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Lenhoff H, Järnbert-Petersson H, Darpo B, Tornvall P, Frick M. Mortality and ventricular arrhythmias in patients on d,l-sotalol for rhythm control of atrial fibrillation: A nationwide cohort study. Heart Rhythm 2023; 20:1473-1480. [PMID: 37598987 DOI: 10.1016/j.hrthm.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/03/2023] [Accepted: 08/11/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Use of d,l-sotalol for rhythm control in patients with atrial fibrillation (AF) has raised safety concerns. Previous randomized studies are few and not designed for mortality outcome. OBJECTIVE The purpose of this study was to compare the incidences of mortality and ventricular arrhythmias in AF patients treated with d,l-sotalol for rhythm control vs matched control patients treated with cardioselective beta-blockers. METHODS This population-based cohort study included AF patients from the Swedish National Patient Registry (2006-2017) who underwent rhythm control after a second cardioversion. Incidence rates (IRs) and adjusted hazard ratios (aHRs) for mortality and a composite endpoint of cardiac arrest/death and ventricular arrhythmias were calculated for the overall cohort and a 1:1 propensity score matched cohort of d,l-sotalol vs beta-blocker treatment. RESULTS Among patient treated with d,l-sotalol (n = 4987) and beta-blocker (n = 27,078) (mean follow-up 458 days), all-cause mortality was lower in patients treated with d,l-sotalol: IR 1.21; 95% confidence interval 0.95-1.52 vs 2.42 (2.26-2.60) deaths per 100 patient-years; aHR 0.66 (0.52-0.83). The difference in mortality persisted in the propensity score matched comparison (n = 4953 in each group): aHR 0.63 (0.48-0.86). No differences were observed in the composite outcome: IR in propensity cohorts 2.13 (1.78-2.52) vs 2.07 (1.73-2.53) events per 100 years; aHR 1.01 (0.78-1.29). CONCLUSION There was no excess mortality with d,l-sotalol compared with cardioselective beta-blockers in patients undergoing rhythm control treatment for AF after a second cardioversion. Our results indicate that the risk associated with d,l-sotalol treatment for AF can be mitigated by careful patient selection and strict adherence to follow-up protocols.
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Affiliation(s)
- Hanna Lenhoff
- Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, South Hospital, Stockholm, Sweden.
| | - Hans Järnbert-Petersson
- Department of Clinical Science and Education, Karolinska Institutet, South Hospital, Stockholm, Sweden
| | | | - Per Tornvall
- Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, South Hospital, Stockholm, Sweden
| | - Mats Frick
- Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, South Hospital, Stockholm, Sweden
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2
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Makone A, Angami K, Bhattacharya D, Frick M, Castillo JG, Herrera R, McKenna L, Moses GK, Rucsineanu O, Sari AH, Stillo J, Agbassi P. One size does not fit all: community views on choices for TB treatment and prevention. Public Health Action 2023; 13:67-69. [PMID: 37736579 PMCID: PMC10446664 DOI: 10.5588/pha.23.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/04/2023] [Indexed: 09/23/2023] Open
Abstract
Treatment and prevention paradigms in TB have been dominated by a 'one-size-fits-all' approach, in which all persons are given the same treatment regimens. This stands in contrast to other health conditions, where differentiated models of care have been shown to be effective. In this Viewpoint, we make the case for considering multiple factors when deciding which regimens should be offered to people with TB infection and disease. Choice about which regimens to use should be made in conjunction with people who have TB and consider efficacy, safety, duration, pill burden, formulation, drug interactions, time spent in monitoring, drug susceptibility, compatibility with other areas of life, and availability of support services. Ideally, these choices should be considered within an equity framework with the most intensified services being offered to those considered most vulnerable.
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Affiliation(s)
- A Makone
- Stellenbosch University, Cape Town, South Africa
- Global TB Community Advisory Board, New York, NY, USA
| | - K Angami
- Global TB Community Advisory Board, New York, NY, USA
- Access to Rights and Knowledge Foundation, Kohima
| | - D Bhattacharya
- Global TB Community Advisory Board, New York, NY, USA
- Survivors Against TB, New Delhi, India
| | - M Frick
- Global TB Community Advisory Board, New York, NY, USA
- Treatment Action Group, New York, NY
| | - J G Castillo
- Global TB Community Advisory Board, New York, NY, USA
- McGovern Medical School at the University of Texas Health Science Center, Houston, TX, USA
| | - R Herrera
- Global TB Community Advisory Board, New York, NY, USA
| | - L McKenna
- Global TB Community Advisory Board, New York, NY, USA
- Survivors Against TB, New Delhi, India
| | - G K Moses
- Global TB Community Advisory Board, New York, NY, USA
| | - O Rucsineanu
- Global TB Community Advisory Board, New York, NY, USA
- Moldova National Association of Tuberculosis Patients "SMIT" (Society of Moldova against Tuberculosis), Chis¸ina˘u, Moldova
| | - A H Sari
- Global TB Community Advisory Board, New York, NY, USA
| | - J Stillo
- Global TB Community Advisory Board, New York, NY, USA
- Department of Anthropology, Wayne State University, Detroit, MI, USA
| | - P Agbassi
- Global TB Community Advisory Board, New York, NY, USA
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3
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Wärme J, Sundqvist MO, Hjort M, Agewall S, Collste O, Ekenbäck C, Frick M, Henareh L, Hofman-Bang C, Spaak J, Sörensson P, Y-Hassan S, Svensson P, Lindahl B, Hofmann R, Tornvall P. Helicobacter pylori and Pro-Inflammatory Protein Biomarkers in Myocardial Infarction with and without Obstructive Coronary Artery Disease. Int J Mol Sci 2023; 24:14143. [PMID: 37762446 PMCID: PMC10531769 DOI: 10.3390/ijms241814143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/05/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
Myocardial infarction (MI) with obstructive coronary artery disease (MI-CAD) and MI in the absence of obstructive coronary artery disease (MINOCA) affect different populations and may have separate pathophysiological mechanisms, with greater inflammatory activity in MINOCA compared to MI-CAD. Helicobacter pylori (Hp) can cause systemic inflammation and has been associated with cardiovascular disease (CVD). We aimed to investigate whether Hp infection is associated with concentrations of protein biomarkers of inflammation and CVD. In a case-control study, patients with MINOCA (n = 99) in Sweden were included, complemented by matched subjects with MI-CAD (n = 99) and controls (n = 100). Protein biomarkers were measured with a proximity extension assay in plasma samples collected 3 months after MI. The seroprevalence of Hp and cytotoxin-associated gene A (CagA) was determined using ELISA. The associations between protein levels and Hp status were studied with linear regression. The prevalence of Hp was 20.2%, 19.2%, and 16.0% for MINOCA, MI-CAD, and controls, respectively (p = 0.73). Seven proteins were associated with Hp in an adjusted model: tissue plasminogen activator (tPA), interleukin-6 (IL-6), myeloperoxidase (MPO), TNF-related activation-induced cytokine (TRANCE), pappalysin-1 (PAPPA), soluble urokinase plasminogen activator receptor (suPAR), and P-selectin glycoprotein ligand 1 (PSGL-1). Hp infection was present in one in five patients with MI, irrespective of the presence of obstructive CAD. Inflammatory proteins were elevated in Hp-positive subjects, thus not ruling out that Hp may promote an inflammatory response and potentially contribute to the development of CVD.
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Affiliation(s)
- Jonatan Wärme
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83 Stockholm, Sweden
- Department of Cardiology, Södersjukhuset, SE-118 83 Stockholm, Sweden
| | - Martin O. Sundqvist
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83 Stockholm, Sweden
- Department of Cardiology, Södersjukhuset, SE-118 83 Stockholm, Sweden
| | - Marcus Hjort
- Department of Medical Sciences, Uppsala University, SE-751 85 Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala University, SE-751 85 Uppsala, Sweden
| | - Stefan Agewall
- Division of Medicine, Institute of Clinical Medicine, University of Oslo, NO-0318 Oslo, Norway
- Department of Cardiology, Oslo University Hospital, NO-0450 Oslo, Norway
| | - Olov Collste
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83 Stockholm, Sweden
- Department of Cardiology, Södersjukhuset, SE-118 83 Stockholm, Sweden
| | - Christina Ekenbäck
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, SE-182 88 Stockholm, Sweden
| | - Mats Frick
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83 Stockholm, Sweden
- Department of Cardiology, Södersjukhuset, SE-118 83 Stockholm, Sweden
| | - Loghman Henareh
- Department of Medicine Huddinge, Karolinska Institute, SE-141 86 Huddinge, Sweden
- Coronary Artery Disease Area, Heart and Vascular Theme, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Claes Hofman-Bang
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, SE-182 88 Stockholm, Sweden
| | - Jonas Spaak
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, SE-182 88 Stockholm, Sweden
| | - Peder Sörensson
- Coronary Artery Disease Area, Heart and Vascular Theme, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institutet, SE-171 76 Stockholm, Sweden
| | - Shams Y-Hassan
- Department of Medicine Huddinge, Karolinska Institute, SE-141 86 Huddinge, Sweden
- Coronary Artery Disease Area, Heart and Vascular Theme, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Per Svensson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83 Stockholm, Sweden
- Department of Cardiology, Södersjukhuset, SE-118 83 Stockholm, Sweden
| | - Bertil Lindahl
- Department of Medical Sciences, Uppsala University, SE-751 85 Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala University, SE-751 85 Uppsala, Sweden
| | - Robin Hofmann
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83 Stockholm, Sweden
- Department of Cardiology, Södersjukhuset, SE-118 83 Stockholm, Sweden
| | - Per Tornvall
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83 Stockholm, Sweden
- Department of Cardiology, Södersjukhuset, SE-118 83 Stockholm, Sweden
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4
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Verheyen N, Ungericht M, Paar L, Danninger K, Schneiderbauer-Porod S, Duca F, Hoeller V, Ablasser K, Kiblboeck D, Frick M, Bonderman D, Dierneder J, Ebner C, Weber T, Poelzl G. Diagnostic accuracy of amyloid scintigraphy for the histopathological diagnosis of cardiac transthyretin amyloidosis – a retrospective Austrian multicenter study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.903] [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
Previous studies indicated that amyloid scintigraphy in combination with free light chain (FLC) assessment yields an excellent diagnostic accuracy for cardiac transthyretin (ATTR) amyloidosis (1). As a consequence, the diagnosis of ATTR amyloidosis is increasingly made without the actual gold-standard method endomyocardial biopsy (EMB). Whether this leads to misdiagnosis in real-world practice is currently underinvestigated. We aimed to describe the diagnostic accuracy of amyloid scintigraphy in a real world setting.
Methods
Seven tertiary care centers throughout Austria agreed to participate in the study and performed a systematic retrospective medical records search from 2017 to 2020. Patients were included in case of available results of amyloid scintigraphy, FLC assessment and EMB, respectively. Amyloid scintigraphy was performed using a 99m-technetium-labelled tracer. Histological analysis was performed using immunohistochemistry. The number of submitted subjects with complete data per center ranged from 2 to 46. The patient number increased with years, with 15 patients investigated in 2017 and 32 in 2020.
Results
We enrolled 101 patients (21% women) with a mean age of 73±9 years and median NT-proBNP (IQR) of 2694 (1601–5239) pg/ml (Table 1). An abnormal Perugini Score (ie. grade II or III) was present in 57 patients (56%) and FLC assessment was overall indicative of monoclonal protein in 60 patients (59%). Among patients with abnormal Perugini Score, 29 had FLC assessment indicative of monoclonal protein. The most common histopathological diagnoses were ATTR in 60 patients (59%) and cardiac light chain (AL) amyloidosis in 20 patients (20%). One further patient was diagnosed with concomitant AL and ATTR amyloidosis. Further diagnoses included ApoA4 (n=2) and AA amyloidosis (n=1), while cardiac amyloidosis was ruled out in 17 patients (17%).
ATTR was diagnosed in 54 patients with Perugini Score II or III compared with 6 patients with Perugini < II, yielding a sensitivity of abnormal Perugini score for ATTR amyloidosis of 90%. Among patients with abnormal Perugini Score (n=57), ATTR was diagnosed in 55 patients, and AL amyloidosis in 3 (one had concomitant ATTR and AL), yielding a positive predictive value (PPV) of abnormal Perugini Score of 97% (Table 2). Two AL patients had Perugini Score of II and one had Perugini Score of III. When excluding patients with monoclonal gammopathy, the PPV of abnormal Perugini Score was 100%.
