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Hassager C, Schmidt H, Møller JE, Grand J, Mølstrøm S, Beske RP, Boesgaard S, Borregaard B, Bekker-Jensen D, Dahl JS, Frydland MS, Høfsten DE, Isse YA, Josiassen J, Lind Jørgensen VR, Kondziella D, Lindholm MG, Moser E, Nyholm BC, Obling LER, Sarkisian L, Søndergaard FT, Thomsen JH, Thune JJ, Venø S, Wiberg SC, Winther-Jensen M, Meyer MAS, Kjaergaard J. Duration of Device-Based Fever Prevention after Cardiac Arrest. N Engl J Med 2023; 388:888-897. [PMID: 36342119 DOI: 10.1056/nejmoa2212528] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Guidelines recommend active fever prevention for 72 hours after cardiac arrest. Data from randomized clinical trials of this intervention have been lacking. METHODS We randomly assigned comatose patients who had been resuscitated after an out-of-hospital cardiac arrest of presumed cardiac cause to device-based temperature control targeting 36°C for 24 hours followed by targeting of 37°C for either 12 or 48 hours (for total intervention times of 36 and 72 hours, respectively) or until the patient regained consciousness. The primary outcome was a composite of death from any cause or hospital discharge with a Cerebral Performance Category of 3 or 4 (range, 1 to 5, with higher scores indicating more severe disability; a category of 3 or 4 indicates severe cerebral disability or coma) within 90 days after randomization. Secondary outcomes included death from any cause and the Montreal Cognitive Assessment score (range, 0 to 30, with higher scores indicating better cognitive ability) at 3 months. RESULTS A total of 393 patients were randomly assigned to temperature control for 36 hours, and 396 patients were assigned to temperature control for 72 hours. At 90 days after randomization, a primary end-point event had occurred in 127 of 393 patients (32.3%) in the 36-hour group and in 133 of 396 patients (33.6%) in the 72-hour group (hazard ratio, 0.99; 95% confidence interval, 0.77 to 1.26; P = 0.70) and mortality was 29.5% in the 36-hour group and 30.3% in the 72-hour group. At 3 months, the median Montreal Cognitive Assessment score was 26 (interquartile range, 24 to 29) and 27 (interquartile range, 24 to 28), respectively. There was no significant between-group difference in the incidence of adverse events. CONCLUSIONS Active device-based fever prevention for 36 or 72 hours after cardiac arrest did not result in significantly different percentages of patients dying or having severe disability or coma. (Funded by the Novo Nordisk Foundation; BOX ClinicalTrials.gov number, NCT03141099.).
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Affiliation(s)
- Christian Hassager
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Henrik Schmidt
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Jacob E Møller
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Johannes Grand
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Simon Mølstrøm
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Rasmus P Beske
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Søren Boesgaard
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Britt Borregaard
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Ditte Bekker-Jensen
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Jordi S Dahl
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Martin S Frydland
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Dan E Høfsten
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Yusuf A Isse
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Jakob Josiassen
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Vibeke R Lind Jørgensen
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Daniel Kondziella
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Matias G Lindholm
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Emil Moser
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Benjamin C Nyholm
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Laust E R Obling
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Laura Sarkisian
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Frederik T Søndergaard
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Jakob H Thomsen
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Jens J Thune
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Søren Venø
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Sebastian C Wiberg
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Matilde Winther-Jensen
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Martin A S Meyer
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Jesper Kjaergaard
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
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Vissing CR, Espersen K, Mills HL, Bartels ED, Jurlander R, Skriver SV, Ghouse J, Thune JJ, Axelsson Raja A, Christensen AH, Bundgaard H. Family Screening in Dilated Cardiomyopathy: Prevalence, Incidence, and Potential for Limiting Follow-Up. JACC Heart Fail 2022; 10:792-803. [PMID: 36328645 DOI: 10.1016/j.jchf.2022.07.009] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/04/2022] [Accepted: 07/06/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND According to patterns of inheritance and incomplete penetrance, fewer than half of relatives to dilated cardiomyopathy probands will develop disease. OBJECTIVES The purpose of this study was to investigate the prevalence and incidence, and to identify predictors of developing familial dilated cardiomyopathy (FDC) in relatives participating in family screening. METHODS The study was a retrospective, longitudinal cohort study of families screened and followed from 2006 to 2020 at a regional assembly of clinics for inherited cardiomyopathies. RESULTS In total, 211 families (563 relatives, 50% women) were included. At baseline, 124 relatives (22%) were diagnosed with FDC. Genetic sequencing identified the etiology in 37% of screened families and classified 101 (18%) relatives as unaffected carriers (n = 43) or noncarriers (ie, not at risk of FDC [n = 58]). The combined clinical and genetic baseline yield was 30%. During follow-up (2,313 person-years, median 5.0 years), 45 developed FDC (incidence rate of 2.0% per person-year; 95% CI: 1.4%-2.8%), increasing the overall yield to 34%. The incidence rate of FDC was high in relatives with baseline abnormalities on electrocardiogram or echocardiography compared with relatives with normal findings (4.7% vs 0.4% per person-year; HR: 12.9; P < 0.001). In total, baseline screening identified 326 (58%) relatives to be at low risk of FDC. CONCLUSIONS Family screening identified a genetic predisposition to or overt FDC in 1 of 3 relatives at baseline. Genetic and clinical screening was normal in more than half of relatives, and these relatives had a low risk of developing FDC during follow-up. Thus, baseline screening identified a large proportion, in whom follow-up may safely be reduced, allowing focused follow-up of relatives at risk.
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Affiliation(s)
- Christoffer R Vissing
- The Capital Region's Unit for Inherited Cardiac Diseases, Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Kiri Espersen
- The Capital Region's Unit for Inherited Cardiac Diseases, Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Helen L Mills
- The Capital Region's Unit for Inherited Cardiac Diseases, Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Emil D Bartels
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Rebecca Jurlander
- The Capital Region's Unit for Inherited Cardiac Diseases, Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sofie V Skriver
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Copenhagen Neuromuscular Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jonas Ghouse
- The Capital Region's Unit for Inherited Cardiac Diseases, Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jens J Thune
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anna Axelsson Raja
- The Capital Region's Unit for Inherited Cardiac Diseases, Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Alex H Christensen
- The Capital Region's Unit for Inherited Cardiac Diseases, Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henning Bundgaard
- The Capital Region's Unit for Inherited Cardiac Diseases, Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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3
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Schmidt H, Kjaergaard J, Hassager C, Mølstrøm S, Grand J, Borregaard B, Roelsgaard Obling LE, Venø S, Sarkisian L, Mamaev D, Jensen LO, Nyholm B, Høfsten DE, Josiassen J, Thomsen JH, Thune JJ, Lindholm MG, Stengaard Meyer MA, Winther-Jensen M, Sørensen M, Frydland M, Beske RP, Frikke-Schmidt R, Wiberg S, Boesgaard S, Lind Jørgensen V, Møller JE. Oxygen Targets in Comatose Survivors of Cardiac Arrest. N Engl J Med 2022; 387:1467-1476. [PMID: 36027567 DOI: 10.1056/nejmoa2208686] [Citation(s) in RCA: 77] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The appropriate oxygenation target for mechanical ventilation in comatose survivors of out-of-hospital cardiac arrest is unknown. METHODS In this randomized trial with a 2-by-2 factorial design, we randomly assigned comatose adults with out-of-hospital cardiac arrest in a 1:1 ratio to either a restrictive oxygen target of a partial pressure of arterial oxygen (Pao2) of 9 to 10 kPa (68 to 75 mm Hg) or a liberal oxygen target of a Pao2 of 13 to 14 kPa (98 to 105 mm Hg); patients were also assigned to one of two blood-pressure targets (reported separately). The primary outcome was a composite of death from any cause or hospital discharge with severe disability or coma (Cerebral Performance Category [CPC] of 3 or 4; categories range from 1 to 5, with higher values indicating more severe disability), whichever occurred first within 90 days after randomization. Secondary outcomes were neuron-specific enolase levels at 48 hours, death from any cause, the score on the Montreal Cognitive Assessment (ranging from 0 to 30, with higher scores indicating better cognitive ability), the score on the modified Rankin scale (ranging from 0 to 6, with higher scores indicating greater disability), and the CPC at 90 days. RESULTS A total of 789 patients underwent randomization. A primary-outcome event occurred in 126 of 394 patients (32.0%) in the restrictive-target group and in 134 of 395 patients (33.9%) in the liberal-target group (hazard ratio, 0.95; 95% confidence interval, 0.75 to 1.21; P = 0.69). At 90 days, death had occurred in 113 patients (28.7%) in the restrictive-target group and in 123 (31.1%) in the liberal-target group. On the CPC, the median category was 1 in the two groups; on the modified Rankin scale, the median score was 2 in the restrictive-target group and 1 in the liberal-target group; and on the Montreal Cognitive Assessment, the median score was 27 in the two groups. At 48 hours, the median neuron-specific enolase level was 17 μg per liter in the restrictive-target group and 18 μg per liter in the liberal-target group. The incidence of adverse events was similar in the two groups. CONCLUSIONS Targeting of a restrictive or liberal oxygenation strategy in comatose patients after resuscitation for cardiac arrest resulted in a similar incidence of death or severe disability or coma. (Funded by the Novo Nordisk Foundation; BOX ClinicalTrials.gov number, NCT03141099.).
