BackgroundFunctional status and health-related quality of life (HRQoL) are important in patients with heart failure (HF). Little is known about the effect of telemonitoring on functional status and HRQoL in that population.Methods and resultsA total of 382 patients with HF (New York Heart Association class 2–4) were included in a randomised controlled trial to investigate the effect of tailored telemonitoring on improving HRQoL and functional status in HF patients. Randomisation was computer-generated with stratification per centre. At baseline and after 12 months, patients’ functional status was determined by metabolic equivalent scores (METS). HRQoL was measured with the EuroQol five dimensions questionnaire (EQ-5D), visual analogue scale (VAS) and Borg rating of perceived exertion scale (Borg). Additional outcome data included number of HF-related outpatient clinic visits and mortality. Telemonitoring was statistically significantly related to an increase in METS after 1 year (regression coefficient 0.318; p = 0.01). Telemonitoring did not improve Borg, EQ-5D or VAS scores after 1 year. EQ-5D [hazard ratio (HR) 0.20, 95% confidence interval (CI) 0.07–0.54], VAS (HR 0.98, 95% CI 0.96–0.99), Borg (HR 1.21, 95% CI 1.11–1.31) and METS (HR 0.73, 95% CI 0.58–0.93) at baseline were significantly associated with survival after 12 months.ConclusionsTailored telemonitoring stabilised the functional status of HF patients but did not improve HRQoL. Therefore, telemonitoring may help to prevent deterioration of exercise capacity in patients with HF. However, because our study is a reanalysis of a randomised controlled trial (RCT), this is considered hypothesis-generating and should be confirmed by adequately powered RCTs.Electronic supplementary materialThe online version of this article (10.1007/s12471-019-01323-x) contains supplementary material, which is available to authorized users.

Reperfusion does not only salvage ischaemic myocardium but can also cause additional cell death which is called lethal reperfusion injury. The time of reperfusion is often accompanied by ventricular arrhythmias, i.e. reperfusion arrhythmias. While both conditions are seen as separate processes, recent research has shown that reperfusion arrhythmias are related to larger infarct size. The pathophysiology of fatal reperfusion injury revolves around intracellular calcium overload and reactive oxidative species inducing apoptosis by opening of the mitochondrial protein transition pore. The pathophysiological basis for reperfusion arrhythmias is the same intracellular calcium overload as that causing fatal reperfusion injury. Therefore both conditions should not be seen as separate entities but as one and the same process resulting in two different visible effects. Reperfusion arrhythmias could therefore be seen as a potential marker for fatal reperfusion injury.

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PREPARE: ISRCTN71104460 http://www.controlled-trials.com/ISRCTN71104460.

Tall and broad R waves in V(1) reflect lateral wall MI, especially in circumflex occlusions.

In the event of MBG 3, VA bursts were associated with significantly larger infarct size even if optimal epicardial and microvascular reperfusion was present.

In the presence of suboptimal reperfusion with MVO by CMR, VA burst does not further define MI size. However, with optimal TIMI 3 reperfusion and optimal microvascular perfusion (i.e. no MVO), VA burst is associated with larger IS, indicating that VA burst is a marker of additional cell death.

Reperfusion cardiac arrhythmias and their relation to reperfusion induced cell deathCitation for published version (APA): van der Weg, K. (2018). Reperfusion cardiac arrhythmias and their relation to reperfusion induced cell death. Proefschriftmaken.nl II Uitgeverij Boxpress. https://doi.org/10.Design by: Bregje Jaspers, ProefschriftOntwerp.nl Printed by: ProefschriftMaken, www.proefschriftmaken.nl © Kirian van der Weg Reperfusion cardiac arrhythmias and their relation to reperfusion induced cell death PROEFSCHRIFT ter verkrijging van de graad van doctor aan de Universiteit Maastricht, op gezag van Rector Magnificius, Prof. dr. Rianne M. Letschert, volgens het besluit van het college van Decanen, in het openbaar te verdedigen op vrijdag 21 december 2018 om 12.00 uur door Kirian van der Weg