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Raunsø J, Song RJ, Vasan RS, Bourdillon MT, Nørager B, Torp-Pedersen C, Gislason GH, Xanthakis V, Andersson C. Familial Clustering of Aortic Size, Aneurysms, and Dissections in the Community. Circulation 2020; 142:920-928. [DOI: 10.1161/circulationaha.120.045990] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background:
Ruptured aortic aneurysm and aortic dissections are potentially preventable disorders associated with high mortality. Screening of individuals at risk may translate into elective surgical interventions and lowered mortality. It is uncertain if the risk of aortic dilation of varying degrees aggregates within families.
Methods:
We investigated the risk of having thoracic and abdominal aortic sizes in the highest quartile (measured by computed tomography scans and indexed for body size) if at least 1 parent did so in the Framingham Heart Study cohorts, and estimated the incidence rates and hazard ratios of developing aortic aneurysm or dissection among first-degree relatives of those with aortic aneurysm or dissection, in comparison with age- and sex-matched controls (1:10 for aortic aneurysm and 1:100 for aortic dissection) using the Danish nationwide administrative registries.
Results:
In the Framingham Heart Study, offspring (n=235) whose parent(s) had a sex- and age-standardized aortic size in the upper quartile had a multivariable-adjusted ≈3-fold increased odds ratio of belonging to the upper quartile themselves. In Denmark, a total of 68 939 individuals (mean age, 42 years) had a first-degree relative with aortic aneurysm and 7209 persons (mean age, 39 years) had a first-degree relative with aortic dissection. During an average follow-up of 7 years, first-degree relatives of patients with aortic aneurysm and dissection had a hazard ratio of 6.70 (95% CI, 5.96–7.52) for developing aortic aneurysm and a hazard ratio of 9.24 (95% CI, 5.53–15.44) for dissection in comparison with matched controls. These estimates remained unchanged on adjusting for several comorbidities, including prevalent hypertension, bicuspid aortic valve, and the Marfan syndrome. For both aortic aneurysm and dissections, the absolute event rates approached 1 per 1000 person-years for first-degree relatives versus 11 to 13 (aortic aneurysm) and 2 to 3 (aortic dissections) per 100 000 person-years among controls.
Conclusions:
Increased aortic size, a precursor of aortic aneurysm and a risk factor for dissection, clusters in families. The incidence rates of aortic aneurysm and dissections approach the incidence rates of other common cardiovascular conditions in first-degree relatives, supporting the use of systematic screening for these conditions.
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Affiliation(s)
- Jakob Raunsø
- Department of Cardiology, Herlev and Gentofte Hospital, Denmark (J.R., B.N.)
| | - Rebecca J. Song
- Department of Epidemiology (R.J.S, R.S.V.), Boston University School of Public Health, MA
| | - Ramachandran S. Vasan
- Department of Epidemiology (R.J.S, R.S.V.), Boston University School of Public Health, MA
- Department of Medicine, Section of Cardiovascular Medicine (R.S.V., C.A.), Boston University Schools of Public Health and Medicine, MA
- Boston University’s and National Heart Lung and Blood Institute’s Framingham Heart Study, MA (R.S.V., V.X., C.A.)
| | | | - Betina Nørager
- Department of Cardiology, Herlev and Gentofte Hospital, Denmark (J.R., B.N.)
| | - Christian Torp-Pedersen
- Department of Clinical Investigation and Cardiology, Nordsjaellands Hospital, Hillerød, Denmark (C.T.-P.)
- Department of Cardiology, Aalborg University Hospital, Denmark (C.T.-P.)
| | - Gunnar H. Gislason
- Department of Cardiology, Herlev and Gentofte Hospital, Denmark (G..H.G., C.A.)
- The Danish Heart Foundation, Copenhagen, Denmark (G.H.G.)
| | - Vanessa Xanthakis
- Department of Biostatistics (V.X.), Boston University School of Public Health, MA
- Boston University’s and National Heart Lung and Blood Institute’s Framingham Heart Study, MA (R.S.V., V.X., C.A.)
| | - Charlotte Andersson
- Department of Medicine, Section of Cardiovascular Medicine (R.S.V., C.A.), Boston University Schools of Public Health and Medicine, MA
- Boston University’s and National Heart Lung and Blood Institute’s Framingham Heart Study, MA (R.S.V., V.X., C.A.)
- Department of Cardiology, Herlev and Gentofte Hospital, Denmark (G..H.G., C.A.)