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Affiliation(s)
- Henrik Schmidt
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Jesper Kjaergaard
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Christian Hassager
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Simon Mølstrøm
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Johannes Grand
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Britt Borregaard
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Laust E Roelsgaard Obling
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Søren Venø
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Laura Sarkisian
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Dmitry Mamaev
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Lisette O Jensen
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Benjamin Nyholm
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Dan E Høfsten
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Jakob Josiassen
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Jakob H Thomsen
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Jens J Thune
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Matias G Lindholm
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Martin A Stengaard Meyer
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Matilde Winther-Jensen
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Marc Sørensen
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Martin Frydland
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Rasmus P Beske
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Ruth Frikke-Schmidt
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Sebastian Wiberg
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Søren Boesgaard
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Vibeke Lind Jørgensen
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Jacob E Møller
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
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Kjaergaard J, Møller JE, Schmidt H, Grand J, Mølstrøm S, Borregaard B, Venø S, Sarkisian L, Mamaev D, Jensen LO, Nyholm B, Høfsten DE, Josiassen J, Thomsen JH, Thune JJ, Obling LER, Lindholm MG, Frydland M, Meyer MAS, Winther-Jensen M, Beske RP, Frikke-Schmidt R, Wiberg S, Boesgaard S, Madsen SA, Jørgensen VL, Hassager C. Blood-Pressure Targets in Comatose Survivors of Cardiac Arrest. N Engl J Med 2022; 387:1456-1466. [PMID: 36027564 DOI: 10.1056/nejmoa2208687] [Citation(s) in RCA: 77] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Evidence to support the choice of blood-pressure targets for the treatment of comatose survivors of out-of-hospital cardiac arrest who are receiving intensive care is limited. METHODS In a double-blind, randomized trial with a 2-by-2 factorial design, we evaluated a mean arterial blood-pressure target of 63 mm Hg as compared with 77 mm Hg in comatose adults who had been resuscitated after an out-of-hospital cardiac arrest of presumed cardiac cause; patients were also assigned to one of two oxygen targets (reported separately). The primary outcome was a composite of death from any cause or hospital discharge with a Cerebral Performance Category (CPC) of 3 or 4 within 90 days (range, 0 to 5, with higher categories indicating more severe disability; a category of 3 or 4 indicates severe disability or coma). Secondary outcomes included neuron-specific enolase levels at 48 hours, death from any cause, scores on the Montreal Cognitive Assessment (range, 0 to 30, with higher scores indicating better cognitive ability) and the modified Rankin scale (range, 0 to 6, with higher scores indicating greater disability) at 3 months, and the CPC at 3 months. RESULTS A total of 789 patients were included in the analysis (393 in the high-target group and 396 in the low-target group). A primary-outcome event occurred in 133 patients (34%) in the high-target group and in 127 patients (32%) in the low-target group (hazard ratio, 1.08; 95% confidence interval [CI], 0.84 to 1.37; P = 0.56). At 90 days, 122 patients (31%) in the high-target group and 114 patients (29%) in the low-target group had died (hazard ratio, 1.13; 95% CI, 0.88 to 1.46). The median CPC was 1 (interquartile range, 1 to 5) in both the high-target group and the low-target group; the corresponding median modified Rankin scale scores were 1 (interquartile range, 0 to 6) and 1 (interquartile range, 0 to 6), and the corresponding median Montreal Cognitive Assessment scores were 27 (interquartile range, 24 to 29) and 26 (interquartile range, 24 to 29). The median neuron-specific enolase level at 48 hours was also similar in the two groups. The percentages of patients with adverse events did not differ significantly between the groups. CONCLUSIONS Targeting a mean arterial blood pressure of 77 mm Hg or 63 mm Hg in patients who had been resuscitated from cardiac arrest did not result in significantly different percentages of patients dying or having severe disability or coma. (Funded by the Novo Nordisk Foundation; BOX ClinicalTrials.gov number, NCT03141099.).
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Affiliation(s)
- Jesper Kjaergaard
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Jacob E Møller
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Henrik Schmidt
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Johannes Grand
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Simon Mølstrøm
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Britt Borregaard
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Søren Venø
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Laura Sarkisian
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Dmitry Mamaev
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Lisette O Jensen
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Benjamin Nyholm
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Dan E Høfsten
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Jakob Josiassen
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Jakob H Thomsen
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Jens J Thune
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Laust E R Obling
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Matias G Lindholm
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Martin Frydland
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Martin A S Meyer
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Matilde Winther-Jensen
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Rasmus P Beske
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Ruth Frikke-Schmidt
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Sebastian Wiberg
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Søren Boesgaard
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Søren A Madsen
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Vibeke L Jørgensen
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Christian Hassager
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
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Vissing CR, Espersen K, Mills HL, Bartels ED, Jurlander R, Skriver SV, Ghouse J, Thune JJ, Axelsson Raja A, Christensen AH, Bundgaard H. Family screening in dilated cardiomyopathy-qualifying screening and need for follow-up. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1683] [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
Background
Guidelines recommend family screening in dilated cardiomyopathy to uncover pre-symptomatic disease to improve morbidity and mortality through early treatment. According to patterns of inheritance and incomplete penetrance, less than half of relatives to dilated cardiomyopathy probands will develop disease, but so far, no guidelines provide recommendations on the frequency and intensity of follow-up screening.
Purpose
To investigate the prevalence and incidence and identify predictors of developing familial dilated cardiomyopathy (FDC) in relatives participating in family screening.
Methods
The study was an observational, longitudinal cohort study of families screened and followed from 2006 to 2020, at a regional assembly of clinics for inherited cardiomyopathies in Denmark.
Results
We included 211 families totaling 774 subjects (n=563 relatives, 47% women). At baseline, 124 relatives (22%) were diagnosed with dilated cardiomyopathy, while 43 relatives (8%) not fulfilling FDC criteria were found to carry class IV to V genetic variants. Thus, the combined clinical and genetic yield of screening was 30% at baseline. Relatives not fulfilling diagnostic criteria for FDC at baseline (n=439), were stratified into four groups based on results from genetic screening and clinical work-up at baseline (Figure 1). The risk of developing FDC during follow-up was strongly associated with this classification (see figure 1 and 2). The highest risk of developing FDC was observed in relatives carrying class IV to V genetic variants (n=43, age-adjusted incidence rate of 10% per person-year), while none of the subjects identified as non-carriers of family variants developed disease (n=58). In subjects sub-grouped according to baseline-findings on ECG and echocardiography, relatives with abnormal (n=70) vs normal (n=268) findings had markedly higher incidence rates of FDC (overall 4.7% vs 0.4% per person-year), regardless of age-group (Figures 1 and 2). The relatives with abnormal ECG and/or echocardiographic findings at baseline had a (age-group-adjusted) hazard ratio of 12.9 (CI: 4.8 to 35.1, p<0.001), when compared to relatives with normal findings.
Conclusion
Family screening identified a genetic predisposition to or overt FDC in 30% of screened relatives at baseline. In relatives not fulfilling criteria for FDC at baseline, findings from genetic testing and/or non-diagnostic findings on echocardiography and/or ECG were strongly associated with progression to disease. Importantly, relatives with normal genetic or objective findings had a low incidence rate and overall risk of developing FDC. Thus, baseline-screening identified a large proportion of relatives, in whom follow-up can be considered to be reduced allowing focused follow-up of relatives at higher risk of progression.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C R Vissing
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - K Espersen
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - H L Mills
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - E D Bartels
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - R Jurlander
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - S V Skriver
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - J Ghouse
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - J J Thune
- Bispebjerg University Hospital , Copenhagen , Denmark
| | - A Axelsson Raja
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | | | - H Bundgaard
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
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Yafasova A, Butt JH, Nielsen JC, Haarbo J, Eiskjaer H, Brandes A, Thoegersen AM, Gustafsson F, Hassager C, Svendsen JH, Hoefsten DE, Torp-Pedersen C, Pehrson S, Thune JJ, Koeber L. Cardiac resynchronisation therapy and implantable cardioverter-defibrillator in non-ischaemic systolic heart failure: extended follow-up of the DANISH trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.841] [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
In the Danish Study to Assess the Efficacy of Implantable Cardioverter-Defibrillators [ICDs] in Patients with Non-ischaemic Systolic Heart Failure on Mortality (DANISH) trial, ICD implantation did not provide an overall survival benefit in patients with non-ischaemic systolic heart failure. A high proportion of patients in the DANISH trial received a cardiac resynchronisation therapy (CRT) device, which improves the prognosis in patients with heart failure. Therefore, it is of interest to examine whether the effect of ICD implantation in patients with non-ischaemic systolic heart failure is modified by CRT.
Purpose
Adding 4 years of additional follow-up to the DANISH trial, we examined the effect of ICD implantation according to status with respect to CRT implantation at baseline.
Methods
In the DANISH trial, 556 patients with non-ischaemic systolic heart failure were randomised to receive an ICD and 560 to receive usual clinical care (control). Patients fulfilling indications for a CRT device received a CRT-defibrillator (if randomised to ICD arm) or CRT-pacemaker (if randomised to control arm). In the ICD group, 322 patients (57.9%) received a CRT device; in the control group, 323 patients (57.7%) received a CRT device. In this extended follow-up study, patients were followed until May 18, 2020. The primary outcome was death from any cause; secondary outcomes were cardiovascular death and sudden cardiovascular death.
