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De Bortoli A, Nordøy I, Connelly JP, Viermyr HK, Bjerkreim RH, Broch K, Olsen PAS, Gude E, Fevang B, Jørgensen SF, Trøseid M, Steen T, Aukrust P, Andreassen AK, Skarpengland T. Diagnostics, treatment and outcomes of cardiac sarcoidosis in a Norwegian cohort. Int J Cardiol 2024; 400:131809. [PMID: 38272129 DOI: 10.1016/j.ijcard.2024.131809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/06/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Evidence-based guidelines for cardiac sarcoidosis (CS) regarding use of second- and third-line agents, treatment duration, surveillance and prognostic factors are lacking. OBJECTIVE To analyze the clinical presentation, diagnostics, treatment, monitoring and clinical outcomes in a Norwegian cohort. METHODS Using discharge diagnoses between 2017 through 2020 from a large tertiary center, we identified 52 patients with CS. We performed a systematic chart review following a pre-specified checklist. The primary outcome of major cardiovascular events (MACE) was defined as a composite of cardiovascular hospitalization, defibrillator therapy, cardiac transplantation, or death. RESULTS 18-fluorodeoxyglucose positron emission tomography (FDG-PET) showed pathological tracer uptake in 35/36 (97%) of immunosuppression-naïve patients. Immunosuppressive treatment was administered to 49/52 patients (94%) for a median of 43 (IQR 34) months; 69% were treated with second-line (methotrexate, azathioprine, mycophenolate mofetil) and 25% with third-line (rituximab, infliximab) agents, respectively. Rituximab reduced inflammation as assessed by interval FDG-PET imaging and was overall well tolerated. Median duration to first MACE was 6 (IQR 10) months and 17/23 patients (74%) experienced a MACE within 12 months from CS diagnosis. No mortality was recorded and 20% achieved full remission. Age below the median of 53 years at time of diagnosis was associated with an increased risk of a MACE. CONCLUSION Long-term immunosuppression including a liberal use of non-steroidal agents, appeared essential in treating CS. Although the burden of cardiovascular events was substantial, the survival was excellent in this contemporary cohort. Prospective randomized studies are urgently needed to define the best therapy for these patients.
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Affiliation(s)
- Alessandro De Bortoli
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Norway; Department of Cardiology, Vestfold Hospital Trust, Tønsberg, Norway; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
| | - Ingvild Nordøy
- Section for Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Norway
| | - James Patrick Connelly
- Division for Radiology and Nuclear Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Hans-Kittil Viermyr
- Section for Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Norway; Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway
| | - Randi Haukaas Bjerkreim
- Section for Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Norway; Department of Infectious Diseases, Vestfold Hospital Trust, Tønsberg, Norway
| | - Kaspar Broch
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Norway
| | | | - Einar Gude
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Norway
| | - Børre Fevang
- Section for Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Norway
| | - Silje F Jørgensen
- Section for Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Norway; Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway
| | - Marius Trøseid
- Section for Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Torkel Steen
- Department of Cardiology, Oslo University Hospital Ullevaal, Norway
| | - Pål Aukrust
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Arne K Andreassen
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Norway
| | - Tonje Skarpengland
- Section for Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Norway
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Holt MF, Flø A, Ravnestad H, Bjørnø V, Gullestad L, Andreassen AK, Broch K, Gude E. Invasive haemodynamics at rest and exercise in cardiac amyloidosis. ESC Heart Fail 2024; 11:1263-1268. [PMID: 38158705 DOI: 10.1002/ehf2.14621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/17/2023] [Indexed: 01/03/2024] Open
Abstract
AIMS Our aim was to investigate haemodynamics at rest and during exercise in patients with transthyretin cardiomyopathy (ATTR-CM) in light of the 2022 European Society of Cardiology (ESC) and European Respiratory Society (ERS) guidelines on pulmonary hypertension (PH). METHODS AND RESULTS We performed right heart catheterization (RHC) in 57 subjects with ATTR-CM. The proportion of patients with PH was 77% according to the 2022 guidelines versus 47% when applying the 2015 guidelines. Isolated post-capillary PH and combined pre- and post-capillary PH were most prevalent. Thirty-six patients underwent a supine bicycle cardiopulmonary exercise test during RHC. Exercise-induced PH was defined as an increase in mean pulmonary arterial pressure from rest to exercise per increase in cardiac output (ΔmPAP/ΔCO) of > 3 mmHg/L/min. An increase in pulmonary arterial wedge pressure per change in cardiac output (ΔPAWP/ΔCO) from rest to exercise >2 mmHg/L/min was considered suggestive of post-capillary exercise-induced PH. All but two patients who exercised during RHC developed exercise-induced PH. The median ΔmPAP/ΔCO was 7.2 mmHg/L/min and ΔPAWP/ΔCO was 5.1 mmHg/L/min. The median ΔRAP/ΔCO was 3.6 mmHg/L/min and ΔRAP/ΔPAWP was 0.6 mmHg/L/min. CONCLUSIONS Most patients with ATTR-CM have isolated post-capillary or combined pre- and post-capillary PH at rest, and almost all patients develop exercise-induced PH with a large post-capillary component. There was a pronounced, but balanced increase in atrial pressures on exercise.
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Affiliation(s)
- Margrethe Flesvig Holt
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - August Flø
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Håvard Ravnestad
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Vilde Bjørnø
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Lars Gullestad
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway
| | - Arne K Andreassen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Kaspar Broch
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway
| | - Einar Gude
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
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Ravindran J, Halvorsen EH, Kongsvik A, Birkeland S, Gude E, De Bortoli AM. En mann i 60-årene med dyspné og systolisk bilyd etter hjerteinfarkt. Tidsskr Nor Laegeforen 2024; 144:23-0373. [PMID: 38349103 DOI: 10.4045/tidsskr.23.0373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
Background Ventricular septal rupture (VSR) following acute myocardial infarction is rare in the modern revascularisation era. Nevertheless, clinical awareness is paramount, as presentation may vary. Case presentation A middle-aged male with no history of cardiovascular disease developed progressive heart failure symptoms while travelling abroad. Initial workup revealed a prominent systolic murmur, but findings were inconsistent with acute coronary syndrome. Transthoracic echocardiogram showed a small hypokinetic area in the basal septum, preserved left ventricular function and no significant valvulopathy. Despite the absence of chest pain, an invasive angiography revealed occlusion of a septal branch emerging from the left anterior descending artery, otherwise patent coronary arteries. Despite administration of diuretics, the patient remained symptomatic and presented two months later to his primary care provider with a persisting systolic murmur. He was subsequently referred to the outpatient cardiology clinic where echocardiography revealed a large VSR involving the basal anteroseptum of the left ventricle with a significant left-to-right shunt. After accurate radiological and haemodynamic assessment of the defect, he successfully underwent elective surgical repair. Interpretation Although traditionally associated with large transmural myocardial infarctions, VSR may arise also from minor, subclinical events. A new-onset murmur is a valuable hint for the alert clinician.
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Affiliation(s)
| | | | | | - Sigurd Birkeland
- Thoraxkirurgisk avdeling, Oslo universitetssykehus, Rikshospitalet
| | - Einar Gude
- Kardiologisk avdeling, Oslo universitetssykehus, Rikshospitalet
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Inoue K, Andersen OS, Remme EW, Khan FH, Andreassen AK, Skulstad H, Gude E, Smiseth OA. Echocardiographic Evaluation of Left Ventricular Filling Pressure in Patients With Pulmonary Hypertension. JACC Cardiovasc Imaging 2024:S1936-878X(24)00024-X. [PMID: 38340138 DOI: 10.1016/j.jcmg.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 02/12/2024]
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Lunde T, Gude E, Myrmel GMS, Haaverstad R, Saeed S. A case report of giant cell myocarditis complicated by severe heart failure: the value of early endomyocardial biopsy and mechanical circulatory support. Cardiovasc Diagn Ther 2023; 13:1136-1146. [PMID: 38162107 PMCID: PMC10753241 DOI: 10.21037/cdt-23-265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/02/2023] [Indexed: 01/03/2024]
Abstract
Background Giant cell myocarditis (GCM) is a rare, probably underdiagnosed and potentially fatal disease in young and middle-aged patients. Disease progression is often rapid, and life-threatening arrhythmias and cardiogenic shock due to progressive left ventricular failure are among the most feared complications. Although cardiac biomarkers and multimodality imaging are used as initial diagnostic tests in most patients, endomyocardial biopsy (EMB) is often required for a definitive diagnosis. However, there are still gaps in our knowledge in terms of the etiology, early diagnosis, management and prognosis of GCM. Case Description We present the case of a male patient in his early 50s admitted to Haukeland University Hospital with fulminant GCM. He had no significant medical history in the past apart from hypertension, and presented to hospital in cardiogenic shock after a few weeks of progressive shortness of breath. Rapid initiation of methylprednisolone had an immediate effect on reducing myocardial inflammation, and sustained treatment with a combination of immunosuppressive agents along with optimal heart failure medications led to complete recovery of the heart function and clinical remission over several years. The case study highlights the urgency of an early EMB, access to mechanical circulatory support (MCS) and the efficacy of immunosuppressive treatment and optimal medical management for heart failure. Finally, our review of the literature also provides an updated guidance on the contemporary management of GCM patients. Conclusions Accurate and early diagnosis with EMB in patients with GCM are crucial for better outcomes. Rapid initiation of methylprednisolone reduces myocardial inflammation and the risk of death. Sustained treatment with a combination of immunosuppressive agents together with optimal heart failure medications are essential for myocardial recovery and long-term stabilization. The use of MCS is the cornerstone in the management of GCM with a clear survival benefit.
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Affiliation(s)
- Torbjørn Lunde
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Einar Gude
- Department of Heart Disease, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Gard M. S. Myrmel
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Rune Haaverstad
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Sahrai Saeed
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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Lyng CS, Gude E, Hodt A, Knudsen EC. First Norwegian case of hereditary ATTR amyloidosis with a novel transthyretin variant. SCAND CARDIOVASC J 2023; 57:2174269. [PMID: 36734834 DOI: 10.1080/14017431.2023.2174269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
An earlier healthy 64-year-old man with previous surgery for bilateral carpal tunnel syndrome (CTS) in his 50s, presented with dyspnoea on exertion. Cardiac amyloidosis was suspected due to "red flag" signs and symptoms. Further investigations with scintigraphy and genetic testing confirmed the diagnosis of hereditary ATTR variant (ATTRv) amyloidosis. This is the first case report of ATTRv amyloidosis in a patient of Norwegian origin and is caused by the mutation E54A (p.E74A) in the transthyretin (TTR) gene. This mutation is previously not reported in international databases. Transthyretin amyloid cardiomyopathy (ATTR-CM) is an underdiagnosed disease with a poor prognosis. Early recognition remains essential to afford the best treatment efficacy.
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Affiliation(s)
| | - Einar Gude
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Anders Hodt
- Department of Nuclear Medicine, Oslo University Hospital, Ullevål, Oslo, Norway
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7
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Gjersvik P, Falk RS, Roscher I, Rizvi SMH, Mjøen G, Gude E, Leuckfeld I, Boberg KM, Veierød MB, Robsahm TE. Rates of Second Tumor, Metastasis, and Death From Cutaneous Squamous Cell Carcinoma in Patients With and Without Transplant-Associated Immunosuppression. JAMA Dermatol 2023; 159:923-929. [PMID: 37466985 PMCID: PMC10357356 DOI: 10.1001/jamadermatol.2023.2029] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/12/2023] [Indexed: 07/20/2023]
Abstract
Importance Cutaneous squamous cell carcinoma (cSCC) may occur with multiple primary tumors, metastasize, and cause death both in immunocompetent and immunosuppressed patients. Objective To study the rates of second cSCC, metastasis, and death from cSCC in patients with and without organ transplant-associated immunosuppressive treatment. Design, Setting, and Participants This population-based, nationwide cohort study used Cancer Registry of Norway data from 47 992 individuals diagnosed with cSCC at 18 years or older between January 1, 1968, and December 31, 2020. Data were analyzed between November 24, 2021, and November 15, 2022. Exposures Receipt of a solid organ transplant at Oslo University Hospital between 1968 and 2012 followed by long-term immunosuppressive treatment. Main Outcomes and Measures Absolute rates of second cSCC, metastasis, and death from cSCC were calculated per 1000 person-years with 95% CIs. Hazard ratios (HRs) estimated using Cox proportional hazard regression were adjusted for age, sex, and year of first cSCC diagnosis. Results The study cohort comprised 1208 organ transplant recipients (OTRs) (median age, 66 years [range, 27-89 years]; 882 men [73.0%] and 326 women [27.0%]) and 46 784 non-OTRs (median age, 79 years [range, 18-106 years]; 25 406 men [54.3%] and 21 378 women [45.7%]). The rate of a second cSCC per 1000 person-years was 30.9 (95% CI, 30.2-31.6) in non-OTRs and 250.6 (95% CI, 232.2-270.1) in OTRs, with OTRs having a 4.3-fold increased rate in the adjusted analysis. The metastasis rate per 1000 person-years was 2.8 (95% CI, 2.6-3.0) in non-OTRs and 4.8 (95% CI, 3.4-6.7) in OTRs, with OTRs having a 1.5-fold increased rate in the adjusted analysis. A total of 30 451 deaths were observed, of which 29 895 (98.2%) were from causes other than cSCC. Death from cSCC was observed in 516 non-OTRs (1.1%) and 40 OTRs (3.3%). The rate of death from cSCC per 1000 person-years was 1.7 (95% CI, 1.5-1.8) in non-OTRs and 5.4 (95% CI, 3.9-7.4) in OTRs, with OTRs having a 5.5-fold increased rate in the adjusted analysis. Conclusions and Relevance In this cohort study, OTRs with cSCC had significantly higher rates of second cSCC, metastasis, and death from cSCC than non-OTRs with cSCC, although most patients with cSCC in both groups died from causes other than cSCC. These findings are relevant for the planning of follow-up of patients with cSCC and for skin cancer services.
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Affiliation(s)
- Petter Gjersvik
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Dermatology, Oslo University Hospital, Oslo, Norway
| | - Ragnhild S. Falk
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Ingrid Roscher
- Department of Dermatology, Oslo University Hospital, Oslo, Norway
| | | | - Geir Mjøen
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Einar Gude
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Inga Leuckfeld
- Department of Respiratory Medicine, Oslo University Hospital, Oslo, Norway
| | - Kirsten Muri Boberg
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Marit B. Veierød
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
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Holt MF, Flø A, Bjørnø V, Husebye T, Knudsen EC, Hodt A, Gustavsen A, Kristiansen HA, Raki M, Broch K, Wien TN, Gude E. A man in his seventies with fatigue and renal failure. Tidsskr Nor Laegeforen 2023; 143:22-0679. [PMID: 37341412 DOI: 10.4045/tidsskr.22.0679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
A man in his seventies underwent routine heart examinations as part of workup for kidney transplantation. Unexpected findings led to more extensive investigations and revealed two rare systemic diseases as causes of his heart failure.