Conclusion
Our data confirm a PPV of abnormal amyloid scintigraphy of 100% for cardiac ATTR amyloidosis when monoclonal gammopathy was excluded. mong patients with monoclonal gammopathy, one of ten patients with abnormal scintigraphy had AL amyloidosis as the underlying condition. Our data underscore that tissue biopsy and histopathological analysis should be performed in every patient with suspected amyloidosis and monoclonal gammopathy even in case of Perugini Score II or III.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N Verheyen
- Medical University of Graz, Clinical Department of Cardiology , Graz , Austria
| | - M Ungericht
- Medical University of Innsbruck, Department of Cardiology , Innsbruck , Austria
| | - L Paar
- Medical University of Graz, Clinical Department of Cardiology , Graz , Austria
| | - K Danninger
- Klinikum Wels-Grieskirchen, Department of Cardiology , Wels , Austria
| | | | - F Duca
- AKH Wien, Department of Cardiology , Vienna , Austria
| | - V Hoeller
- Medical University of Graz, Clinical Department of Cardiology , Graz , Austria
| | - K Ablasser
- Medical University of Graz, Clinical Department of Cardiology , Graz , Austria
| | - D Kiblboeck
- Kepler University Hospital Linz, Department of Cardiology , Linz , Austria
| | - M Frick
- Academic Teaching Hospital Feldkirch, Department of Internal Medicine , Feldkirch , Austria
| | - D Bonderman
- Klinik Favoriten, Department of Internal Medicine , Vienna , Austria
| | - J Dierneder
- Ordensklinikum Linz Elisabethinen, Department of Nuclear Medicine , Linz , Austria
| | - C Ebner
- Ordensklinikum Linz Elisabethinen, Department of Internal Medicine , Linz , Austria
| | - T Weber
- Klinikum Wels-Grieskirchen, Department of Cardiology , Wels , Austria
| | - G Poelzl
- Medical University of Innsbruck, Department of Cardiology , Innsbruck , Austria
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5
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Kirschfink A, Alachkar MN, Vogt F, Schroeder J, Lehrke M, Frick M, Almalla M, Marx N, Altiok E. Outcome of transcutaneous edge-to-edge mitral valve repair in patients with diabetes mellitus: results from a real-world cohort. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2114] [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
Transcutaneous edge-to-edge repair (TEER) has become a treatment option for selected patients with severe mitral regurgitation (MR). Analysis of the COAPT trial indicated patients with diabetes mellitus to have higher death rates and a trend to higher rates of heart failure hospitalization (HFH) than those without diabetes. However, in that study only patients with secondary MR with specific criteria were included and there are only limited data on diabetes patients in real-world settings.
Purpose
This study sought to evaluate safety and efficacy of TEER in patients with diabetes mellitus in comparison to non-diabetics.
Methods
In this monocentric study 340 consecutive patients with severe primary and secondary MR who underwent TEER were included. Immediate results of the procedure, intrahospital as well as one-year outcome were compared between patients with and without diabetes.
Results
Diabetes was present in 109 patients (32%) of the study group. Patients with diabetes were younger (75±8 vs. 78±8 years; p=0.003), had more often ischemic cardiomyopathy (68% vs. 48%, p<0.001), previous coronary-artery bypass graft (35% vs. 20%; p=0.002) and arterial hypertension (89% vs. 75%; p<0.001) compared to those without diabetes. All other baseline clinical and imaging characteristics including NYHA class, left ventricular dimensions and function (ejection fraction: 38±13% vs. 41±14%; p=0.10) as well as severity of MR were not different between both patient groups (Table 1).
Success of the procedure was comparable between patients with and without diabetes (95% vs. 95%; p=0.84). There was no difference in intrahospital mortality between both groups (5.5% vs. 4.8%; p=0.98). At one-year follow up, there was no difference regarding all-cause mortality (24.2% vs. 23.0%; p=0.72), HFH (37.4% vs. 31.0%, p=0.23), NYHA class (p=0.11) or MR severity (p=0.20) between both groups (Table 2).
Conclusion
In contrast to previous published data on patients with diabetes and severe MR TEER seems to be similar safe and effective in a real-world setting compared to non-diabetics.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Kirschfink
- RWTH University Hospital Aachen, Internal Medicine I, Cardiology, Angiology and Intensive Care Medicine , Aachen , Germany
| | | | - F Vogt
- RWTH University Hospital Aachen, Internal Medicine I, Cardiology, Angiology and Intensive Care Medicine , Aachen , Germany
| | - J Schroeder
- RWTH University Hospital Aachen, Internal Medicine I, Cardiology, Angiology and Intensive Care Medicine , Aachen , Germany
| | - M Lehrke
- RWTH University Hospital Aachen, Internal Medicine I, Cardiology, Angiology and Intensive Care Medicine , Aachen , Germany
| | - M Frick
- RWTH University Hospital Aachen, Internal Medicine I, Cardiology, Angiology and Intensive Care Medicine , Aachen , Germany
| | - M Almalla
- RWTH University Hospital Aachen, Internal Medicine I, Cardiology, Angiology and Intensive Care Medicine , Aachen , Germany
| | - N Marx
- RWTH University Hospital Aachen, Internal Medicine I, Cardiology, Angiology and Intensive Care Medicine , Aachen , Germany
| | - E Altiok
- RWTH University Hospital Aachen, Internal Medicine I, Cardiology, Angiology and Intensive Care Medicine , Aachen , Germany
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Svenungsson E, Spaak J, Strandberg K, Wallén HN, Agewall S, Brolin EB, Collste O, Daniel M, Ekenbäck C, Frick M, Henareh L, Malmqvist K, Elvin K, Sörensson P, Y-Hassan S, Hofman-Bang C, Tornvall P. Antiphospholipid antibodies in patients with myocardial infarction with and without obstructive coronary arteries. J Intern Med 2022; 291:327-337. [PMID: 34820922 DOI: 10.1111/joim.13409] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Recent studies demonstrate that prothrombotic antiphospholipid antibodies (aPL) are overrepresented in patients with myocardial infarction (MI) due to coronary artery disease (MICAD). However, it is not known whether aPL differ between the two subsets of MI: MICAD and MI with nonobstructive coronary arteries (MINOCA). OBJECTIVES To determine whether aPL are associated with MINOCA or MICAD, or with hypercoagulability as assessed by activated protein C-protein C inhibitor (APC-PCI) complex. METHODS Well-characterized patients with MINOCA (n = 98), age- and gender-matched patients with MICAD (n = 99), and healthy controls (n = 100) were included in a cross-sectional case-control study. Autoantibodies (IgA/G/M) targeting cardiolipin and β2 glycoprotein-I and specific nuclear antigens were analyzed by multiplexed bead technology. The concentration of APC-PCI was determined as a measure of hypercoagulability by an immunofluorometric sandwich assay. RESULTS Both prevalence and titers of aPL of the IgG isotype (anti-cardiolipin and/or anti-β2 glycoprotein-I) were higher in patients with MINOCA and MICAD than in controls. aPL IgG positivity was twice as frequent among patients with MICAD than MINOCA (11% vs. 6%, nonsignificant). We observed no group differences regarding aPL IgA/M or antibodies targeting specific nuclear antigens. Levels of APC-PCI were elevated in aPL IgG-positive compared to aPL IgG-negative MICAD patients. CONCLUSIONS aPL IgG, but not IgA/M, are enriched particularly in patients with MICAD but also in patients with MINOCA, as compared to controls. Interestingly, signs of hypercoagulability-measured by increased levels of the APC-PCI complex-were present in aPL IgG-positive MICAD patients, indicating an association with functional disturbances of the coagulation system.
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Affiliation(s)
- Elisabet Svenungsson
- Department of Medicine, Solna, Division of Rheumatology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Spaak
- Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Karin Strandberg
- Department of Clinical Chemistry and Pharmacology, Division of Laboratory Medicine, Coagulation Laboratory Malmö, University and Regional Laboratories, Region Skåne, Sweden
| | - Håkan N Wallén
- Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Stefan Agewall
- Department of Cardiology, Oslo University Hospital and Institute of Clinical Sciences, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Elin B Brolin
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Department of Radiology, Capio S:t Göran's Hospital, Stockholm, Sweden
| | - Olov Collste
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Maria Daniel
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Christina Ekenbäck
- Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mats Frick
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Loghman Henareh
- Department of Medicine, Heart and Vascular Theme, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Karin Malmqvist
- Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kerstin Elvin
- Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Peder Sörensson
- Department of Medicine, Solna, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Shams Y-Hassan
- Coronary Artery Disease Area, Heart and Vascular Theme, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Claes Hofman-Bang
- Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Per Tornvall
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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7
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Affiliation(s)
- R E Chaisson
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - M Frick
- Treatment Action Group, New York, NY
| | - P Nahid
- UCSF Center for Tuberculosis, University of California, San Francisco, San Francisco, CA, USA
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8
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Arvanitis P, Johansson AK, Frick M, Malmborg H, Gerovasileiou S, Larsson EM, Blomström-Lundqvist C. Recent-onset atrial fibrillation: a study exploring the elements of Virchow's triad after cardioversion. J Interv Card Electrophysiol 2021; 64:49-58. [PMID: 34689250 PMCID: PMC9236986 DOI: 10.1007/s10840-021-01078-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/10/2021] [Indexed: 12/11/2022]
Abstract
Purpose Atrial fibrillation (AF) imposes an inherent risk for stroke and silent cerebral emboli, partly related to left atrial (LA) remodeling and activation of inflammatory and coagulation systems. The aim was to explore the effects of cardioversion (CV) and short-lasting AF on left atrial hemodynamics, inflammatory, coagulative and cardiac biomarkers, and the association between LA functional recovery and the presence of a prior history of AF. Methods Patients referred for CV within 48 h after AF onset were prospectively included. Echocardiography and blood sampling were performed immediately prior, 1–3 h after, and at 7–10 days after CV. The presence of chronic white matter hyperintensities (WMH) on magnetic resonance imaging was related to biomarker levels. Results Forty-three patients (84% males), aged 55±9.6 years, with median CHA2DS2-VASc score 1 (IQR 0–1) were included. The LA emptying fraction (LAEF), LA peak longitudinal strain during reservoir, conduit, and contractile phases improved significantly after CV. Only LAEF normalized within 10 days. Interleukin-6, high-sensitivity cardiac-troponin-T (hs-cTNT), N-terminal-pro-brain-natriuretic peptide, prothrombin-fragment 1+2 (PTf1+2), and fibrinogen decreased significantly after CV. There was a trend towards higher C-reactive protein, hs-cTNT, and PTf1+2 levels in patients with WMH (n=21) compared to those without (n=22). At 7–10 days, the LAEF was significantly lower in patients with a prior history of AF versus those without. Conclusion Although LA stunning resolved within 10 days, LAEF remained significantly lower in patients with a prior history of AF versus those without. Inflammatory and coagulative biomarkers were higher before CV, but subsided after 7–10 days, which altogether might suggest an enhanced thrombogenicity, even in these low-risk patients. Supplementary Information The online version contains supplementary material available at 10.1007/s10840-021-01078-9.
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Affiliation(s)
- Panagiotis Arvanitis
- Department of Medical Science and Cardiology, Uppsala University, Sjukhusvägen 9, Ing 35, 75309, Uppsala, Sweden.
| | - Anna-Karin Johansson
- Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, South Hospital, Stockholm, Sweden
| | - Mats Frick
- Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, South Hospital, Stockholm, Sweden
| | - Helena Malmborg
- Department of Medical Science and Cardiology, Uppsala University, Sjukhusvägen 9, Ing 35, 75309, Uppsala, Sweden
| | - Spyridon Gerovasileiou
- Department of Medical Sciences, Uppsala University, Clinical Physiology and Cardiology, Uppsala University, Uppsala, Sweden
| | - Elna-Marie Larsson
- Department of Surgical Science, Radiology, Uppsala University, Uppsala, Sweden
| | - Carina Blomström-Lundqvist
- Department of Medical Science and Cardiology, Uppsala University, Sjukhusvägen 9, Ing 35, 75309, Uppsala, Sweden
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9
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Karolyi M, Gotschy A, Plein S, Paetsch I, Jahnke C, Frick M, Gebker R, Alkadhi H, Manka R. 3D cardiac magnetic resonance stress-perfusion in elderly patients. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Swiss National Science Foundation
Introduction
Age related comorbidities and reduced compliance often limit ischaemia testing in elderly patients.
Purpose
To assessed the accuracy of 3D cardiac magnetic resonance (CMR) stress perfusion in the elderly population.
Methods
56 patients aged ≥75 years underwent 3D CMR stress-perfusion and invasive coronary angiography with quantitative coronary angiography (QCA) and fractional flow reserve (FFR) as part of a multicenter study. The accuracy of 3D CMR stress-perfusion was compared to patients aged <75 years old (n = 360) using qualitative and quantitative imaging parameters.
Results
Sensitivity, specificity, positive and negative predictive values of qualitative 3D perfusion CMR were similar for both age groups in the detection of high-grade (≥50%) coronary stenosis on QCA and hemodynamically relevant (<0.8) stenosis on FFR, p > 0.05 all. Quantitative myocardial ischemia burden was larger in elderly patients (15% ± 17% vs. 9% ± 13%) with similarly high diagnostic accuracy of quantitative 3D CMR perfusion in both age groups to predict pathological FFR (AUC ≥75: 0.906; AUC <75: 0.866).