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Hansen VB, Aagaard S, Hygum A, Johansen JB, Pedersen SS, Nielsen VL, Neergaard MA, Salomonsen GR, Guldin MB, Gustafsson I, Eiskjær H, Gustafsson F, Roikjær SG, Nørager B, Larsen H, Zwisler AD. The First Steps Taken to Implement Palliative Care in Advanced Heart Disease: A Position Statement from Denmark. J Palliat Med 2020; 23:1159-1166. [PMID: 32380928 DOI: 10.1089/jpm.2019.0566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
According to the World Health Organization, palliative care must be available for everyone with life-threatening diseases. However, in daily practice the primary focus worldwide is on cancer patients. The aim of the article was to generate a national position statement as the first step in implementing palliative care in severe heart disease with focus on advanced heart failure, including tools to identify the need for and timing of palliative care and how palliative care could be organized in Denmark. A task force was formed in the Danish Society of Cardiology Heart Failure Working Group, and the position statement was prepared in collaboration with members from a broad group of specialties, including palliative medicine. Because of major gaps in evidence, the position statement was based on small and low-quality studies and clinical practice statements. This position statement was aligned with the European Society of Cardiology recommendation, focusing on relieving suffering from the early disease stages parallel to standard care and supplementing life-prolonging treatment. The statement delivers practical guidance on clinical aspects and managing symptoms during the three stages of advanced heart disease. Furthermore, the statement describes the importance of communication and topics to be broached, including deactivating implantable cardioverter defibrillators. The statement recommends a targeted effort on organizational strategies using high-quality assessment tools and emphasizes multidisciplinary and intersectoral collaboration. Danish cardiologists supported by allied professionals acknowledge the importance of palliative care in advanced heart disease. This national position statement intended to inform and influence policy and practice and can hopefully inspire other countries to take action toward implementing palliative care in advanced heart disease.
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Affiliation(s)
- Vibeke Brogaard Hansen
- Heart Failure, Department of Cardiology, Lillebaelt Hospital Vejle, Vejle, Denmark.,Danish Society of Cardiology, Copenhagen, Denmark
| | - Susanne Aagaard
- Danish Society of Cardiology, Copenhagen, Denmark.,Heart Failure, Department of Heart Disease, Aarhus University Hospital, Aarhus, Denmark
| | - Anette Hygum
- Palliative Care Team, Department of Oncology, Lillebaelt Hospital Vejle, Vejle, Denmark.,Danish Society of Palliative Medicine, Copenhagen, Denmark
| | - Jens Brock Johansen
- Danish Society of Cardiology, Copenhagen, Denmark.,Arrhythmias, Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Susanne S Pedersen
- Danish Society of Cardiology, Copenhagen, Denmark.,Palliative Care Team, Department of Oncology, Lillebaelt Hospital Vejle, Vejle, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Vivi Lindeborg Nielsen
- Danish Society of Cardiovascular and Thoracic Surgery Nursing, Copenhagen, Denmark.,Heart Failure, Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Mette Asbjørn Neergaard
- Danish Society of Palliative Medicine, Copenhagen, Denmark.,Palliative Care Team, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Gitte Ryom Salomonsen
- Heart Failure, Department of Heart Disease, Aarhus University Hospital, Aarhus, Denmark.,Danish Society of Cardiovascular and Thoracic Surgery Nursing, Copenhagen, Denmark
| | - Mai-Britt Guldin
- Institute of Public Health-Research Unit for General Practice, Aarhus University Hospital, Aarhus, Denmark
| | - Ida Gustafsson
- Danish Society of Cardiology, Copenhagen, Denmark.,Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Hans Eiskjær
- Danish Society of Cardiology, Copenhagen, Denmark.,Heart Failure, Department of Heart Disease, Aarhus University Hospital, Aarhus, Denmark
| | - Finn Gustafsson
- Danish Society of Cardiology, Copenhagen, Denmark.,Heart Failure, Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Stine Gundtoft Roikjær
- Danish Society of Cardiology, Copenhagen, Denmark.,Danish Knowledge Centre for Rehabilitation and Palliative Care (REHPA), Odense University Hospital and University of Southern Denmark, Nyborg, Denmark
| | - Betina Nørager
- Danish Society of Cardiology, Copenhagen, Denmark.,Congenital Heart Diseases, Department of Cardiology, Herlev & Gentofte Hospital, Herlev, Denmark
| | - Henrik Larsen