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Affiliation(s)
| | - August Flø
- Kardiologisk avdeling, Oslo universitetssykehus, Rikshospitalet
| | - Vilde Bjørnø
- Kardiologisk avdeling, Oslo universitetssykehus, Rikshospitalet
| | - Trygve Husebye
- Hjertemedisinsk avdeling, Oslo universitetssykehus, Ullevål
| | | | - Anders Hodt
- Avdeling for nukleærmedisin, Oslo universitetssykehus
| | - Alice Gustavsen
- Avdeling for immunologi og transfusjonsmedisin, Oslo universitetssykehus
| | | | | | - Kaspar Broch
- Kardiologisk avdeling, Oslo universitetssykehus, Rikshospitalet
| | | | - Einar Gude
- Kardiologisk avdeling, Oslo universitetssykehus, Rikshospitalet
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Bach-Gansmo T, Hodt A, Schjesvold FH, Gude E, Wien TN. Bone scintigraphy reduces the need for biopsy in suspected cardiac amyloidosis. Tidsskr Nor Laegeforen 2023; 143:22-0644. [PMID: 37341415 DOI: 10.4045/tidsskr.22.0644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
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Andel PM, Aukrust P, Gleditsch J, Gude E, Haugeberg G, Høie S, Salte T, Steine K, Atar D. Recurrent pericarditis. Tidsskr Nor Laegeforen 2023; 143:22-0580. [PMID: 37254974 DOI: 10.4045/tidsskr.22.0580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Pericarditis is an important differential diagnosis in patients with chest pain. The two most common causes in the developed world are idiopathic pericarditis and inflammation following cardiac surgery or myocardial infarction. Recurrence of pericarditis affects up to 30 % of patients, half of whom experience multiple episodes, and approximately 10 % develop steroid-dependent and colchicine-refractory pericarditis. Recurrence is due to autoinflammatory processes in the pericardium. Advanced diagnostic imaging and treatment with colchicine and interleukin-1 inhibitors has helped reduce morbidity considerably in recent years. In this clinical review, we summarise up-to-date knowledge about the diagnostic evaluation and treatment of patients with recurrent primary pericarditis.
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Affiliation(s)
- Peter M Andel
- Revmatologisk seksjon, Oslo universitetssykehus, Rikshospitalet, og, Hjertemedisinsk avdeling, Sykehuset Østfold, og, Institutt for klinisk medisin, Universitetet i Oslo
| | - Pål Aukrust
- Institutt for indremedisinsk forskning, Universitetet i Oslo, og, Seksjon for klinisk immunologi og infeksjonsmedisin, Oslo universitetssykehus, Rikshospitalet
| | - Jostein Gleditsch
- Avdeling for bildediagnostikk, Sykehuset Østfold, og, Institutt for klinisk medisin, Universitetet i Oslo
| | - Einar Gude
- Hjertemedisinsk avdeling, Oslo universitetssykehus, Rikshospitalet
| | - Glenn Haugeberg
- Revmatologisk seksjon, Sørlandet sykehus, Kristiansand, og, Institutt for nevromedisin og bevegelsesvitenskap, NTNU
| | - Sverre Høie
- Hjertemedisinsk avdeling, Sørlandet sykehus, Arendal, og, Institutt for klinisk medisin, Universitetet i Oslo
| | - Tore Salte
- Revmatologisk avdeling, Stavanger universitetssjukehus
| | - Kjetil Steine
- Hjertemedisinsk avdeling, Akershus universitetssykehus, og, Institutt for klinisk medisin, Universitetet i Oslo
| | - Dan Atar
- Hjertemedisinsk avdeling, Oslo universitetssykehus, Ullevål sykehus, og, Institutt for klinisk medisin, Universitetet i Oslo
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Eldhagen P, Lehtonen J, Gude E, Gustafsson F, Bagger-Bahnsen A, Vakevainen M, Pilgaard T, Wedell-Wedellsborg D, Poulsen SH. Health-related quality of life among transthyretin amyloid cardiomyopathy patients. ESC Heart Fail 2023; 10:1871-1882. [PMID: 36946241 DOI: 10.1002/ehf2.14350] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/22/2023] [Accepted: 02/26/2023] [Indexed: 03/23/2023] Open
Abstract
AIMS Transthyretin amyloid cardiomyopathy (ATTR CM) is a progressive and severe heart disease with physical and psychological implications. The Nordic PROACT study was conducted to investigate the health-related quality of life (HRQoL) in ATTR CM patients. METHODS AND RESULTS The Nordic PROACT study was a cross-sectional non-interventional study conducted in 12 cardiology hospital clinics across Norway, Sweden, Finland and Denmark. Men and women aged ≥18 years diagnosed with symptomatic ATTR CM were included. The investigator provided information on medical history, biomarkers, current treatment, co-morbidities and disease severity according to the New York Heart Association (NYHA) class and the National Amyloidosis Centre (NAC) staging. Patients completed the HRQoL questionnaires in the form of the Kansas City Cardiomyopathy Questionnaire (KCCQ), the EQ-5D-5L index with Visual Analog Scale (VAS), and the Major Depression Inventory (MDI). A total of 169 patients (mean ± SD age 77.7 ± 6.2 years) were included. Ninety-two per cent were men. Seventy-six per cent had wildtype ATTR CM (ATTRwt CM) and 15% had a hereditary form of ATTR CM (ATTRv CM) while 9% were genetically unclassified. Most patients were in NYHA class II (54%) and NAC stage 1 (53%). Participation in randomized clinical trials (RCT) was noted in 58% of the patients. The 169 ATTR CM patients had a mean ± SD KCCQ score of 64.3 ± 23.1 for total symptom score, 64.8 ± 20.9 for overall summary score (OSS) and 65.1 ± 21.5 for clinical summary score. The EQ-5D-5L total utility score was 0.8 ± 0.2 and the EQ-5D-5L VAS score was 62.9 ± 20.6. The vast majority (89%) did not report any signs of depression. Patients with ATTRv CM had a higher KCCQ OSS as compared with ATTRwt CM, while EQ-5D-5L utility score, EQ-5D-5L VAS and MDI were similar. Non-RCT participants had a poorer HRQoL as compared with RCT participants as reflected in lower KCCQ OSS and EQ-5D-5L VAS scores and a higher MDI score. Patients with higher NYHA classes and NAC disease stages had a poorer HRQoL as demonstrated by lower KCCQ and EQ-5D-5L scores and higher MDI scores. Correlation between KCCQ, EQ-5D-5L and MDI and the covariate NYHA class remained significant (P < 0.05) after adjusting for multiple testing. CONCLUSIONS KCCQ scores were lower than previously reported for patients with other heart diseases of non-ATTR CM origin. The HRQoL measures correlated well to NYHA class and NAC disease stage. The prevalence of depression appeared to be low.
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Affiliation(s)
- Per Eldhagen
- Department of Medicine, Karolinska Institute, Karolinska University Hospital, Solna, Sweden
| | - Jukka Lehtonen
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Einar Gude
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
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Abstract
Heart failure with preserved ejection fraction (HFpEF) is increasing in prevalence and represents approximately 50% of all heart failure (HF) patients. Patients with this complex clinical scenario, characterized by high filling pressures, and reduced cardiac output (CO) associated with progressive multi-organ involvement, have so far not experienced any significant improvement in quality of life or survival with traditional HF treatment. Left ventricular assist devices (LVAD) have offered a new treatment alternative in terminal heart failure patients with reduced ejection fraction (HFrEF), providing a unique combination of significant pressure and volume unloading together with an increase in CO. The small left ventricular cavity in HFpEF patients challenges left-sided pressure unloading, and new anatomical entry points need to be explored for mechanical pressure and volume unloading. Optimized and pressure/volume-adjusted mechanical circulatory support (MCS) devices for HFrEF patients may conceivably be customized for HFpEF anatomy and hemodynamics. We have developed a long-term MCS device for HFpEF patients with atrial unloading in a pulsed algorithm, leading to a significant reduction of filling pressure, maintenance of pulse pressure, and increase in CO demonstrated in animal testing. In this article, we will discuss HFpEF pathology, hemodynamics, and the principles behind our novel MCS device that may improve symptoms and prognosis in HFpEF patients. Data from mock-loop hemolysis studies, acute, and chronic animal studies will be presented.
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Affiliation(s)
- Einar Gude
- Dept of Cardiology, Oslo University Hospital, Oslo, Norway.
| | - Arnt E Fiane
- Dept of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
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13
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Ravnestad H, Andersen R, Birkeland S, Svalebjørg M, Lingaas PS, Gude E, Gullestad L, Escobar Kvitting J, Broch K, Andreassen AK. Pulmonary endarterectomy and balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension: Comparison of changes in hemodynamics and functional capacity. Pulm Circ 2023; 13:e12199. [PMID: 36788941 PMCID: PMC9912021 DOI: 10.1002/pul2.12199] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/18/2023] [Accepted: 01/28/2023] [Indexed: 02/04/2023] Open
Abstract
The treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH) is pulmonary endarterectomy (PEA). Balloon pulmonary angioplasty (BPA) is an emerging option for inoperable patients. Comparisons of the hemodynamic and functional outcome between these treatments are scarce. In this single-center observational cohort study, we compared hemodynamics by right heart catheterization and peak oxygen consumption before and 5 months (±14 days) after either PEA or BPA. Comprehensive evaluation and selection for PEA or BPA was performed by an expert CTEPH team. Fourty-two and fourty consecutive patients were treated with PEA or BPA, respectively. Demographics were similar between groups. Both PEA and BPA significantly reduced mean pulmonary artery pressure (from 46 ± 11 mmHg at baseline to 28 ± 13 mmHg at follow-up; p < 0.001 and from 43 ± 12 mmHg to 31 ± 9 mmHg; p < 0.001) and pulmonary vascular resistance (from 686 ± 347 dyn s cm-5 at baseline to 281 ± 197 dyn s cm-5 at follow-up; p < 0.001 and from 544 ± 322 dyn s cm-5 to 338 ± 180 dyn s cm-5; p < 0.001), with significantly lower reductions for both parameters in the former group. However, cardiopulmonary exercise testing revealed no significant between group differences in exercise capacity. Diffusion capacity for carbon monoxide at baseline was the only follow-up predictor for peak VO2. In our study, PEA reduced pulmonary pressures more than BPA did, but similar improvements were observed for exercise capacity. Thus, while long term data after BPA is lacking, BPA treated CTEPH patients can expect physical gains in line with PEA.
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Affiliation(s)
- Håvard Ravnestad
- Department of CardiologyOslo University HospitalRikshospitaletNorway
| | - Rune Andersen
- Department of RadiologyOslo University HospitalRikshospitaletNorway
| | - Sigurd Birkeland
- Department of Cardiothoracic SurgeryOslo University HospitalRikshospitaletNorway
| | - Morten Svalebjørg
- Department of AnesthesiologyOslo University HospitalRikshospitaletNorway
| | - Per Snorre Lingaas
- Department of Cardiothoracic SurgeryOslo University HospitalRikshospitaletNorway
| | - Einar Gude
- Department of CardiologyOslo University HospitalRikshospitaletNorway
| | - Lars Gullestad
- Department of CardiologyOslo University HospitalRikshospitaletNorway
| | - John‐Peder Escobar Kvitting
- Department of Cardiothoracic SurgeryOslo University HospitalRikshospitaletNorway
- Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Kaspar Broch
- Department of CardiologyOslo University HospitalRikshospitaletNorway
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14
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Didriksen H, Molberg Ø, Mehta A, Jordan S, Palchevskiy V, Fretheim H, Gude E, Ueland T, Brunborg C, Garen T, Midtvedt Ø, Andreassen AK, Lund-Johansen F, Distler O, Belperio J, Hoffmann-Vold AM. Target organ expression and biomarker characterization of chemokine CCL21 in systemic sclerosis associated pulmonary arterial hypertension. Front Immunol 2022; 13:991743. [PMID: 36211384 PMCID: PMC9541617 DOI: 10.3389/fimmu.2022.991743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/10/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Systemic sclerosis (SSc) is a heterogenous disorder that appears to result from interplay between vascular pathologies, tissue fibrosis and immune processes, with evidence for deregulation of chemokines, which normally control immune trafficking. We recently identified altered levels of chemokine CCL21 in SSc associated pulmonary arterial hypertension (PAH). Here, we aimed to define target organ expression and biomarker characteristics of CCL21. Materials and methods To investigate target organ expression of CCL21, we performed immunohistochemistry (IHC) on explanted lung tissues from SSc-PAH patients. We assessed serum levels of CCL21 by ELISA and Luminex in two well-characterized SSc cohorts from Oslo (OUH, n=552) and Zurich (n=93) University hospitals and in 168 healthy controls. For detection of anti-CCl21 antibodies, we performed protein array analysis applying serum samples from SSc patients (n=300) and healthy controls. To characterize circulating CCL21 in SSc, we applied immunoprecipitation (IP) with antibodies detecting both full length and tailless and a custom-made antibody detecting only the C-terminal of CCL21. IP products were analyzed by SDS-PAGE/western blot and Mass spectrometry (MS). Results By IHC, we found that CCL21 was mainly expressed in the airway epithelial cells of SSc patients with PAH. In the analysis of serum levels of CCL21 we found weak correlation between Luminex and ELISA (r=0.515, p<0.001). Serum levels of anti-CCL21 antibodies were higher in SSc patients than in healthy controls (p<0.001), but only 5% of the SSc population were positive for anti-CCL21 antibodies in SSc, and we found no correlation between anti-CCl21 and serum levels of CCL21. By MS, we only identified peptides located within amino acid (aa) 23-102 of CCL21, indicating that CCL21 in SSc circulate as a truncated protein without the C-terminal tail. Conclusion This study demonstrates expression of CCL21 in epithelial lung tissue from SSc patients with PAH, and indicate that CCL21 in SSc circulates as a truncated protein. We extend previous observations indicating biomarker potential of CCL21, but find that Luminex is not suitable as platform for biomarker analyses. Finally, in vivo generated anti-CCL21 antibodies exist in SSc, but do not appear to modify serum CCL21 levels in patients with SSc-PAH.
