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The Cardiovascular Center
To provide excellence in cardiovascular patient care, research and education
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we prevent
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we cure
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we care
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we discover
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we teach
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we are
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we prevent we cure we care
we discover we teach we are
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Cardiovascular Center and
CARIM mission statement
The Cardiovascular Center (CVC) and Cardiovascular Research
Institute Maastricht (CARIM) aim to provide excellence in cardiovascular patient care, research, and education.
Our mission is supported by high-quality and innovative health
care, dedication to excellent research, and an appreciation of individual responsibility, mutual respect, and collaboration.
We feel that combining the medical center and research institute
is the best way to achieve our ambitions in prevention, care, cure,
teaching, and discovering. We therefore invest in our patients’ futures by combining the highest level of care, research, and education. In addition, we aim to train and recruit upcoming specialists,
researchers, nurses, and others who support these activities.
We recognize that we are part of a larger societal environment
and aim to embrace the ensuing responsibilities along with our
dedication to our patients. We look forward to collaborating with
societal and industrial partners to jointly offer the best possible
service and research and, in essence, to make society healthier. To
this end, we focus not only on treatment and cure, but also on
prevention. Last but not least, we recognize that our staff ’s individual talents, diversity, innovative power, creativity, and dedication
are the key factors to our strength and success.
Cardiovascular Center and Cardiovascular Research Institute
Maastricht:
To provide excellence in cardiovascular patient care, research and
education.
Prof. Dr. Michael Jacobs,
Chairman CVC
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Prof. Dr. Mat Daemen,
Chairman CARIM
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Cross-border excellence and
strategic alliance
Maastricht University Medical Center+
The University Hospital Maastricht (azM) and Faculty of Health,
Medicine, and Life Sciences (FHML) of Maastricht University
(UM) joined forces in January 2008 to form the Maastricht
University Medical Center+ (Maastricht UMC+), the eighth
such center in the Netherlands. Its main tasks include patient
care, education, and research, all of which are closely interrelated. Of equal importance are top referral and advanced
clinical care, both of which require close cooperation with basic and (experimental) clinical research at Maastricht UMC+.
Key research areas include cardiovascular and chronic diseases,
oncology, mental health care, and neurosciences.
Maastricht University Medical Center+ and
Klinikum Aachen (Germany)
Maastricht and Aachen are centrally located and have established unique, cross-border cooperation in Europe, with strong
political support from the Dutch, German, and European governments. The Departments of Vascular Surgery of both institutions have joined forces to create the first cross-border
European Vascular Center Aachen-Maastricht. This accredited
center of excellence performs the full spectrum of open and
endovascular procedures in multidisciplinary teams, using telemedicine technology to monitor and observe surgical procedures, and has specific expertise in aortic pathology. Recently, a
joint training program for PhD students (EUCAR) was set up
between Aachen and Maastricht with the goal of becoming a
Euregional Cardiovascular Center of Excellence (ECCE). Both
institutions have close links with technical universities, allowing
intensive research at the frontiers of new cardiovascular technologies such as tissue engineering, molecular imaging, and the
development of assist devices.
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Cardiovascular Center and CARIM: from bench to bedside
While the introduction of thrombolytics, heart surgery, and
vascular intervention techniques have been increasingly successful in treating cardiovascular diseases, they remain the
leading cause of death (32%) in the Netherlands and the
Western world. In 2006, more than 42,000 people died of
cardiovascular disease in the Netherlands. While emphasis
in the past decades has mainly been on treatment, recent
years have seen a paradigm shift towards prevention and
early diagnosis.
For this reason, the CVC and CARIM joined forces in 2007
to form the Maastricht Cardiovascular Center, whose focus
is on basic disease mechanisms as well as on early diagnosis
and individual risk stratification of cardiovascular diseases in
order to allow faster translation of new research concepts
into clinical practice.