- Danish Society of Palliative Medicine, Copenhagen, Denmark.,Palliative Care Team, Department of Oncology, Rigshospitalet, Copenhagen, Denmark.,Danish Multidisciplinary Group for Cancer and Palliative Care, Copenhagen, Denmark
| | - Ann-Dorthe Zwisler
- Danish Society of Cardiology, Copenhagen, Denmark.,Danish Knowledge Centre for Rehabilitation and Palliative Care (REHPA), Odense University Hospital and University of Southern Denmark, Nyborg, Denmark.,Rehabilitation, Department of Cardiology, Odense University Hospital, Odense, Denmark
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Husic M, Nørager B, Egstrup K, Møller JE. Serial changes in regional diastolic left ventricular function after a first acute myocardial infraction. J Am Soc Echocardiogr 2006; 18:1173-80. [PMID: 16275526 DOI: 10.1016/j.echo.2005.03.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2005] [Indexed: 12/11/2022]
Abstract
After acute myocardial infarction (AMI), regional diastolic function may be abnormal even though regional systolic function appears normal. However, it is not known whether this represents a transient or permanent phenomenon, and the relation to myocardial viability is not known. To determine this we assessed regional left ventricular function during contraction and filling after AMI in 106 patients with a first AMI. Echocardiography with color kinesis was performed on day 1 and 1, 3, and 6 months after AMI. For both left ventricular systole and diastole the percentage of segments with abnormal wall motion was calculated. During the first 6 months, the area of diastolic wall-motion abnormality decreased (38 +/- 16%-30 +/- 27%, P = .001) whereas no overall change in area of systolic wall-motion abnormality was seen (18 +/- 15%-19 +/- 19%, P = .66). However, for patients with no viable myocardium no significant change in diastolic wall-motion abnormality occurred (baseline 45 +/- 12% vs 44 +/- 27% at 6 months, P = .93). In contrast, a significant decrease was seen for patients with viability (33 +/- 16%-22 +/- 23%, P < .001). This was almost exclusively caused by normalization of regions where only diastolic wall-motion abnormalities were present (19 +/- 11%-7 +/- 15%, P < .0001). In a multivariable regression model, myocardial viability (P = .01) and N-terminal pro-brain natriuretic peptide concentration on day 3 (P = .003) were associated with changes in regional diastolic wall-motion abnormalities. Thus, abnormal diastolic wall motion during diastole is frequently present after AMI, and it seems to resolve to a greater extent than abnormal systolic wall-motion abnormality especially for patients with myocardial viability. This suggests diastolic stunning.
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Affiliation(s)
- Mirza Husic
- Department of Medical Research, Svendborg Hospital, Svendborg, Denmark
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Nørager B, Husic M, Møller JE, Bo Hansen A, Pellikka PA, Egstrup K. Changes in the Doppler myocardial performance index during dobutamine echocardiography: association with neurohormonal activation and prognosis after acute myocardial infarction. Heart 2005; 92:1071-6. [PMID: 16387817 PMCID: PMC1861079 DOI: 10.1136/hrt.2005.066225] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To test whether an increase in Doppler myocardial performance index (MPI) during dobutamine stress echocardiography, reflecting deterioration of overall left ventricular function, is associated with increased N-terminal pro-brain natriuretic peptide (NT-pro-BNP) concentration and provides prognostic information beyond conventional systolic wall motion analysis after acute myocardial infarction (AMI). DESIGN Prospective, observational study. METHODS Dobutamine-atropine stress echocardiography (DASE) and NT-pro-BNP were assessed five days after AMI in 109 consecutive patients. MPI was measured at rest and at low-dose (10 microg/kg/min) and peak dobutamine infusion (<or= 40 microg/kg/min with or without atropine). MAIN OUTCOME MEASURES End point was a composite of cardiac death or readmission for heart failure or reinfarction. RESULTS In 35 patients (32%), MPI increased at low-dose DASE. This was associated with higher NT-pro-BNP concentrations (beta = 0.30, p = 0.004). During a mean follow up of 27 (SD 7) months, 8 patients died of cardiac causes and 15 patients were readmitted for heart failure or reinfarction. On Cox regression analysis, an increase in MPI at low-dose DASE (p = 0.02) was an independent predictor of cardiac events. In contrast, traditional wall motion analysis during DASE provided no additional prognostic information. CONCLUSIONS An increase in MPI at low-dose DASE, reflecting early deterioration of overall left ventricular function, is associated with raised NT-pro-BNP concentration and provides prognostic information beyond conventional stress echocardiographic data after AMI.