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Affiliation(s)
- Henriette Didriksen
- Department of Rheumatology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Øyvind Molberg
- Department of Rheumatology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Adi Mehta
- Department of Immunology, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Suzana Jordan
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Vyacheslav Palchevskiy
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA, United States
| | - Håvard Fretheim
- Department of Rheumatology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Einar Gude
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Thor Ueland
- Research Institute of Internal Medicine, Oslo University Hospital – Rikshospitalet, Oslo, Norway
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Torhild Garen
- Department of Rheumatology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Øyvind Midtvedt
- Department of Rheumatology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Arne K. Andreassen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | | | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - John Belperio
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA, United States
| | - Anna-Maria Hoffmann-Vold
- Department of Rheumatology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- *Correspondence: Anna-Maria Hoffmann-Vold,
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15
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Lauppe R, Liseth Hansen J, Fornwall A, Johansson K, Rozenbaum MH, Strand AM, Väkeväinen M, Kuusisto J, Gude E, Smith JG, Gustafsson F. Prevalence, characteristics, and mortality of patients with transthyretin amyloid cardiomyopathy in the Nordic countries. ESC Heart Fail 2022; 9:2528-2537. [PMID: 35560802 PMCID: PMC9288758 DOI: 10.1002/ehf2.13961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/15/2022] [Accepted: 04/20/2022] [Indexed: 11/10/2022] Open
Abstract
Aims Transthyretin amyloid cardiomyopathy (ATTR‐CM) is a progressive condition caused by deposition of transthyretin amyloid fibrils in the heart and is associated with poor quality of life and a shortened lifespan. This study aimed to describe the prevalence, clinical characteristics, and mortality of patients with ATTR‐CM, using multiple national health registers in Denmark, Finland, Norway, and Sweden. Methods and results Transthyretin amyloid cardiomyopathy patients were identified during 2008–2018 using a combination of diagnosis codes for amyloidosis and heart disease and were matched to patients with non‐ATTR heart failure (HF). An identical study design was used in each country to facilitate comparison and aggregation of results. A total of 1930 ATTR‐CM patients were identified from national health registers in the four countries. In 2018, prevalence of ATTR‐CM per 100 000 inhabitants ranged from 1.4 in Denmark to 5.0 in Sweden; a steep increase over time was observed in Sweden and Norway. Median survival from diagnosis was 30 months for ATTR‐CM patients and 67 months for matched HF patients. Survival was significantly lower for female than for male ATTR‐CM patients (median survival: 22 and 36 months), while no significant difference was observed in the HF cohort. Conclusions This study provides the first nationwide estimates of the prevalence, clinical characteristics, and mortality of patients with ATTR‐CM, using identical study design across several countries. Findings corroborate previous case series showing high mortality in ATTR‐CM, two‐fold higher than for other HF patients and higher in women than men, highlighting the need for more precise and early diagnosis to reduce the disease burden.
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Affiliation(s)
| | - Johan Liseth Hansen
- Quantify Research, Stockholm, Sweden.,Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | | | | | | | | | - Johanna Kuusisto
- Department of Medicine and Clinical Research, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Einar Gude
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - J Gustav Smith
- Department of Cardiology, Wallenberg Center for Molecular Medicine and Lund University Diabetes Center, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden.,The Wallenberg Laboratory/Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
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16
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Englund KVB, Østby CM, Ueland T, Aukrust P, Gude E, Andreassen AK, Gullestad L, Broch K. Iron homeostasis in heart transplant recipients randomized to ferric derisomaltose or placebo. Clin Transplant 2022; 36:e14695. [PMID: 35532871 PMCID: PMC9541327 DOI: 10.1111/ctr.14695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/12/2022] [Accepted: 04/25/2022] [Indexed: 11/29/2022]
Abstract
Introduction The randomized IronIC trial evaluated the effect of intravenous ferric derisomaltose on physical capacity in iron‐deficient, maintenance heart transplant (HTx) recipients. Iron deficiency was defined as in heart failure with high cut‐points for ferritin to compensate for inflammation. However, intravenous iron did not improve physical capacity except in patients with ferritin <30 μg/L. We aimed to explore determinants of iron status in the 102 IronIC participants to better define iron deficiency in the HTx population. Methods We assessed key governors of iron homeostasis, such as hepcidin, soluble transferrin receptor (sTfR), and interleukin‐6 (IL‐6). We also measured growth factors and inflammatory markers with relevance for iron metabolism. The results were compared to those of 21 healthy controls. Results Hepcidin did not differ between HTx recipients and controls, even though markers of inflammation were modestly elevated. However, HTx recipients with ferritin <30 μg/L or sTfR above the reference range had significantly reduced hepcidin levels suggestive of true iron deficiency. In these patients, intravenous iron improved peak oxygen uptake. Hepcidin correlated positively with ferritin and negatively with sTfR. Conclusion HTx recipients with iron deficiency as defined in heart failure do not have elevated hepcidin levels, although inflammatory markers are modestly increased. The high ferritin cut‐offs used in heart failure may not be suitable to define iron deficiency in the HTx population. We suggest that hepcidin and sTfR should be measured to identify patients with true iron deficiency, who might benefit from treatment with intravenous iron.
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Affiliation(s)
- Kristine V Brautaset Englund
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Department of Rheumatology, Dermatology and Infectious Disease, Oslo University Hospital, Oslo, Norway.,K.G. Jebsen Cardiac Research Center and Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Charlotte M Østby
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Thor Ueland
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Pål Aukrust
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.,Department of Rheumatology, Dermatology and Infectious Disease, Oslo University Hospital, Oslo, Norway
| | - Einar Gude
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,K.G. Jebsen Cardiac Research Center and Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Arne K Andreassen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,K.G. Jebsen Cardiac Research Center and Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lars Gullestad
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,K.G. Jebsen Cardiac Research Center and Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kaspar Broch
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,K.G. Jebsen Cardiac Research Center and Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Oslo, Norway
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17
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Brautaset Englund K, Oestby C, Rolid K, Gude E, Andreassen A, Gullestad L, Broch K. Cognitive Function in Iron Deficient Heart Transplant Recipients Receiving Intravenous Iron Supplement: A Prespecified Secondary Endpoint in the Randomized Ironic Trial. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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18
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Lauppe R, Liseth Hansen J, Fornwall A, Johansson K, Rozenbaum MH, Strand AM, Vakevainen M, Kuusisto J, Gude E, Smith JG, Gustafsson F. Healthcare resource use of patients with transthyretin amyloid cardiomyopathy. ESC Heart Fail 2022; 9:1636-1642. [PMID: 35365974 PMCID: PMC9065857 DOI: 10.1002/ehf2.13913] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/01/2022] [Accepted: 03/11/2022] [Indexed: 11/27/2022] Open
Abstract
Aims Transthyretin amyloid cardiomyopathy (ATTR‐CM) is the cardiac manifestation of transthyretin amyloidosis (ATTR). The aim of this study was to estimate healthcare resource use for ATTR‐CM patients compared with heart failure (HF) patients, in Denmark, Finland, Norway, and Sweden. Methods and results Data from nationwide healthcare registers in the four countries were used. ATTR‐CM patients were defined as individuals diagnosed with amyloidosis and cardiomyopathy or HF between 2008 and 2018. Patients in the ATTR‐CM cohort were matched to patients with HF but without ATTR‐CM diagnosis. Resource use included number of visits to specialty outpatient and inpatient hospital care. A total of 1831 ATTR‐CM and 1831 HF patients were included in the analysis. The mean number of hospital‐based healthcare contacts increased in both the ATTR‐CM and HF cohort during 3 years pre‐diagnosis and was consistently higher for the ATTR‐CM cohort compared with the HF cohort, with 6.1 [CI: 5.9–6.3] vs. 3.2 [CI: 3.1–3.3] outpatient visits and 1.03 [CI: 0.96–1.1] vs. 0.7 [CI: 0.7–0.8] hospitalizations. In the first year following diagnosis, patients with ATTR‐CM continued to visit outpatient care (10.2 [CI: 10.1, 10.4] vs. 5.7 [CI: 5.6, 5.9]) and were admitted to hospital more frequently (3.3 [CI: 3.2, 3.4] vs. 2.5 [CI: 2.5, 2.6]) than HF patients. Conclusions Transthyretin amyloid cardiomyopathy imposes a high burden on healthcare systems with twice as many outpatient specialist visits and 50% more hospitalizations in the year after diagnosis compared with HF patients without ATTR‐CM. Studies to investigate if earlier diagnosis and treatment of ATTR‐CM may lower resource use are warranted.
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Affiliation(s)
- Rosa Lauppe
- Quantify Research AB, Stockholm, 112 21, Sweden
| | - Johan Liseth Hansen
- Quantify Research AB, Stockholm, 112 21, Sweden.,Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | | | | | | | | | - Johanna Kuusisto
- Department of Medicine and Clinical Research, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Einar Gude
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - J Gustav Smith
- Department of Cardiology, Wallenberg Center for Molecular Medicine and Lund University Diabetes Center, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden.,The Wallenberg Laboratory/Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
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19
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Kvaslerud AB, Gude E, Eriksen G, Andreassen AK, Gullestad L, Broch K. Diastolic Dysfunction Is Unmasked on Exercise in Patients With Asymptomatic, Severe Aortic Stenosis: An Invasive Hemodynamic Study. Circ Heart Fail 2022; 15:e009253. [PMID: 35137599 DOI: 10.1161/circheartfailure.121.009253] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Optimal timing of aortic valve replacement remains difficult in patients with asymptomatic, severe aortic stenosis (AS). More accurate diagnostic methods are warranted for the detection of subtle ventricular impairment. We aimed to evaluate diastolic function in asymptomatic patients with severe AS. METHODS In this cross-sectional study, patients with asymptomatic, severe AS were evaluated with right heart catheterization at rest and during moderate exercise. The patients also underwent cardiopulmonary exercise testing to objectify functional capacity and confirm the absence of symptoms. RESULTS Between February 2019 and May 2021, we included 50 patients aged 70±12 years. The patients had severe AS with peak velocity 4.4±0.4 m/s, mean gradient 46±9 mm Hg, and an indexed valve area of 0.47±0.08 cm2 at rest. All patients were asymptomatic and had normal left ventricular ejection fraction. Five patients had postcapillary pulmonary hypertension at rest. During exercise, 44 patients (88%) had an increase in the mean pulmonary artery pressure per increase in cardiac output of >3 mm Hg/L per minute, of whom 93% had a concomitant increase in the pulmonary artery wedge pressure per increase in cardiac output >2 mm Hg/L per minute, suggesting exercise-induced pulmonary hypertension due to left heart disease. Female gender and increasing age were associated with a higher increase in the pulmonary artery wedge pressure per increase in cardiac output ratio. The catheterization was well tolerated, and there were no adverse events. CONCLUSIONS A large proportion of asymptomatic patients with severe, degenerative AS have exercise-induced postcapillary pulmonary hypertension.
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Affiliation(s)
- Anette B Kvaslerud
- Department of Cardiology, Rikshospitalet, Oslo University Hospital, Norway (A.B.K., E.G., G.E., A.K.A., L.G., K.B.).,KG Jebsen Center for Cardiac Research, Center for Heart Failure Research, University of Oslo, Norway. (A.B.K., L.G., K.B.).,Faculty of Medicine, University of Oslo, Norway. (A.B.K., L.G., K.B.)
| | - Einar Gude
- Department of Cardiology, Rikshospitalet, Oslo University Hospital, Norway (A.B.K., E.G., G.E., A.K.A., L.G., K.B.)
| | - Gunnar Eriksen
- Department of Cardiology, Rikshospitalet, Oslo University Hospital, Norway (A.B.K., E.G., G.E., A.K.A., L.G., K.B.)
| | - Arne K Andreassen
- Department of Cardiology, Rikshospitalet, Oslo University Hospital, Norway (A.B.K., E.G., G.E., A.K.A., L.G., K.B.)
| | - Lars Gullestad
- Department of Cardiology, Rikshospitalet, Oslo University Hospital, Norway (A.B.K., E.G., G.E., A.K.A., L.G., K.B.).,KG Jebsen Center for Cardiac Research, Center for Heart Failure Research, University of Oslo, Norway. (A.B.K., L.G., K.B.).,Faculty of Medicine, University of Oslo, Norway. (A.B.K., L.G., K.B.)
| | - Kaspar Broch
- Department of Cardiology, Rikshospitalet, Oslo University Hospital, Norway (A.B.K., E.G., G.E., A.K.A., L.G., K.B.).,KG Jebsen Center for Cardiac Research, Center for Heart Failure Research, University of Oslo, Norway. (A.B.K., L.G., K.B.).,Faculty of Medicine, University of Oslo, Norway. (A.B.K., L.G., K.B.)
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20
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Inoue K, Khan FH, Remme EW, Ohte N, García-Izquierdo E, Chetrit M, Moñivas-Palomero V, Mingo-Santos S, Andersen ØS, Gude E, Andreassen AK, Wang TKM, Kikuchi S, Stugaard M, Ha JW, Klein AL, Nagueh SF, Smiseth OA. Corrigendum to: Determinants of left atrial reservoir and pump strain and use of atrial strain for evaluation of left ventricular filling pressure. Eur Heart J Cardiovasc Imaging 2021; 23:136. [PMID: 34608485 PMCID: PMC8685597 DOI: 10.1093/ehjci/jeab194] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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21
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Lauppe RE, Liseth Hansen J, Gerdesköld C, Rozenbaum MH, Strand AM, Vakevainen M, Kuusisto J, Gude E, Gustafsson F, Smith JG. Nationwide prevalence and characteristics of transthyretin amyloid cardiomyopathy in Sweden. Open Heart 2021; 8:openhrt-2021-001755. [PMID: 34645699 PMCID: PMC8515473 DOI: 10.1136/openhrt-2021-001755] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/23/2021] [Indexed: 01/15/2023] Open
Abstract
Objective Transthyretin amyloid cardiomyopathy (ATTR-CM) is a rare, progressive and fatal condition caused by deposition of transthyretin amyloid fibrils in the heart. This study aims to identify all patients diagnosed with ATTR-CM in Sweden, estimate the prevalence of ATTR-CM, describe patient characteristics and mortality, assess the importance of early symptoms (red flags) for identification of ATTR-CM, and compare with patients with heart failure (HF). Methods This retrospective study combined multiple national health registers covering all specialist visits and prescriptions for the entire population of Sweden. Between January 2008 and December 2018, patients with ATTR-CM were identified retrospectively based on a combination of diagnosis codes and compared with matched, all-cause non-ATTR HF patients. Results Overall, a total of 994 patients diagnosed with ATTR-CM were identified, with an average age at diagnosis of 73 years, and 30% of whom were female. The prevalence of diagnosed ATTR-CM cases in 2018 was 5.0 per 100 000. The median survival from diagnosis was 37.6 months (CI 33.8 to 43.8), with a lower median survival in women (27.9 months, CI 23.3 to 33.8) compared with men (43.5 months, CI 37.6 to 49.6). Patients with ATTR-CM demonstrated reduced survival compared with patients with HF (p<0.001). Compared with patients with HF, clinical identification of carpal tunnel syndrome, spinal stenosis, and atrioventricular and left bundle branch block can facilitate earlier diagnosis of ATTR-CM. Conclusions This study provides the first nationwide estimates of ATTR-CM prevalence and risk factors. The results reinforce the severity of the disease and the importance of earlier diagnosis, especially for female patients, in order to allow effective treatment and prevention of disease progression.