We have opted for four focal areas in the domain of cardiovascular diseases: unstable atherosclerotic plaques and arterial thrombosis; heart failure and atrial fibrillation; (molecular) imaging as the interconnecting technology; and obesity/
diabetes as the interconnecting risk profile. These choices
were based on the already existing basic and clinical research quality and its clinical importance, thus focusing and
increasing current cardiovascular research in Maastricht and
paving the way to faster application in the clinic in order to
better serve the patient.
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This figure shows the patient passing
through the several stages of his treatment in the CVC. The quality of treatment is guaranteed by the close collaboration between the Research institute
CARIM, the medical disciplines and the
partners in the public and industrial environment. All activities are supported
by a technological platform. In this platform the latest technical solutions in the
diagnosis and treatment of cardiovascular diseases are integrated.
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Cardiovascular Center
The CVC is continuously looking for ways to adapt to changing patient demands and changing markets in our international region.
The Center is characterized by a unique mix of specialists
involved in vascular diseases: cardiology, cardiothoracic surgery, vascular surgery, vascular medicine, vascular neurology,
and interventional radiology. All medical doctors, nurses, and
laboratory technicians from these departments are now officially represented in the CVC, which consists of 433 employees. Every year, this team handles approximately 50,000
outpatient visits and performs 5000 invasive and 22,000
non-invasive tests, 2500 cardiovascular interventions, and
2000 cardiovascular surgical procedures. The CVC serves as
a platform that offers protocolized, well organized, multidisciplinary top referral care embedded in (clinical) research
and education programs. With this integrated organization,
the CVC strives to be an international reference institute for
cardiovascular diseases.
Focus on patient care
The development of demand-driven care has led to the
establishment of a cardiovascular center offering multidisciplinary treatment. Patient care is structured around specific
disease groups, resulting in integrated care and tailor-made
treatment. This ensures state-of-the-art and efficient care
by a team of professionals offering patient support before,
during, and after treatment.
Center of Excellence
The abovementioned multidisciplinary approach results in
innovative procedures such as hybrid interventions. Diseases
like atrial fibrillation (cardiac arrhythmia) can be cured via
a unique collaboration between interventional cardiologists
and surgeons aiming to combine their most successful techniques. This unique manner of treatment, by joint collaboration, is just one example of many that have been started
within the CVC.
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Prevention
Paradoxically, despite excellent treatment possibilities, the
risk of cardiovascular disease is rapidly increasing for many
people. The answer lies in early diagnosis. Recent developments have greatly improved our knowledge of the
molecular mechanisms involved in cardiovascular diseases
as well as medical technology – especially in the area of
(molecular) imaging and biosensors – and improved collaboration between basic researchers, clinicians, academics,
and industry, as in the Center for Translational Molecular
Medicine (CTMM).This will enable us not only to develop
early diagnosis parameters but also to actually measure
them in risk groups. In addition, we have established a
cardiovascular disease prevention program.
HAPPY (Heart Attack Prevention Program for You) is an
important element of CVC’s preventive care inside and
outside the azM. It aims to increase people’s awareness
of cardiovascular disease risks and to encourage lifestyle
changes conducive to improving the function of the heart
and arteries.
The escalating incidence of obesity and diabetes constitutes a grave threat to future cardiovascular health. This
prospect becomes even worse when one considers the
substantial presence of child obesity.The HAPPY program
was designed to avert this epidemic threat.
HAPPY involves a unique mass screening and communication concept; a Maastricht pilot study showed that
the program can screen 250 people per hour. In addition,
tailor-made advice can be sent to participants using communication technology and software, including medical
advice and lifestyle (e.g., food and exercise) recommendations.
In 2008, HAPPY will be used in several companies, as well
as in the azM, with the aim of making and keeping staff
healthier.
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Clinical Pathways Cardiovascular Center
Cardiac arrhythmias
The CVC is specialized in the treatment of arrhythmias. Along
with traditional treatment with medication, there are devices
that can be implanted that ensure that the heart maintains
its normal rhythm (sinus rhythm). These includes pacemakers
and ICDs. A very common arrhythmia is atrial fibrillation. Atrial fibrillation may cause severe palpitations, stroke, and heart
failure. The complications may be treated by oral anticoagulation and ablation of the arrhythmia. Echocardiography plays an
important role in recognizing patients at high risk for stroke.