Conclusions
3D CMR perfusion is well suited for myocardial ischaemia testing in the elderly patients with similarly high diagnostic accuracy as in younger individuals.
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Affiliation(s)
- M Karolyi
- University of Zurich, Zurich, Switzerland
| | - A Gotschy
- University of Zurich, Zurich, Switzerland
| | - S Plein
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - I Paetsch
- University of Leipzig, Leipzig, Germany
| | - C Jahnke
- University of Leipzig, Leipzig, Germany
| | - M Frick
- RWTH University Hospital Aachen, Aachen, Germany
| | - R Gebker
- German Heart Institute Berlin, Berlin, Germany
| | - H Alkadhi
- University of Zurich, Zurich, Switzerland
| | - R Manka
- University of Zurich, Zurich, Switzerland
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10
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Wild V, Frick M, Denholm J. WHO ethics guidance on TB care and migration: challenges to the implementation process. Int J Tuberc Lung Dis 2021; 24:32-37. [PMID: 32553041 DOI: 10.5588/ijtld.17.0882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
We summarise the current ethical guidance on tuberculosis (TB) care and migration, as set out in the WHO "Ethics Guidance for the Implementation of the End TB Strategy." Among other aspects, the Ethics Guidance states that there should be firm legal principles in place that ensure the enforcement of migration law on the one hand and the protection of human rights, including the right to health, on the other are separated from one another. As a challenge to the Ethics Guidance and its implementation, we describe two cases, each of which typifies particular problems. Case one describes the experience of a migrant worker in the United Arab Emirates who is deported when mandatory medical exams show evidence of current or prior TB. Case two raises the issue of providing more than TB care, which may also be needed for holistic care. The paper concludes with our suggestions for ways in which we could make progress towards ethically optimal TB care for migrants.
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Affiliation(s)
- V Wild
- Institute of Ethics, History and Theory of Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - M Frick
- Treatment Action Group, New York, NY, USA
| | - J Denholm
- Victorian Tuberculosis Program, Melbourne Health, Melbourne, VIC, Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute, Melbourne, VIC, Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, VIC, Australia
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11
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Lenhoff H, Darpö B, Page A, Couderc JP, Tornvall P, Frick M. Diurnal QT analysis in patients with sotalol after cardioversion of atrial fibrillation. Ann Noninvasive Electrocardiol 2021; 26:e12834. [PMID: 33629473 PMCID: PMC8293609 DOI: 10.1111/anec.12834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 01/26/2021] [Accepted: 01/29/2021] [Indexed: 12/18/2022] Open
Abstract
Background The risk of ventricular arrhythmias in patients on QT prolonging drugs is indicated to be increased early after cardioversion (CV) of atrial fibrillation (AF) to sinus rhythm (SR). Sotalol, used to prevent AF relapse, prolongs cardiac repolarization and corrected QT interval (QTc). A pronounced QTc prolongation is an established marker of pro‐arrhythmias. Our objective was to use novel technique to quantify and evaluate the diurnal variation of the QTc interval after elective CV to SR in patients on sotalol or metoprolol. Methods Fifty patients underwent twelve‐lead Holter recording for 24 hr after elective CV for persistent AF. All patients had the highest tolerable stable dose of sotalol (n = 27) or metoprolol (n = 23). Measurements of QT and RR intervals were performed on all valid beats. Results A clear diurnal variation of both HR and QTc was seen in both groups, more pronounced in patients on sotalol, where a high percentage of heartbeats with QTc >500 ms was observed, especially at night. Six patients (22%) on sotalol but none on metoprolol had >20% of all heart beats within the 24‐hour recording with QTc >500 ms. Conclusion Twenty‐four‐hour Holter recordings with QT‐measurement immediately after CV demonstrated that one in five patients on sotalol had >20% of all heart beats with prolonged QTc >500 ms, especially during night‐time. The QTc diurnal variation was retained in patients on β‐blockade or a potent class III anti‐arrhythmic drug with β‐blocking properties.
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Affiliation(s)
- Hanna Lenhoff
- Division of Cardiology, Department of Clinical Science and Education, Karolinska Institutet, South Hospital, Stockholm, Sweden
| | - Börje Darpö
- Department of Clinical Sciences, Karolinska Institutet, Danderyd, Sweden
| | - Alex Page
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, NY, USA
| | - Jean Philippe Couderc
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, NY, USA
| | - Per Tornvall
- Division of Cardiology, Department of Clinical Science and Education, Karolinska Institutet, South Hospital, Stockholm, Sweden
| | - Mats Frick
- Division of Cardiology, Department of Clinical Science and Education, Karolinska Institutet, South Hospital, Stockholm, Sweden
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12
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Svensson P, Bergstrom M, Discacciati A, Ljung L, Jernberg T, Frick M, Linder R, Askling J. Is rheumatoid arthritis a risk factor for acute coronary syndrome also among individuals at elevated risk, such as individuals presenting with acute chest pain? RMD Open 2020; 6:rmdopen-2020-001463. [PMID: 33243783 PMCID: PMC7856117 DOI: 10.1136/rmdopen-2020-001463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/05/2020] [Accepted: 11/11/2020] [Indexed: 11/16/2022] Open
Abstract
Background Patients with rheumatoid arthritis (RA) are, on average, at increased risk of acute coronary syndrome (ACS) compared to the general population, but it remains unknown whether RA remains an ACS risk factor also in settings where the ACS risk is already high elevated, such as among individuals presenting to the emergency department (ED) with chest pain. Methods and results We included 49 283 individuals (514 (1.0%) had RA) presenting with chest pain at the four hospital EDs in Stockholm, Sweden, 2013–2016 in a cohort study. Information on exposure (RA), outcome (ACS) and comorbidities was provided through national registers. The association between RA and ACS was assessed, overall and by levels of high-sensitivity cardiac troponin T (hs-cTnT) and number of ACS risk factors, using logistic regression models adjusted for age, sex, hospital, calendar year and cardiovascular risk factors. ACS was more common in patients with (8.2%) than without (4.6%) RA, adjusted OR =1.4, 95% CI 1.0 to 2.0. This association was particularly strong in individuals with initial hs-cTnT levels between 5 and 14 ng/L, or no additional ACS risk factors (adjusted ORs above 2), but no longer detectable in those with hs-cTnT >14 ng/L or with three or more additional ACS risk factors. Conclusion RA is a risk factor for ACS also among patients at the ED with chest pain. This association is not explained by traditional ACS risk factors, and most pronounced in patients with normal hs-cTnT and few other ACS risk factors, prompting particular ACS vigilance in this RA patient group.
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Affiliation(s)
- Per Svensson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden .,Department of Cardiology, Södersjukhuset, Sweden
| | | | - Andrea Discacciati
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden
| | - Lina Ljung
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, Södersjukhuset, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Sweden
| | - Mats Frick
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, Södersjukhuset, Sweden
| | - Rickard Linder
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Sweden
| | - Johan Askling
- Department of Medicine Solna, Karolinska Institutet, Sweden.,Rheumatology, Theme Inflammation and infection, Karolinska University Hospital, Sweden
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13
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Frick M, Bauermann K, Kirschfink A, Hamada S, Weber O, Marx N, Altiok E. High sensitive troponin T as gatekeeper for cardiac magnetic resonance imaging in patients with suspected acute myocarditis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The diagnosis of acute (AM) is difficult because of the variable, unspecific clinical presentation. Cardiac magnetic resonance (CMR) is the noninvasive gold standard diagnostic tool, but limited availability and high costs make a quick and inexpensive test necessary to clarify the need for CMR. Quantification of high sensitive Troponin T (hsTNT) is a broadly available, specific blood test for cardiomyocyte damage.
Aim
The aim of this study was to evaluate hsTNT as a gatekeeper for CMR with a lower cut off-value for exclusion and an upper cut-off value for confirmation of acute myocarditis as defined by CMR.
Methods
This retrospective analysis included 244 patients (age 39±17 years, 71% male) who received CMR for clinically suspected AM and quantification of hsTNT within 28 days (Median: 2 days) of CMR. CMR (1.5 Tesla) consisted of cine-sequences, edema-sensitive T2 and late gadolinium enhancement (LGE) imaging. AM was diagnosed in presence of both, myocardial edema and LGE consistent with acute myocarditis.
Results
Of 244 patients, 78 (32%) were CMR-positive (CMR+) for AM. 166 (68%) were CMR negative (CMR−). Mean hsTNT was 206±454 pg/ml.
HsTNT was significantly higher in CMR+ than in CMR− (604±639 pg/ml vs 20±56 pg/ml, p<0.001, see figure A). 8 CMR+ patients (10%) had hsTNT in the normal range (<14 ng/ml).
HsTNT showed good discriminatory performance in the Receiver Operator Characteristic (ROC) analysis (AUC 0.91, see figure B).
A lower cut-off value of 4 pg/ml had a sensitivity of 98.7% for diagnosis of AM (hsTNT ≥4 pg/ml) and a negative predictive value of 98.2% for rule out of AM (hsTNT<4 pg/ml) as defined by CMR, leading to a reduction of 23.4% of CMR exams. An upper cut-off value of >343 pg/ml had a specificity of 99.4% and positive predictive value of 97.8% for diagnosis of AM, leading to a reduction of 18.4% of CMR exams (see table).
Conclusions
hsTNT showed good discriminatory capacity for acute myocarditis (AM) as defined by CMR. However, 10% of patients had hsTNT in the normal range (<14 pg/ml). A lower cut-off value of <4 pg/ml ruled out AM with very high negative predictive value, whereas an upper cut-off of >343 pg/ml had a very high positive predictive value for confirmation of AM as defined by CMR. Performing CMR only in patients with hsTNT between 4 and 343 pg/ml would have led to a reduction of 41.8% of CMR exams.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Frick
- RWTH University Hospital Aachen, Internal Medicine I, Cardiology, Pulmonology & Vascular Medicine, Aachen, Germany
| | - K Bauermann
- RWTH University Hospital Aachen, Internal Medicine I, Cardiology, Pulmonology & Vascular Medicine, Aachen, Germany
| | - A Kirschfink
- RWTH University Hospital Aachen, Internal Medicine I, Cardiology, Pulmonology & Vascular Medicine, Aachen, Germany
| | - S Hamada
- RWTH University Hospital Aachen, Internal Medicine I, Cardiology, Pulmonology & Vascular Medicine, Aachen, Germany
| | - O Weber
- Philips GmbH, Market DACH, Hamburg, Germany
| | - N Marx
- RWTH University Hospital Aachen, Internal Medicine I, Cardiology, Pulmonology & Vascular Medicine, Aachen, Germany
| | - E Altiok
- RWTH University Hospital Aachen, Internal Medicine I, Cardiology, Pulmonology & Vascular Medicine, Aachen, Germany
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14
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Arvanitis P, Johansson A, Frick M, Malmborg H, Gerovasileiou S, Larsson E, Blomstrom Lundqvist C. Timing and degree of left atrial stunning and reverse functional remodeling following electrical cardioversion in patients with recent onset atrial fibrillation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0465] [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
Atrial fibrillation (AF) results in left atrial electrical, structural and functional remodeling. Restoration of sinus rhythm hallmarks the beginning of reverse remodeling, the extent of which may depend on the type of AF.
Purpose
The aim of the study was to assess resumption of left atrial function after electric cardioversion in patients with recent onset AF and to explore the association between reverse remodeling and the type of atrial fibrillation.
Methods
Patients with AF duration <48 hours were prospectively included. Trans-thoracic echocardiography was performed prior, immediately after (2–4 hours) and 7–10 days following CV. Left atrial volume index (LAVI), left atrial global longitudinal strain during reservoir (LAGLS-res), conduit (LAGLS-cond) and contractile (LAGLS-contr) phases, left atrial ejection fraction (LAEF) and left ventricular ejection fraction (LVEF) were measured.
Results
Forty-three patients (84% males) aged 55±9.6 years, (mean±SD), with median CHA2DS2-VASc score 1 (interquartile range 0–1) were included. Repeated measure analysis of variance revealed a statistically significant overall change for LAGLS-res F(2,78)=55.4, p<0,001, LAGLS-cond F(2,78)=23.3, p<0,001, LAGLS-contr F(2,78)=39.7, p<0,001, LAEF F(2,80)=28.5, p<0.001 and LVEF F(2,80)=8.4, p<0.001. At 7–10 days, LAGLS-contr 12±4%, LAEF 53±9% and LVEF 60±6 (mean±SD) return within normal reference intervals. Notably left atrial recovery seems to precede left ventricular recovery. No statistical significant interaction with the type of atrial fibrillation could be shown.