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Affiliation(s)
| | - Johan Liseth Hansen
- Quantify Research AB, Stockholm, Sweden.,Institute of Health and Society, University of Oslo Faculty of Medicine, Oslo, Norway
| | | | | | | | | | - Johanna Kuusisto
- Department of Medicine and Clinical Research, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Einar Gude
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - J Gustav Smith
- Department of Cardiology, Wallenberg Center for Molecular Medicine and Lund University Diabetes Centre, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden .,The Wallenberg Laboratory/Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University and Sahlgrenska University Hospital, Gothenburg, Sweden
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22
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Brautaset Englund KV, Østby CM, Tjønnås G, Gude E, Andreassen AK, Gullestad L, Broch K. Prevalence of iron deficiency in heart transplant recipients. Clin Transplant 2021; 35:e14346. [PMID: 33969559 DOI: 10.1111/ctr.14346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Optimal iron management is crucial to marginal patients such as heart transplant recipients. As inflammatory mechanisms are present in transplant recipients, the definition of iron deficiency used in the general population might not be appropriate. OBJECTIVE To evaluate the prevalence and determinants of iron deficiency in Norwegian heart transplant recipients. METHODS We consecutively assessed iron parameters in all Norwegian heart transplant recipients at their annual follow-up. Several definitions of iron deficiency suggested in the literature were assessed: ferritin <100 µg/L, or ferritin 100-300 µg/L combined with transferrin saturation of <20% (IDHF ); ferritin <100 µg/L (IDF100 ); transferrin saturation of <20% (IDTsat ), and ferritin <30 µg/L (IDF30 ). RESULTS 179 of 378 heart transplant recipients (47%) had iron deficiency defined as IDHF . 152 patients (40%) had IDF100 , and 103 patients (27%) had IDTsat . 17 patients (5%) had IDF30 . 88 patients (23%) had a C-reactive protein (CRP) >5.0 µg/L. CONCLUSION Iron deficiency defined as IDHF , IDF100, or IDTsat is prevalent in the heart transplant population, while IDF30 is not. Further research is required to identify the mechanisms of iron homeostasis in heart transplant recipients and to establish a definition of iron deficiency suitable for this population.
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Affiliation(s)
- Kristine V Brautaset Englund
- Department of Cardiology, Oslo University Hospital, Oslo, Norway.,University of Oslo, Oslo, Norway.,K.G.Jebsen Cardiac Research Center and Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Gry Tjønnås
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Einar Gude
- Department of Cardiology, Oslo University Hospital, Oslo, Norway.,K.G.Jebsen Cardiac Research Center and Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Arne K Andreassen
- Department of Cardiology, Oslo University Hospital, Oslo, Norway.,K.G.Jebsen Cardiac Research Center and Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lars Gullestad
- Department of Cardiology, Oslo University Hospital, Oslo, Norway.,University of Oslo, Oslo, Norway.,K.G.Jebsen Cardiac Research Center and Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kaspar Broch
- Department of Cardiology, Oslo University Hospital, Oslo, Norway.,K.G.Jebsen Cardiac Research Center and Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Oslo, Norway
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23
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Bürker BS, Malt UF, Gude E, Grov I, Relbo Authen A, Dew MA, Gullestad L. Symptoms of anxiety after heart transplantation and their association with mortality: A secondary analysis. Clin Transplant 2021; 35:e14323. [PMID: 33882158 DOI: 10.1111/ctr.14323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/30/2021] [Accepted: 04/12/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Few studies, with inconclusive results, have examined the association of anxiety with mortality after heart transplantation (HTx). We examined whether anxiety symptoms, measured several years after HTx, are associated with increased mortality during long-term follow-up. METHODS Anxiety symptoms were measured with the anxiety subscale of the Symptom Checklist-90-R (SCL-90-R) in 142 HTx recipients at a mean of 5.7 years (SD: 3.9) after HTx. Anxiety symptoms' impact on mortality during follow-up for up to 18.6 years was examined with Cox proportional hazard models. We accounted for relevant sociodemographic and clinical variables, including depressive symptoms (measured by the depression subscale of the SCL-90-R), in the multivariate analyses. In additional analyses, we explored the combined effect of anxious and depressive symptomatology. RESULTS Anxiety symptoms were not significantly associated with mortality (univariate analysis: HR (95% CI): 1.04 (0.75-1.45); p = .813). Exploration of the combined effect of anxious and depressive symptomatology on mortality rendered non-significant results. Depressive symptoms were independently associated with mortality (multivariate analysis: HR (95% CI): 1.86 (1.07-3.24); p = .028). CONCLUSIONS Depressive symptoms' negative impact on survival after HTx was confirmed, while anxiety symptoms were not significantly associated with mortality during long-term follow-up. Anxiety symptoms' predictive role after HTx requires further study.
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Affiliation(s)
- Britta S Bürker
- Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway.,Department of Psychiatry, Nordland Hospital Trust Bodø, Bodø, Norway
| | - Ulrik F Malt
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Section for C-L psychiatry and Psychosomatic Medicine, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Einar Gude
- Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Ingelin Grov
- Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Anne Relbo Authen
- Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lars Gullestad
- Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,KG Jebsen Center for Cardiac Research and Center for Heart Failure Research, University of Oslo, Oslo, Norway
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24
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Englund KB, Oestby C, Rolid K, Gude E, Andreassen A, Gullestad L, Broch K. Health Related Quality of Life in Iron Deficient Heart Transplant Recipients Receiving Intravenous Iron Supplement: A Prespecified Secondary Endpoint in the IronIC Trial. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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25
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Ravnestad H, Andersen R, Birkeland S, Svalebjørg M, Lingaas P, Gude E, Gullestad L, Broch K, Andreassen A. Pulmonary Endarterectomy (PEA) vs. Balloon Pulmonary Angioplasty (BPA) in Chronic Thrombo-Embolic Pulmonary Hypertension (CTEPH): Comparison of Improvements in Hemodynamics and Functional Capacity. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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26
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Khan F, Inoue K, Remme EW, Ohte N, Garcia-Izquierdo E, Chetrit M, Andersen OS, Gude E, Andreassen AK, Kikuchi S, Stugaard M, Ha JW, Klein A, Nagueh SF, Smiseth OA. Evaluation of left ventricular filling pressure by echocardiography: incremental diagnostic information from left atrial strain. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): South-Eastern Norway Regional Health Authority
Background
Elevated left ventricular (LV) filling pressure is an important diagnostic feature of heart failure.
Objectives
To investigate determinants of left atrial (LA) reservoir and pump strain and if these parameters may serve as markers of LV filling pressure.
Methods
In a multicenter study of 322 patients with cardiovascular disease of different etiologies, LA strain by speckle tracking echocardiography was compared to conventional echocardiographic markers using invasive pressure as reference.
Results
Left ventricular filling pressure correlated well with LA reservoir and pump strain (r-values
‑0.52 and ‑0.57, respectively) (Figure). However, LV global longitudinal strain (GLS) was the strongest determinant of LA reservoir strain (r = 0.64), and correlated well with LA pump strain (r = 0.51). For both LA strains, association with filling pressure was strongest in patients with reduced LV ejection fraction. In patients with normal GLS (≥18%), atrial strains provided no information regarding filling pressure (Figure). Reservoir strain <18% and pump strain <8% predicted elevated LV filling pressure better (p < 0.05) than the conventional indices LA volume, ratio of mitral early filling velocity/annular velocity and tricuspid regurgitation velocity. Accuracy to classify filling pressure as normal or elevated was 75% for both LA strains . When any one of the conventional indices were missing, and were replaced by LA strains, the combination of indices had accuracy 82% to correctly classify filling pressure.
Conclusions
Left atrial reservoir and pump strain may serve as clinical markers of LV filling pressure, but will be useful predominantly in patients with reduced systolic function. Due to limited diagnostic accuracy, LA strain should be used in combination with other indices.
Abstract Figure
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Affiliation(s)
- F Khan
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - K Inoue
- Ehime University Graduate School of Medicine, Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime, Japan
| | - EW Remme
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - N Ohte
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - M Chetrit
- Cleveland Clinic, Cleveland, United States of America
| | - OS Andersen
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - E Gude
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - AK Andreassen
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - S Kikuchi
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - M Stugaard
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - JW Ha
- Yonsei University College of Medicine, Cardiology Division, Seoul, Korea (Republic of)
| | - A Klein
- Cleveland Clinic, Cleveland, United States of America
| | - SF Nagueh
- The Methodist Hospital, Houston, United States of America
| | - OA Smiseth
- Oslo University Hospital Rikshospitalet, Oslo, Norway
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27
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Didriksen H, Molberg Ø, Fretheim H, Gude E, Jordan S, Brunborg C, Palchevskiy V, Garen T, Midtvedt Ø, Andreassen AK, Distler O, Belperio J, Hoffmann-Vold AM. Association of Lymphangiogenic Factors With Pulmonary Arterial Hypertension in Systemic Sclerosis. Arthritis Rheumatol 2021; 73:1277-1287. [PMID: 33497027 DOI: 10.1002/art.41665] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/17/2020] [Accepted: 01/21/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Pulmonary arterial hypertension (PAH) is a major complication in systemic sclerosis (SSc), a disease marked by vascular and lymphatic vessel abnormalities. This study was undertaken to assess the role of the lymphangiogenic factors vascular endothelial growth factor C (VEGF-C) and angiopoietin 2 (Ang-2) and the soluble forms of their respective cognate receptors, soluble VEGF receptor 3 (sVEGFR-3) and soluble TIE-2, in patients with SSc, and to evaluate their predictive ability as markers for PAH development in SSc. METHODS In this cohort study, we used multiplex bead assays to assess serum levels of lymphangiogenic factors in 2 well-characterized SSc cohorts: an unselected identification cohort of SSc patients from Oslo University Hospital (n = 371), and a PAH-enriched validation cohort of SSc patients from Zurich University Hospital and Oslo University Hospital (n = 149). As controls for the identification and validation cohorts, we obtained serum samples from 100 healthy individuals and 68 healthy individuals, respectively. Patients in whom SSc-related PAH was identified by right-sided heart catheterization (RHC) in both cohorts were studied in prediction analyses. PAH was defined according to the European Society of Cardiology/European Respiratory Society 2015 guidelines for the diagnosis and treatment of PAH. Associations of serum levels of lymphangiogenic factors with the risk of PAH development were assessed in logistic regression and Cox regression analyses. Associations in Cox regression analyses were expressed as the hazard ratio (HR) with 95% confidence interval (95% CI). RESULTS In the identification cohort, SSc patients had lower mean serum levels of VEGF-C and higher mean serum levels of Ang-2 compared to healthy controls (for VEGF-C, mean ± SD 2.1 ± 0.5 ng/ml in patients versus 2.5 ± 0.4 ng/ml in controls; for Ang-2, mean ± SD 6.1 ± 7.6 ng/ml in patients versus 2.8 ± 1.8 ng/ml in controls; each P < 0.001); these same trends were observed in SSc patients with PAH compared to those without PAH. The association of serum VEGF-C levels with SSc-PAH was confirmed in the PAH-enriched RHC validation cohort. For prediction analyses, we assembled all 251 cases of SSc-PAH identified by RHC from the identification and validation cohorts. In multivariable Cox regression analyses adjusted for age and sex, the mean serum levels of VEGF-C and sVEGFR-3 were predictive of PAH development in patients with SSc (for VEGF-C, HR 0.53 [95% CI 0.29-0.97], P = 0.04; for sVEGFR-3, HR 1.21 [95% CI 1.01-1.45], P = 0.042). CONCLUSION These findings support the notion that lymphangiogenesis is deregulated during PAH development in SSc, and indicate that VEGF-C could be a promising marker for early PAH detection in patients with SSc.
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Affiliation(s)
| | - Øyvind Molberg
- Oslo University Hospital, Rikshospitalet, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Einar Gude
- Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | | | | | | | - Torhild Garen
- Oslo University Hospital, Rikshospitalet, Oslo, Norway
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28
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Inoue K, Khan FH, Remme EW, Ohte N, García-Izquierdo E, Chetrit M, Moñivas-Palomero V, Mingo-Santos S, Andersen ØS, Gude E, Andreassen AK, Wang TKM, Kikuchi S, Stugaard M, Ha JW, Klein AL, Nagueh SF, Smiseth OA. Determinants of left atrial reservoir and pump strain and use of atrial strain for evaluation of left ventricular filling pressure. Eur Heart J Cardiovasc Imaging 2021; 23:61-70. [PMID: 33496314 PMCID: PMC8685600 DOI: 10.1093/ehjci/jeaa415] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/17/2020] [Indexed: 01/29/2023] Open
Abstract
AIMS The aim of this study is to investigate determinants of left atrial (LA) reservoir and pump strain and if these parameters may serve as non-invasive markers of left ventricular (LV) filling pressure. METHODS AND RESULTS In a multicentre study of 322 patients with cardiovascular disease of different aetiologies, LA strain and other echocardiographic parameters were compared with invasively measured LV filling pressure. The strongest determinants of LA reservoir and pump strain were LV global longitudinal strain (GLS) (r-values 0.64 and 0.51, respectively) and LV filling pressure (r-values -0.52 and -0.57, respectively). Left atrial volume was another independent, but weaker determinant of both LA strains. For both LA strains, association with LV filling pressure was strongest in patients with reduced LV ejection fraction. Left atrial reservoir strain <18% and LA pump strain <8% predicted elevated LV filling pressure better (P < 0.05) than LA volume and conventional Doppler parameters. Accuracy to identify elevated LV filling pressure was 75% for LA reservoir strain alone and 72% for pump strain alone. When combined with conventional parameters, accuracy was 82% for both LA strains. In patients with normal LV systolic function by GLS, LA pump strain >14% identified normal LV filling pressure with 92% accuracy. CONCLUSION Left atrial reservoir and pump strain are determined predominantly by LV GLS and filling pressure. Accuracy of LA strains to identify elevated LV filling pressure was best in patients with reduced LV systolic function. High values of LA pump strain, however, identified normal LV filling pressure with good accuracy in patients with normal systolic function.
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Affiliation(s)
- Katsuji Inoue
- Institute for Surgical Research and Department of Cardiology, Rikshospitalet, Oslo University Hospital, and University of Oslo, N-0027 Oslo, Norway.,Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Faraz H Khan
- Institute for Surgical Research and Department of Cardiology, Rikshospitalet, Oslo University Hospital, and University of Oslo, N-0027 Oslo, Norway
| | - Espen W Remme
- Institute for Surgical Research and Department of Cardiology, Rikshospitalet, Oslo University Hospital, and University of Oslo, N-0027 Oslo, Norway
| | - Nobuyuki Ohte
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | | | - Michael Chetrit
- Department of Cardiovascular Medicine, McGill University Health Centre, Montreal, Canada
| | | | - Susana Mingo-Santos
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Øyvind S Andersen
- Institute for Surgical Research and Department of Cardiology, Rikshospitalet, Oslo University Hospital, and University of Oslo, N-0027 Oslo, Norway
| | - Einar Gude
- Institute for Surgical Research and Department of Cardiology, Rikshospitalet, Oslo University Hospital, and University of Oslo, N-0027 Oslo, Norway
| | - Arne K Andreassen
- Institute for Surgical Research and Department of Cardiology, Rikshospitalet, Oslo University Hospital, and University of Oslo, N-0027 Oslo, Norway
| | - Tom Kai Ming Wang
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, OH, USA
| | - Shohei Kikuchi
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Marie Stugaard
- Department of Cardiology, Ringerike Hospital, Vestre Viken Hospital Trust, Hønefoss, Norway
| | - Jong-Won Ha
- Cardiology Division, Yonsei University College of Medicine, Seoul, Korea
| | - Allan L Klein
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, OH, USA
| | - Sherif F Nagueh
- Department of Cardiology, Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Otto A Smiseth
- Institute for Surgical Research and Department of Cardiology, Rikshospitalet, Oslo University Hospital, and University of Oslo, N-0027 Oslo, Norway
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29
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Rolid K, Andreassen AK, Yardley M, Gude E, Bjørkelund E, Authen AR, Grov I, Broch K, Gullestad L, Nytrøen K. Long-term effects of high-intensity training vs moderate intensity training in heart transplant recipients: A 3-year follow-up study of the randomized-controlled HITTS study. Am J Transplant 2020; 20:3538-3549. [PMID: 32484261 DOI: 10.1111/ajt.16087] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/01/2020] [Accepted: 05/19/2020] [Indexed: 01/25/2023]
Abstract
The randomized controlled High-Intensity Interval Training in De Novo Heart Transplant Recipients in Scandinavia (HITTS) study compared 9 months of high-intensity interval training (HIT) with moderate intensity continuous training in de novo heart transplant recipients. In our 3-year follow-up study, we aimed to determine whether the effect of early initiation of HIT on peak oxygen consumption (VO2peak ) persisted for 2 years postintervention. The study's primary end point was the change in VO2peak (mL/kg/min). The secondary end points were muscle strength, body composition, heart rate response, health-related quality of life, daily physical activity, biomarkers, and heart function. Of 78 patients who completed the 1-year HITTS trial, 65 entered our study and 62 completed the study tests. VO2peak increased from baseline to 1 year and leveled off thereafter. During the intervention period, the increase in VO2peak was larger in the HIT arm; however, 2 years later, there was no significant between-group difference in VO2peak . However, the mean change in the anaerobic threshold and extensor muscle endurance remained significantly higher in the HIT group. Early initiation of HIT after heart transplantation appears to have some sustainable long-term effects. Clinical trial registration number: NCT01796379.