Nevertheless, many atrial fibrillation patients suffer stroke despite adequate anticoagulation. The CVC Maastricht performs
targeted transesophageal echocardiography and biomarker
assessment to improve stroke prevention. In addition, our
center is one of the leading centers in cryocatheter ablation
of the arrhythmia, as well as in combined minimal invasive
surgery to eliminate the arrhythmia and the stroke risk.
Coronary artery disease
Many cardiac patients suffer from coronary artery disease,
which leads to angina pectoris and myocardial infarction. The
CVC Maastricht has an extensive PCI program that includes
advanced intra-coronary interventions like coated stent placement, thrombosuction, and primary stenting for patients with
an acute myocardial infarction. In the case of a severe infarct
with low blood pressure and shock, temporary support of
the circulation with ELS is performed together with thoracic
surgery.To diagnose coronary artery disease, conventional coronary angiography is used by most centers. In the past year,
we developed one of the largest programs for cardiac CT
including CT-angiography, which replaces conventional angiography in many patients.
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Heart failure
Heart failure is a growing problem in an aging population. It is a syndrome
characterized by shortness of breath, fluid retention, and left ventricular
dysfunction and has various causes . In the CVC Maastricht, we treat heart
failure patients in a heart failure outpatient clinic, together with specialized
nurses who also visit the patients at home and give them all the information and support they need to manage their illness. By means of The Health
Buddy®, a telemonitoring device, the patients is under remote control for
their complaints the patients’ complaints are monitored by remote control.
Stable patients are asked to participate in the rehabilitation program.
Unraveling the causes of heart failure is a focus of our research. We investigate the genetic and inflammatory background of heart failure, as well
as viral persistence as a cause of idiopathic cardiomyopathy. This research
program contains an innovative diagnostic and treatment algorithm that
has attracted the interest of many centers around the world.
Imaging
Since imaging is a crucial tool in the modern diagnostics of cardiovascular
disease, several imaging technologies, such as echocardiography, echo Doppler imaging of the vasculature, magnetic resonance imaging, and cardiac
catheterization, and experts, such as cardiologists, vascular surgeons, and
(interventional) radiologists, have been brought together in the CVC. This
enables us to visualize and, if necessary, treat abnormalities in the heart
valves, aneurysms of the abdominal aorta, and critical stenoses in the coronary and peripheral arteries.
Also here we try to provide top level service by validating and implementing novel cutting edge technologies. One of these is multi-slice CT
technology, which can superbly visualize the heart and coronary arteries
within a few seconds. Further implementation of this ultra-fast technology
will most certainly improve the detection of even very early changes in the
cardiovascular system, which opens up new possibilities for detection and
prevention of cardiovascular diseases in a large number of individuals.
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Cardiac thoracic surgery focus2
Offering the best possible care to patients undergoing cardiac surgery starts with organizing all care activities around
a single concept. FOCUs2, or Facilitating Optimal Care Using
Short Stay Strategies, is a reorganization program focused
on quality control and improvement. Quality is the product
not only of the surgical intervention, but also of waiting listcontrol, preoperative, postoperative care, rehabilitation, and
secondary prevention programs. Coordinating the work of
all the professionals involved in these various activities is a
great challenge. The structure of the CVC, however, offers
the unique opportunity to bring together these individual
professionals in one organization, creating a dedicated team
with one single program and one common mission.