Results
During a median follow-up of 9.5 years, the ICD group did not have significantly lower all-cause mortality compared with the control group (hazard ratio [HR] 0.89 [95% CI, 0.74–1.08]). The results were independent of whether the patient received a CRT device at randomisation (patients with a CRT device: HR 0.92 [95% CI, 0.72–1.18]; patients without a CRT device: HR 0.86 [95% CI, 0.64–1.14]; P for interaction, 0.72). Similarly, ICD implantation did not reduce rates of cardiovascular death overall (HR 0.87 [95% CI, 0.70–1.09]), and this association was not modified by CRT (patients with a CRT device: HR 0.89 [95% CI, 0.66–1.19]; patients without a CRT device: HR 0.85 [95% CI, 0.60–1.20]; P for interaction, 0.86). The ICD group had significantly lower rates of sudden cardiovascular death in the overall population (HR, 0.60 [95% CI, 0.40–0.92]), and this association was not modified by CRT (patients with a CRT device: HR 0.69 [95% CI, 0.40–1.21]; patients without a CRT device: HR 0.51 [95% CI, 0.26–0.97]; P for interaction, 0.47). See Figure 1 for all results.
Conclusions
In this extended follow-up study of the DANISH trial, the effect of ICD implantation in patients with non-ischaemic systolic heart failure was not modified by CRT.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The DANISH trial was supported by unrestricted grants from Medtronic, St Jude Medical, Tryg Fonden, and the Danish Heart Foundation. No further funding was obtained for this follow-up study.
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Affiliation(s)
- A Yafasova
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - J H Butt
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - J C Nielsen
- Aarhus University Hospital , Aarhus , Denmark
| | - J Haarbo
- Herlev Hospital , Herlev , Denmark
| | - H Eiskjaer
- Aarhus University Hospital , Aarhus , Denmark
| | - A Brandes
- Odense University Hospital , Odense , Denmark
| | | | - F Gustafsson
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - C Hassager
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - J H Svendsen
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - D E Hoefsten
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | | | - S Pehrson
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - J J Thune
- Bispebjerg and Frederiksberg Hospital , Frederiksberg , Denmark
| | - L Koeber
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
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7
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Lopes LR, Losi MA, Sheikh N, Laroche C, Charron P, Gimeno J, Kaski JP, Maggioni AP, Tavazzi L, Arbustini E, Brito D, Celutkiene J, Hagege A, Linhart A, Mogensen J, Garcia-Pinilla JM, Ripoll-Vera T, Seggewiss H, Villacorta E, Caforio A, Elliott PM, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Erlinge D, Emberson J, Glikson M, Gray A, Kayikcioglu M, Maggioni A, Nagy KV, Nedoshivin A, Petronio AS, Hesselink JR, Wallentin L, Zeymer U, Caforio A, Blanes JRG, Charron P, Elliott P, Kaski JP, Maggioni AP, Tavazzi L, Tendera M, Komissarova S, Chakova N, Niyazova S, Linhart A, Kuchynka P, Palecek T, Podzimkova J, Fikrle M, Nemecek E, Bundgaard H, Tfelt-Hansen J, Theilade J, Thune JJ, Axelsson A, Mogensen J, Henriksen F, Hey T, Nielsen SK, Videbaek L, Andreasen S, Arnsted H, Saad A, Ali M, Lommi J, Helio T, Nieminen MS, Dubourg O, Mansencal N, Arslan M, Tsieu VS, Damy T, Guellich A, Guendouz S, Tissot CM, Lamine A, Rappeneau S, Hagege A, Desnos M, Bachet A, Hamzaoui M, Charron P, Isnard R, Legrand L, Maupain C, Gandjbakhch E, Kerneis M, Pruny JF, Bauer A, Pfeiffer B, Felix SB, Dorr M, Kaczmarek S, Lehnert K, Pedersen AL, Beug D, Bruder M, Böhm M, Kindermann I, Linicus Y, Werner C, Neurath B, Schild-Ungerbuehler M, Seggewiss H, Pfeiffer B, Neugebauer A, McKeown P, Muir A, McOsker J, Jardine T, Divine G, Elliott P, Lorenzini M, Watkinson O, Wicks E, Iqbal H, Mohiddin S, O'Mahony C, Sekri N, Carr-White G, Bueser T, Rajani R, Clack L, Damm J, Jones S, Sanchez-Vidal R, Smith M, Walters T, Wilson K, Rosmini S, Anastasakis A, Ritsatos K, Vlagkouli V, Forster T, Sepp R, Borbas J, Nagy V, Tringer A, Kakonyi K, Szabo LA, Maleki M, Bezanjani FN, Amin A, Naderi N, Parsaee M, Taghavi S, Ghadrdoost B, Jafari S, Khoshavi M, Rapezzi C, Biagini E, Corsini A, Gagliardi C, Graziosi M, Longhi S, Milandri A, Ragni L, Palmieri S, Olivotto I, Arretini A, Castelli G, Cecchi F, Fornaro A, Tomberli B, Spirito P, Devoto E, Bella PD, Maccabelli G, Sala S, Guarracini F, Peretto G, Russo MG, Calabro R, Pacileo G, Limongelli G, Masarone D, Pazzanese V, Rea A, Rubino M, Tramonte S, Valente F, Caiazza M, Cirillo A, Del Giorno G, Esposito A, Gravino R, Marrazzo T, Trimarco B, Losi MA, Di Nardo C, Giamundo A, Musella F, Pacelli F, Scatteia A, Canciello G, Caforio A, Iliceto S, Calore C, Leoni L, Marra MP, Rigato I, Tarantini G, Schiavo A, Testolina M, Arbustini E, Di Toro A, Giuliani LP, Serio A, Fedele F, Frustaci A, Alfarano M, Chimenti C, Drago F, Baban A, Calò L, Lanzillo C, Martino A, Uguccioni M, Zachara E, Halasz G, Re F, Sinagra G, Carriere C, Merlo M, Ramani F, Kavoliuniene A, Krivickiene A, Tamuleviciute-Prasciene E, Viezelis M, Celutkiene J, Balkeviciene L, Laukyte M, Paleviciute E, Pinto Y, Wilde A, Asselbergs FW, Sammani A, Van Der Heijden J, Van Laake L, De Jonge N, Hassink R, Kirkels JH, Ajuluchukwu J, Olusegun-Joseph A, Ekure E, Mizia-Stec K, Tendera M, Czekaj A, Sikora-Puz A, Skoczynska A, Wybraniec M, Rubis P, Dziewiecka E, Wisniowska-Smialek S, Bilinska Z, Chmielewski P, Foss-Nieradko B, Michalak E, Stepien-Wojno M, Mazek B, Lopes LR, Almeida AR, Cruz I, Gomes AC, Pereira AR, Brito D, Madeira H, Francisco AR, Menezes M, Moldovan O, Guimaraes TO, Silva D, Ginghina C, Jurcut R, Mursa A, Popescu BA, Apetrei E, Militaru S, Coman IM, Frigy A, Fogarasi Z, Kocsis I, Szabo IA, Fehervari L, Nikitin I, Resnik E, Komissarova M, Lazarev V, Shebzukhova M, Ustyuzhanin D, Blagova O, Alieva I, Kulikova V, Lutokhina Y, Pavlenko E, Varionchik N, Ristic AD, Seferovic PM, Veljic I, Zivkovic I, Milinkovic I, Pavlovic A, Radovanovic G, Simeunovic D, Zdravkovic M, Aleksic M, Djokic J, Hinic S, Klasnja S, Mircetic K, Monserrat L, Fernandez X, Garcia-Giustiniani D, Larrañaga JM, Ortiz-Genga M, Barriales-Villa R, Martinez-Veira C, Veira E, Cequier A, Salazar-Mendiguchia J, Manito N, Gonzalez J, Fernández-Avilés F, Medrano C, Yotti R, Cuenca S, Espinosa MA, Mendez I, Zatarain E, Alvarez R, Pavia PG, Briceno A, Cobo-Marcos M, Dominguez F, Galvan EDT, Pinilla JMG, Abdeselam-Mohamed N, Lopez-Garrido MA, Hidalgo LM, Ortega-Jimenez MV, Mezcua AR, Guijarro-Contreras A, Gomez-Garcia D, Robles-Mezcua M, Blanes JRG, Castro FJ, Esparza CM, Molina MS, García MS, Cuenca DL, de Mallorca P, Ripoll-Vera T, Alvarez J, Nunez J, Gomez Y, Fernandez PLS, Villacorta E, Avila C, Bravo L, Diaz-Pelaez E, Gallego-Delgado M, Garcia-Cuenllas L, Plata B, Lopez-Haldon JE, Pena Pena ML, Perez EMC, Zorio E, Arnau MA, Sanz J, Marques-Sule E. Association between common cardiovascular risk factors and clinical phenotype in patients with hypertrophic cardiomyopathy from the European Society of Cardiology (ESC) EurObservational Research Programme (EORP) Cardiomyopathy/Myocarditis registry. Eur Heart J Qual Care Clin Outcomes 2022; 9:42-53. [PMID: 35138368 PMCID: PMC9745665 DOI: 10.1093/ehjqcco/qcac006] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 12/15/2022]
Abstract
AIMS The interaction between common cardiovascular risk factors (CVRF) and hypertrophic cardiomyopathy (HCM) is poorly studied. We sought to explore the relation between CVRF and the clinical characteristics of patients with HCM enrolled in the EURObservational Research Programme (EORP) Cardiomyopathy registry. METHODS AND RESULTS 1739 patients with HCM were studied. The relation between hypertension (HT), diabetes (DM), body mass index (BMI), and clinical traits was analysed. Analyses were stratified according to the presence or absence of a pathogenic variant in a sarcomere gene. The prevalence of HT, DM, and obesity (Ob) was 37, 10, and 21%, respectively. HT, DM, and Ob were associated with older age (P<0.001), less family history of HCM (HT and DM P<0.001), higher New York Heart Association (NYHA) class (P<0.001), atrial fibrillation (HT and DM P<0.001; Ob p = 0.03) and LV (left ventricular) diastolic dysfunction (HT and Ob P<0.001; DM P = 0.003). Stroke was more frequent in HT (P<0.001) and mutation-positive patients with DM (P = 0.02). HT and Ob were associated with higher provocable LV outflow tract gradients (HT P<0.001, Ob P = 0.036). LV hypertrophy was more severe in Ob (P = 0.018). HT and Ob were independently associated with NYHA class (OR 1.419, P = 0.017 and OR 1.584, P = 0.004, respectively). Other associations, including a higher proportion of females in HT and of systolic dysfunction in HT and Ob, were observed only in mutation-positive patients. CONCLUSION Common CVRF are associated with a more severe HCM phenotype, suggesting a proactive management of CVRF should be promoted. An interaction between genotype and CVRF was observed for some traits.