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Affiliation(s)
- Katrine Rolid
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,The Norwegian Health Association, Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Norway and the Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
| | - Arne K Andreassen
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Marianne Yardley
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,The Norwegian Health Association, Oslo, Norway
| | - Einar Gude
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | | | - Anne R Authen
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Ingelin Grov
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Kaspar Broch
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Norway and the Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
| | - Lars Gullestad
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Norway and the Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
| | - Kari Nytrøen
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Norway and the Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
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30
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Khan F, Inoue K, Remme E, Andersen O, Gude E, Skulstad H, Chetrit M, Garcia-Izquierdo Jaen E, Ha J, Klein A, Kikuchi S, Ohte N, Nagueh S, Smiseth O. Assessment of left ventricular filling pressure: left atrial reservoir strain is an excellent replacement for missing tricuspid regurgitation velocity. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/12/2022] Open
Abstract
Abstract
Background
When evaluating left ventricular filling pressure (LVFP) according to current guidelines, tricuspid regurgitation (TR) velocity is often not available.
Purpose
In the present study we investigate if left atrial (LA) reservoir strain may be used instead of TR velocity for evaluation of LVFP.
Methods
We performed a prospective, multicenter, multinational and multivendor study in an all comer population of 322 patients with suspected heart failure or other cardiovascular disease where LVFP was measured by right- or left heart catheterization, as pulmonary capillary wedge pressure or pre-A LV diastolic pressure, respectively. Echocardiography was performed within 1 day of catheterization.
101 patients classified as special populations in the 2016 ASE/EACVI recommendations (i.e. non-cardiac pulmonary hypertension, atrial fibrillation, hypertrophic and restrictive cardiomyopathies) were excluded. Of the remaining 221 patients, 118 patients had EF ≥50% and 103 patients had EF <50%. Regression analysis was performed for LA reservoir strain and TR velocity against LVFP. LA reservoir strain at a cut-off value of <18% was applied instead of TR velocity in the 2016 ASE/EACVI algorithm and compared with the current algorithm.
Results
LA reservoir strain correlated better with LVFP than TR velocity, r=0.62 vs 0.40 (p<0.01) (Figure 1). When replacing TR velocity with LA reservoir strain, the feasibility of the ASE/EACVI 2016 algorithm increased from 91.8% to 98.1%. The accuracy of the algorithm was not significantly altered (80% vs 79%).
An accuracy of 80% for the algorithm is lower than what has been reported in earlier publications, this may be due to inclusion of patients without suspected heart failure and no assessment of clinical data, which in turn may have influenced the accuracy of the algorithm.
Conclusion
LA reservoir strain has better correlation to LVFP than TR velocity, and can be used in the ASE/EACVI 2016 algorithm for estimation of LVFP as a replacement when TR velocity is missing.
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): South-Eastern Norway Regional Health Authority
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Affiliation(s)
- F Khan
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - K Inoue
- Ehime University Graduate School of Medicine, Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime, Japan
| | - E.W Remme
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - O.S Andersen
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - E Gude
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - H Skulstad
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - M Chetrit
- Cleveland Clinic, Cleveland, United States of America
| | | | - J.W Ha
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - A.L Klein
- Cleveland Clinic, Cleveland, United States of America
| | - S Kikuchi
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - N Ohte
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - S.F Nagueh
- The Methodist Hospital, Houston, United States of America
| | - O.A Smiseth
- Oslo University Hospital Rikshospitalet, Oslo, Norway
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Khan F, Inoue K, Remme E, Andersen O, Gude E, Skulstad H, Chetrit M, Garcia-Izquierdo Jaen E, Ha J, Klein A, Kikuchi S, Ohte N, Nagueh S, Smiseth O. Which single echo parameter is the best marker of left ventricular filling pressure? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/15/2022] Open
Abstract
Abstract
Background
Estimation of left ventricular filling pressure (LVFP) is highly relevant in clinical practice. Invasive pressure remains the gold standard, but a number of echocardiographic parameters that correlate with LVFP are used as non-invasive markers of pressure.
Purpose
We investigated how different echocardiographic parameters correlated with invasively measured LVFP, and how accurately those parameters could differentiate between normal or elevated LVFP.
Method
We performed a prospective, multicenter, multinational and multivendor study in an all comer population of 322 patients with suspected heart failure or other cardiovascular disease. 194 patients had EF ≥50% and 129 had EF <50%. LVFP was measured by right- or left heart catheterization, as pulmonary capillary wedge pressure or pre-A LV diastolic pressure, respectively.
When excluding all special patient populations defined in the 2016 recommendations for echocardiographic evaluation of LV diastolic function, 213 patients remained. Of these 135 had EF ≥50% and 74 had EF <50%.
Echocardiography was performed within 1 day of catheterization. Previously recommended cut-off values for established parameters were used to determine the accuracy of classifying LVFP as normal or elevated. For left atrial (LA) reservoir strain, based on ROC analysis, a cut-off value of <18% was used as marker of elevated LVFP.
Results
LA reservoir strain and the ratio of peak mitral early flow velocity (E) and LA reservoir strain (E/LA strain) showed the best correlations to LVFP (Table 1, Figure 1). They also had the highest accuracy, 75% for both, in classifying LVFP as normal or elevated in the whole patient population. E/LA reservoir strain provided no additional diagnostic value to using LA reservoir strain alone.
In HFpEF patients accuracy was essentially similar for LA strain, E/LA strain and E/e', whereas in HFrEF patients the two former tended to be better than E/e'.
Conclusion
Parameters containing LA reservoir strain showed the best correlation to LVFP. This indicates that LA reservoir strain may have a role in evaluation of LVFP.
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): South-Eastern Norway Regional Health Authority
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Affiliation(s)
- F Khan
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - K Inoue
- Ehime University Graduate School of Medicine, Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime, Japan
| | - E.W Remme
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - O.S Andersen
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - E Gude
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - H Skulstad
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - M Chetrit
- Cleveland Clinic, Cleveland, United States of America
| | | | - J.W Ha
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - A.L Klein
- Cleveland Clinic, Cleveland, United States of America
| | - S Kikuchi
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - N Ohte
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - S.F Nagueh
- The Methodist Hospital, Houston, United States of America
| | - O.A Smiseth
- Oslo University Hospital Rikshospitalet, Oslo, Norway
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Rolid K, Andreassen AK, Yardley M, Gude E, Bjørkelund E, Authen AR, Grov I, Pettersen KI, Dall CH, Karason K, Broch K, Gullestad L, Nytrøen K. High-intensity interval training and health-related quality of life in de novo heart transplant recipients - results from a randomized controlled trial. Health Qual Life Outcomes 2020; 18:283. [PMID: 32807179 PMCID: PMC7433122 DOI: 10.1186/s12955-020-01536-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 08/11/2020] [Indexed: 02/07/2023] Open
Abstract
Background Studies on the effect of high-intensity interval training (HIT) compared with moderate intensity continuous training (MICT) on health-related quality of life (HRQoL) after heart transplantation (HTx) is scarce. No available studies among de novo HTx recipients exists. This study aimed to investigate the effect of HIT vs. MICT on HRQoL in de novo recipients. Methods The HITTS study randomized eighty-one de novo HTx recipients to receive either HIT or MICT (1:1). The HIT intervention were performed with 2–4 interval bouts with an intensity of 85–95% of maximal effort. The MICT group exercised at an intensity of 60–80% of their maximal effort with a duration of 25 min. HRQoL was assessed by the Short Form-36 version 2 (SF-36v2) and the Hospital Anxiety and Depression Scale, mean 11 weeks after surgery and after a nine months’ intervention. The participants recorded their subjective effect of the interventions on their general health and well-being on a numeric visual analogue scale. Clinical examinations and physical tests were performed. Differences between groups were investigated with independent Student t-tests and with Mann-Whitney U tests where appropriate. Within-group differences were analyzed with Paired-Sample t-tests and Wilcoxon Signed Rank tests. Correlations between SF-36 scores and VO2peak were examined with Pearson’s correlations. Results Seventy-eight participants completed the intervention. Both exercise modes were associated with improved exercise capacity on the physical function scores of HRQoL. Mental health scores remained unchanged. No differences in the change in HRQoL between the groups occurred except for Role Emotional subscale with a larger increase in the HIT arm. Better self-reported physical function was associated with higher VO2peak and muscle strength. Conclusion HIT and MICT resulted in similar mean changes in HRQoL the first year after HTx. Both groups experienced significant improvements in the physical SF-36v2. Trial registration ClinicalTrials.gov number: NCT01796379 Registered 18 February 2013.
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Affiliation(s)
- Katrine Rolid
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Rikshospitalet, , PO Box 4950 Nydalen, N-0424, Oslo, Norway. .,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway. .,The Norwegian Health Association, Oslo, Norway. .,KG Jebsen Center for Cardiac Research, University of Oslo, Norway and Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway.
| | - Arne K Andreassen
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Rikshospitalet, , PO Box 4950 Nydalen, N-0424, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Marianne Yardley
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Rikshospitalet, , PO Box 4950 Nydalen, N-0424, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,The Norwegian Health Association, Oslo, Norway
| | - Einar Gude
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Rikshospitalet, , PO Box 4950 Nydalen, N-0424, Oslo, Norway
| | - Elisabeth Bjørkelund
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Rikshospitalet, , PO Box 4950 Nydalen, N-0424, Oslo, Norway
| | - Anne R Authen
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Rikshospitalet, , PO Box 4950 Nydalen, N-0424, Oslo, Norway
| | - Ingelin Grov
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Rikshospitalet, , PO Box 4950 Nydalen, N-0424, Oslo, Norway
| | - Kjell I Pettersen
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Rikshospitalet, , PO Box 4950 Nydalen, N-0424, Oslo, Norway
| | - Christian H Dall
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Kristjan Karason
- Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kaspar Broch
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Rikshospitalet, , PO Box 4950 Nydalen, N-0424, Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Norway and Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
| | - Lars Gullestad
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Rikshospitalet, , PO Box 4950 Nydalen, N-0424, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Norway and Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
| | - Kari Nytrøen
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Rikshospitalet, , PO Box 4950 Nydalen, N-0424, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Norway and Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
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Broch K, Gude E, Karason K, Dellgren G, Rådegran G, Gjesdal G, Gustafsson F, Eiskjær H, Lommi J, Pentikäinen M, Lemström KB, Andreassen AK, Gullestad L. Cholesterol lowering with EVOLocumab to prevent cardiac allograft Vasculopathy in De‐novo heart transplant recipients: Design of the randomized controlled EVOLVD trial. Clin Transplant 2020; 34:e13984. [DOI: 10.1111/ctr.13984] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 01/20/2023]
Affiliation(s)
- Kaspar Broch
- Department of Cardiology Oslo University Hospital, Rikshospitalet Oslo Norway
| | - Einar Gude
- Department of Cardiology Oslo University Hospital, Rikshospitalet Oslo Norway
| | - Kristjan Karason
- Transplant Institute Sahlgrenska University Hospital Gothenburg Sweden
| | - Göran Dellgren
- Transplant Institute Sahlgrenska University Hospital Gothenburg Sweden
| | - Göran Rådegran
- The Clinic for Heart Failure and Valvular Disease Skåne University Hospital Lund Sweden
- Lund University Lund Sweden
| | - Grunde Gjesdal
- The Clinic for Heart Failure and Valvular Disease Skåne University Hospital Lund Sweden
| | | | - Hans Eiskjær
- Department of Cardiology Aarhus University Hospital Aarhus Denmark
| | - Jyri Lommi
- Helsinki University Hospital Heart and Lung Center Helsinki Finland
| | | | - Karl B. Lemström
- Helsinki University Hospital Heart and Lung Center Helsinki Finland
- University of Helsinki Helsinki Finland
| | - Arne K. Andreassen
- Department of Cardiology Oslo University Hospital, Rikshospitalet Oslo Norway
| | - Lars Gullestad
- Department of Cardiology Oslo University Hospital, Rikshospitalet Oslo Norway
- KG Jebsen Center for Cardiac Research University of Oslo Norway and Center for Heart Failure Research Oslo University Hospital Norway
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Broch K, Popperud T, Gude E, Fløisand Y, Antal EA, Bosse G, Jonsrud C, Hegard T, Skaara S, Elsais A. A Middle-Aged Man Presenting With Progressive Heart Failure, Myopathy, and Monoclonal Gammopathy of Uncertain Significance. JACC Case Rep 2020; 2:785-789. [PMID: 34317348 PMCID: PMC8301701 DOI: 10.1016/j.jaccas.2020.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/03/2020] [Accepted: 02/07/2020] [Indexed: 11/19/2022]
Abstract
A 48-year-old man presented with rapidly progressive heart failure and monoclonal gammopathy of uncertain significance. No specific cause was detected on endomyocardial biopsy. As the heart failure worsened, he also developed progressive skeletal myopathy. This provided the clue to the diagnosis, and cardiac function recovered rapidly with cause-directed therapy. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Kaspar Broch
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Address for correspondence: Dr. Kaspar Broch, Department of Cardiology, Oslo University Hospital, Rikshospitalet Sognsvannsveien 20, 0382 Oslo, Norway.