Minimally invasive surgery
Heart surgery is considered the most invasive of all forms
of surgery. The CVC physicians, however, believe this is set
to change. The transition to minimally invasive heart surgery has been initiated thanks to a non-dogmatic attitude
towards traditional discipline interests. The unique collaboration between intervention cardiologists and surgeons aiming to combine their most successful techniques ensures
that patients receive better treatment, with fewer operative
traumas. The procedures are carried out in what is called an
‘endosuite’ or ‘hybrid room,’ combining advanced online imaging with the possibilities offered by an OR. The first group
of patients to benefit from this new approach will mainly
consist of people suffering from cardiac arrhythmia, heart
valve diseases, and coronary artery problems.
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Aneurysm
Dilated blood vessels (aneurysms) can appear in any artery
of the human body, but they most commonly affect the aorta.
If the diameter of an artery increases, the risk of rupture
also increases and the aneurysm becomes life-threatening.
Treatment aims to exclude the aneurysm by means of an
open surgical procedure or endoprosthesis implantation. If
the aneurysm involves important side branches, such as arteries to the brain, liver, intestines, or kidneys, the procedure
becomes more complex. The CVC acts as a referral institute
for these complex aortic diseases, both nationally and internationally. Basic research focuses on the effects of organ perfusion during surgery and the development of new, minimally
invasive techniques to treat aneurysms with side branches.
Peripheral vascular disease
Vascular disease is mainly caused by extensive and advanced
atherosclerosis of the blood vessels to the brain, heart, abdominal organs, and legs. Peripheral vascular disease mainly
affects the lower limbs and causes such clinical symptoms
as mild limited walking ability and severe critical ischemia,
requiring amputation as the last option. Treatment focuses
on reducing risk factors (e.g., smoking, cholesterol), dilating
stenoses by means of balloons and stents, and bypass grafts.
Future research will, however, concentrate on genetic causes
and analysis of risk factors with the subsequent development
of new treatment modalities -- a transition from secondary
to primary prevention and from symptom treatment to
disease prevention.
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Hypertension
Hypertension is one of the main risk factors for cardiovascular and cerebrovascular diseases. More than 20% of the
Dutch population suffers from high blood pressure; yet, if
hypertension is not diagnosed early, organ damage to the
heart, vessels, brain, and kidneys will develop. Treatment depends on the assessment of other cardiovascular risk factors
in combination with target organ damage; 10% of patients
do not respond adequately to treatment. In such cases, secondary causes, such as angiography of the renal arteries and
determination of neurohumoral system activity, have to be
explored. In extreme cases of treatment resistance, baroreceptor reflex therapy should also be considered. The Maastricht UMC is the center with the most expertise in applying
this treatment, which acts by electrically activating the carotid
artery baroreceptors.
Cardiovascular risk management
Risk management provides a structured approach to assessing cardiovascular risk factors, the treatment of which
prevents future cardiovascular events. Patient referral from
general practitioners and hospital specialists is based on cardiovascular events during youth, events in the absence of
classic risk factors, and a familial or genetic history of such
events. Nurses and physicians cooperate to put together a
complete cardiovascular risk profile, including determination
of the presence of hyperlipidemias, hypertension, diabetes
mellitus, hyperhomocysteinemia, vasculitis, and occasionally
coagulation abnormalities and genetic variants. Treatment is
initiated depending on these abnormalities in combination
with the presence of a family history, smoking, obesity, or an
unhealthy lifestyle. Integration of treatment of all risk factors
substantially reduces future cardiovascular morbidity and
mortality.
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Thrombosis
Patients at the CVC see the internist/vascular medicine specialist for analysis of the causes and consequences of deep
venous thrombosis, pulmonary embolism, and arterial thromboembolism. Topics of interest in research and management
include the molecular mechanisms leading to thrombosis
(so-called “thrombophilia”) and treatment optimization (e.g.,
by modifying anticoagulant type and dose or adjusting platelet inhibiting agents, and counseling patients about treatment
complications, prevention of bleeding, use of antithrombotic
treatment during pregnancy, etc.). Patients with deep venous
thrombosis and/or pulmonary embolism are followed for
two years, during which specific research projects exist parallel to patient care and medical student education. A main
topic of interest for the coming years is improving individual
efficacy and safety of antithrombotic therapy in the many
patients with arterial vascular disease by way of novel laboratory technology.