Conclusion
Left atrial functional reverse remodeling occurs within ten days after successful electric cardioversion of patients with recent onset atrial fibrillation.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Swedish Heart-Lung Foundation, Correvio International Sárl (Geneva Switzerland), Selanders Stiftelse
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Affiliation(s)
- P Arvanitis
- Uppsala University, Department of Medical Science and Cardiology, Uppsala, Sweden
| | - A.K Johansson
- South Hospital Stockholm, Dep. of Cardiology, Stockholm, Sweden
| | - M Frick
- South Hospital Stockholm, Dep. of Cardiology, Stockholm, Sweden
| | - H Malmborg
- Uppsala University, Department of Medical Science and Cardiology, Uppsala, Sweden
| | - S Gerovasileiou
- Uppsala University Hospital, Department of Clinical Physiology and Cardiology, Uppsala, Sweden
| | - E.M Larsson
- Uppsala University, Department of Surgical Science, Radiology, Uppsala, Sweden
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15
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Arvanitis P, Johansson A, Frick M, Malmborg H, Larsson E, Blomstrom Lundqvist C. Activation of inflammatory/coagulation system following electrical cardioversion of patient with recent onset atrial fibrillation: an explorative study of the relation to white matter hyperintensities. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0464] [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
White matter hyperintensities (WMH), assessed using Fazekas scale, are more prevalent in patients with atrial fibrillation (AF), although its pathophysiologic mechanism(s) is unclear.
Purpose
The study objective was to explore the association between cardiac, inflammatory and coagulation biomarkers and white matter hyperintensities in anticoagulant-naïve patients following electrical cardioversion (CV) of recent onset AF.
Methods
Patients with AF duration <48 hours were prospectively included. Brain magnetic resonance imaging (MRI), C-reactive protein (CRP), high-sensitivity troponin T (hs-TNT), NT-proBNP, Interleukin 6, P-selectin, D-dimer, prothrombin fragment 1+2, von Willebrand factor Ag, coagulation factor VIII C and fibrinogen, were obtained sequentially prior, after (2–4 hours) and 7–10 days following CV. Repeated measure analysis of variance was performed.
Results
Forty-three patients (84% males), aged 55±9.6 years, (mean±SD) with median CHA2DS2-VASc score 1 (interquartile range 0–1) were included. Sequential MRI showed no new brain lesions after CV, while WMH were present at baseline in 21/43 (49%) patients. Repeated measure analysis of variance revealed a statistically significant overall change for hs-TNT: F(2,84)=6.056, p=0.03, NT-proBNP: F(2,84)=106.02, p<0.001, P-selectin: F(2,84)=8.69, p<0.001 and vWF:Ag: F(2,84)=4.078, p=0.02. CRP, IL-6, coagulation factor VIII-C and fibrinogen showed the same pattern, however none reached statistical significance. Patients with WMH had persistent higher values for CRP, hs-TNT, D-dimer, prothrombin fragment 1+2 and fibrinogen prior and after CV, as values at 7–10 days coincided; however, statistical interaction was not significant.
Conclusion
Transient activation of inflammatory and coagulation systems during atrial fibrillation subsides within 7–10 days after electric cardioversion of recent onset atrial fibrillation. A tendency of higher degree of activation during atrial fibrillation was observed in patients with white matter hyperintensities.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Swedish Heart-Lung Foundation, Swedish Research Council, Correvio International Sárl (Geneva Switzerland), Selanders Stiftelse
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Affiliation(s)
- P Arvanitis
- Uppsala University, Department of Medical Science and Cardiology, Uppsala, Sweden
| | - A.K Johansson
- South Hospital Stockholm, Dep. of Cardiology, Stockholm, Sweden
| | - M Frick
- South Hospital Stockholm, Dep. of Cardiology, Stockholm, Sweden
| | - H Malmborg
- Uppsala University, Department of Medical Science and Cardiology, Uppsala, Sweden
| | - E.M Larsson
- Uppsala University, Department of Surgical Science, Radiology, Uppsala, Sweden
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16
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Lee S, Kao G, Feigenberg S, Dorsey J, Frick M, Jean-Baptiste S, Uche C, Fan Y, Xiao Y. Predicting Circulating Tumor Cells from Intratumoral Radiomic Heterogeneity of 18F-FDG-PET/CT in Early Stage Non-Small Cell Lung Cancer Treated with Stereotactic Body Radiation Therapy. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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17
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Frick M, Hiniker S, Yoo C, Hoppe R. Consolidative Radiation Therapy Following Autologous Stem Cell Transplant in Relapsed or Refractory Hodgkin Lymphoma. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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18
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Jean-Baptiste S, Frick M, Mendes A, Swisher-McClure S, Berman A, Levin W, Cengel K, Hahn S, Dorsey J, Simone C, Feigenberg S, Kao G. When Failure is Final: Subsequent Outcomes of Patients with Stage I NSCLC who Fail Initial Stereotactic Body Radiation Therapy Monitored with Circulating Tumor Cells. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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19
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Doerler J, Edlinger M, Alber H, Berger R, Frick M, Hammerer M, Hasun M, Huber K, Lamm G, Lassnig E, Von Lewinski D, Roithinger F, Siostrzonek P, Steinwender C, Weidinger F. Prasugrel compared to ticagrelor in primary PCI. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1737] [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
Prasugrel and ticagrelor have similar recommendations in the setting of primary PCI by current guidelines. Data comparing both in daily clinical practice of primary PCI for ST-elevation myocardial infarction is limited.
Purpose
To compare the effect of prasugrel and ticagrelor on in-hospital outcomes after primary PCI.
Methods and results
We prospectively enrolled 5365 patients treated with prasugrel (n=2785, 51.9%) or ticagrelor (n=2580; 48.1%) in the setting of primary PCI from January 2011 to December 2018 in a nationwide registry. In-hospital outcomes were compared and multiple logistic regression analysis was performed. Prasugrel treated patients were younger, less often in cardiogenic shock, with lower rates of previous stroke and had shorter ischemic time. Both groups showed similar rates of previous MI, diabetes and current resuscitation. In the univariate analysis mortality was lower in patients with prasugrel (2.5% vs. 4.4% p<0.01). Similarly, MACE (3.3% vs. 5.3%, p<0.01) and NACE (4.0% vs. 5.7% p<0.01) were lower in prasugrel treated patients, whereas major bleeding events did not differ (0.4% vs. 0.6% p=0.24).
After adjustment in multivariable analysis mortality (0.99 95% CI 0.57 to 1.72), MACE (OR 0.99 95% CI 0.65 to 1.52) as well as NACE (0.86 95% CI 0.61 to 1.22) did not differ in patients treated with prasugrel compared to ticagrelor.
Conclusion
Patients treated with prasugrel showed improved outcomes compared to ticagrelor in a large cohort of primary PCI. However, after adjustment for confounders the Advantage of prasugrel in primary PCI did not persist.
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): Austrian Society of Cardiology
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Affiliation(s)
- J Doerler
- Innsbruck Medical University, Department of Internal Medicine III, Cardiology, Innsbruck, Austria
| | - M Edlinger
- Innsbruck Medical University, Department of Internal Medicine III, Cardiology, Innsbruck, Austria
| | - H Alber
- Hospital Klagenfurt, Department of Internal Medicine and Cardiology, Klagenfurt, Austria
| | - R Berger
- Hospital Brothers of Mercy, Department of Internal Medicine I, Eisenstadt, Austria
| | - M Frick
- Academic Teaching Hospital, Department of Internal Medicine I, Feldkirch, Austria
| | - M Hammerer
- Paracelsus Medical University, Department of Internal Medicine II, Salzburg, Austria
| | - M Hasun
- Rudolfstiftung Hospital, 2nd Medical Department with Cardiology and intensive Care Medicine, Vienna, Austria
| | - K Huber
- Wilhelminen Hospital, 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Vienna, Austria
| | - G Lamm
- University Hospital St. Polten, Department of Internal Medicine III, St. Polten, Austria
| | - E Lassnig
- Klinikum Wels-Grieskirchen, Department of Internal Medicine II, Wels, Austria
| | - D Von Lewinski
- Medical University of Graz, Department of Cardiology, Graz, Austria
| | - F.X Roithinger
- Landesklinikum Wiener Neustadt, Department of Internal Medicine, Cardiology and Nephrology, Wiener Neustadt, Austria
| | - P Siostrzonek
- Ordensklinikum Barmherzige Schwestern, Department of Internal Medicine II, Linz, Austria
| | - C Steinwender
- Kepler University Hospital Linz, Department of Internal Medicine I, Linz, Austria
| | - F Weidinger
- Rudolfstiftung Hospital, 2nd Medical Department with Cardiology and intensive Care Medicine, Vienna, Austria
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20
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Wahrenberg A, Magnusson PKE, Discacciati A, Ljung L, Jernberg T, Frick M, Linder R, Svensson P. Family history of coronary artery disease is associated with acute coronary syndrome in 28,188 chest pain patients. European Heart Journal. Acute Cardiovascular Care 2020; 9:741-747. [DOI: 10.1177/2048872619853521] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background:
The value of family history of coronary artery disease (CAD) in diagnosing acute coronary syndrome (ACS) in chest pain patients is uncertain, especially in relation to high-sensitivity assays for cardiac troponin T (hs-cTnT), which have improved ACS diagnostics. Our objective was to investigate the association between verified family history of CAD and ACS in chest pain patients, overall and in different strata of initial hs-cTnT.
Methods:
Data on chest pain patients visiting four emergency departments in Sweden during 2013–2016 were cross-referenced with national registers of kinship, diseases and prescriptions. Family history of early CAD was defined as the occurrence of myocardial infarction or coronary revascularization before the age of 55 years in male and 65 years in female first-degree relatives. The outcome was combined including ACS and cardiovascular death within 30 days of presentation.
Results:
Of 28,188 patients, 4.7% of patients had ACS. In total, 8.2% and 32.4% had a family history of early and ever-occurring CAD, respectively. Family history of CAD was positively associated with the outcome, independently of age, gender, cardiovascular risk factors and electrocardiogram findings. The strongest association was observed for family history of early CAD (odds ratio 1.62, 95% confidence interval 1.35–1.94). Stronger associations were observed in young patients (e.g. <65 years) and in patients with non-elevated initial hs-cTnT levels (p-value for interaction = 0.004 and 0.001, respectively).
Conclusions:
Family history of CAD is associated with ACS in chest pain patients, especially in patients of young age or with non-elevated initial hs-cTnT levels.
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Affiliation(s)
- Agnes Wahrenberg
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Patrik KE Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Andrea Discacciati
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lina Ljung
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Södersjukhuset, Stockholm, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Mats Frick
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Södersjukhuset, Stockholm, Sweden
| | - Rickard Linder
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Per Svensson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Södersjukhuset, Stockholm, Sweden
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21
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Arvanitis P, Johansson AK, Frick M, Malmborg H, Gerovasileiou S, Larsson EM, Blomström-Lundqvist C. Serial Magnetic Resonance Imaging after Electrical Cardioversion of Recent Onset Atrial Fibrillation in Anticoagulant-Naïve Patients - A Prospective Study Exploring Clinically Silent Cerebral Lesions. J Atr Fibrillation 2020; 13:2271. [PMID: 34950290 DOI: 10.4022/jafib.2271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 12/27/2019] [Accepted: 01/06/2020] [Indexed: 11/10/2022]
Abstract
Background Patients with atrial fibrillation (AF) have a high incidence of cognitive impairment, which may be related to clinically silent microembolism causing cerebral infarctions. Objective To explore the occurrence and timing of silent brain lesions following electrical cardioversion (CV) of recent onset AF in anticoagulant-naïve patients and to study related effects on cognitive function and biomarkers of cerebral damage, S100b. Methods Patients with AF duration > 48 hours were prospectively included. Brain magnetic resonance imaging (MRI) and S100b, were obtained prior, after and 7-10 days following CV. Trail making tests (TMT-A and TMT-B) and their difference, ΔΤΜΤ, were assessed prior to CV, 7-10 days and 30 days after CV. Results Forty-three patients (84% males) with median CHA2DS2-VASc score 1 (interquartile range 0-1) were included. Sequential MRI, including diffusion weighted scans, showed no new brain lesions after CV. Chronic white matter hyperintensities were present at baseline in 21/43 (49%) patients. The S100b (µg/l) levels increased significantly from baseline, (mean ±SD) 0.0472±0.0182 to 0.0551±0.0185 after CV, p=0.001 and then decreased 7-10 days after CV to 0.0450±0.0186, p <.;0.001. Consecutive TMT scores improved successively after CV, being statistically and clinically significant for TMT-B (p<0.01) and ΔΤΜΤ (p=0.005) between 7-10 days and 30 days after CV (Reliable Change Index >1.96). Conclusions New brain lesions could not be detected on MRI after CV, but the high incidence of white matter hyperintensities and the transient increase in S100b may indicate transient or minor brain damage undetectable by MRI thus heightening the need to reevaluate thromboembolic risk prior to CV even in low risk patients.