| | - Trine Popperud
- Department of Neurology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Einar Gude
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Yngvar Fløisand
- Department of Hematology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Ellen-Ann Antal
- Department of Pathology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Gerhard Bosse
- Department of Radiology and Nuclear Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Christoffer Jonsrud
- Department of Medical Genetics, University Hospital of North Norway, Tromsø, Norway
| | - Terje Hegard
- Department of Medicine, Telemark Hospital Trust, Notodden Hospital, Notodden, Norway
| | - Silje Skaara
- Department of Neurology, Telemark Hospital Trust, Skien, Norway
| | - Ahmed Elsais
- Department of Neurology, Oslo University Hospital Rikshospitalet, Oslo, Norway
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Nytrøen K, Rolid K, Andreassen AK, Yardley M, Gude E, Dahle DO, Bjørkelund E, Relbo Authen A, Grov I, Philip Wigh J, Have Dall C, Gustafsson F, Karason K, Gullestad L. Effect of High-Intensity Interval Training in De Novo Heart Transplant Recipients in Scandinavia. Circulation 2020; 139:2198-2211. [PMID: 30773030 DOI: 10.1161/circulationaha.118.036747] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND There is no consensus on how, when, or at what intensity exercise should be performed after heart transplantation (HTx). We have recently shown that high-intensity interval training (HIT) is safe, well tolerated, and efficacious in the maintenance state after HTx, but studies have not investigated HIT effects in the de novo HTx state. We hypothesized that HIT could be introduced early after HTx and that it could lead to clinically meaningful increases in exercise capacity and health-related quality of life. METHODS This multicenter, prospective, randomized, controlled trial included 81 patients a mean of 11 weeks (range, 7-16 weeks) after an HTx. Patients were randomized 1:1 to 9 months of either HIT (4×4-minute intervals at 85%-95% of peak effort) or moderate-intensity continuous training (60%-80% of peak effort). The primary outcome was the effect of HIT versus moderate-intensity continuous training on the change in aerobic exercise capacity, assessed as the peak oxygen consumption (Vo2peak). Secondary outcomes included tolerability, safety, adverse events, isokinetic muscular strength, body composition, health-related quality of life, left ventricular function, hemodynamics, endothelial function, and biomarkers. RESULTS From baseline to follow-up, 96% of patients completed the study. There were no serious exercise-related adverse events. The population comprised 73% men, and the mean±SD age was 49±13 years. At the 1-year follow-up, the HIT group demonstrated greater improvements than the moderate-intensity continuous training group; the groups showed significantly different changes in the Vo2peak (mean difference between groups, 1.8 mL·kg-1·min-1), the anaerobic threshold (0.28 L/min), the peak expiratory flow (11%), and the extensor muscle exercise capacity (464 J). The 1.8-mL·kg-1·min-1 difference was equal to ≈0.5 metabolic equivalents, which is regarded as clinically meaningful and relevant. Health-related quality of life was similar between the groups, as indicated by results from the Short Form-36 (version 2), Hospital Anxiety and Depression Scale, and a visual analog scale. CONCLUSIONS We demonstrated that HIT was a safe, efficient exercise method in de novo HTx recipients. HIT, compared with moderate-intensity continuous training, resulted in a clinically significantly greater change in exercise capacity based on the Vo2peak values (25% versus 15%), anaerobic threshold, peak expiratory flow, and muscular exercise capacity. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier NCT01796379.
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Affiliation(s)
- Kari Nytrøen
- Departments of Cardiology (K.N., K.R., A.K.A., M.Y., E.G., E.B., A.R.A., I.G., L.G.), Oslo University Hospital Rikshospitalet, Norway.,Institute of Clinical Medicine, Faculty of Medicine (K.N., K.R., A.K.A., M.Y., L.G.), University of Oslo, Norway.,KG Jebsen Center for Cardiac Research (K.N., K.R., E.G., L.G.), University of Oslo, Norway.,Center for Heart Failure Research, Oslo University Hospital, Norway (K.N., K.R., E.G., L.G.)
| | - Katrine Rolid
- Departments of Cardiology (K.N., K.R., A.K.A., M.Y., E.G., E.B., A.R.A., I.G., L.G.), Oslo University Hospital Rikshospitalet, Norway.,Institute of Clinical Medicine, Faculty of Medicine (K.N., K.R., A.K.A., M.Y., L.G.), University of Oslo, Norway.,KG Jebsen Center for Cardiac Research (K.N., K.R., E.G., L.G.), University of Oslo, Norway.,Norwegian Health Association, Oslo, Norway (K.R., M.Y.).,Center for Heart Failure Research, Oslo University Hospital, Norway (K.N., K.R., E.G., L.G.)
| | - Arne Kristian Andreassen
- Departments of Cardiology (K.N., K.R., A.K.A., M.Y., E.G., E.B., A.R.A., I.G., L.G.), Oslo University Hospital Rikshospitalet, Norway.,Institute of Clinical Medicine, Faculty of Medicine (K.N., K.R., A.K.A., M.Y., L.G.), University of Oslo, Norway
| | - Marianne Yardley
- Departments of Cardiology (K.N., K.R., A.K.A., M.Y., E.G., E.B., A.R.A., I.G., L.G.), Oslo University Hospital Rikshospitalet, Norway.,Institute of Clinical Medicine, Faculty of Medicine (K.N., K.R., A.K.A., M.Y., L.G.), University of Oslo, Norway.,Norwegian Health Association, Oslo, Norway (K.R., M.Y.)
| | - Einar Gude
- Departments of Cardiology (K.N., K.R., A.K.A., M.Y., E.G., E.B., A.R.A., I.G., L.G.), Oslo University Hospital Rikshospitalet, Norway.,KG Jebsen Center for Cardiac Research (K.N., K.R., E.G., L.G.), University of Oslo, Norway.,Center for Heart Failure Research, Oslo University Hospital, Norway (K.N., K.R., E.G., L.G.)
| | - Dag Olav Dahle
- Transplantation Medicine (D.O.D.), Oslo University Hospital Rikshospitalet, Norway
| | - Elisabeth Bjørkelund
- Departments of Cardiology (K.N., K.R., A.K.A., M.Y., E.G., E.B., A.R.A., I.G., L.G.), Oslo University Hospital Rikshospitalet, Norway
| | - Anne Relbo Authen
- Departments of Cardiology (K.N., K.R., A.K.A., M.Y., E.G., E.B., A.R.A., I.G., L.G.), Oslo University Hospital Rikshospitalet, Norway
| | - Ingelin Grov
- Departments of Cardiology (K.N., K.R., A.K.A., M.Y., E.G., E.B., A.R.A., I.G., L.G.), Oslo University Hospital Rikshospitalet, Norway
| | - Julia Philip Wigh
- Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden (J.P.W., K.K.)
| | - Christian Have Dall
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (C.H.D.).,University of Copenhagen, Denmark (C.H.D., F.G.)
| | - Finn Gustafsson
- University of Copenhagen, Denmark (C.H.D., F.G.).,Rigshospitalet, Copenhagen, Denmark (F.G.)
| | - Kristjan Karason
- Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden (J.P.W., K.K.)
| | - Lars Gullestad
- Departments of Cardiology (K.N., K.R., A.K.A., M.Y., E.G., E.B., A.R.A., I.G., L.G.), Oslo University Hospital Rikshospitalet, Norway.,Institute of Clinical Medicine, Faculty of Medicine (K.N., K.R., A.K.A., M.Y., L.G.), University of Oslo, Norway.,KG Jebsen Center for Cardiac Research (K.N., K.R., E.G., L.G.), University of Oslo, Norway.,Center for Heart Failure Research, Oslo University Hospital, Norway (K.N., K.R., E.G., L.G.)
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36
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Rolid K, Andreassen A, Yardley M, Bjørkelund E, Authen A, Grov I, Gude E, Broch K, Gullestad L, Nytrøen K. Effect of High-Intensity Interval Training in De Novo Heart Transplant Recipients - 3-year Results from the HITTS Randomized Controlled Trial. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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37
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Brautaset Englund K, Østby C, Vartdal T, Rolid K, Gude E, Andreassen A, Gullestad L, Broch K. Intravenous Iron Supplement for Iron Deficiency in Cardiac Transplant Recipients (IronIC) - A Randomized, Double Blind, Controlled Trial. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Bergh N, Gude E, Bartfay S, K Andreassen A, Arora S, Dahlberg P, Dellgren G, Gullestad L, Gustafsson F, Karasson K, Rådegran G, Bollano E, Andersson B. Invasive haemodynamics in de novo everolimus vs. calcineurin inhibitor heart transplant recipients. ESC Heart Fail 2020; 7:567-576. [PMID: 32059083 PMCID: PMC7160471 DOI: 10.1002/ehf2.12608] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 11/25/2019] [Accepted: 12/09/2019] [Indexed: 12/21/2022] Open
Abstract
Aims Invasive haemodynamic profiles at rest and during exercise after heart transplantation (HTx) have never been described in a randomized trial where de novo everolimus (EVR)‐based therapy with early calcineurin inhibitor (CNI) withdrawal has been compared with conventional CNI treatment. We report central invasive haemodynamic parameters at rest and exercise during a 3 year follow‐up after HTx in a sub‐study of the SCandiavian Heart transplant Everolimus De novo stUdy with earLy calcineurin inhibitor avoidancE trial. We hypothesized that the nephroprotective properties, the less development of cardiac allograft vasculopathy (CAV), and the antifibrotic properties of EVR, in comparison with CNI‐based immunosuppression, would demonstrate favourable invasive haemodynamic profiles in patients at rest and during exercise. Methods and results Ninety of 115 HTx recipients randomized to EVR or CNI treatment performed right heart catheterization at rest and 68 performed right heart catheterization at exercise up to 3 years after HTx. Haemodynamic profiles were compared between EVR and CNI treatment groups. Resting haemodynamics improved in both groups from pre‐HTx to the first follow‐up at 7–11 weeks post‐HTx and thereafter remained unchanged up to 3 years of follow‐up. During follow‐up, cardiac reserve during exercise increased with higher levels of maximum heart rate (118 to 148 b.p.m., P < 0.001), mean arterial pressure (103 to 128 mmHg, P < 0.001), and cardiac output (10.3 to 12.2 l/min, P < 0.001). No significant differences in haemodynamic parameters were observed between the EVR and CNI groups at rest or exercise. Isolated post‐capillary pulmonary hypertension (mean pulmonary arterial pressure > 20 mmHg, pulmonary arterial wedge pressure ≥ 15 mmHg, and pulmonary vascular resistance <3) were measured in 11% of the patients at 7–11 weeks, 5% at 12 months, and 6% at 36 months after HTx. The EVR group had significantly better kidney function (76 mL/min/1 vs. 60 mL/min/1, P < 0.001) and reduced CAV (P < 0.01) but an increased rate of early biopsy‐proven treated rejections (21.2% vs 5.7%, P < 0.01) compared with the CNI group at any time point. The differences in renal function, CAV, or early biopsy‐proven treated acute rejections were not associated with altered haemodynamics. Conclusions De novo EVR treatment with early CNI withdrawal compared with conventional CNI therapy did not result in differences in haemodynamics at rest or during exercise up to 3 years after HTx despite significant differences in renal function, reduced CAV, and number of early biopsy‐proven treated rejections.
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Affiliation(s)
- Niklas Bergh
- Department of CardiologySahlgrenska University HospitalGothenburgSweden
- Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Einar Gude
- Department of CardiologyOslo University Hospital RikshospitaletOsloNorway
| | - Sven‐Erik Bartfay
- Department of CardiologySahlgrenska University HospitalGothenburgSweden
- Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Arne K Andreassen
- Department of CardiologyOslo University Hospital RikshospitaletOsloNorway
- KG Jebsen Center for Cardiac ResearchUniversity of OsloOsloNorway
- Center for Heart Failure ResearchOslo University HospitalOsloNorway
| | - Satish Arora
- Department of CardiologyOslo University Hospital RikshospitaletOsloNorway
- KG Jebsen Center for Cardiac ResearchUniversity of OsloOsloNorway
- Center for Heart Failure ResearchOslo University HospitalOsloNorway
| | - Pia Dahlberg
- Department of CardiologySahlgrenska University HospitalGothenburgSweden
- Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Göran Dellgren
- Department of Clinical SciencesLund University, Lund, SwedenTransplant Institute, Sahlgrenska University HospitalGothenburgSweden
| | - Lars Gullestad
- Department of CardiologyOslo University Hospital RikshospitaletOsloNorway
- KG Jebsen Center for Cardiac ResearchUniversity of OsloOsloNorway
- Center for Heart Failure ResearchOslo University HospitalOsloNorway
- Faculty of MedicineUniversity of OsloOsloNorway
| | - Finn Gustafsson
- Department of Cardiology, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Kristjan Karasson
- Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Göran Rådegran
- The Section for Heart Failure and Valvular Disease, VO Heart and Lung MedicineSkåne University HospitalLundSweden
- Department of Clinical SciencesLund University, Lund, SwedenTransplant Institute, Sahlgrenska University HospitalGothenburgSweden
| | - Entela Bollano
- Department of CardiologySahlgrenska University HospitalGothenburgSweden
- Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Bert Andersson
- Department of CardiologySahlgrenska University HospitalGothenburgSweden
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Nelson LM, Andreassen AK, Arora S, Andersson B, Gude E, Eiskjaer H, Rådegran G, Dellgren G, Gullestad L, Gustafsson F. Mild acute cellular rejection and development of cardiac allograft vasculopathy assessed by intravascular ultrasound and coronary angiography in heart transplant recipients-a SCHEDULE trial substudy. Transpl Int 2020; 33:517-528. [PMID: 31958178 DOI: 10.1111/tri.13577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/20/2019] [Accepted: 01/13/2020] [Indexed: 12/18/2022]
Abstract
To evaluate the association between mild acute cellular rejection (ACR) and the development of cardiac allograft vasculopathy (CAV) after heart transplantation (HTx). Substudy of the SCHEDULE trial (n = 115), where de novo HTx recipients were randomized to (i) everolimus with early CNI elimination or (ii) CNI-based immunosuppression. Seventy-six patients (66%) were included based on matched intravascular ultrasound (IVUS) examinations at baseline and year 3 post-HTx. Biopsy-proven ACR within year 1 post-HTx was recorded and graded (1R, 2R, 3R). Development of CAV was assessed by IVUS and coronary angiography at year 3 post-HTx. Median age was 53 years (45-61), and 71% were male. ACR was recorded in 67%, and patients were grouped by rejection profile: no ACR (33%), only 1R (42%), and ≥2R (25%). Median ∆MIT (maximal intimal thickness)BL-3Y was not significantly different between groups (P = 0.84). The incidence of CAV was 49% by IVUS and 26% by coronary angiography with no significant differences between groups. No correlation was found between number of 1R and ∆MITBL-3Y (r = -0.025, P = 0.83). The number of 1R was not a significant predictor of ∆MITBL-3Y (P = 0.58), and no significant interaction with treatment was found (P = 0.98). The burden of mild ACR was not associated with CAV development.
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Affiliation(s)
- Laerke Marie Nelson
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Satish Arora
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,K.G. Jebsen Cardiac Research Centre and Center for Heart Failure Research, Oslo, Norway
| | - Bert Andersson
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Einar Gude
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Hans Eiskjaer
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Göran Rådegran
- The Section for Heart Failure and Valvular Disease, Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences Lund, Cardiology, Lund University, Lund, Sweden
| | - Göran Dellgren
- Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars Gullestad
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,K.G. Jebsen Cardiac Research Centre and Center for Heart Failure Research, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Finn Gustafsson
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Khan FH, Inoue K, Andersen OS, Gude E, Skulstad H, Smiseth OA, Remme EW. 1231 Left atrial septal and lateral wall strains contain different pressure information: Utility in pulmonary hypertension. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.692] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
South-Eastern Norway Regional Health Authority
Background
Reduced left atrial (LA) reservoir strain is a marker of elevated LA pressure. Thus it could be a potential non-invasive marker to differentiate pre- and post-capillary pulmonary hypertension (PH) as the latter is defined by elevated pulmonary capillary wedge pressure (PCWP) > 15 mmHg. However, in pre-capillary PH patients with elevated right atrial pressure (RAP), the atrial septal geometry may be abnormal. This could lead to lower regional LA septal strain, making LA lateral wall strain more accurately reflect PCWP.