Stroke
Early treatment of stroke or brain infarction (also known as
a cerebrovascular accident, or CVA) can reduce stroke severity. In the Maastricht UMC, swift action in cases of acute
stroke is organized at the emergency room (ER) level by
way of agreements with general practitioners, the ambulance
service, and other emergency services within the hospital.
In the Netherlands, 5-7% of stroke patients are treated for
intravenous thrombolysis; at the Maastricht UMC, this figure
stands at 10-15% . The possibility of increasing this number is
curtailed only by lack of time. One intended development is
a specialized ER for stroke patients only, set to house an ultramodern CT-scanner and to guarantee rapid diagnosis and
modern intervention possibilities. Treatment of acute brain
attacks will soon be possible 24 hours a day by way of intravenous or intra-arterial endovascular therapy.
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CARIM
The CARrdiovascular research Institute Maastricht (CARIM) combines all cardiovascular disease research carried
out at Maastricht University (UM). With an annual budget
of approximately �23 million and around 250 researchers
from 13 disciplines, CARIM is the UM’s largest research institute and one of the largest in the Netherlands. Training
of young scientists is an important goal of CARIM, which is
approved by the Royal Netherlands Academy of Sciences
and Art (KNAW) as a research school. Also, the European
Union has approved CARIM as a training center for young
scientists.
CARIM produces more than 400 scientific articles and
around 30 PhD dissertations each year and works closely
with such national programs as CTMM and various European networks. Its research concentrates on three major
themes: thrombosis and hemostasis, cardiac function and
failure, and vascular biology. Each theme includes various
multidisciplinary programs headed by program leaders. Below you can read about 12 CARIM programs: the first 3 are
examples of thrombosis and hemostasis research, the next
4 deal with cardiac function and failure, and the last 5 focus
on vascular biology.
Many of these programs not only carry out basic research
but often also examine the value of its clinical application,
the possibilities of which will be greatly reinforced by the
joining of CARIM and HVC to focus on shared research
themes.
we discover
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Annexin V
The human protein annexin A5 receives much attention as a molecular imaging agent to visualize and measure programmed cell death (apoptosis); it was discovered and developed at
CARIM’s biochemistry department. Preclinical and clinical studies have shown that its use in
non invasive imaging of apoptosis has diagnostic value in identifying early onset of heart failure
and unstable atherosclerotic plaques, the main cause of the clinical symptoms of atherosclerosis. Annexin A5 is currently being explored as a therapeutic agent to deliver drugs to tissues
with abundant apoptosis.
Clinical aspects: thrombosis and hemostasis
Thrombin is a key protein in the blood coagulation cascade, and functional measurement of
thrombin generation (TG) is a central feature of clinical thrombosis research. TG is measured
using calibrated automated thrombography (CAT); adding the anticoagulant activated protein
C (APC) allows for an indication of TG’s sensitivity to APC. It has been used to document
increased risk of venous thromboembolism (thrombophilia), while genetic and/or acquired
risk factors (e.g., the ‘pill’) have been successfully identified using the TG-based APC resistance
assay.
Platelets in TG will provide a novel strategy to study the risk of thrombosis in patients with
intravascular stents and ischemic events. In addition, CAT can be used to monitor the perioperative effects of treatment with prohemostatic agents, as well as to guide novel anticoagulant treatments.
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Protein synthesis
At CARIM´s biochemistry department, we have recently successfully introduced a new technology
platform for the discovery of biologically active molecules. This entails the combined application of
innovative in silico techniques, such as structural bioinformatics techniques (particularly structurebased virtual ligand screening), with state-of-the-art technology, including surface plasmon resonance (SPR). We have thus created an environment that allows the optimal study and exploitation
of the protein structures involved in cardiovascular disease.