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Affiliation(s)
- Panagiotis Arvanitis
- Department of Medical Science and Cardiology, Uppsala University, Uppsala, Sweden.,Joint primary authors
| | - Anna-Karin Johansson
- Stockholm South General Hospital, Department of Cardiology, Stockholm, Sweden.,Joint primary authors
| | - Mats Frick
- Stockholm South General Hospital, Department of Cardiology, Stockholm, Sweden
| | - Helena Malmborg
- Department of Medical Science and Cardiology, Uppsala University, Uppsala, Sweden
| | - Spyridon Gerovasileiou
- Department of Medical Sciences, Uppsala University, Clinical Physiology and Cardiology, Uppsala University Hospital, Uppsala, Sweden
| | - Elna-Marie Larsson
- Department of Surgical Science, Radiology, Uppsala University, Uppsala, Sweden
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22
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Arvanitis P, Johansson AK, Frick M, Malmborg H, Larsson EM, Blomstrom Lundqvist C. P1080Magnetic resonance imaging after electrical cardioversion of recent-onset atrial fibrillation in anticoagulant-naive patients - a study exploring clinically silent cerebral lesions. Europace 2020. [DOI: 10.1093/europace/euaa162.377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Unrestricted grants from the Swedish Heart-Lung Foundation, the Swedish Research Council, Correvio International Sárl (CH) and Selanders stiftelse
Background
Patients with atrial fibrillation (AF) have a high incidence of cognitive impairment, which may be related to clinically silent microembolism causing cerebral infarctions.
Purpose
To explore the occurrence and timing of silent brain lesions following electrical cardioversion (CV) of recent onset AF in anticoagulant-naïve patients and to further study related effects on cognitive function and biomarkers of cerebral damage, S100b.
Methods
Patients with AF duration < 48 hours were prospectively included. Brain magnetic resonance imaging (MRI) and S100b, were obtained prior, after and 7-10 days following CV. Trail making tests (TMT-A and TMT-B) and their difference, ΔΤΜΤ, were assessed prior to CV, 7-10 days and 30 days after CV.
Results
Forty-three patients (84% males) with mean CHA2DS2-VASc score 0.6 ± 0.7 were included. Sequential MRI, including diffusion weighted scans, showed no new brain lesions after CV.
Chronic white matter hyperintensities (WMH) were present at baseline in 21/43 (49%) patients. By partitioning the study population into four major groups according to the extend of WMH (Fazekas score 0 or ≥ 1) and the presence or absence of TE risk factors (CHA2DS2-VASc score 0 or ≥ 1), the TE risk as defined by CHA2DS2-VASc score ≥ 1, was associated with a higher incidence of WMH, Pearson χ2(1,N = 43)=3.95, p = 0.047.
The S100b (µg/l) levels increased significantly from baseline, (mean ± SD) 0.0472 ± 0.0182 to 0.0551 ± 0.0185 after CV, p = 0.001 and then decreased 7-10 days after CV to 0.0450 ± 0.0186, p < 0.001. Subgroup analysis according to the presence of at least one TE risk factor as defined by CHA2DS2-VASc score showed that statistical significance of repeated measures ANOVA was maintained; for patients with no risk factors F (2,30)=12.59, p < 0.001 and for patients with CHA2DS2-VASc score ≥1 F(2,36)=4.43, p < 0.019.
Consecutive TMT scores improved successively after CV, being statistically and clinically significant for TMT-B (p < 0.01) and ΔΤΜΤ (p = 0.005) between 7-10 days and 30 days after CV (Reliable Change Index >1.96).
Conclusion
New brain lesions could not be detected on MRI after CV, but the high incidence of white matter hyperintensities and the transient increase in S100b may indicate transient or minor brain damage undetectable by MRI thus heightening the need to reevaluate thromboembolic risk prior to CV even in low risk patients.
Abstract Figure. S100b_TMT
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Affiliation(s)
- P Arvanitis
- Uppsala University, Uppsala University Hospital, Dep. of Cardiology, Uppsala, Sweden
| | - A K Johansson
- South Hospital Stockholm, Dep. of Cardiology, Stockholm, Sweden
| | - M Frick
- South Hospital Stockholm, Dep. of Cardiology, Stockholm, Sweden
| | - H Malmborg
- Uppsala University, Uppsala University Hospital, Dep. of Cardiology, Uppsala, Sweden
| | - E M Larsson
- Uppsala University, Uppsala University Hospital, Dep. of Radiology, Uppsala, Sweden
| | - C Blomstrom Lundqvist
- Uppsala University, Uppsala University Hospital, Dep. of Cardiology, Uppsala, Sweden
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23
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Stillo J, Frick M, Cong Y. Upholding ethical values and human rights at the frontier of TB research. Int J Tuberc Lung Dis 2020; 24:48-56. [PMID: 32553044 DOI: 10.5588/ijtld.17.0897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Until recently, human rights have played a minor role in the fight against tuberculosis (TB), even less so in TB research. This is changing, however. The WHO's End TB Strategy and Ethics Guidance stress respect for human rights and ethical principles in every area of TB care, including research. The desired reductions in TB incidence and mortality are impossible without new tools and strategies to fight the disease. Yet, little suggests that the current state of TB research-including funding levels, evidence being produced, and community involvement-will alleviate concerns related to the availability, accessibility, and acceptability of TB diagnostics, drugs, and prevention in the near future. In this article, we consider these ethics concerns in relation to the right to enjoy the benefits of scientific progress and the right to health. We also reflect on community involvement in research and offer recommendations in the spirit of the rights to health and science, such as involving affected communities in all aspects of research planning, execution, and dissemination. Finally, we argue that states have a responsibility under international law for the continued realization of the right to health. This realization rests, in part, on the realization of the right to science.
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Affiliation(s)
- J Stillo
- College of Liberal Arts and Sciences, Wayne State University, Detroit, MI
| | - M Frick
- Treatment Action Group, New York, NY, USA
| | - Y Cong
- Program of Medical Ethics, Peking University Health Science Center, Beijing, China
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24
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Hövels-Gürich H, Hamada S, Kirschfink A, Ostermayer S, Lebherz C, Kerst G, Marx N, Frick M. Coronary Artery Morphology and Function Late after Neonatal Arterial Switch Operation (ASO) for Transposition of the Great Arteries (TGA)—A Cardiac Magnetic Resonance (CMR) Study and Follow-up Recommendations. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705576] [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] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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25
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Mysdotter V, Frick M, Jernberg T, Eggers K, Svensson P. P3595Risk factors, comorbidities and early dynamic change in high-sensitive cardiac troponin T -The importance of initial troponin level at presentation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The one-hour troponin-algorithm is recommended together with a clinical evaluation for rule-in and rule-out of acute coronary syndrome (ACS) in the emergency department (ED). Since risk factors and many comorbidities are associated with small elevations of high-sensitive cardiac troponin T (hs-cTnT), their additive value for discrimination of ACS have been questioned. However, the importance of the initial troponin level for how risk factors and/or comorbidities associate with early dynamic change in hs-cTnT is poorly studied.
Purpose
To investigate the association between risk factors and early dynamic change of hs-cTnT among those with an elevated compared to non-elevated initial hs-cTnT.
Methods
This was a retrospective study among patients admitted to four urban emergency departments (ED) between 2014–2016 with the chief complaint of chest pain and with two clinical routine hs-cTnT measurements at presentation and at >30–104 minutes later. Clinical data from the ED visit were cross-referenced to national registers retrieving information on diagnoses and treatments to identify: cardiovascular disease (CVD, defined as previous myocardial infarction, stroke or peripheral vascular disease), hypertension (HT), hyperlipidemia (HL), diabetes mellitus (DM), chronic kidney disease (CKD), Heart failure (CHF) and atrial fibrillation (AF). The association between risk factors and early dynamic change was studied separately for those with an elevated (>14ng/L, dynamic change set as >20%) and a non-elevated (≤14ng/L, dynamic change set as >2ng/L) initial hs-cTnT.
Results
9278 patients were identified. All risk factors and comorbidities were more common among those with an elevated hs-cTnT. Dynamic change was present in 236 (3.4%) of 7024 patients with an initial hs-cTnT ≤14ng/L and 307 (13.6%) of 2254 with an initial hs-cTnT >14ng/L respectively. Among those with non-elevated initial hs-cTnT those with dynamic change were more likely to be older: age >70 (odds ratio (OR); 95% CI: 1.5; 1.1–2.0), have CVD (1.7: 1.2–2.5), HT (1.4; 1.1–1.8), eGFR<60 (1.8; 1.3–2.5) or AF (1.5; 1.0–2.4). Conversely, in patients with initial elevated hs-cTnT most conditions were negatively associated with early dynamic change: age >70 (0.5; 0.4–0.6), CVD (0.5; 0.4–0.7), HT (0.6; 0.46–0.8), eGFR<60 (0.4; 0.3–0.6), CHF (0.4; 0.3–0.5), AF (0.4; 0.3–0.6) and no risk factors were positively associated with dynamic change. Different cut-offs for dynamic change for instance >4ng/L (at initial hs-cTnT <14ng/L) and >50% (initial >14ng/L) were tested but did not affect the overall results.
Fig 1. Forest plot dynamic hs-cTnT
Conclusions
Many risk factors and comorbidities show opposite associations with early dynamic change of hs-cTnT depending on the baseline concentration. The findings stress the importance of initial troponin level when assessing patients with risk factors presenting with ACS symptoms in the ED, however further investigations are needed to establish the definite dependency.
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Affiliation(s)
- V Mysdotter
- South Hospital Stockholm, Department of Clinical Science and Education, Stockholm, Sweden
| | - M Frick
- South Hospital Stockholm, Department of Clinical Science and Education, Stockholm, Sweden
| | - T Jernberg
- South Hospital Stockholm, Department of Clinical Science and Education, Stockholm, Sweden
| | - K Eggers
- Uppsala University Hospital, Department of Cardiology, Uppsala, Sweden
| | - P Svensson
- South Hospital Stockholm, Department of Clinical Science and Education, Stockholm, Sweden
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26
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Frick M, Feigenberg S, Jean-Baptiste S, Aguarin L, Mendes A, Chinniah C, Swisher-McClure S, Hahn S, Cengel K, Berman A, Levin W, Dorsey J, Simone C, Kao G. Pre-Treatment Circulating Tumor Cell Levels Correlate with Regional and Distant Failure Rates Following Stereotactic Body Radiation Therapy for Early Stage Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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27
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Affiliation(s)
- J. Furin
- Global Health and Social Medicine, Harvard Medical School, Boston, MA
| | - M. Frick
- Treatment Action Group—TB/HIV, New York, NY, USA , ,
| | - L. McKenna
- Treatment Action Group—TB/HIV, New York, NY, USA , ,
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28
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Ljung L, Reichard C, Hagerman P, Eggers KM, Frick M, Lindahl B, Linder R, Martinsson A, Melki D, Svensson P, Jernberg T. Sensitivity of undetectable level of high-sensitivity troponin T at presentation in a large non-ST-segment elevation myocardial infarction cohort of early presenters. Int J Cardiol 2019; 284:6-11. [DOI: 10.1016/j.ijcard.2018.10.088] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 09/26/2018] [Accepted: 10/25/2018] [Indexed: 11/26/2022]
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29
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Hjort M, Eggers KM, Lindhagen L, Agewall S, Brolin EB, Collste O, Daniel M, Ekenbäck C, Frick M, Henareh L, Hofman-Bang C, Malmqvist K, Spaak J, Sörensson P, Y-Hassan S, Tornvall P, Lindahl B. Increased Inflammatory Activity in Patients 3 Months after Myocardial Infarction with Nonobstructive Coronary Arteries. Clin Chem 2019; 65:1023-1030. [PMID: 31072836 DOI: 10.1373/clinchem.2018.301085] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 03/26/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Around 5%-10% of patients with myocardial infarction (MI) present with nonobstructive coronary arteries (MINOCA). We aimed to assess pathophysiological mechanisms in MINOCA by extensively evaluating cardiovascular biomarkers in the stable phase after an event, comparing MINOCA patients with cardiovascular healthy controls and MI patients with obstructive coronary artery disease (MI-CAD). METHODS Ninety-one biomarkers were measured with a proximity extension assay 3 months after MI in 97 MINOCA patients, 97 age- and sex-matched MI-CAD patients, and 98 controls. Lasso analyses (penalized logistic regression models) and adjusted multiple linear regression models were used for statistical analyses. RESULTS In the Lasso analysis (MINOCA vs MI-CAD), 8 biomarkers provided discriminatory value: P-selectin glycoprotein ligand 1, C-X-C motif chemokine 1, TNF-related activation-induced cytokine, and pappalysin-1 (PAPPA) with increasing probabilities of MINOCA, and tissue-type plasminogen activator, B-type natriuretic peptide, myeloperoxidase, and interleukin-1 receptor antagonist protein with increasing probabilities of MI-CAD. Comparing MINOCA vs controls, 7 biomarkers provided discriminatory value: N-terminal pro-B-type natriuretic peptide, renin, NF-κ-B essential modulator, PAPPA, interleukin-6, and soluble urokinase plasminogen activator surface receptor with increasing probabilities of MINOCA, and agouti-related protein with increasing probabilities of controls. Adjusted multiple linear regression analyses showed that group affiliation was associated with the concentrations of 7 of the 8 biomarkers in the comparison MINOCA vs MI-CAD and 5 of the 7 biomarkers in MINOCA vs controls. CONCLUSIONS Three months after the MI, the biomarker concentrations indicated greater inflammatory activity in MINOCA patients than in both MI-CAD patients and healthy controls, and a varying degree of myocardial dysfunction among the 3 cohorts.