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Affiliation(s)
- B Nørager
- Department of Medical Research, Svendborg Hospital, Svendborg, Denmark.
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Husic M, Nørager B, Egstrup K, Møller JE. Usefulness of left ventricular diastolic wall motion abnormality as an early predictor of left ventricular dilation after a first acute myocardial infarction. Am J Cardiol 2005; 96:1186-9. [PMID: 16253579 DOI: 10.1016/j.amjcard.2005.06.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2005] [Revised: 06/13/2005] [Accepted: 06/13/2005] [Indexed: 11/30/2022]
Abstract
To determine the relation between regional diastolic wall motion abnormality and left ventricular remodeling after acute myocardial infarction (AMI), Doppler echocardiography and color kinesis with assessment of global and regional systolic and diastolic functions were performed in 84 patients who developed AMI within 24 hours of admission. In a multivariate logistic regression analysis, the percentage of left ventricular myocardial segments with diastolic wall motion abnormality (p = 0.008), absence of myocardial viability (p = 0.01), and overall diastolic function (p = 0.001) were predictors of remodeling after AMI.
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Affiliation(s)
- Mirza Husic
- The Department of Medicine, Svendborg Hospital, Svendborg, Denmark
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Husic M, Nørager B, Egstrup K, Lang RM, Møller JE. Diastolic wall motion abnormality after myocardial infarction: relation to neurohormonal activation and prognostic implications. Am Heart J 2005; 150:767-74. [PMID: 16209980 DOI: 10.1016/j.ahj.2004.11.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2004] [Accepted: 11/14/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND Systolic wall motion abnormality (WMA) after acute myocardial infarction (AMI) is a major determinant of outcome; the presence and importance of diastolic WMA after AMI are unknown. We therefore sought to detect diastolic WMA using color kinesis and to assess its relation to neurohormonal activation and its prognostic importance in a consecutive population with a first AMI. METHODS Complete color-encoded color kinesis and 2-dimensional and Doppler echocardiography were performed in 149 consecutive patients with documented first AMI within 24 hours of their admission. N-terminal pro-brain natriuretic peptide was measured 3 days after AMI. Study end point was cardiac death or readmission for heart failure. RESULTS Diastolic area of WMA exceeded the systolic area in all but 5 patients (97%) and was significantly correlated with brain natriuretic peptide (unadjusted beta = .67, P < .0001; adjusted for systolic function, age, Killip class, and overall diastolic function beta = .27, P = .007). Diastolic WMA was also correlated with the number of diseased vessels on coronary angiography (beta = .59, P < .0001). During follow-up, 25 patients died and 11 were readmitted because of recurrent heart failure. On univariate analysis, the area of diastolic WMA was a predictor of the composite end point (hazard ratio 1.07 [95% CI 1.05-1.09], P < .0001) and remained a predictor on multivariate Cox analysis after adjustment of well-known risk factors, left ventricular systolic and overall diastolic functions (hazard ratio 1.09 [95% CI 1.06-1.15], P < .001). CONCLUSION The extent of diastolic WMA can be assessed early after AMI using color kinesis. Diastolic WMA is associated with neurohormonal activation and angiographic severity of coronary artery disease and provides independent prognostic information.
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Affiliation(s)
- Mirza Husic
- Department of Medicine, Svendborg Hospital, Svenborg, Denmark
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Nørager B, Husic M, Møller JE, Pellikka PA, Appleton CP, Egstrup K. The Doppler myocardial performance index during low-dose dobutamine echocardiography predicts mortality and left ventricular dilation after a first acute myocardial infarction. Am Heart J 2005; 150:522-9. [PMID: 16169335 DOI: 10.1016/j.ahj.2004.10.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2004] [Accepted: 10/26/2004] [Indexed: 01/08/2023]
Abstract
BACKGROUND Myocardial viability can be detected by wall motion analysis during low-dose dobutamine echocardiography (LDDE) after acute myocardial infarction (AMI). However, wall motion analysis describes only left ventricular (LV) systolic reserve. The Doppler myocardial performance index (MPI) is a quantitative measure of combined LV systolic and diastolic function. We hypothesized that an increase (deterioration) in MPI during LDDE, reflecting reduced systolic and diastolic LV reserve, could provide prognostic information beyond conventional systolic wall motion analysis on mortality, morbidity, and LV remodeling after AMI. METHODS Low-dose dobutamine echocardiography (10 microg/kg per minute) was performed within 24 hours and echocardiography was repeated 5 days and 1, 3, and 6 months after a first AMI in 162 consecutive patients. Patients were followed for 25 +/- 11 months. End points were all-cause mortality and cardiac events (cardiac death or readmission for heart failure or reinfarction). RESULTS In 72 (44%) patients, MPI increased during LDDE. This was independently associated with subsequent LV dilation at 6 months of follow-up (beta = .73, P < .0001). An increase in MPI during LDDE was a powerful prognostic indicator and remained a predictor of mortality (HR 1.92, 95% CI 1.36-2.71, P < .0001) and cardiac events (HR 2.45, 95% CI 1.83-3.27, P < .0001) after adjustment for clinical data, indices of LV function at rest, and wall motion analysis during LDDE. CONCLUSIONS Early after AMI, deterioration in MPI during LDDE predicts subsequent LV dilation and provides prognostic information incremental to clinical data, indices of LV function at rest, and conventional stress echocardiographic data.