With the help of a rational approach and in silico techniques, we are able to select biologically active
molecules from large pools of compounds (close to one million) relatively cheaply and quickly, as
compared to the more traditional, high throughput screening (HTS) approaches. Newly discovered
molecules may find their application as in vitro research tools, but can also be developed into lead
compounds for cardiovascular disease therapy or diagnosis.
Left ventricle apex pacing
Pacemaker therapy is designed to normalize heart rhythm. To this end, the heart is usually stimulated artificially from the right ventricle (RV). Side effects include abnormal left ventricular (LV) electrical activation and contraction and compromised LV pump function. In experiments with animals
and in children, we have shown that LV apex pacing results in near-normal pump function.
On the basis of these findings, we treated a girl who had been paced from the RV wall since birth.
At age two she developed heart failure, as evidenced by progressive LV dilatation and a shortening
fraction of 20%. After initiation of LV apex pacing, this shortening fraction increased immediately to
31%, LV dilatation returned to near normal, and her condition improved considerably and permanently. Thus, it is clear that proper positioning of the pacing electrode is of crucial importance for
heart pump function, especially in children.
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Viral cardiomyopathies
Long-term virus persistence in the heart is increasingly recognized as a cause of cardiac failure:
over 70% of patients with a previously unknown cause of heart failure carry a heart virus such
as the common cough.These viruses mainly affect young, previously healthy and active individuals
(mean age: 40). We thus perform basic research into the mechanisms of these viruses, which may
cause heart failure.
• Why do these viruses cause heart inflammation and injury?
• Are only select individuals prone to virus-induced heart failure?
• Do immunoglobulins, for instance, offer a treatment option?
Based on our bench-to-bedside research, we are identifying novel targets for treating these patients. We have recently found, for example, that high levels of matrix protein thrombospondin-2
protect against inflammation and resulting injury in enterovirus-induced heart disease.
Early diagnosis of acute myocardial infarction
In our research on the regulation of cardiac energy metabolism, we discovered a small cellular
protein capable of binding fatty acids (FABP). We demonstrated that it facilitates the transportation of fatty acids from the cell membrane to mitochondria for energy production.
We also found, as early as 1988, that, upon cardiac injury, FABP is rapidly released from the
damaged myocytes. This suggested that the presence of FABP in blood plasma may be used to
confirm or exclude acute myocardial infarction. In an (EU-funded) European multi-center clinical
trial, FABP was the best early indicator of infarction diagnosis in patients with chest pain. In 2007,
commercial activities with respect to FABP were initiated in collaboration with BioMedbooster
and an industrial partner.
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Atrial fibrillation
Atrial fibrillation is the most frequent cardiac arrhythmia and a new epidemic in medicine. It
causes not only palpitations but also stroke, heart failure, and death. Despite its clinical importance, current treatment of atrial fibrillation is still far from satisfactory.Therefore, prevention has
become the focus of many researchers in this field.
In a translational approach at Maastricht UMC+, new tools for early detection of patients at risk
for atrial fibrillation are being developed and implemented in routine clinical practice. Together
with industry partners and basic scientists, implantable arrhythmia recorders are being developed to detect asymptomatic episodes of atrial fibrillation, while advanced mapping and new
echocardiographic techniques investigate electrophysiological changes preceding the atrial fibrillation to optimize preventive treatment. Cure can be brought about through hybrid procedures
including newly developed transvenous catheters and minimally invasive surgical ablation tools
and techniques.
Therapeutic neovascularisation
Stimulating new blood vessels or collateral growth is an important method of improving perfusion to an ischemic heart or leg (therapeutic neovascularization). A set of naturally occurring
growth factors, such as platelet- derived growth factor (PDGF), have been explored for this
purpose. PDGF not only induces but also stabilizes new blood vessels and improves heart
remodeling and function after infarct improvement. To avoid systemic side effects and achieve
optimal effect, sustained local delivery is necessary. In highly relevant preclinical models, we have
shown that polymer- facilitated PDGF delivery to the heart is an effective therapeutic option to
treat cardiac ischemia. The next step is to study the effects of PDGF delivery in a clinical trial.