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Affiliation(s)
- Luis R Lopes
- Corresponding author. Tel: +447765109343, , Twitter handle: @LuisRLopesDr
| | - Maria-Angela Losi
- Department of Advanced Biomedical Sciences, University Federico II, Corso Umberto I, 40, Naples 80138, Italy
| | - Nabeel Sheikh
- Department of Cardiology and Division of Cardiovascular Sciences, Guy's and St. Thomas’ Hospitals and King's College London, Strand, London WC2R 2LS, UK
| | - Cécile Laroche
- EORP, European Society of Cardiology, Sophia-Antipolis, France
| | | | | | - Juan P Kaski
- Institute of Cardiovascular Science, University College London, Gower St, London WC1E 6BT, UK,Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
| | - Aldo P Maggioni
- EORP, European Society of Cardiology, Sophia-Antipolis, France,Maria Cecilia Hospital, GVM Care&Research, Via Corriera, 1, Cotignola 48033 RA, Italy
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care&Research, Via Corriera, 1, Cotignola 48033 RA, Italy
| | | | - Dulce Brito
- Serviço de Cardiologia, Centro Hospitalar Universitário Lisboa Norte, Lisbon 1169-050, Portugal,CCUL, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz MB, Lisbon 1649-028, Portugal
| | - Jelena Celutkiene
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Universiteto g. 3, Vilnius 01513, Lithuania,State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | | | - Ales Linhart
- 2nd Department of Internal Cardiovascular Medicine, General University Hospital and First Medical Faculty, Charles University, Opletalova 38, Prague 110 00, Czech Republic
| | - Jens Mogensen
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, Odense 5000, Denmark
| | - José Manuel Garcia-Pinilla
- Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares. Servicio de Cardiología. Hospital Universitario Virgen de la Victoria. IBIMA. Málaga and Ciber-Cardiovascular. Instituto de Salud Carlos III. Madrid, Spain
| | - Tomas Ripoll-Vera
- Inherited Cardiovascular Disease Unit Son Llatzer University Hospital & IdISBa, Palma de Mallorca, Spain
| | - Hubert Seggewiss
- Universitätsklinikum Würzburg, Deutsches Zentrum für Herzinsuffizienz (DZHI), Comprehensive Heart Failure Center (CHFC), Am Schwarzenberg 15, Haus 15A, 97078 Wurzburg, Germany
| | - Eduardo Villacorta
- Member of National Centers of expertise for familial cardiopathies (CSUR), Cardiology Department, University Hospital of Salamanca. Institute of Biomedical Research of Salamanca (IBSAL), CIBERCV, Salamanca, Spain
| | | | - Perry M Elliott
- Institute of Cardiovascular Science, University College London, Gower St, London WC1E 6BT, UK,St. Bartholomew's Hospital, Barts Heart Centre, Barts Health NHS Trust, Whitechapel Rd, London E1 1BB, UK
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Winslow UC, Thune JJ, Elming MB, Philbert BT, Svendsen JH, Pehrson S, Jons C, Bundgaard H, Kober L, Risum N. Reduced longitudinal strain in the left ventricular inferior wall predicts malignant arrhythmia in non-ischemic heart failure. A DANISH substudy. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.081] [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: None.
BACKGROUND
Small studies have suggested that poor regional myocardial function may be associated with malignant arrhythmias, in particular around the inferior-posterior region. We tested this hypothesis in a subgroup of patients from the DANISH trial.
METHODS
From two centers, 317 patients with non-ischemic heart failure (LVEF < 35%) from the DANISH trial were evaluated by 2D-strain echocardiography. Regional strain was calculated as the average longitudinal strain in basal-, midventricular- and apical segments in each of the six left ventricular walls. Reduced regional function was defined as below-median regional strain. The endpoint was a composite of sudden cardiac death (SCD), sustained VT, admission with ventricular arrhythmia, and appropriate therapy from a primary prophylactic ICD. Time-to-first-event analysis was performed using Cox models.
RESULTS
Mean age at inclusion was 62 years (72% male), median LVEF was 25% (IQR 20-30) median inferior strain was -8.7% (IQR -12.3; -4.9). After a five-year follow-up, 43 events were observed. Reduced inferior strain was associated with the composite endpoint in univariate analysis with a HR 2.08(95% CI 1.11-3.90), P = 0.021. After multivariate adjustment for clinical and echocardiographic parameters, inferior strain remained an independent predictor with a HR 2.78(95% CI 1.39–5.56), P = 0.004. Strain measurements in no other region were associated with the endpoint in the multivariate analysis. In subgroup analysis of patients in the two lower age tertiles (<68 of age) we found that reduced inferior- and posterior strain were associated with development of the composite endpoint after multivariate adjustment with HRs of 3.25(95% CI 1.41-7.53), P = 0.006 and 2.51(95% CI 1.14-5.53), P = 0.022.
CONCLUSIONS
Low inferior-posterior strain was associated with a 2-3-fold increase in risk of malignant arrhythmia and SCD in patients with non-ischemic heart failure. Abstract Figure.
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Affiliation(s)
- UC Winslow
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - JJ Thune
- Bispebjerg University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - MB Elming
- Roskilde Hospital, Department of Cardiology, Roskilde, Denmark
| | - BT Philbert
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - JH Svendsen
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - S Pehrson
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - C Jons
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - H Bundgaard
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - L Kober
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - N Risum
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
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9
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Bhatt AS, Jering KS, Vaduganathan M, Claggett BL, Cunningham JW, Rosenthal N, Signorovitch J, Thune JJ, Vardeny O, Solomon SD. Clinical Outcomes in Patients With Heart Failure Hospitalized With COVID-19. JACC Heart Fail 2021; 9:65-73. [PMID: 33384064 PMCID: PMC7833294 DOI: 10.1016/j.jchf.2020.11.003] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/06/2020] [Accepted: 11/12/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate in-hospital outcomes among patients with a history of heart failure (HF) hospitalized with coronavirus disease-2019 (COVID-19). BACKGROUND Cardiometabolic comorbidities are common in patients with severe COVID-19. Patients with HF may be particularly susceptible to COVID-19 complications. METHODS The Premier Healthcare Database was used to identify patients with at least 1 HF hospitalization or 2 HF outpatient visits between January 1, 2019, and March 31, 2020, who were subsequently hospitalized between April and September 2020. Baseline characteristics, health care resource utilization, and mortality rates were compared between those hospitalized with COVID-19 and those hospitalized with other causes. Predictors of in-hospital mortality were identified in HF patients hospitalized with COVID-19 by using multivariate logistic regression. RESULTS Among 1,212,153 patients with history of HF, 132,312 patients were hospitalized from April 1, 2020, to September 30, 2020. A total of 23,843 patients (18.0%) were hospitalized with acute HF, 8,383 patients (6.4%) were hospitalized with COVID-19, and 100,068 patients (75.6%) were hospitalized with alternative reasons. Hospitalization with COVID-19 was associated with greater odds of in-hospital mortality as compared with hospitalization with acute HF; 24.2% of patients hospitalized with COVID-19 died in-hospital compared to 2.6% of those hospitalized with acute HF. This association was strongest in April (adjusted odds ratio [OR]: 14.48; 95% confidence interval [CI]:12.25 to 17.12) than in subsequent months (adjusted OR: 10.11; 95% CI: 8.95 to 11.42; pinteraction <0.001). Among patients with HF hospitalized with COVID-19, male sex (adjusted OR: 1.26; 95% CI: 1.13 to 1.40) and morbid obesity (adjusted OR: 1.25; 95% CI: 1.07 to 1.46) were associated with greater odds of in-hospital mortality, along with age (adjusted OR: 1.35; 95% CI: 1.29 to 1.42 per 10 years) and admission earlier in the pandemic. CONCLUSIONS Patients with HF hospitalized with COVID-19 are at high risk for complications, with nearly 1 in 4 dying during hospitalization.