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Affiliation(s)
- Betina Nørager
- Department of Medical Research, Svendborg Hospital, Denmark.
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Nørager B, Husic M, Møller JE, Egstrup K. The myocardial performance index during low-dose dobutamine echocardiography in control subjects and patients with a recent myocardial infarction: a new index of left ventricular functional reserve? J Am Soc Echocardiogr 2004; 17:732-8. [PMID: 15220897 DOI: 10.1016/j.echo.2004.03.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Wall-motion analysis during low-dose dobutamine echocardiography (LDDE) is a semiquantitative measure of left ventricular contractile reserve after myocardial infarction (MI). The Doppler echocardiographic myocardial performance index (MPI) is a quantitative measure of combined left ventricular systolic and diastolic function. We sought to characterize the changes in MPI during LDDE in control subjects and patients with MI, and to describe the relation of these changes to changes in regional systolic function. METHODS MPI was obtained at rest and during LDDE (10 microg/kg/min) in 25 healthy volunteers (group 1) and 50 patients with a recent MI. Patients were divided into two subsets; those with (n = 23; group 2A) and those without (n = 27; group 2B) a contractile reserve defined as an improvement of wall motion in more than two contiguous infarct-zone segments during LDDE. DeltaMPI was defined as the change from rest to LDDE. RESULTS MPI decreased significantly during LDDE in groups 1 and 2A, whereas MPI increased in group 2B (DeltaMPI = 0.12 +/- 0.04 and 0.10 +/- 0.08 vs -0.03 +/- 0.08, P <.0001). On multivariate analysis, Deltawall-motion score index predicted DeltaMPI (beta = 0.65, P <.0001) independently of age, sex, and the dobutamine-induced change in heart rate and systolic blood pressure. CONCLUSIONS Data suggest that the change in MPI during LDDE may provide a simple and quantitative measure of overall left ventricular functional reserve in patients with a recent MI.
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Affiliation(s)
- Betina Nørager
- Department of Medical Research, Svenborg Hospital, Svenborg, Denmark.
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Poulsen SH, Møller JE, Nørager B, Egstrup K. Prognostic implications of left ventricular diastolic dysfunction with preserved systolic function following acute myocardial infarction. Cardiology 2002; 95:190-7. [PMID: 11585994 DOI: 10.1159/000047371] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The contribution of diastolic dysfunction in patients with preserved left ventricular (LV) systolic function to impaired functional status and cardiac mortality in myocardial infarction (MI) is unknown. In the present study, assessment of LV diastolic function was performed by Doppler analysis of the mitral and pulmonary venous flow, and the propagation velocity of early mitral flow by color M-mode Doppler echocardiography in 183 consecutive patients at day 5-7 following their first acute MI. Patients were classified into four groups: group A: preserved LV systolic and diastolic function (n = 73); group B: LV systolic dysfunction with preserved diastolic function (n = 10); group C: LV diastolic dysfunction with preserved systolic function (n = 60); group D: combined LV systolic and diastolic dysfunction (n = 40). The cardiac mortality rate at 1 year was significantly higher in groups C (13%) and D (38%) compared to A (2%) (p < 0.01). Multivariate regression analysis identified LV diastolic dysfunction (p = 0.001), Killip class >or=II (p = 0.006), and age (0.008) as predictors of cardiac death or readmission due to heart failure. The presence of LV diastolic dysfunction with preserved systolic dysfunction is associated with increased morbidity and mortality following acute MI.
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Affiliation(s)
- S H Poulsen
- Section of Cardiology, Department of Medicine, Haderslev Hospital, Haderslev, Denmark.
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