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Vascular protection by the endothelial glycocalyx:
diagnostic and therapeutic implications
The inner surface of blood vessels is coated with a protective layer of complex carbohydrate structures – the endothelial glycocalyx. New technological developments allow reliable assessment of
glycocalyx quality in patients, and recent studies indeed demonstrate that exposure to cardiovascular risk factors such as high cholesterol, smoking, and diabetes damages the glycocalyx even before
vascular damage becomes evident. This now allows for early detection of elevated cardiovascular
risk and the development of new therapies to increase vascular protection by glyocalyx.
Diabetes/Metabolism
Diabetes mellitus is a common metabolic disease affecting approximately 150 million people worldwide, including 600,000 in the Netherlands. This figure is expected to double in the next 10 years,
particularly due to a sharp increase in obesity prevalence.
Since the vast majority of diabetic patients will develop cardiovascular disease, we have created a
large cohort of type 2 diabetic patients. We intend to determine in detail their risk for cardiovascular
disease and to follow their progress over time in what will be the largest cohort in the Netherlands
and one of the largest worldwide. This unique approach and the multidisciplinary network of basic
scientists and clinicians will enable us to identify new (bio)markers and define new approaches,
including those related to cardiac and arterial structure and function, in order to reduce the burden
of diabetic disease and its cardiovascular complications.
New biomarkers for plaque instability: the power of
integrated translational research
Unstable atherosclerotic plaques are widely recognized as major culprits of acute cardiovascular
syndromes. In the search for new predictive biomarkers of patients at risk, we have pursued two
strategies. First, we successfully identified auto-antibodies in the bloodstreams of patients with acute
myocardial infarction against protein fragments exclusively present in unstable plaque. Second, we
found elevated levels of three molecules that regulate inflammatory cell influx in patients with unstable angina pectoris and showed that these molecules may also predict whether patients are likely
to suffer an infarct in the near future. Both sets of biomarkers are currently being tested for their
diagnostic value in large clinical trials.
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Monocyte
Molecular magnetic resonance
imaging of vascular disease
LDL
Magnetic resonance imaging (MRI) provides excellent, noninvasive visualization of blood vessel anatomy and function.
Development of molecular MRI is particularly important
as it may introduce novel ways to image vascular disease in
great detail by way of molecular processes, potentially at an
early, curable stage.To visualize molecular markers in vascular
diseases such as atherosclerosis (image left, fresh thrombus
in carotid artery) and vascular tumor growth (image right,
activated tumor microvessels) with MRI, we are developing
novel contrast media and MRI techniques. Our translational
research explores vascular biology, evaluates imaging feasibility in cells and disease models, and finally applies and validates
it in human vascular disease.
Initiation:
LDL modification
in the vessel wall
mLDL
Smooth muscle cells
we discover
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Endothelium
The macrophage as a central player
in the development of atherosclerosis
Atherosclerosis develops when LDL (the “bad” cholesterol)
, the body’s main transporter of fatty substances, leaks from
the blood into the artery walls, where it causes a local inflammatory response. This allows immune cells such as monocytes (which normally circulate in the blood) to move into
the artery walls, where they differentiate into macrophages
that remove LDL as ‘vacuum cleaners’. Excess LDL in the
arterial wall causes the macrophages to absorb so much fatty
material that they develop into fat-laden foam cells called
histiocytes, the accumulation of which leads to plaque formation. Macrophages thus play a key role in the development of
atherosclerosis. Our research focuses on further unraveling
the exact role of macrophages in this disease.
fibrous cap
Macrophage
Inflammatory
mediators
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Foam cell
formation
Cell death
Migration & division
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Teaching
The small-scale education provided by the UM Faculty of Health,
Medicine, and Life Sciences (FHML) has traditionally been problem- and patient- focused, and continues to slowly but surely
move from the university to the hospital setting.