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Affiliation(s)
- Ankeet S Bhatt
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Karola S Jering
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Muthiah Vaduganathan
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Brian L Claggett
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan W Cunningham
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ning Rosenthal
- Premier Applied Sciences, Premier Inc., Charlotte, North Carolina, USA
| | | | - Jens J Thune
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Orly Vardeny
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans' Affairs Health Care System, Minneapolis, Minnesota, USA
| | - Scott D Solomon
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
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10
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Bundgaard JS, Thune JJ, Nielsen JC, Videbæk R, Haarbo J, Bruun NE, Videbæk L, Aagaard D, Korup E, Jensen G, Hildebrandt P, Steffensen FH, Eiskjær H, Brandes A, Thøgersen AM, Melchior TM, Pedersen OD, Gustafsson F, Egstrup K, Hassager C, Svendsen JH, Høfsten DE, Torp-Pedersen C, Pedersen SS, Pehrson S, Køber L, Mogensen UM. The impact of implantable cardioverter-defibrillator implantation on health-related quality of life in the DANISH trial. Europace 2020; 21:900-908. [PMID: 30796456 DOI: 10.1093/europace/euz018] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 01/28/2019] [Indexed: 11/14/2022] Open
Abstract
AIM The Danish Study to Assess the Efficacy of Implantable Cardioverter-Defibrillators (ICD) in Patients with Non-ischaemic Systolic Heart Failure (HF) on Mortality (DANISH) found no overall effect on all-cause mortality. The effect of ICD implantation on health-related quality of life (HRQoL) remains to be established as previous trials have demonstrated conflicting results. We investigated the impact of ICD implantation on HRQoL in patients with non-ischaemic systolic HF, a prespecified secondary endpoint in DANISH. METHODS AND RESULTS In DANISH, a total of 1116 patients with non-ischaemic systolic HF were randomly assigned (1:1) to ICD implantation or usual clinical care (control). Patients completed disease-specific HRQoL as assessed by Minnesota Living with Heart Failure Questionnaire (MLHFQ; 0-105, high indicating worse). Changes in HRQoL 8 months after randomization were assessed with a mixed-effects model. At randomization, MLHFQ was completed by 935 (84%) patients (n = 472 in the ICD group and n = 463 in the control group) and was reassessed in 274 (58%) and 292 (63%) patients, respectively after 8 months for the primary analysis. Patients in the ICD group vs. the control group had similar improvements in MLHFQ after 8 months [least square mean -7.0 vs. -4.2 (P = 0.13)]. A clinically relevant improvement (decrease ≥5) in the MLHFQ overall score at 8 months was observed in 151 patients in the ICD group and 148 patients in the control group [55% vs. 51%, respectively (P = 0.25)]. CONCLUSION Implantable cardioverter-defibrillator implantation in patients with non-ischaemic systolic HF did not significantly alter HRQoL compared with patients randomized to usual clinical care.
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Affiliation(s)
- Johan S Bundgaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jens J Thune
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jens C Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Regitze Videbæk
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jens Haarbo
- Department of Cardiology, University Hospital Gentofte, Copenhagen, Denmark
| | - Niels E Bruun
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark.,Clinical Institute, Copenhagen University, Copenhagen, Denmark.,Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Lars Videbæk
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - David Aagaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Eva Korup
- Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Gunnar Jensen
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Per Hildebrandt
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark.,Frederiksberg Heart Clinic, Frederiksberg, Denmark
| | | | - Hans Eiskjær
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Axel Brandes
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Anna M Thøgersen
- Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Thomas M Melchior
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Ole D Pedersen
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Kenneth Egstrup
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jesper H Svendsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Dan E Høfsten
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Susanne S Pedersen
- Department of Cardiology, Odense University Hospital, Odense, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Steen Pehrson
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Ulrik M Mogensen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
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11
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Bundgaard JS, Thune JJ, Torp-Pedersen C, Nielsen JC, Haarbo J, Rørth R, Videbæk L, Melchior T, Pedersen SS, Køber L, Mogensen UM. Self-reported health status and the associated risk of mortality in heart failure: The DANISH trial. J Psychosom Res 2020; 137:110220. [PMID: 32836103 DOI: 10.1016/j.jpsychores.2020.110220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Received: 05/10/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To examine the gradual association between self-reported health status and mortality in patients with heart failure (HF) as current research has focused on poor health status and increased risk of mortality. METHOD This is a substudy of the DANISH (Defibrillator Implantation in Patients with Nonischemic Systolic HF) trial in which 1116 patients were randomized to receive or not receive an implantable cardioverter-defibrillator. Health status was assessed by a single question of the Short-Form 36. Patients were classified as having excellent/very good, good, fair (reference) or poor health status. We assessed the association between health status and mortality using multivariable Cox proportional hazard models. RESULTS Self-reported health status was completed by 943 (84%) patients at randomization with a median follow-up of 67 months and a health status distribution of; excellent/very good (n = 79, 8%), good (n = 369, 39%), fair (n = 409, 43%), and poor (n = 86, 9%). All-cause mortality (death events/ 100 person-years) occurred with gradual differences according to health status from excellent/ very good (2.14), good (3.74), fair (5.21) to poor health status (5.57). The gradual difference yielded a crude hazard ratio (HR) of 0.40, 95% CI 0.20-0.80 (adjusted HR 0.47 (95% CI 0.23-0.95) for excellent/ very good health status, HR 0.71, 95% CI 0.52-0.97 (adjusted HR 0.78 (95% CI 0.56-1.08) for good health status. Poor being worse than fair health status yielded a crude HR of 1.07, 95% CI 0.67-1.69. CONCLUSION Excellent/very good self-reported health status as assessed by a single question was associated with lower long-term mortality in patients with HF.
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Affiliation(s)
- Johan S Bundgaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Jens J Thune
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology and Clinical Research, Nordsjaellands Hospital, Hillerød, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Jens C Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Haarbo
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
| | - Rasmus Rørth
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Videbæk
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Thomas Melchior
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Susanne S Pedersen
- Department of Cardiology, Odense University Hospital, Odense, Denmark.; Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ulrik M Mogensen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
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12
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Bundgaard JS, Thune JJ, Gislason G, Fosbøl EL, Torp-Pedersen C, Aagaard D, Nielsen JC, Haarbo J, Thøgersen AM, Videbæk L, Jensen G, Olesen LL, Kristensen SL, Pedersen SS, Køber L, Mogensen UM. Quality of life and the associated risk of all-cause mortality in nonischemic heart failure. Int J Cardiol 2020; 305:92-98. [DOI: 10.1016/j.ijcard.2020.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 12/21/2019] [Accepted: 02/03/2020] [Indexed: 11/30/2022]
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13
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Byrne C, Ahlehoff O, Pedersen F, Pehrson S, Nielsen JC, Eiskjaer H, Videbaek L, Svendsen JH, Haarbo J, Thoegersen AM, Koeber L, Thune JJ. P2627Diffuse coronary artery disease and effect of implantable cardioverter-defibrillators in patients with non-ischaemic systolic heart failure. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0950] [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
Implantable defibrillators reduce mortality in patients with ischaemic heart failure. The recent Danish Study to Assess the Efficacy of Implantable Cardioverter Defibrillators in Patients With Non-Ischaemic Systolic Heart Failure on Mortality (DANISH) found no overall effect on all-cause mortality with ICD implantation. Coronary artery disease (CAD) as the cause of heart failure had to be ruled out prior to inclusion into DANISH, but patients could have diffuse atherosclerosis, one- or two-vessel disease on the qualifying coronary angiogram if the investigator did not find that the degree of CAD could explain the severely reduced left ventricular ejection fraction. It is unknown if concomitant coronary atherosclerosis is related to outcome in patients with non-ischaemic cardiomyopathy and whether the effect of implanting an ICD is different in patients with non-ischaemic cardiomyopathy and coronary atherosclerosis.
Purpose
The aim of this study was to investigate the association between coronary atherosclerosis and all-cause mortality in patients with non-ischaemic systolic heart failure and the effect of ICD implantation in these patients.
Methods
Of the 1116 patients from the DANISH study, 838 patients with available coronary angiography data were included in this subgroup analysis. Patients were considered to have coronary atherosclerosis if the invasive cardiologist described diffuse atherosclerosis or coronary stenosis. We used cox regression to assess the relationship between coronary atherosclerosis and mortality and between ICD implantation and mortality in patients with and without coronary atherosclerosis. Data are presented as hazard ratios with 95% confidence intervals.
Results
Of the 838 patients, 266 (32%) had coronary atherosclerosis, 216 (81%) of whom were reported as having atherosclerosis without stenoses. Patients with coronary atherosclerosis were significantly older (median age 67 years vs 61 years), more often male (77% vs 70%) and had a higher prevalence of diabetes (30% vs 17%).
