammation and endothelial oxidative stress in ACHD leading to a reduced nitric oxide bioavailability and endothelial dysfunction. As such I assume that CMD is associated with systemic endothelial dysfunction, reflecting CMD as part of a systemic microvascular disorder. I am convinced that detecting CMD is important to allow identification of ACHD with an unfavorable prognosis and that this CMD can easily be identified with adenosine-based Doppler echocardiography. Finally, the potential therapeutic effect of exercise training will be investigated.

Researcher(s)

• Promoter: Van Berendoncks An
• Co-promoter: Hens Wendy
• Co-promoter: Segers Vincent
• Co-promoter: Van Craenenbroeck Emeline
• Fellow: Vanreusel Inne

Research team(s)

• Cardiovascular diseases (CARDIOVASC)

Project type(s)

• Research Project

Abstract

Exercise capacity is markedly depressed in adults with congenital heart disease (ACDH) and associated with an increased risk of hospitalization or death. Right ventricular (RV) function is of major importance in ACHD prognosis. Our group recently demonstrated reduced subclinical RV function in ACHD patients with RV overload. Moreover, in a TOF population, strain measurements could predict functional capacity. In other study populations (HFpEF and PAH patients) coronary microvascular dysfunction (CMD) has been shown to be highly prevalent and associated with worse RV strain and exercise intolerance. To the best of our knowledge, the presence of CMD has not been investigated before in ACHD. We hypothesize that multiple factors including genetics, underlying cardiac abnormality, history of cardiac surgery and RV overload, further aggravated by classical acquired risk factors that are known to induce an inflammatory state and reduce nitric oxide bioavailability promote systemic inflammation leading to endothelial dysfunction. As such we hypothesize that the presence of endothelial dysfunction can act as a prognostic and potential therapeutic marker in ACHD. In this research project, we aim to design a prospective study of CMD in ACHD. Potential correlates of reduced CFR including RV loading conditions, clinical and biochemical markers, systemic endothelial function and echocardiographic data will be investigated as well as the potential therapeutic effect of exercise training.

Researcher(s)

• Promoter: Van Berendoncks An
• Co-promoter: Heidbuchel Hein
• Co-promoter: Van Craenenbroeck Emeline
• Fellow: Vanreusel Inne

Research team(s)

• Cardiovascular diseases (CARDIOVASC)

Project type(s)

• Research Project

Abstract

In the next 2 years, we first plan to investigate the effect of exercise training on metabolic gene expression at the level of the skeletal muscle. Next, we would like to explore the underlying mechanisms and possible hypothesis for the observed abnormalities using myoblastcultures. Further, the hypothesis of adiponectin as a biomarker for wasting in CHF will be explored by correlating adiponectin levels with measurements of muscle strength and muscle mass (CT scan). Finally, we will compare the observed metabolic disturbances in our CHF patients with another population characterized by insulin resistance, metabolic syndrome patients.

Researcher(s)

• Promoter: Conraads Viviane
• Co-promoter: Vrints Christiaan
• Fellow: Van Berendoncks An

Research team(s)

Project type(s)

• Research Project

Abstract

During the first 2 years, the aims of our research project were focused at (1) the investigation of the prognostic impact of adiponectin in relation to other clinical, laboratory and exercise data; (2) the examination of possible modulation of adiponectin levels by physical training; (3) the exploration of the underlying pathophysiological mechanisms for the increased adiponectin concentrations in CHF with the investigation of local adiponectin expression at the level of the skeletal muscle and the downstream pathway.

Researcher(s)

• Promoter: Conraads Viviane
• Co-promoter: Vrints Christiaan
• Fellow: Van Berendoncks An

Research team(s)

Project type(s)

• Research Project