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Affiliation(s)
- Marcus Hjort
- Department of Medical Sciences, and .,Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | | | - Lars Lindhagen
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Stefan Agewall
- Institute of Clinical Sciences, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Elin B Brolin
- Department of Clinical Science, Intervention and Technology
| | - Olov Collste
- Department of Clinical Sciences and Education, Södersjukhuset
| | - Maria Daniel
- Department of Clinical Sciences and Education, Södersjukhuset
| | - Christina Ekenbäck
- Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital
| | - Mats Frick
- Department of Clinical Sciences and Education, Södersjukhuset
| | - Loghman Henareh
- Heart and Vascular Theme, Department of Medicine, Karolinska University Hospital, and
| | - Claes Hofman-Bang
- Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital
| | - Karin Malmqvist
- Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital
| | - Jonas Spaak
- Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital
| | - Peder Sörensson
- Department of Molecular Medicine and Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Shams Y-Hassan
- Heart and Vascular Theme, Department of Medicine, Karolinska University Hospital, and
| | - Per Tornvall
- Department of Clinical Sciences and Education, Södersjukhuset
| | - Bertil Lindahl
- Department of Medical Sciences, and.,Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
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30
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Niezink A, Jain V, Chouvalova O, Wijsman R, Muijs C, Frick M, Doucette A, Simone C, Chinniah C, Widder J, Langendijk J, Van der Schaaf A, Berman A. PO-0782 External validation of NTCP models for pneumonitis in lung cancer patients receiving proton therapy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31202-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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31
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Nero D, Agewall S, Daniel M, Caidahl K, Collste O, Ekenbäck C, Frick M, Henareh L, Jernberg T, Malmqvist K, Schenck-Gustafsson K, Spaak J, Sörensson P, Sundin Ö, Y-Hassan S, Hofman-Bang C, Tornvall P. Personality Traits in Patients with Myocardial Infarction with Nonobstructive Coronary Arteries. Am J Med 2019; 132:374-381.e1. [PMID: 30503881 DOI: 10.1016/j.amjmed.2018.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 11/13/2018] [Accepted: 11/13/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The purpose of this study was to describe type A behavior pattern and trait anger in patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) and compare them with patients with coronary heart disease and healthy controls. Type A behavior pattern and anger have been linked to coronary heart disease in previous studies. This is the first study to assess type A behavior pattern and trait anger in MINOCA patients. METHODS One hundred MINOCA patients, consecutively recruited during 2007-2011 at 5 coronary care units in Stockholm, were matched for sex and age to 100 coronary heart disease patients and 100 healthy controls. All participants completed the Bortner Rating Scale to quantify type A behavior pattern and the Spielberger Trait Anger Scale to quantify anger 3 months after the acute event. RESULTS MINOCA patients' Bortner Rating Scale score was 70.9 ± 10.8 (mean ± SD) and Spielberger Trait Anger Scale score was 14 (12-17) (median; interquartile range). Coronary heart disease patients' Bortner Rating Scale score was 70.5 ± 10.2 and Spielberger Trait Anger Scale score was 14 (12-17). Healthy controls' Bortner Rating Scale score was 71.9 ± 9.1 and Spielberger Trait Anger Scale score was 13 (11-16). CONCLUSION We found no significant differences in Bortner Rating Scale score and Spielberger Trait Anger Scale score among MINOCA, coronary heart disease patients, and healthy controls, regardless of whether total scores, subscales, or cutoffs were used to classify type A behavior pattern and trait anger. However, we cannot exclude the existence of an occasional episode of anger or mental stress in relation to the coronary event. This is the first study to assess type A behavior pattern and trait anger in patients with MINOCA, and future studies need to confirm the current findings before any firm conclusions can be made.
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Affiliation(s)
- Daniella Nero
- Departments of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
| | - Stefan Agewall
- Institute of Clinical Sciences, University of Oslo and Oslo University Hospital Ullevål, Norway
| | - Maria Daniel
- Departments of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Kenneth Caidahl
- Department of Molecular Medicine and Surgery, Karolinska Institute and Karolinska University Hospital Solna, Stockholm, Sweden; Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Olov Collste
- Departments of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | | | - Mats Frick
- Departments of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Loghman Henareh
- Coronary Artery and Vascular Disease, Heart and Vascular Theme. Department of Medicine, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - Karin Malmqvist
- Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - Karin Schenck-Gustafsson
- Centre for Gender Medicine, Karolinska Institute and Karolinska University Hospital Solna, Institutionen för medicin, enhet kardiologi, FOU Tema Hjärta-Kärl. Stockholm, Sweden
| | - Jonas Spaak
- Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - Peder Sörensson
- Department of Molecular Medicine and Surgery, Karolinska Institute and Karolinska University Hospital Solna, Stockholm, Sweden
| | | | - Shams Y-Hassan
- Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - Claes Hofman-Bang
- Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - Per Tornvall
- Departments of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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32
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Benedek P, Eriksson M, Duvefelt K, Freyschuss A, Frick M, Lundman P, Nylund L, Szummer K. Genetic testing for familial hypercholesterolemia among survivors of acute coronary syndrome. J Intern Med 2018; 284:674-684. [PMID: 29974534 DOI: 10.1111/joim.12812] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 12/22/2022]
Abstract
BACKGROUND Familial hypercholesterolemia could be prevalent among patients with acute coronary syndrome. OBJECTIVE To investigate both the frequency of causative mutations for familial hypercholesterolemia (FH) and the optimal selection of patients for genetic testing among patients with an acute coronary syndrome (ACS). METHODS One hundred and sixteen patients with an ACS during 2009-2015 were identified through the SWEDEHEART registry. Patients who had either a high total cholesterol level ≥7 mmol L-1 combined with a triglyceride level ≤2.6 mmol L-1 , or were treated with lipid-lowering medication and had a total cholesterol level >4.9 mmol L-1 and a triglyceride level ≤2.6 mmol L-1 were included. Genetic testing was performed first with a regionally designed FH mutation panel (118 mutations), followed by testing with a commercially available FH genetic analysis (Progenika Biopharma). RESULTS A total of 6.9% (8/116) patients had a FH-causative mutation, all in the LDL-receptor. Five patients were detected on the panel, and further testing of the remaining 111 patients detected an additional 3 FH-causative mutations. Baseline characteristics were similar in FH-positive and FH-negative patients with respect to age, gender, prior ACS and diabetes. Patients with a FH-causative mutation had higher Dutch Lipid Clinical Network (DLCN) score (5.5 (5.0-6.5) vs 3.0 (2.0-5.0), P < 0.001) and a higher low-density lipoprotein level (5.7 (4.7-6.5) vs 4.9 (3.5-5.4), P = 0.030). The Dutch Lipid Clinical Network (DLCN) score had a good discrimination with an area under the curve of 0.856 (95% CI 0.763-0.949). CONCLUSION Genetic testing for FH should be considered in patients with ACS and high DLCN score.
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Affiliation(s)
- P Benedek
- Department of Medicine, Karolinska Institutet, Huddinge, Stockholm, Sweden.,Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
| | - M Eriksson
- Department of Medicine, Karolinska Institutet, Huddinge, Stockholm, Sweden.,Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
| | - K Duvefelt
- Mutation Analysis Facility, Clinical Research Center, Karolinska University Hospital, Stockholm, Sweden
| | - A Freyschuss
- Department of Medicine, Section of Cardiology, Karolinska Institutet, Huddinge, Stockholm, Sweden.,Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - M Frick
- Department of Cardiology, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - P Lundman
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - L Nylund
- Department of Medicine, Section of Cardiology, Karolinska Institutet, Huddinge, Stockholm, Sweden.,Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - K Szummer
- Department of Medicine, Section of Cardiology, Karolinska Institutet, Huddinge, Stockholm, Sweden.,Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
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Mendoza-Topaz C, Nelson G, Howard G, Hafner S, Rademacher P, Frick M, Nichols BJ. Cells respond to deletion of CAV1 by increasing synthesis of extracellular matrix. PLoS One 2018; 13:e0205306. [PMID: 30346954 PMCID: PMC6197626 DOI: 10.1371/journal.pone.0205306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 09/21/2018] [Indexed: 12/21/2022] Open
Abstract
A range of cellular functions have been attributed to caveolae, flask-like invaginations of the plasma membrane. Here, we have used RNA-seq to achieve quantitative transcriptional profiling of primary embryonic fibroblasts from caveolin 1 knockout mice (CAV1-/- MEFs), and thereby to gain hypothesis-free insight into how these cells respond to the absence of caveolae. Components of the extracellular matrix were decisively over-represented within the set of genes displaying altered expression in CAV1-/- MEFs when compared to congenic wild-type controls. This was confirmed biochemically and by imaging for selected examples. Up-regulation of components of the extracellular matrix was also observed in a second cell line, NIH-3T3 cells genome edited to delete CAV1. Up-regulation of components of the extracellular matrix was detected in vivo by assessing collagen deposition and compliance of CAV1-/- lungs. We discuss the implications of these findings in terms of the cellular function of caveolae.