In univariable analysis, coronary atherosclerosis was a significant predictor of all-cause mortality (HR, 1.41; 95% CI, 1.04–1.91; P=0.03). However, the association between coronary atherosclerosis and all-cause mortality disappeared when adjusting for age, gender and diabetes (HR 1.02, 0.75–1.41, P=0.88). Adjusted hazard ratios are shown in Figure 1.
There was no association between ICD treatment and all-cause mortality in patients with or without coronary atherosclerosis (HR 0.94; 0.58–1.52; P=0.79 vs HR 0.82; 0.56–1.20; P=0.30), P for interaction=0.67.
Figure 1
Conclusions
In patients with non-ischaemic systolic heart failure, the concomitant presence of coronary atherosclerosis was associated with increased mortality. However, this association was not independent of other risk factors. ICD implantation was not associated with mortality risk in patients either with or without concomitant coronary atherosclerosis.
Acknowledgement/Funding
TrygFonden (Copenhagen, DK), Medtronic (US) and St. Jude Medical (US)
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Affiliation(s)
- C Byrne
- Rigshospitalet - Copenhagen University Hospital, Heart Centre, Department of Cardiology, Copenhagen, Denmark
| | - O Ahlehoff
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - F Pedersen
- Rigshospitalet - Copenhagen University Hospital, Heart Centre, Department of Cardiology, Copenhagen, Denmark
| | - S Pehrson
- Rigshospitalet - Copenhagen University Hospital, Heart Centre, Department of Cardiology, Copenhagen, Denmark
| | - J C Nielsen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - H Eiskjaer
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - L Videbaek
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - J H Svendsen
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - J Haarbo
- Herlev and Gentofte Hospital, Department of Cardiology, Hellerup, Denmark
| | - A M Thoegersen
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - L Koeber
- Rigshospitalet - Copenhagen University Hospital, Heart Centre, Department of Cardiology, Copenhagen, Denmark
| | - J J Thune
- Bispebjerg University Hospital, Department of Cardiology, Copenhagen, Denmark
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14
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Elming MB, Thoegersen AM, Videbaek L, Bruun NE, Eiskjaer H, Haarbo J, Egstrup K, Gustafsson F, Svendsen JH, Hoefsten DE, Pehrson S, Nielsen JC, Koeber LV, Thune JJ. P4533Duration of heart failure and effect of defibrillator implantation in patients with non-ischemic systolic heart failure. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0925] [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
Introduction
Patients with non-ischemic systolic heart failure have increased risk of sudden cardiac death (SCD) and death from progressive pump failure. Whether the risk of SCD changes over time is unknown. We seek to investigate the relationship between duration of heart failure, mode of death, and effect of implantable cardioverter defibrillator (ICD) implantation.
Methods
We examined the risk of all-cause death and SCD according to the duration of heart failure among patients with non-ischemic systolic heart failure enrolled in the Danish Study to Assess the Efficacy of ICDs in Patients with Non-ischemic Systolic Heart Failure on Mortality (DANISH) trial. Patients were divided according to quartiles of heart failure duration (Q1 ≤8 months, Q2 9 ≤18 months, Q3 19 ≤65 months, Q4 ≥66 months).
Results
A total number of 1116 patients were included. Patients with the longest duration of heart failure were older, more often men, had more comorbidity, and more often received cardiac resynchronizing therapy device. Doubling of heart failure duration was an independent predictor of both all-cause mortality (HR 1.26 95% CI 1.17–1.37, p<0.0001), and SCD (HR 1.29 95% CI 1.11–1.49, p=0.0009). The proportion of deaths caused by SCD was not different between heart failure quartiles (p=0.91), and the effect of ICD implantation on all-cause mortality was not modified by the duration of heart failure (p=0.59).
Duration of heart failure and death
Conclusions
Duration of heart failure predicted both all-cause mortality and risk of SCD independently of other risk indicators. However, the proportion of death caused by SCD did not change with longer duration of heart failure and the effect of ICD was not modified by the duration of heart failure.
Acknowledgement/Funding
The work was sponsored by The Danish Heart Foundation (Hjerteforeningen) and the Lundbeck Foundation (Lundbeckfonden). The DANISH trial was supported
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Affiliation(s)
- M B Elming
- Rigshospitalet - Copenhagen University Hospital, Dept. of Cardiology, Copenhagen, Denmark
| | - A M Thoegersen
- Aalborg University Hospital, Cardiology, Aalborg, Denmark
| | - L Videbaek
- Odense University Hospital, Cardiology, Odense, Denmark
| | - N E Bruun
- University Hospital, Cardiology, Roskilde, Denmark
| | - H Eiskjaer
- Aarhus University Hospital, Cardiology, Aarhus, Denmark
| | - J Haarbo
- University of Copenhagen, Hellerup, Cardiology, Gentofte, Denmark
| | - K Egstrup
- Odense University Hospital, Cardiology, Svendborg, Denmark
| | - F Gustafsson
- Rigshospitalet - Copenhagen University Hospital, Dept. of Cardiology, Copenhagen, Denmark
| | - J H Svendsen
- Rigshospitalet - Copenhagen University Hospital, Dept. of Cardiology, Copenhagen, Denmark
| | - D E Hoefsten
- Rigshospitalet - Copenhagen University Hospital, Dept. of Cardiology, Copenhagen, Denmark
| | - S Pehrson
- Rigshospitalet - Copenhagen University Hospital, Dept. of Cardiology, Copenhagen, Denmark
| | - J C Nielsen
- Aarhus University Hospital, Cardiology, Aarhus, Denmark
| | - L V Koeber
- Aarhus University Hospital, Cardiology, Aarhus, Denmark
| | - J J Thune
- Bispebjerg University Hospital, Cardiology, Copenhagen, Denmark
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15
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Groarke JD, Galazka PZ, Cirino AL, Lakdawala NK, Thune JJ, Bundgaard H, Orav EJ, Levine RA, Ho CY. Intrinsic mitral valve alterations in hypertrophic cardiomyopathy sarcomere mutation carriers. Eur Heart J Cardiovasc Imaging 2018; 19:1109-1116. [PMID: 30052928 PMCID: PMC6148328 DOI: 10.1093/ehjci/jey095] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/29/2018] [Accepted: 06/21/2018] [Indexed: 11/13/2022] Open
Abstract
Aims Mitral valve (MV) abnormalities are recognized features of hypertrophic cardiomyopathy (HCM), and there is preliminary evidence suggesting they are intrinsic phenotypic manifestations of sarcomere mutations, present in mutation carriers without left ventricular (LV) hypertrophy (subclinical HCM). However, further study is required to characterize the nature of these changes and their functional impact. Thus, we performed comprehensive echocardiographic analysis of MV structure and function on a genotyped population. Methods and results MV and papillary muscle echocardiographic parameters were measured in 192 genotyped individuals, including 50 overt HCM, 79 subclinical HCM, and 63 mutation-negative, healthy relatives as normal controls. Compared to controls, subclinical HCM subjects had elongated anterior MV leaflets relative to LV end-diastolic volume index (0.57 ± 0.02 vs. 0.51 ± 0.02 mm/mL/m2, P = 0.013) and anteriorly displaced papillary muscles [decreased papillary-septal separation (31.1 ± 0.7 vs. 34.2 ± 0.9 mm, P = 0.004) and relative antero-posterior position ratio of the papillary muscles (0.67 ± 0.01 vs. 0.71 ± 0.01, P = 0.011]. Similar findings were identified comparing overt HCM to controls. These MV changes were associated with an increased prevalence of systolic anterior motion (SAM) of the MV amongst subclinical HCM subjects. Conclusions Sarcomere mutations are associated with primary abnormalities of the MV apparatus, specifically excess anterior leaflet length relative to LV cavity size and anterior displacement of the papillary muscles; both features predisposing to SAM. These abnormalities appear to be early phenotypic consequences of sarcomere mutations, observed in mutation carriers with normal LV wall thickness.