In addition to health care and scientific research tasks, the CVC
and CARIM staff also play major roles in the basic medical doctoral and specialist programs.Within the Medicine, Medical Doctor/Clinical Researcher, Biomedical Technology, and Molecular
Life Sciences programs, they contribute to innovative teaching in
the outpatient clinic, where third-year students gain experience
with real patients and clinical workshops, as well as practical and
meet-the-expert sessions, in which students and professionals
jointly discuss complex themes.
In 2006, Maastricht and Aachen jointly established the world’s
first cross-border surgical training center. Following a quality audit, the Ärtztekammer Nordrhein-Westfalen granted the center
the authority to provide a full vascular surgery program in the
combined Aachen-Maastricht area.
The CVC organizes several congresses. The well-known European Vascular Course will be co-organized by the CVC in Maastricht as of 2009, with live sessions demonstrating the latest innovative cardiovascular procedures.
we teach
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Key figures Maastricht UMC+:
• 715 beds (occupancy rate 80.4%);
• 22 ORs, including 15 central, 4 anesthesia
(in elective surgery centers) and 3 in outpatient clinic;
• 25,768 admissions per year (average stay 7.66 days);
• 394,632 outpatient clinic patients per year;
• 17,765 patients per day;
• 26,963 ER visitors;
• 4730 staff;
• total consolidated annual budget of € 345 million;
85% (€ 295 million) earmarked for patient care; 15%
(€ 50 million) for education and research (Ministry of
Education, Culture and Science contribution).
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Outcome CVC 2007
PCI
1,823
Stents of which 28,2% Drug Eluting
2,154
Diagnostic Catheterization Procedures
3,565
Ablations
283
Of which Pulmonairy Vein Isolation
58
ICD of which 35% biventriculair
227
Pacemakers
208
Open Heart
940
TAAA
50
Endovascular prosthesis
87
Beds
129
Bed occupancy rate
81,36%
Average length of stay
4,6 days
Clinical Admissions
4,642
Clinical days
34,874
Treatment in day care
3,876
Key figures CVC
Personnel 2007
Medical Staff
41
Residents
36
Other
356
Total
433
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Funding CVC (* € 1.000)
2005
2006
2007
Personnel
Materials
€ 15,830 € 17,426 € 15,873 € 15,154 €17,048 €18,136 Total
€ 33,256 € 31,027 € 35,184 Funding
Patientcare
€ 28,189 € 26,175 € 29,664 Research and Teaching fee
€ 4,974 € 4,619 € 5,235 Other
€ 93 € 233 € 285 Total
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Key figures CARIM
(average 2001-2007)
Personnel CARIM:
Scientific staff (in fte)
Faculty
48
Other
65
PhD Students
90
Technicians
42
Output CARIM (average per year):
Publications in refereed journals
450
PhD Thesis
30
Patents
7
Funding CARIM (x €1,000):
2005
2006
2007
Direct funding (University)
7,500
Research funds (NWO)
1,800
Contract (other external funding) 7,200
7,800
1,650
7,800
10,550
2,700
10,200
Total
16,500
17,250
23,450 Personnel
Other costs
11,750
4,700
11,200
5,900
14,400
8,600
Total
16,450
17,100
23,000
50
150
450
Result
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45%
12%
43%
63%
37%
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VOJWFSTJUZIPTQJUBM
.BBTUSJDIU
Hart en Vaat Centrum
Maastricht UMC+
Cardiovascular Center
Carim
Universiteit Maastricht
P. Debeijelaan 25
6229 HX Maastricht
+31 (0)43 387 65 43
P. Debeijelaan 25
6229 HX Maastricht
+31 (0)43 387 43 93
Universiteitssingel 50
6229 ER Maastricht
+31 (0)43 388 16 47
Minderbroedersberg 4-6
6211 LK Maastricht
+31 (0)43 388 22 22
Concept: Roger Peters, Cardiovascular Center Fotografie: Guy van Grinsven, Studiopress Opmaak: Gitta Orbons, Studiopress - Di-gitta-al
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