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Affiliation(s)
- C. Mendoza-Topaz
- Medical Research Council Laboratory of Molecular Biology, Cambridge, United Kingdom
| | - G. Nelson
- Medical Research Council Laboratory of Molecular Biology, Cambridge, United Kingdom
| | - G. Howard
- Medical Research Council Laboratory of Molecular Biology, Cambridge, United Kingdom
| | - S. Hafner
- Institute of Pathophysiological Anesthesiology and Process Engineering, University of Ulm, Ulm, Germany
| | - P. Rademacher
- Institute of Pathophysiological Anesthesiology and Process Engineering, University of Ulm, Ulm, Germany
| | - M. Frick
- Institute of General Physiology, University of Ulm, Ulm, Germany
| | - B. J. Nichols
- Medical Research Council Laboratory of Molecular Biology, Cambridge, United Kingdom
- * E-mail:
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Pasterk L, Gobbato S, Bonetti N, Frick M, Meier S, Liu M, Camici GG, Luescher TF, Egloff M, Koepfli P, Schmid HR, Beer JH. P6561Mechanism of ultra-low LDL-C and platelets - insights from Tangier disease patients and patients on PCSK9 inhibitor therapy. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6561] [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)
- L Pasterk
- University of Zurich, Center for Molecular Cardiology, Zurich, Switzerland
| | - S Gobbato
- University of Zurich, Center for Molecular Cardiology, Zurich, Switzerland
| | - N Bonetti
- University of Zurich, Center for Molecular Cardiology, Zurich, Switzerland
| | - M Frick
- Cantonal Hospital of Baden, Baden, Switzerland
| | - S Meier
- Cantonal Hospital of Baden, Baden, Switzerland
| | - M Liu
- Cantonal Hospital of Baden, Baden, Switzerland
| | - G G Camici
- University of Zurich, Center for Molecular Cardiology, Zurich, Switzerland
| | - T F Luescher
- University of Zurich, Center for Molecular Cardiology, Zurich, Switzerland
| | - M Egloff
- Cantonal Hospital of Baden, Baden, Switzerland
| | - P Koepfli
- Cantonal Hospital of Baden, Baden, Switzerland
| | - H R Schmid
- Cantonal Hospital of Baden, Baden, Switzerland
| | - J H Beer
- Cantonal Hospital of Baden, Baden, Switzerland
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35
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Ljung L, Reichard C, Hagerman P, Egggers KM, Frick M, Lindahl B, Linder R, Martinsson A, Melki D, Svensson P, Jernberg T. P827Insufficient sensitivity when using undetectable baseline high-sensitivity cardiac troponin T (hs-cTnT <5 ng/L) to rule out myocardial infarction in patients with short time from symptom onset. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p827] [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)
- L Ljung
- South Hospital Stockholm, Department of Clinical Science and Education, Karolinska Institutet and Department of Cardiology, Stockholm, Sweden
| | - C Reichard
- Danderyd University Hospital, Danderyd, Stockholm, Sweden
| | - P Hagerman
- Capio St Goran Hospital, Stockholm, Sweden
| | - K M Egggers
- Uppsala University, Department of Medical Sciences, Uppsala, Sweden
| | - M Frick
- South Hospital Stockholm, Department of Clinical Science and Education, Karolinska Institutet and Department of Cardiology, Stockholm, Sweden
| | - B Lindahl
- Uppsala University, Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala, Sweden
| | - R Linder
- Danderyd University Hospital, Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
| | | | - D Melki
- Karolinska University Hospital, Stockholm, Sweden
| | - P Svensson
- South Hospital Stockholm, Department of Clinical Science and Education, Karolinska Institutet and Department of Cardiology, Stockholm, Sweden
| | - T Jernberg
- Danderyd University Hospital, Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
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Lofmark H, Ljung L, Eggers K, Frick M, Linder R, Lindahl B, Martinsson A, Melki D, Sarkar N, Svensson P, Winter R, Jernberg T. P3666A simplified HEART-score improves discrimination for myocardial infarction in chest pain patients presenting to the emergency department. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3666] [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)
- H Lofmark
- Institution for cardiaovascular diease, Department of cardiology, Danderyd, Sweden
| | - L Ljung
- Institution for cardiaovascular diease, Department of cardiology, Danderyd, Sweden
| | - K Eggers
- Institution for cardiaovascular diease, Department of cardiology, Danderyd, Sweden
| | - M Frick
- Institution for cardiaovascular diease, Department of cardiology, Danderyd, Sweden
| | - R Linder
- Institution for cardiaovascular diease, Department of cardiology, Danderyd, Sweden
| | - B Lindahl
- Institution for cardiaovascular diease, Department of cardiology, Danderyd, Sweden
| | - A Martinsson
- Institution for cardiaovascular diease, Department of cardiology, Danderyd, Sweden
| | - D Melki
- Institution for cardiaovascular diease, Department of cardiology, Danderyd, Sweden
| | - N Sarkar
- Institution for cardiaovascular diease, Department of cardiology, Danderyd, Sweden
| | - P Svensson
- Institution for cardiaovascular diease, Department of cardiology, Danderyd, Sweden
| | - R Winter
- Institution for cardiaovascular diease, Department of cardiology, Danderyd, Sweden
| | - T Jernberg
- Institution for cardiaovascular diease, Department of cardiology, Danderyd, Sweden
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Bergstrom M, Askling J, Discacciati A, Frick M, Jernberg T, Linder R, Ljung L, Svensson P. P5423Rheumatoid arthritis as an emergency department risk factor for acute coronary syndrome. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5423] [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 Bergstrom
- Karolinska Institute, Department of medicine, Solna, Stockholm, Sweden
| | - J Askling
- Karolinska Institute, Department of medicine, Solna, Stockholm, Sweden
| | - A Discacciati
- Karolinska Institute, Institute of Environmental Medicine, Stockholm, Sweden
| | - M Frick
- South Hospital Stockholm, Department of cardiology, Stockholm, Sweden
| | - T Jernberg
- Danderyd University Hospital, Department of Clinical Sciences, Stockholm, Sweden
| | - R Linder
- Danderyd University Hospital, Department of Clinical Sciences, Stockholm, Sweden
| | - L Ljung
- South Hospital Stockholm, Department of cardiology, Stockholm, Sweden
| | - P Svensson
- South Hospital Stockholm, Department of cardiology, Stockholm, Sweden
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Wahrenberg A, Magnusson P, Discacciati A, Ljung L, Jernberg T, Frick M, Linder R, Svensson P. P817Family history of coronary artery disease predicts acute coronary syndrome in 28,188 chest pain patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p817] [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)
| | - P Magnusson
- Karolinska Institute, Department of Medical Epidemiology and Biostatistics, Stockholm, Sweden
| | - A Discacciati
- Karolinska Institute, Unit of Biostatistics, Institute of Environmental Medicine, Stockholm, Sweden
| | - L Ljung
- South Hospital Stockholm, Stockholm, Sweden
| | - T Jernberg
- Danderyd University Hospital, Stockholm, Sweden
| | - M Frick
- South Hospital Stockholm, Stockholm, Sweden
| | - R Linder
- Danderyd University Hospital, Stockholm, Sweden
| | - P Svensson
- Karolinska Institute, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
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Branstrand S, Discacciati A, Frick M, Jernberg T, Linder R, Ljung L, Svensson P. P4605Low education but not income level predicts acute coronary syndrome in 46,654 chest pain patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4605] [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)
| | - A Discacciati
- Karolinska Institute, Unit of Biostatistics, Institute of Environmental Medicine, Stockholm, Sweden
| | - M Frick
- South Hospital Stockholm, Stockholm, Sweden
| | - T Jernberg
- Danderyd University Hospital, Stockholm, Sweden
| | - R Linder
- Danderyd University Hospital, Stockholm, Sweden
| | - L Ljung
- South Hospital Stockholm, Stockholm, Sweden
| | - P Svensson
- Karolinska Institute, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
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Pairet N, Mang S, Fois G, Keck M, Kühnbach M, Gindele J, Frick M, Dietl P, Lamb DJ. TRPV4 inhibition attenuates stretch-induced inflammatory cellular responses and lung barrier dysfunction during mechanical ventilation. PLoS One 2018; 13:e0196055. [PMID: 29664963 PMCID: PMC5903668 DOI: 10.1371/journal.pone.0196055] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/01/2018] [Indexed: 02/06/2023] Open
Abstract
Mechanical ventilation is an important tool for supporting critically ill patients but may also exert pathological forces on lung cells leading to Ventilator-Induced Lung Injury (VILI). We hypothesised that inhibition of the force-sensitive transient receptor potential vanilloid (TRPV4) ion channel may attenuate the negative effects of mechanical ventilation. Mechanical stretch increased intracellular Ca2+ influx and induced release of pro-inflammatory cytokines in lung epithelial cells that was partially blocked by about 30% with the selective TRPV4 inhibitor GSK2193874, but nearly completely blocked with the pan-calcium channel blocker ruthenium red, suggesting the involvement of more than one calcium channel in the response to mechanical stress. Mechanical stretch also induced the release of pro-inflammatory cytokines from M1 macrophages, but in contrast this was entirely dependent upon TRPV4. In a murine ventilation model, TRPV4 inhibition attenuated both pulmonary barrier permeability increase and pro-inflammatory cytokines release due to high tidal volume ventilation. Taken together, these data suggest TRPV4 inhibitors may have utility as a prophylactic pharmacological treatment to improve the negative pathological stretch-response of lung cells during ventilation and potentially support patients receiving mechanical ventilation.
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Affiliation(s)
- N. Pairet
- Immunology & Respiratory Diseases Research, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riß, Germany
- Department of General Physiology, University of Ulm, Ulm, Germany
- * E-mail:
| | - S. Mang
- Immunology & Respiratory Diseases Research, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riß, Germany
- Institute of Immunology, Hannover Medical School, Hannover, Germany
| | - G. Fois
- Department of General Physiology, University of Ulm, Ulm, Germany
| | - M. Keck
- Immunology & Respiratory Diseases Research, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riß, Germany
| | - M. Kühnbach
- Immunology & Respiratory Diseases Research, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riß, Germany
| | - J. Gindele
- Immunology & Respiratory Diseases Research, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riß, Germany
- Department of General Physiology, University of Ulm, Ulm, Germany
| | - M. Frick
- Department of General Physiology, University of Ulm, Ulm, Germany
| | - P. Dietl
- Department of General Physiology, University of Ulm, Ulm, Germany
| | - D. J. Lamb
- Immunology & Respiratory Diseases Research, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riß, Germany
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Syvänne M, Silveira A, Luong LA, Nieminen M, Humphries S, Frick M, Taskinen MR, Hamsten A. Fibrinolytic Proteins and Progression of Coronary Artery Disease in Relation to Gemfibrozil Therapy. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1613826] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryImpaired fibrinolytic function, mainly due to increased plasma plasminogen activator inhibitor-1 (PAI-1) activity, is common in patients with manifest coronary artery disease (CAD) and a predictor of recurrent cardiovascular events. We investigated the relationships of plasma tissue-type plasminogen activator (tPA) and PAI-1 antigen levels, plasma PAI-1 activity and PAI 4/5-guanosine (4G/5G) genotype to CAD progression in 203 middle-aged men participating in the Lopid Coronary Angiography Trial (LOCAT).A higher tPA antigen concentration, whether baseline or on-trial, was associated with a more severe global angiographic response (p < 0.05), an association mainly accounted for by progression of diffuse lesions in graft-affected segments (change in per-patient means of average diameters of segments haemodynamically related to bypass grafts). Plasma PAI-1 activity and mass concentration and 4G/5G PAI-1 genotype were unrelated to angiographic outcome measurements. tPA and PAI-1 antigen increased significantly in the gemfibrozil group (+11.3% and + 16.4%, respectively, p < 0.001), whereas there was no treatment effect on PAI-1 activity (median change 0.0%).It is concluded that fibrinolytic function does not substantially influence progression of CAD as assessed by angiography in middle-aged men. Furthermore, pronounced long-term lowering of serum triglycerides by gemfibrozil treatment does not significantly affect the plasma PAI-1 activity level but increases the plasma tPA and PAI-1 antigen concentrations.
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42
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Frick M, Rosenthal S, Vapiwala N, Monzon B, Berman A. Practices and Perceptions of Survivorship Care in Radiation Oncology: Results from a Nationally Distributed Survey. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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43
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Frick M, Rosenthal S, Vapiwala N, Monzon B, Berman A. Survivorship Care Training and Education Among Radiation Oncologists: Results from a Nationally-Distributed Survey. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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44
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Wild V, Jaff D, Shah NS, Frick M. Tuberculosis, human rights and ethics considerations along the route of a highly vulnerable migrant from sub-Saharan Africa to Europe. Int J Tuberc Lung Dis 2017; 21:1075-1085. [PMID: 28911349 PMCID: PMC5793855 DOI: 10.5588/ijtld.17.0324] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Migrant health is a critical public health issue, and in many countries attention to this topic has focused on the link between migration and communicable diseases, including tuberculosis (TB). When creating public health policies to address the complex challenges posed by TB and migration, countries should focus these policies on evidence, ethics, and human rights. This paper traces a commonly used migration route from sub-Saharan Africa to Europe, identifying situations at each stage in which human rights and ethical values might be affected in relation to TB care. This illustration provides the basis for discussing TB and migration from the perspective of human rights, with a focus on the right to health. We then highlight three strands of discussion in the ethics and justice literature in an effort to develop more comprehensive ethics of migrant health. These strands include theories of global justice and global health ethics, the creation of 'firewalls' to separate enforcement of immigration law from protection of human rights, and the importance of non-stigmatization to health justice. The paper closes by reflecting briefly on how TB programs can better incorporate human rights and ethical principles and values into public health practice.
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Affiliation(s)
- V Wild
- Ludwig-Maximilians-University, Munich, Germany
| | - D Jaff
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - N S Shah
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - M Frick
- Treatment Action Group, New York, New York, USA
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45
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Frick M, Aguarin L, Chinniah C, Manning B, Swisher-McClure S, Berman A, Levin W, Cengel K, Hahn S, Dorsey J, Kao G, Simone C. Prospective Assessment of Circulating Tumor Cells (CTCs) as a Biomarker for Treatment Failure in Patients with Clinical Stage I Non-Small Cell Lung Cancer (NSCLC) Treated with Stereotactic Body Radiation Therapy (SBRT). Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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46
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Frick M, Vachani C, Hampshire M, Bach C, Arnold-Korzeniowski K, Metz J, Hill-Kayser C. Survivorship after Treatment of Pancreatic Cancer: Insights Via an Internet-Based Survivorship Care Plan Tool. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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47
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Hofmann R, James SK, Jernberg T, Lindahl B, Erlinge D, Witt N, Arefalk G, Frick M, Alfredsson J, Nilsson L, Ravn-Fischer A, Omerovic E, Kellerth T, Sparv D, Ekelund U, Linder R, Ekström M, Lauermann J, Haaga U, Pernow J, Östlund O, Herlitz J, Svensson L. Oxygen Therapy in Suspected Acute Myocardial Infarction. N Engl J Med 2017; 377:1240-1249. [PMID: 28844200 DOI: 10.1056/nejmoa1706222] [Citation(s) in RCA: 219] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The clinical effect of routine oxygen therapy in patients with suspected acute myocardial infarction who do not have hypoxemia at baseline is uncertain. METHODS In this registry-based randomized clinical trial, we used nationwide Swedish registries for patient enrollment and data collection. Patients with suspected myocardial infarction and an oxygen saturation of 90% or higher were randomly assigned to receive either supplemental oxygen (6 liters per minute for 6 to 12 hours, delivered through an open face mask) or ambient air. RESULTS A total of 6629 patients were enrolled. The median duration of oxygen therapy was 11.6 hours, and the median oxygen saturation at the end of the treatment period was 99% among patients assigned to oxygen and 97% among patients assigned to ambient air. Hypoxemia developed in 62 patients (1.9%) in the oxygen group, as compared with 254 patients (7.7%) in the ambient-air group. The median of the highest troponin level during hospitalization was 946.5 ng per liter in the oxygen group and 983.0 ng per liter in the ambient-air group. The primary end point of death from any cause within 1 year after randomization occurred in 5.0% of patients (166 of 3311) assigned to oxygen and in 5.1% of patients (168 of 3318) assigned to ambient air (hazard ratio, 0.97; 95% confidence interval [CI], 0.79 to 1.21; P=0.80). Rehospitalization with myocardial infarction within 1 year occurred in 126 patients (3.8%) assigned to oxygen and in 111 patients (3.3%) assigned to ambient air (hazard ratio, 1.13; 95% CI, 0.88 to 1.46; P=0.33). The results were consistent across all predefined subgroups. CONCLUSIONS Routine use of supplemental oxygen in patients with suspected myocardial infarction who did not have hypoxemia was not found to reduce 1-year all-cause mortality. (Funded by the Swedish Heart-Lung Foundation and others; DETO2X-AMI ClinicalTrials.gov number, NCT01787110 .).