Purpose
We investigated if LA lateral wall strain can differentiate between pre- and post-capillary PH, and how LA lateral wall strain and LA septal strain are both affected by elevated RAP in pre-capillary PH. Furthermore we investigated if LA septal strain can be used in pre-capillary PH patients to identify those with elevated RAP.
Methods
We analysed 63 patients with PH, 28 pre-capillary and 35 post-capillary, who underwent right heart catheterisation. Echocardiography was performed simultaneously with or within 24 hours of the invasive pressure measurements. Regional LA septal strain and lateral wall strain were measured from the apical four chamber view.
Results
Pulmonary artery pressure was 39.5 ± 11.1 mmHg (mean ± SD) in the pre-capillary PH patients and 37.0 ± 10.1 mmHg in the post-capillary PH patients (p = ns). Mean PCWP was 9.9 ± 2.5 mmHg and 24.5 ± 6.0 mmHg (p < 0.001), respectively.
LA lateral wall strain was significantly lower in patients with post-capillary PH compared to pre-capillary PH (11.9 ± 7.7% vs 26.6 ± 9.9%, p < 0.001) (Fig. a,b). At a cut-off value of 18.0%, LA lateral wall strain could predict elevated PCWP > 15 mmHg with AUC = 0.88, sensitivity = 85.7% and specificity = 76.3%.
In the 28 patients with pre-capillary PH, we classified mean RAP ≥ 10 mmHg as elevated and < 10 mmHg as normal. Seven of these patients had elevated RAP and showed significantly reduced LA septal strain compared to the 21 patients with normal RAP (13.0 ± 6.2% vs 22.1 ± 7.6%, p < 0.01). LA lateral wall strain showed no difference in these groups of pre-capillary PH patients (25.8 ± 10.1% vs 28.9 ± 9.4%) (Fig. c).
Conclusions
LA lateral wall strain can be used for differentiating between pre- and post-capillary PH. In addition, LA septal strain may be used in pre-capillary PH patients to identify those with elevated RAP.
Abstract 1231 Figure
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Affiliation(s)
- F H Khan
- Oslo University Hospital, Institute for Surgical research, Oslo, Norway
| | - K Inoue
- Ehime University Graduate School of Medicine, Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime, Japan
| | - O S Andersen
- Oslo University Hospital, Institute for Surgical research, Oslo, Norway
| | - E Gude
- Oslo University Hospital, Department of cardiology, Oslo, Norway
| | - H Skulstad
- Oslo University Hospital, Department of cardiology, Oslo, Norway
| | - O A Smiseth
- Oslo University Hospital, Institute for Surgical research, Oslo, Norway
| | - E W Remme
- Oslo University Hospital, Institute for Surgical research, Oslo, Norway
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Gude E, Hoel TN, Sørensen G, Broch K, Meyer A, Fiane AE. Long-term continuous flow mechanical biventricular support: 9 years and counting. Interact Cardiovasc Thorac Surg 2020; 30:81-84. [PMID: 31580433 DOI: 10.1093/icvts/ivz231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 08/01/2019] [Accepted: 08/14/2019] [Indexed: 11/13/2022] Open
Abstract
We report 2 continuous flow HeartWareTM left ventricular assist devices successfully used in a patient with advanced heart failure of giant cell myocarditis origin in a biventricular configuration. Despite technical challenges of adapting a left ventricular assist device engineered for systemic pressure to function as a right ventricular assist device, the addition of dynamic banding on the right ventricular assist device outflow graft allowed successful adaptation of afterload. This patient has now been on biventricular configuration support for 9 years, and remains stable to this day.
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Affiliation(s)
- Einar Gude
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Tom N Hoel
- Department of Cardiothoracic Surgery, Oslo University Hospital. Rikshospitalet, Oslo, Norway
| | - Gro Sørensen
- Department of Cardiothoracic Surgery, Oslo University Hospital. Rikshospitalet, Oslo, Norway
| | - Kaspar Broch
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Anders Meyer
- Department of Cardiology, Elverum Hospital, Elverum, Norway
| | - Arnt E Fiane
- Department of Cardiothoracic Surgery, Oslo University Hospital. Rikshospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
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Inoue K, Remme EW, Khan FH, Andersen OS, Gude E, Skulstad H, Smiseth OA. P4368Estimation of pulmonary artery pressure from right atrial strain and tricuspid regurgitation velocity. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0773] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/15/2022] Open
Abstract
Abstract
Background
Systolic pulmonary artery pressure (SPAP) can be estimated non-invasively as the sum of indices for right atrial (RA) pressure and tricuspid regurgitation (TR) pressure gradient. Although echocardiographic evaluation of inferior vena cava diameter and collapsibility is currently being used to estimate RA pressure (IVC method), RA strain may be an alternative since atrial strain is related to atrial pressure.
Objective
We tested if RA strain by speckle tracking echocardiography can be used as a surrogate of mean RA pressure (RA strain method), and by adding the TR pressure gradient, be used to estimate SPAP.
Methods
We retrospectively analyzed 91 patients (mean age, 58 years) referred to right heart catheterization due to unexplained dyspnea or suspected pulmonary hypertension. Echocardiography was performed within 24 hours of the invasive procedure. RA reservoir strain was calculated from apical four-chamber view. SPAP was calculated as the sum of peak TR pressure gradient and estimated RA pressure by the IVC or RA strain methods.
Results
Right heart catheterization showed SPAP and mean RA pressures of 51±20 mmHg and 9±6 mmHg, respectively. RA reservoir strain was inversely correlated with mean RA pressure (r=−0.61, p<0.01). Thus, we set mean RA pressure as 5, 10 and 15 mmHg depending on high (≥25%), middle (10–25%) and low (≤10%) values of RA reservoir strain. As shown in the figure, both the RA strain and IVC methods when combined with peak TR velocity, provided good estimates of invasively measured SPAP.
Conclusions
RA strain provides a semiquantitative measure of RA pressure, which can be used in combination with peak TR velocity to estimate SPAP. This approach can be used as an alternative when the IVC method is not available in cases with poor subcostal window.
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Affiliation(s)
- K Inoue
- Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - E W Remme
- Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - F H Khan
- Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - O S Andersen
- Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - E Gude
- Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - H Skulstad
- Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - O A Smiseth
- Oslo University Hospital, Rikshospitalet, Oslo, Norway
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Inoue K, Remme EW, Khan FH, Andersen OS, Gude E, Skulstad H, Smiseth OA. P2452Application of left atrial strain for differentiation between pre- and post-capillary pulmonary hypertension. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/14/2022] Open
Abstract
Abstract
Background
Pulmonary hypertension (PH) is classified as pre- or post-capillary PH, and pulmonary capillary wedge pressure (PCWP) >15 mmHg is used as criterion for post-capillary PH. Elevated left atrial (LA) pressure is associated with reduced LA reservoir strain. Thus, LA strain may potentially serve to differentiate between these diagnoses.
Objectives
This study tested the hypothesis that LA strain can be used as a noninvasive parameter to differentiate between pre- and post-capillary PH.
Methods
We analyzed 103 patients (mean age: 58 years, 51 female) referred to right heart catheterization due to unexplained dyspnea or suspected heart failure. Echocardiography was performed within 24 hours of the invasive procedure. Mean pulmonary artery pressure (PAP) was noninvasively estimated from tricuspid regurgitation (TR) velocity and inferior vena cava (IVC) diameter and collapsibility. LA reservoir strain was calculated from apical four-chamber view by speckle tracking echocardiography, and was feasible in 101 patients.
Results
Twenty-eight patients were invasively confirmed with pre-capillary PH and 43 patients with post-capillary PH. The remaining 32 patients had no PH. LA reservoir strain was significantly lower in patients with post-capillary PH than patients with pre-capillary PH (9.9±5.5% vs. 24.6±8.2%, p<0.01). At a cut-off value of 15.4%, LA reservoir strain could predict elevated PCWP >15 mmHg with AUC=0.88, sensitivity=84.8% and specificity=81.8%. As shown in the figure, echocardiography with LA reservoir strain correctly differentiated 82% of patients into pre- and post-capillary PH.
Conclusions
These results suggest that LA reservoir strain can be used to predict elevated PCWP, thus allowing discrimination between pre- and post-capillary PH.
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Affiliation(s)
- K Inoue
- Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - E W Remme
- Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - F H Khan
- Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - O S Andersen
- Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - E Gude
- Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - H Skulstad
- Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - O A Smiseth
- Oslo University Hospital, Rikshospitalet, Oslo, Norway
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Khan FH, Andersen OS, Gude E, Skulstad H, Smiseth OA, Remme EW. P1480Left atrial strain improves estimation of left ventricular filling pressure. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0245] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/13/2022] Open
Abstract
Abstract
Background
The current algorithm in the 2016 recommendations for echocardiographic estimation of left ventricular filling pressure (LVFP) as normal or elevated, combines traditional indices of mitral inflow velocities, tissue Doppler, left atrial volume and tricuspid regurgitation velocity (Figure A). Some of the patients remain unclassified by this algorithm. Left atrial (LA) strain is a novel index that correlates well with LVFP and may improve estimation of LVFP in these patients.
Purpose
We tested if LA strain can improve estimation of LVFP for the patients that are unclassified by the 2016 algorithm.
Methods
We analyzed data from 100 patients who were referred to right heart catheterization due to unexplained dyspnea or suspected heart failure. Echocardiography was performed simultaneously with or within 24 hours of right heart catheterization. Pulmonary capillary wedge pressure (PCWP) was used as an estimate for LVFP and defined as elevated if above 12 mmHg. Elevated LVFP was first estimated using the 2016 algorithm. In patients who were unclassified by the algorithm due to conflicting indices or unattainable indices, LA strain was subsequently used to detect elevated LVFP using a cut-off found from ROC analysis of the whole cohort.
Results
Six patients were unclassified by the 2016 algorithm. The ROC analysis of all 100 patients showed that at an LA strain cut-off of above or below 16.2%, LVFP was correctly classified as normal or elevated, respectively, with a sensitivity of 83% and specificity of 88%. All 6 unclassified patients by the 2016 algorithm were correctly classified using the LA strain cut-off, effectively increasing the accuracy of the algorithm by 6 percentage points.
Conclusions
LA strain may have a role in non-invasive estimation of LVFP, particularly in patients who remain unclassified when using the conventional echocardiographic indices.
Acknowledgement/Funding
South-Eastern Norway Regional Health Authority
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Affiliation(s)
- F H Khan
- Oslo University Hospital, Institute for Surgical research, Oslo, Norway
| | - O S Andersen
- Oslo University Hospital, Institute for Surgical research, Oslo, Norway
| | - E Gude
- Oslo University Hospital, Department of cardiology, Oslo, Norway
| | - H Skulstad
- Oslo University Hospital, Department of cardiology, Oslo, Norway
| | - O A Smiseth
- Oslo University Hospital, Institute for Surgical research, Oslo, Norway
| | - E W Remme
- Oslo University Hospital, Institute for Surgical research, Oslo, Norway
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Higashi H, Inoue K, Saito M, Kinoshita M, Aono J, Ikeda S, Andersen OS, Gude E, Skulstad H, Remme EW, Smiseth OA, Yamaguchi O. P2458Restricted left atrial motion as a result of atrial stiffening in patients with cardiac amyloidosis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0790] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/12/2022] Open
Abstract
Abstract
Background
Left atrial (LA) involvement of abnormal amyloid fibrils could induce LA dysfunction and stiffening in patients with cardiac amyloidosis (CA). Thus, the assessments of LA function and stiffness might be a potential approach to diagnose CA phenotype among patients with hypertrophied hearts.
Purpose
We sought to determine whether LA reservoir strain with speckle tracking echocardiography could be used a marker of LA stiffness in a derivation cohort. Furthermore, we tested to our hypothesis that LA reservoir strain could differentiate CA patients from hypertrophic cardiomyopathy (HCM) in an independent validation cohort.
Methods
In the derivation cohort, echocardiography was performed simultaneously with measurements of pulmonary capillary wedge pressure (PCWP) in 50 patients with suspected or established heart failure and relatively preserved left ventricular (LV) ejection fraction (56±10%). LA maximum and minimum volume index, and reservoir strain were measured from apical four-chamber view. LA stiffness index was computed as a pressure rise from x-trough to v-wave divided by an increase from minimum to maximum indexed LA volume (Figure A). In an independent validation group, we studied a total of 33 biopsy-proved CA patients and 127 HCM patients (LV ejection fraction: 57±11% vs. 66±10%, P<0.01) in sinus rhythm on the date of comprehensive echocardiographic study. Among them, cardiac magnetic resonance imaging (CMR) could be evaluated in 17 CA patients and 98 HCM patients. Furthermore, right heart catheterization was performed with 12 CA patients and 12 HCM patients in the CMR group.
Results
The derivation cohort study found that there was a significant curvilinear correlation of LA reservoir strain to LA stiffness index (Figure B). In the validation cohort, LA reservoir strain was reduced in patients with CA compared with HCM in all participants (11.6±5.6% vs. 18.5±6.9%, P<0.01), although there was no significant difference of LA maximal volume index between 2 groups (37±16 ml/m2 vs. 37±12 ml/m2, p=0.89). In the CMR group, the late gadolinium enhancement was observed in the LA wall in 16 patients with CA (94.1%) as shown in Figure C. In contrast, the LA enhancement revealed only in 1 patient with HCM (1.0%). Among patients with invasive measures, LA stiffness index [median (interquartile range)] was higher in patients with CA than that in patients with HCM [1.1 (0.4–2.8) vs. 0.2 (0.1–0.6), P=0.01].
Conclusions
LA reservoir function was fairly limited in patients with CA compared with HCM. Restricted LA motion might be related to atrial amyloid deposits or fibrosis, which potentially provokes atrial chamber stiffening.