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Affiliation(s)
- John D Groarke
- Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, USA
| | - Patrycja Z Galazka
- Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, USA
| | - Allison L Cirino
- Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, USA
| | - Neal K Lakdawala
- Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, USA
| | - Jens J Thune
- Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Bispebjerg Bakke 23, Denmark
| | - Henning Bundgaard
- The Unit for Inherited Cardiac Diseases, The Heart Center, Rigshospitalet, Copenhagen Health Science Partners, Copenhagen University, Blegdamsvej 9, Denmark
| | - E John Orav
- Division of General Medicine, Brigham and Women’s Hospital, Boston, 75 Francis Street, MA USA
| | - Robert A Levine
- Cardiology Division, Massachusetts General Hospital, 32 Fruit Street, Boston, MA, USA
| | - Carolyn Y Ho
- Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, USA
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16
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Byrne C, Hasbak P, Kjaer A, Thune JJ, Koeber L. P4703Impaired myocardial perfusion is associated with increasing left ventricular mass in patients with non-ischaemic systolic heart failure: a cross-sectional study using Rubidium-82 PET/CT. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- C Byrne
- Rigshospitalet - Copenhagen University Hospital, Heart Centre, Department of Cardiology, Copenhagen, Denmark
| | - P Hasbak
- Rigshospitalet - Copenhagen University Hospital, Department of Clinical Physiology, Nuclear Medicine & PET, Diagnostic Centre, Copenhagen, Denmark
| | - A Kjaer
- Rigshospitalet - Copenhagen University Hospital, Department of Clinical Physiology, Nuclear Medicine & PET, Diagnostic Centre, Copenhagen, Denmark
| | - J J Thune
- Bispebjerg University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - L Koeber
- Rigshospitalet - Copenhagen University Hospital, Heart Centre, Department of Cardiology, Copenhagen, Denmark
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17
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Bundgaard J, Pehrson S, Nielsen JC, Videbaek L, Haarbo J, Bruun NE, Svendsen JH, Thune JJ, Brandes A, Egstrup K, Thoegersen AM, Eiskjaer H, Korup E, Koeber L, Mogensen UM. P2490The impact of ICD implantation on health-related quality of life in the DANISH trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Bundgaard
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - S Pehrson
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | | | - L Videbaek
- Odense University Hospital, Odense, Denmark
| | - J Haarbo
- Gentofte University Hospital, Gentofte, Denmark
| | - N E Bruun
- Aalborg University Hospital, Aalborg, Denmark
| | - J H Svendsen
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - J J Thune
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - A Brandes
- Odense University Hospital, Odense, Denmark
| | - K Egstrup
- Odense University Hospital, Odense, Denmark
| | | | - H Eiskjaer
- Aarhus University Hospital, Aarhus, Denmark
| | - E Korup
- Aalborg University Hospital, Aalborg, Denmark
| | - L Koeber
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - U M Mogensen
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
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18
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Roerth R, Thune JJ, Nielsen JC, Haarbo J, Videbaek L, Korup E, Bruun NE, Eiskjaer H, Hassager C, Svendsen JH, Hoefsten D, Torp-Pedersen C, Pehrson S, Kober L, Kristensen SL. 3382Diabetes and risk of death in non-ischemic systolic heart failure. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.3382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- R Roerth
- Rigshospitalet - Copenhagen University Hospital, Heart Center, Department of Cardiology, Copenhagen, Denmark
| | - J J Thune
- Rigshospitalet - Copenhagen University Hospital, Heart Center, Department of Cardiology, Copenhagen, Denmark
| | - J C Nielsen
- Aarhus University Hospital, Cardiology, Aarhus, Denmark
| | - J Haarbo
- Gentofte University Hospital, Department of cardiology, Gentofte, Denmark
| | - L Videbaek
- Odense University Hospital, Odense, Denmark
| | - E Korup
- Aalborg University Hospital, Cardiology, Aalborg, Denmark
| | - N E Bruun
- Gentofte University Hospital, Department of cardiology, Gentofte, Denmark
| | - H Eiskjaer
- Aarhus University Hospital, Cardiology, Aarhus, Denmark
| | - C Hassager
- Rigshospitalet - Copenhagen University Hospital, Heart Center, Department of Cardiology, Copenhagen, Denmark
| | - J H Svendsen
- Rigshospitalet - Copenhagen University Hospital, Heart Center, Department of Cardiology, Copenhagen, Denmark
| | - D Hoefsten
- Rigshospitalet - Copenhagen University Hospital, Heart Center, Department of Cardiology, Copenhagen, Denmark
| | - C Torp-Pedersen
- Aalborg University, Department of Health, Science and Technology, Aalborg, Denmark
| | - S Pehrson
- Rigshospitalet - Copenhagen University Hospital, Heart Center, Department of Cardiology, Copenhagen, Denmark
| | - L Kober
- Rigshospitalet - Copenhagen University Hospital, Heart Center, Department of Cardiology, Copenhagen, Denmark
| | - S L Kristensen
- Rigshospitalet - Copenhagen University Hospital, Heart Center, Department of Cardiology, Copenhagen, Denmark
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19
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Elming MB, Hammer-Hansen S, Voges I, Nyktari E, Raja AA, Svendsen JH, Pehrson S, Signorovitch J, Koeber LV, Prasad S, Thune JJ. 5038Right ventricular dysfunction and the effect of defibrillator implantation in patients with nonischemic systolic heart failure. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.5038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M B Elming
- Rigshospitalet - Copenhagen University Hospital, Dept. of Cardiology, Copenhagen, Denmark
| | - S Hammer-Hansen
- Rigshospitalet - Copenhagen University Hospital, Dept. of Cardiology, Copenhagen, Denmark
| | - I Voges
- Royal Brompton Hospital, London, United Kingdom
| | - E Nyktari
- Royal Brompton Hospital, London, United Kingdom
| | - A A Raja
- Rigshospitalet - Copenhagen University Hospital, Dept. of Cardiology, Copenhagen, Denmark
| | - J H Svendsen
- Rigshospitalet - Copenhagen University Hospital, Dept. of Cardiology, Copenhagen, Denmark
| | - S Pehrson
- Rigshospitalet - Copenhagen University Hospital, Dept. of Cardiology, Copenhagen, Denmark
| | - J Signorovitch
- Analysis Group Inc., Boston, Massachusetts, United States of America
| | - L V Koeber
- Rigshospitalet - Copenhagen University Hospital, Dept. of Cardiology, Copenhagen, Denmark
| | - S Prasad
- Royal Brompton Hospital, London, United Kingdom
| | - J J Thune
- Bispebjerg University Hospital, Cardiology, Copenhagen, Denmark
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20
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Køber L, Thune JJ, Nielsen JC, Haarbo J, Videbæk L, Korup E, Jensen G, Hildebrandt P, Steffensen FH, Bruun NE, Eiskjær H, Brandes A, Thøgersen AM, Gustafsson F, Egstrup K, Videbæk R, Hassager C, Svendsen JH, Høfsten DE, Torp-Pedersen C, Pehrson S. Defibrillator Implantation in Patients with Nonischemic Systolic Heart Failure. N Engl J Med 2016; 375:1221-30. [PMID: 27571011 DOI: 10.1056/nejmoa1608029] [Citation(s) in RCA: 1151] [Impact Index Per Article: 143.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The benefit of an implantable cardioverter-defibrillator (ICD) in patients with symptomatic systolic heart failure caused by coronary artery disease has been well documented. However, the evidence for a benefit of prophylactic ICDs in patients with systolic heart failure that is not due to coronary artery disease has been based primarily on subgroup analyses. The management of heart failure has improved since the landmark ICD trials, and many patients now receive cardiac resynchronization therapy (CRT). METHODS In a randomized, controlled trial, 556 patients with symptomatic systolic heart failure (left ventricular ejection fraction, ≤35%) not caused by coronary artery disease were assigned to receive an ICD, and 560 patients were assigned to receive usual clinical care (control group). In both groups, 58% of the patients received CRT. The primary outcome of the trial was death from any cause. The secondary outcomes were sudden cardiac death and cardiovascular death. RESULTS After a median follow-up period of 67.6 months, the primary outcome had occurred in 120 patients (21.6%) in the ICD group and in 131 patients (23.4%) in the control group (hazard ratio, 0.87; 95% confidence interval [CI], 0.68 to 1.12; P=0.28). Sudden cardiac death occurred in 24 patients (4.3%) in the ICD group and in 46 patients (8.2%) in the control group (hazard ratio, 0.50; 95% CI, 0.31 to 0.82; P=0.005). Device infection occurred in 27 patients (4.9%) in the ICD group and in 20 patients (3.6%) in the control group (P=0.29). CONCLUSIONS In this trial, prophylactic ICD implantation in patients with symptomatic systolic heart failure not caused by coronary artery disease was not associated with a significantly lower long-term rate of death from any cause than was usual clinical care. (Funded by Medtronic and others; DANISH ClinicalTrials.gov number, NCT00542945 .).
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Affiliation(s)
- Lars Køber
- From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark
| | - Jens J Thune
- From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark
| | - Jens C Nielsen
- From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark
| | - Jens Haarbo
- From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark
| | - Lars Videbæk
- From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark
| | - Eva Korup
- From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark
| | - Gunnar Jensen
- From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark
| | - Per Hildebrandt
- From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark
| | - Flemming H Steffensen
- From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark
| | - Niels E Bruun
- From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark
| | - Hans Eiskjær
- From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark
| | - Axel Brandes
- From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark
| | - Anna M Thøgersen
- From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark
| | - Finn Gustafsson
- From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark
| | - Kenneth Egstrup
- From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark
| | - Regitze Videbæk
- From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark
| | - Christian Hassager
- From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark
| | - Jesper H Svendsen
- From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark
| | - Dan E Høfsten
- From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark
| | - Christian Torp-Pedersen
- From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark
| | - Steen Pehrson
- From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark
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Ersbøll M, Andersen MJ, Valeur N, Mogensen UM, Fakhri Y, Fahkri Y, Thune JJ, Møller JE, Hassager C, Søgaard P, Køber L. Early diastolic strain rate in relation to systolic and diastolic function and prognosis in acute myocardial infarction: a two-dimensional speckle-tracking study. Eur Heart J 2013; 35:648-56. [PMID: 23713080 DOI: 10.1093/eurheartj/eht179] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [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: 12/14/2022] Open
Abstract
AIMS Diastolic dysfunction in acute myocardial infarction (MI) is associated with adverse outcome. Recently, the ratio of early mitral inflow velocity (E) to global diastolic strain rate (e'sr) has been proposed as a marker of elevated LV filling pressure. However, the prognostic value of this measure has not been demonstrated in a large-scale setting when existing parameters of diastolic function are known. We hypothesized that the E/e'sr ratio would be independently associated with an adverse outcome in patients with MI. METHODS AND RESULTS We prospectively included patients with MI and performed echocardiography with comprehensive diastolic evaluation including E/e'sr. The relationship between E/e'sr and the primary composite endpoint (all-cause mortality, hospitalization for heart failure (HF), stroke, and new onset atrial fibrillation) was analysed with Cox models. A total of 1048 patients (mean age 63 ± 12, 73% male) were included and 142 patients (13.5%) reached the primary endpoint (median follow-up 29 months). A significant prognostic value was found for E/e'sr [hazard ratio (HR) per 1 unit change: 2.36, 95% confidence interval (CI): 2.02-2.75, P < 0.0001]. After multivariable adjustment E/e'sr remained independently related to the combined endpoint (HR per 1 unit change, 1.50; CI: 1.05-2.13, P = 0.02). The prognostic value of E/e'sr was driven by mortality (HR per 1 unit change, 2.52; CI: 2.09-3.04, P < 0.0001) and HF admissions (HR per 1 unit change, 2.79; CI: 2.23-3.48, P < 0.0001). CONCLUSION Deformation-based E/e'sr contributes important information about global myocardial relaxation superior to velocity-based analysis and is independently associated with the outcome in acute MI.