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Affiliation(s)
- H Higashi
- Ehime University Graduate School of Medicine, Toon, Japan
| | - K Inoue
- Ehime University Graduate School of Medicine, Toon, Japan
| | - M Saito
- Kitaishikai Hospital, Ozu, Japan
| | - M Kinoshita
- Ehime University Graduate School of Medicine, Toon, Japan
| | - J Aono
- Ehime University Graduate School of Medicine, Toon, Japan
| | - S Ikeda
- Ehime University Graduate School of Medicine, Toon, Japan
| | | | - E Gude
- Oslo University Hospital, Oslo, Norway
| | | | - E W Remme
- Oslo University Hospital, Oslo, Norway
| | | | - O Yamaguchi
- Ehime University Graduate School of Medicine, Toon, Japan
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Tennøe AH, Murbræch K, Andreassen JC, Fretheim H, Garen T, Gude E, Andreassen A, Aakhus S, Molberg Ø, Hoffmann-Vold AM. Left Ventricular Diastolic Dysfunction Predicts Mortality in Patients With Systemic Sclerosis. J Am Coll Cardiol 2019; 72:1804-1813. [PMID: 30286924 DOI: 10.1016/j.jacc.2018.07.068] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 07/03/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Primary cardiac affection is common and is a major cause of death in systemic sclerosis (SSc), but there are knowledge gaps regarding the effect of cardiac dysfunction on mortality. OBJECTIVES The purpose of this study was to evaluate diastolic function in a large, unselected SSc cohort and assess the effect of diastolic dysfunction (DD) on mortality. METHODS SSc patients followed prospectively at the Oslo University Hospital from 2003 to 2016 with available echocardiographies and matched control subjects were included. DD was assessed by echocardiography according to the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines. Pulmonary hypertension (PH) was diagnosed by right heart catheterization. Vital status was available for all patients. Cox regression analyses with hazards ratios (HRs) were conducted. RESULTS Diastolic function was assessed in 275 SSc patients at baseline and in 186 patients at follow-up. At baseline, 46 of the 275 SSc patients (17%) were diagnosed with DD and 195 (71%) had normal diastolic function. After a median follow-up of 3.4 years (interquartile range: 1.6 to 6.2 years), the proportion of DD increased from 17% to 29%. During follow-up, 57% of patients with DD at baseline died, compared with 13% of patients with normal diastolic function. At baseline, 86 patients had performed right heart catheterization, and 43 were diagnosed with PH; of these 60% deceased. In multivariable Cox regression analyses, DD was a stronger predictor of death (HR: 3.7; 95% CI: 1.69 to 8.14; c-index 0.89) than PH (HR: 2.0; 95% CI: 1.1 to 3.9; c-index 0.84). CONCLUSIONS DD is frequent in SSc, and the presence of DD is associated with high mortality. DD exceeds PH with respect to predicting mortality.
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Affiliation(s)
- Anders H Tennøe
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Klaus Murbræch
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | | | - Håvard Fretheim
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Torhild Garen
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
| | - Einar Gude
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Arne Andreassen
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Svend Aakhus
- Department of Circulation and Imaging, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Cardiology, St. Olav's Hospital, Trondheim, Norway
| | - Øyvind Molberg
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anna-Maria Hoffmann-Vold
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
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Bendz B, Gude E, Ragnarsson A, Endresen K, Aaberge L, Geiran O, Simonsen S. Intra-aortic balloon pump in acute chest pain and cardiogenic shock - a long-term follow-up. SCAND CARDIOVASC J 2019; 53:337-341. [PMID: 31476881 DOI: 10.1080/14017431.2019.1657938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives. Coronary revascularisation and intra-aortic balloon pump (IABP) has been considered the gold standard treatment of acute coronary syndrome with cardiogenic shock, recently challenged by the SHOCK II study. The aim of this non-randomised study was to investigate the long term prognosis after immediate IABP supported angiography, in patients with acute chest pain and cardiogenic shock, treated with percutaneous coronary intervention (PCI), cardiac surgery or optimal medical treatment. We assessed data from 281 consecutive patients admitted to our department from 2004 to 2010. Results. Mean (±SD) age was 63.8 ± 11.5 (range 30-84) years with a follow-up of 5.6 ± 4.4 (0-12.7) years. Acute myocardial infarction was the primary diagnosis in 93% of the patients, 4% presented with unstable angina pectoris and 3% cardiomyopathy or arrhythmias of non-ischemic aetiology. Systolic blood pressure at admittance was 85 ± 18 mmHg and diastolic 55 ± 18 mmHg. Thirty day, one- and five-year survival was 71.2%, 67.3% and 57.7%, respectively. PCI was performed immediately in 70%, surgery was done in 17%, and 13% were not eligible for any revascularisation. Independent variables predicting mortality were medical treatment vs revascularisation, out-of-hospital cardiac arrest, and advanced age. Three serious non-fatal complications occurred due to IABP treatment, i.e. 0.001 per treatment day. Conclusions. We report the use of IABP in patients with acute chest pain admitted for angiography. Long-term survival is acceptable and discriminating factors were no revascularisation, out-of-hospital cardiac arrest and age. IABP was safe and feasible and the complication rate was low.
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Affiliation(s)
- Bjørn Bendz
- Department of Cardiology.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | | | | | | | - Odd Geiran
- Department of Cardio-Thoracic Surgery, Heart-Lung Clinic, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Arora S, Andreassen AK, Karason K, Gustafsson F, Eiskjær H, Bøtker HE, Rådegran G, Gude E, Ioanes D, Solbu D, Dellgren G, Ueland T, Aukrust P, Gullestad L. Effect of Everolimus Initiation and Calcineurin Inhibitor Elimination on Cardiac Allograft Vasculopathy in De Novo Heart Transplant Recipients. Circ Heart Fail 2019; 11:e004050. [PMID: 30354362 DOI: 10.1161/circheartfailure.117.004050] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Cardiac allograft vasculopathy (CAV) limits survival after heart transplantation, and the effect of different immunosuppressive regimens on CAV is not fully understood. The randomized SCHEDULE trial (Scandinavian Heart Transplant Everolimus De Novo Study With Early Calcineurin Inhibitors Avoidance) evaluated whether initiation of the proliferation signal inhibitor everolimus and early cyclosporine elimination can reduce CAV development. Methods and Results The SCHEDULE trial was a multicenter Scandinavian trial, where 115 de novo heart transplantation recipients were randomized to everolimus with complete cyclosporine withdrawal 7 to 11 weeks after heart transplantation or standard cyclosporine-based immunosuppression. Seventy-six (66%) patients had matched intravascular ultrasound examinations at baseline and 12 and 36 months. Intravascular ultrasound analysis evaluated maximal intimal thickness, percent atheroma volume, and total atheroma volume. Qualitative plaque analysis using virtual histology assessed fibrous, fibrofatty, and calcified tissue as well as necrotic core. Serum inflammatory markers were measured in parallel. The everolimus group (n=37) demonstrated significantly reduced CAV progression as compared with the cyclosporine group (n=39) at 36 months (Δ maximal intimal thickness, 0.09±0.05 versus 0.15±0.16 mm [ P=0.03]; Δ percent atheroma volume, 5.3±2.8% versus 7.6±5.9% [ P=0.03]; and Δ total atheroma volume, 33.9±71.2 versus 54.2±96.0 mm3 [ P=0.34], respectively]. At 36 months the number of everolimus patients with rejection graded ≥2R was 15 (41%) as compared with 5 (13%) in the cyclosporine group ( P=0.01). Everolimus did not affect CAV morphology or immune marker activity during the follow-up period. Conclusions The SCHEDULE trial demonstrates that everolimus initiation and early cyclosporine elimination significantly reduces CAV progression at 12 months, and this beneficial effect is clearly sustained at 36 months. Clinical trial registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT01266148.
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Affiliation(s)
- Satish Arora
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway (S.A., A.K.A., E.G., L.G.).,Center for Heart Failure Research, University of Oslo and Faculty of Medicine, University of Oslo, Norway (S.A.)
| | - Arne K Andreassen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway (S.A., A.K.A., E.G., L.G.)
| | - Kristjan Karason
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (K.K., D.I.)
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (F.G.)
| | - Hans Eiskjær
- Department of Cardiology, Aarhus University Hospital, Denmark (H.E., H.E.B.)
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Denmark (H.E., H.E.B.)
| | - Göran Rådegran
- The Section for Heart Failure and Valvular Disease, VO Heart and Lung Medicine, Skåne University Hospital and Department of Clinical Sciences, Lund University, Sweden (G.R.)
| | - Einar Gude
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway (S.A., A.K.A., E.G., L.G.)
| | - Dan Ioanes
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (K.K., D.I.)
| | - Dag Solbu
- Novartis Norge AS, Oslo, Norway (D.S.)
| | - Göran Dellgren
- Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden (G.D.)
| | - Thor Ueland
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Norway (T.U., P.A.).,K.G. Jebsen Inflammatory Research Center, Faculty of Medicine, University of Oslo, Norway (T.U., P.A.).,K. G. Jebsen Thrombosis Research and Expertise Center, University of Tromsø, Norway (T.U., P.A.).,Faculty of Medicine, University of Oslo, Norway (T.U., P.A., L.G.)
| | - Pål Aukrust
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Norway (T.U., P.A.).,Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Rikshospitalet, Norway (P.A.).,K.G. Jebsen Inflammatory Research Center, Faculty of Medicine, University of Oslo, Norway (T.U., P.A.).,K. G. Jebsen Thrombosis Research and Expertise Center, University of Tromsø, Norway (T.U., P.A.).,Faculty of Medicine, University of Oslo, Norway (T.U., P.A., L.G.)
| | - Lars Gullestad
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway (S.A., A.K.A., E.G., L.G.).,Faculty of Medicine, University of Oslo, Norway (T.U., P.A., L.G.)
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Trøseid M, Mayerhofer CCK, Broch K, Arora S, Svardal A, Hov JR, Andreassen AK, Gude E, Karason K, Dellgren G, Berge RK, Gullestad L, Aukrust P, Ueland T. The carnitine-butyrobetaine-TMAO pathway after cardiac transplant: Impact on cardiac allograft vasculopathy and acute rejection. J Heart Lung Transplant 2019; 38:1097-1103. [PMID: 31301965 DOI: 10.1016/j.healun.2019.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 05/06/2019] [Accepted: 06/16/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Alterations in the partly microbiota-dependent carnitine-γ-butyrobetaine (γBB)-trimethylamine N-oxide (TMAO) pathway have been linked to the progression of heart failure and atherosclerotic disease. We evaluated if circulating γBB, TMAO, and their common precursors carnitine and trimethyllysine (TML) were dysregulated after heart transplantation and associated with development of cardiac allograft vasculopathy (CAV) and acute rejection. METHODS We measured these metabolites in plasma from heart transplant recipients with everolimus-based (n = 32) and standard cyclosporine-based immunosuppression (n = 30) at different time-points and accompanied by assessment of CAV by intravascular ultrasound. RESULTS Baseline levels of carnitine, TMAO, and TML were elevated in heart transplant recipients compared with controls, and TML remained elevated throughout the observation period. The microbiota-dependent metabolite γBB increased steadily during 3 years of follow-up, with a similar decrease in its endogenous precursor TML. The increase in γBB and the change in TML were associated with a change in total atheroma volume from baseline to 3 years. Increases in γBB and carnitine levels from baseline to 1 year were associated with an increased frequency of acute rejection within the first year after heart transplant. CONCLUSIONS Our study reveals alterations of the carnitine-γBB-TMAO pathway after heart transplant, with increasing levels of γBB being associated with acute rejection and increase in total atheroma volume during 3 years of follow-up. Future studies should clarify whether interactions between dietary factors, immunosuppressive drugs, and the gut microbiota could influence acute rejection and CAV development to delineate mechanisms and potential novel treatment targets.
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Affiliation(s)
- Marius Trøseid
- Research Institute of Internal Medicine; Section of Clinical Immunology and Infectious Diseases; Norwegian PSC Research Center and Section of Gastroenterology, Oslo University Hospital Rikshospitalet, Oslo, Norway; K.G. Jebsen Inflammation Research Centre, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Cristiane C K Mayerhofer
- Research Institute of Internal Medicine; K.G. Jebsen Inflammation Research Centre, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kaspar Broch
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Satish Arora
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Asbjørn Svardal
- Department of Clinical Sciences, University of Bergen, Bergen, Norway
| | - Johannes R Hov
- Research Institute of Internal Medicine; Norwegian PSC Research Center and Section of Gastroenterology, Oslo University Hospital Rikshospitalet, Oslo, Norway; K.G. Jebsen Inflammation Research Centre, Faculty of Medicine, University of Oslo, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Arne K Andreassen
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Einar Gude
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Kristjan Karason
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gøran Dellgren
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Rolf K Berge
- Department of Clinical Sciences, University of Bergen, Bergen, Norway; Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Lars Gullestad
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Pål Aukrust
- Research Institute of Internal Medicine; Section of Clinical Immunology and Infectious Diseases; K.G. Jebsen Inflammation Research Centre, Faculty of Medicine, University of Oslo, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; K.G. Jebsen Thrombosis Research and Expertise Centre, University of Tromsø, Tromsø, Norway
| | - Thor Ueland
- Research Institute of Internal Medicine; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; K.G. Jebsen Thrombosis Research and Expertise Centre, University of Tromsø, Tromsø, Norway
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Tennøe AH, Murbræch K, Andreassen JC, Fretheim H, Midtvedt Ø, Garen T, Dalen H, Gude E, Andreassen A, Aakhus S, Molberg Ø, Hoffmann-Vold AM. Systolic Dysfunction in Systemic Sclerosis: Prevalence and Prognostic Implications. ACR Open Rheumatol 2019; 1:258-266. [PMID: 31777802 PMCID: PMC6857986 DOI: 10.1002/acr2.1037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Objective Primary cardiac involvement is presumed to account for a substantial part of disease-related mortality in systemic sclerosis (SSc). Still, there are knowledge gaps on the evolution and total burden of systolic dysfunction in SSc. Here we evaluated prospective left ventricular (LV) and right ventricular (RV) systolic function in an unselected SSc cohort and assessed the burden of systolic dysfunction on mortality. Methods From the Oslo University Hospital cohort, 277 SSc patients were included from 2003-2016 and compared with healthy controls. Serial echocardiographies were reevaluated in order to detect change in systolic function. Right heart catheterization was performed on patients suspected of pulmonary hypertension. Descriptive and regression analyses were conducted. Results At baseline, LV systolic dysfunction by ejection fraction less than 50%, or a global longitudinal strain greater than -17.0%, was found in 12% and 24%, respectively. RV systolic dysfunction measured by tricuspid annular plane systolic excursion (TAPSE) less than 17 mm was evident in 10%. Follow-up echocardiography was performed after a median of 3.3 years (interquartile range [IQR] 1.5-5.6). At follow-up, LV systolic function remained stable, whereas RV function evaluated by TAPSE deteriorated (mean 23.1 to 21.7 mm, P = 0.005) equaling a 15% prevalence of RV systolic dysfunction. RV systolic function predicted mortality in multivariable models (hazard ratio 0.41, 95% confidence interval [CI] 0.19-0.90, P value 0.027), whereas LV systolic function lost predictive significance when adjusted for TAPSE. Conclusion In this unselected and prospective study, systolic dysfunction of the LV and RV was a frequent complication of SSc. LV systolic function remained stable across the observation period, whereas RV function deteriorated and predicted mortality.
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Affiliation(s)
- Anders H Tennøe
- Oslo University Hospital, Oslo, Norway and University of Oslo Oslo Norway
| | | | | | - Håvard Fretheim
- Oslo University Hospital, Oslo, Norway and University of Oslo Oslo Norway
| | | | | | - Håvard Dalen
- Norwegian University of Science and Technology, Trondheim, Norway and Clinic of Cardiology, St. Olav's Hospital, Trondheim, Norway, and Levanger Hospital, Nord-Trøndelag Hospital Trust Levanger Norway
| | | | | | - Svend Aakhus
- Norwegian University of Science and Technology, Trondheim, Norway and Clinic of Cardiology, St. Olav's Hospital Trondheim Norway
| | - Øyvind Molberg
- Oslo University Hospital, Oslo, Norway and University of Oslo Oslo Norway
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