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Affiliation(s)
- Mads Ersbøll
- The Heart Centre, Department of Cardiology, University Hospital Rigshospitalet, Copenhagen, Denmark
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Lakdawala NK, Thune JJ, Colan SD, Cirino AL, Farrohi F, Rivero J, McDonough B, Sparks E, Orav EJ, Seidman JG, Seidman CE, Ho CY. Subtle abnormalities in contractile function are an early manifestation of sarcomere mutations in dilated cardiomyopathy. ACTA ACUST UNITED AC 2012; 5:503-10. [PMID: 22949430 DOI: 10.1161/circgenetics.112.962761] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sarcomere mutations cause both dilated cardiomyopathy (DCM) and hypertrophic cardiomyopathy (HCM); however, the steps leading from mutation to disease are not well described. By studying mutation carriers before a clinical diagnosis develops, we characterize the early manifestations of sarcomere mutations in DCM and investigate how these manifestations differ from sarcomere mutations associated with HCM. METHODS AND RESULTS Sixty-two genotyped individuals in families with sarcomeric DCM underwent clinical evaluation including strain echocardiography. The group included 12 subclinical DCM mutation carriers with normal cardiac dimensions and left ventricular ejection fraction (LVEF ≥55%), 21 overt DCM subjects, and 29 related mutation (-) normal controls. Results were compared with a previously characterized cohort of 60 subclinical HCM subjects (sarcomere mutation carriers without left ventricular hypertrophy). Systolic myocardial tissue velocity, longitudinal, circumferential, and radial strain, and longitudinal and radial strain rate were reduced by 10%-23% in subclinical DCM mutation carriers compared with controls (P<0.001 for all comparisons), after adjusting for age and family relations. No significant differences in diastolic parameters were identified comparing the subclinical and control cohorts. The opposite pattern of contractile abnormalities with reduced diastolic but preserved systolic function was seen in subclinical HCM. CONCLUSIONS Subtle abnormalities in systolic function are present in subclinical DCM mutation carriers, despite normal left ventricular size and ejection fraction. In contrast, impaired relaxation and preserved systolic function appear to be the predominant early manifestations of sarcomere mutations that lead to HCM. These findings support the theory that the mutation's intrinsic impact on sarcomere function influences whether a dilated or hypertrophic phenotype develops.
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Affiliation(s)
- Neal K Lakdawala
- Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
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Thune JJ, Signorovitch J, Kober L, Velazquez EJ, McMurray JJV, Califf RM, Maggioni AP, Rouleau JL, Howlett J, Zelenkofske S, Pfeffer MA, Solomon SD. Effect of antecedent hypertension and follow-up blood pressure on outcomes after high-risk myocardial infarction. Hypertension 2007; 51:48-54. [PMID: 18025296 DOI: 10.1161/hypertensionaha.107.093682] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The influence of blood pressure on outcomes after high-risk myocardial infarction is not well characterized. We studied the relationship between blood pressure and the risk of cardiovascular events in 14 703 patients with heart failure, left ventricular systolic dysfunction, or both after acute myocardial infarction in the Valsartan in Myocardial Infarction Trial. We assessed the relationship between antecedent hypertension and outcomes and the association between elevated (systolic: >140 mm Hg) or low blood pressure (systolic: <100 mm Hg) in 2 of 3 follow-up visits during the first 6 months and subsequent cardiovascular events over a median 24.7 months of follow-up. Antecedent hypertension independently increased the risk of heart failure (hazard ratio [HR]: 1.19; 95% CI: 1.08 to 1.32), stroke (HR: 1.27; 95% CI: 1.02 to 1.58), cardiovascular death (HR: 1.11; 95% CI: 1.01 to 1.22), and the composite of death, myocardial infarction, heart failure, stroke, or cardiac arrest (HR: 1.13; 95% CI: 1.06 to 1.21). While low blood pressure in the postmyocardial infarction period was associated with increased risk of adverse events, patients with elevated blood pressure (n=1226) were at significantly higher risk of stroke (adjusted HR: 1.64; 95% CI: 1.17 to 2.29) and combined cardiovascular events (adjusted HR: 1.14; 95% CI: 1.00 to 1.31). Six months after a high-risk myocardial infarction, elevated systolic blood pressure, a potentially modifiable risk factor, is associated with an increased risk of subsequent stroke and cardiovascular events. Whether aggressive antihypertensive treatment can reduce this risk remains unknown.
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Affiliation(s)
- Jens J Thune
- Brigham and Women's Hospital, Boston, MA 02115, USA
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24
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Abstract
In a stereological study of the human substantia nigra (SN), the total number of melanin-positive and melanin-negative neurones from 28 male subjects aged 19-92 years was estimated using a uniform sampling design and optical disectors. There was a significant decrease in the total number of melanin-positive neurones as a function of age (r(2)=0.18, residual-CV=0.35, 2P=0.032). Using the rotator method, the size distribution of the melanin-positive neurones was estimated and showed a significant difference in mean cell volume of melanin-positive neurones between the seven youngest (21,077 microm(3)) and the seven oldest individuals (32,011 microm(3)), 2P=0.022. Using a combination of the total number of melanin-positive neurones and their size distribution, the total perikaryon volume of melanin-positive neurones could be estimated and showed no decrease with increasing age (r(2)=0.01, residual-CV=0.41, 2P=0.62). Age-related decline in dopamine-transporter neurones within the SN might explain the occurrence of extrapyramidal symptoms in many elderly individuals. Although age-related cell hypertrophy is usually considered to be an indication of cell degeneration or necrosis, this might not always be the case. The fact that motor symptoms, although present in many of the elderly, are of a limited nature despite the high percentage of lost neurones could be due to a compensatory increase in the cell body of dopamine-producing SN neurones. Thus, the total amount of cell substance capable of producing the essential transmitters might not be reduced to a critically low level as a result of ageing.
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Affiliation(s)
- C R Cabello
- Bartholin Institute and Research Laboratory for Stereology and Neuroscience, Bispebjerg University Hospital, DK-2400 Copenhagen NV, Denmark
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25
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Abstract
The prefrontal cortex (PFC), defined as the cortical region which has the major reciprocal connections with the mediodorsal thalamic nucleus (MD), has often been implicated in schizophrenia. Morphometric studies have shown altered neuronal density and structure in parts of the PFC in schizophrenic brains. In addition, the MD and nucleus accumbens have shown a significant deficit in total neuron number. The purpose of the present study was to estimate the total neuron number in the PFC in schizophrenics and controls. Using a stereological design, the PFC was studied in eight brains from schizophrenic patients and 10 age-matched control brains. The bilateral average total number of neurons in the PFC was estimated to be 2.76 x 10(9) (CV=S.D./mean=0.15) in the schizophrenic brains whereas that of controls was a non-significantly different value of 3.11 x 10(9) (CV=0.22; P=0.23). Furthermore, no significant differences were found between the two groups in neuronal density (P=0.10) or volume of the PFC (P=0.49). It is of course possible that a neuronal deficit, which cannot be revealed when estimating the total global number of neurons in the whole PFC, might exist in a subregion of the PFC. In conclusion, uniform loss of neuronal soma in the PFC does not appear to constitute the neural substrate of the pathological process in schizophrenia.
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Affiliation(s)
- J J Thune
- Research Laboratory for Stereology and Neuroscience, University of Copenhagen, Bispebjerg Hospital, Copenhagen, Denmark.
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26
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Abstract
Stereological studies have contributed with important results to the understanding of brain abnormalities in schizophrenia. The data obtained from stereological studies of brains from schizophrenic patients, including studies of the thalamus, hippocampus, and cortex, are discussed and suggest a central role of the thalamic nuclei in the etiology of the disease. The basic stereological tools are presented and possible biases in quantification studies are discussed.
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Affiliation(s)
- J J Thune
- Neurological Research Laboratory, Bartholin Institute, Kommunehospitalet, Oster Farimagsgade 5, 1399, Copenhagen, Denmark.
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