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Affiliation(s)
- Robin Hofmann
- From the Department of Clinical Science and Education, Division of Cardiology (R.H., N.W., M.F.), and Center for Resuscitation Science (L.S.), Karolinska Institutet, Södersjukhuset, and the Department of Clinical Sciences, Cardiology, Danderyd Hospital, Karolinska Institutet (T.J., R.L., M.E.), Stockholm, the Department of Medical Sciences, Cardiology (S.K.J., B.L., G.A.), and Uppsala Clinical Research Center (S.K.J., O.Ö.), Uppsala University, Uppsala, the Department of Clinical Sciences, Cardiology (D.E., D.S.), and Department of Clinical Sciences, Emergency Medicine (U.E.), Lund University, Lund, the Department of Medical and Health Sciences and Department of Cardiology, Linköping University, Linköping (J.A., L.N.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (A.R.-F., E.O., J.H.), the Department of Cardiology, Örebro University Hospital, Örebro (T.K.), the Department of Internal Medicine, Division of Cardiology, Ryhov Hospital, Jönköping (J.L.), the Department of Cardiology, Karlstad Central Hospital, Karlstad (U.H.), the Department of Cardiology, Karolinska University Hospital (J.P.), and the Department of Medicine, Karolinska Institutet (J.P., L.S.), Solna, and the Department of Health Sciences, University of Borås, Borås (J.H.) - all in Sweden
| | - Stefan K James
- From the Department of Clinical Science and Education, Division of Cardiology (R.H., N.W., M.F.), and Center for Resuscitation Science (L.S.), Karolinska Institutet, Södersjukhuset, and the Department of Clinical Sciences, Cardiology, Danderyd Hospital, Karolinska Institutet (T.J., R.L., M.E.), Stockholm, the Department of Medical Sciences, Cardiology (S.K.J., B.L., G.A.), and Uppsala Clinical Research Center (S.K.J., O.Ö.), Uppsala University, Uppsala, the Department of Clinical Sciences, Cardiology (D.E., D.S.), and Department of Clinical Sciences, Emergency Medicine (U.E.), Lund University, Lund, the Department of Medical and Health Sciences and Department of Cardiology, Linköping University, Linköping (J.A., L.N.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (A.R.-F., E.O., J.H.), the Department of Cardiology, Örebro University Hospital, Örebro (T.K.), the Department of Internal Medicine, Division of Cardiology, Ryhov Hospital, Jönköping (J.L.), the Department of Cardiology, Karlstad Central Hospital, Karlstad (U.H.), the Department of Cardiology, Karolinska University Hospital (J.P.), and the Department of Medicine, Karolinska Institutet (J.P., L.S.), Solna, and the Department of Health Sciences, University of Borås, Borås (J.H.) - all in Sweden
| | - Tomas Jernberg
- From the Department of Clinical Science and Education, Division of Cardiology (R.H., N.W., M.F.), and Center for Resuscitation Science (L.S.), Karolinska Institutet, Södersjukhuset, and the Department of Clinical Sciences, Cardiology, Danderyd Hospital, Karolinska Institutet (T.J., R.L., M.E.), Stockholm, the Department of Medical Sciences, Cardiology (S.K.J., B.L., G.A.), and Uppsala Clinical Research Center (S.K.J., O.Ö.), Uppsala University, Uppsala, the Department of Clinical Sciences, Cardiology (D.E., D.S.), and Department of Clinical Sciences, Emergency Medicine (U.E.), Lund University, Lund, the Department of Medical and Health Sciences and Department of Cardiology, Linköping University, Linköping (J.A., L.N.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (A.R.-F., E.O., J.H.), the Department of Cardiology, Örebro University Hospital, Örebro (T.K.), the Department of Internal Medicine, Division of Cardiology, Ryhov Hospital, Jönköping (J.L.), the Department of Cardiology, Karlstad Central Hospital, Karlstad (U.H.), the Department of Cardiology, Karolinska University Hospital (J.P.), and the Department of Medicine, Karolinska Institutet (J.P., L.S.), Solna, and the Department of Health Sciences, University of Borås, Borås (J.H.) - all in Sweden
| | - Bertil Lindahl
- From the Department of Clinical Science and Education, Division of Cardiology (R.H., N.W., M.F.), and Center for Resuscitation Science (L.S.), Karolinska Institutet, Södersjukhuset, and the Department of Clinical Sciences, Cardiology, Danderyd Hospital, Karolinska Institutet (T.J., R.L., M.E.), Stockholm, the Department of Medical Sciences, Cardiology (S.K.J., B.L., G.A.), and Uppsala Clinical Research Center (S.K.J., O.Ö.), Uppsala University, Uppsala, the Department of Clinical Sciences, Cardiology (D.E., D.S.), and Department of Clinical Sciences, Emergency Medicine (U.E.), Lund University, Lund, the Department of Medical and Health Sciences and Department of Cardiology, Linköping University, Linköping (J.A., L.N.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (A.R.-F., E.O., J.H.), the Department of Cardiology, Örebro University Hospital, Örebro (T.K.), the Department of Internal Medicine, Division of Cardiology, Ryhov Hospital, Jönköping (J.L.), the Department of Cardiology, Karlstad Central Hospital, Karlstad (U.H.), the Department of Cardiology, Karolinska University Hospital (J.P.), and the Department of Medicine, Karolinska Institutet (J.P., L.S.), Solna, and the Department of Health Sciences, University of Borås, Borås (J.H.) - all in Sweden
| | - David Erlinge
- From the Department of Clinical Science and Education, Division of Cardiology (R.H., N.W., M.F.), and Center for Resuscitation Science (L.S.), Karolinska Institutet, Södersjukhuset, and the Department of Clinical Sciences, Cardiology, Danderyd Hospital, Karolinska Institutet (T.J., R.L., M.E.), Stockholm, the Department of Medical Sciences, Cardiology (S.K.J., B.L., G.A.), and Uppsala Clinical Research Center (S.K.J., O.Ö.), Uppsala University, Uppsala, the Department of Clinical Sciences, Cardiology (D.E., D.S.), and Department of Clinical Sciences, Emergency Medicine (U.E.), Lund University, Lund, the Department of Medical and Health Sciences and Department of Cardiology, Linköping University, Linköping (J.A., L.N.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (A.R.-F., E.O., J.H.), the Department of Cardiology, Örebro University Hospital, Örebro (T.K.), the Department of Internal Medicine, Division of Cardiology, Ryhov Hospital, Jönköping (J.L.), the Department of Cardiology, Karlstad Central Hospital, Karlstad (U.H.), the Department of Cardiology, Karolinska University Hospital (J.P.), and the Department of Medicine, Karolinska Institutet (J.P., L.S.), Solna, and the Department of Health Sciences, University of Borås, Borås (J.H.) - all in Sweden
| | - Nils Witt
- From the Department of Clinical Science and Education, Division of Cardiology (R.H., N.W., M.F.), and Center for Resuscitation Science (L.S.), Karolinska Institutet, Södersjukhuset, and the Department of Clinical Sciences, Cardiology, Danderyd Hospital, Karolinska Institutet (T.J., R.L., M.E.), Stockholm, the Department of Medical Sciences, Cardiology (S.K.J., B.L., G.A.), and Uppsala Clinical Research Center (S.K.J., O.Ö.), Uppsala University, Uppsala, the Department of Clinical Sciences, Cardiology (D.E., D.S.), and Department of Clinical Sciences, Emergency Medicine (U.E.), Lund University, Lund, the Department of Medical and Health Sciences and Department of Cardiology, Linköping University, Linköping (J.A., L.N.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (A.R.-F., E.O., J.H.), the Department of Cardiology, Örebro University Hospital, Örebro (T.K.), the Department of Internal Medicine, Division of Cardiology, Ryhov Hospital, Jönköping (J.L.), the Department of Cardiology, Karlstad Central Hospital, Karlstad (U.H.), the Department of Cardiology, Karolinska University Hospital (J.P.), and the Department of Medicine, Karolinska Institutet (J.P., L.S.), Solna, and the Department of Health Sciences, University of Borås, Borås (J.H.) - all in Sweden
| | - Gabriel Arefalk
- From the Department of Clinical Science and Education, Division of Cardiology (R.H., N.W., M.F.), and Center for Resuscitation Science (L.S.), Karolinska Institutet, Södersjukhuset, and the Department of Clinical Sciences, Cardiology, Danderyd Hospital, Karolinska Institutet (T.J., R.L., M.E.), Stockholm, the Department of Medical Sciences, Cardiology (S.K.J., B.L., G.A.), and Uppsala Clinical Research Center (S.K.J., O.Ö.), Uppsala University, Uppsala, the Department of Clinical Sciences, Cardiology (D.E., D.S.), and Department of Clinical Sciences, Emergency Medicine (U.E.), Lund University, Lund, the Department of Medical and Health Sciences and Department of Cardiology, Linköping University, Linköping (J.A., L.N.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (A.R.-F., E.O., J.H.), the Department of Cardiology, Örebro University Hospital, Örebro (T.K.), the Department of Internal Medicine, Division of Cardiology, Ryhov Hospital, Jönköping (J.L.), the Department of Cardiology, Karlstad Central Hospital, Karlstad (U.H.), the Department of Cardiology, Karolinska University Hospital (J.P.), and the Department of Medicine, Karolinska Institutet (J.P., L.S.), Solna, and the Department of Health Sciences, University of Borås, Borås (J.H.) - all in Sweden
| | - Mats Frick
- From the Department of Clinical Science and Education, Division of Cardiology (R.H., N.W., M.F.), and Center for Resuscitation Science (L.S.), Karolinska Institutet, Södersjukhuset, and the Department of Clinical Sciences, Cardiology, Danderyd Hospital, Karolinska Institutet (T.J., R.L., M.E.), Stockholm, the Department of Medical Sciences, Cardiology (S.K.J., B.L., G.A.), and Uppsala Clinical Research Center (S.K.J., O.Ö.), Uppsala University, Uppsala, the Department of Clinical Sciences, Cardiology (D.E., D.S.), and Department of Clinical Sciences, Emergency Medicine (U.E.), Lund University, Lund, the Department of Medical and Health Sciences and Department of Cardiology, Linköping University, Linköping (J.A., L.N.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (A.R.-F., E.O., J.H.), the Department of Cardiology, Örebro University Hospital, Örebro (T.K.), the Department of Internal Medicine, Division of Cardiology, Ryhov Hospital, Jönköping (J.L.), the Department of Cardiology, Karlstad Central Hospital, Karlstad (U.H.), the Department of Cardiology, Karolinska University Hospital (J.P.), and the Department of Medicine, Karolinska Institutet (J.P., L.S.), Solna, and the Department of Health Sciences, University of Borås, Borås (J.H.) - all in Sweden
| | - Joakim Alfredsson
- From the Department of Clinical Science and Education, Division of Cardiology (R.H., N.W., M.F.), and Center for Resuscitation Science (L.S.), Karolinska Institutet, Södersjukhuset, and the Department of Clinical Sciences, Cardiology, Danderyd Hospital, Karolinska Institutet (T.J., R.L., M.E.), Stockholm, the Department of Medical Sciences, Cardiology (S.K.J., B.L., G.A.), and Uppsala Clinical Research Center (S.K.J., O.Ö.), Uppsala University, Uppsala, the Department of Clinical Sciences, Cardiology (D.E., D.S.), and Department of Clinical Sciences, Emergency Medicine (U.E.), Lund University, Lund, the Department of Medical and Health Sciences and Department of Cardiology, Linköping University, Linköping (J.A., L.N.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (A.R.-F., E.O., J.H.), the Department of Cardiology, Örebro University Hospital, Örebro (T.K.), the Department of Internal Medicine, Division of Cardiology, Ryhov Hospital, Jönköping (J.L.), the Department of Cardiology, Karlstad Central Hospital, Karlstad (U.H.), the Department of Cardiology, Karolinska University Hospital (J.P.), and the Department of Medicine, Karolinska Institutet (J.P., L.S.), Solna, and the Department of Health Sciences, University of Borås, Borås (J.H.) - all in Sweden
| | - Lennart Nilsson
- From the Department of Clinical Science and Education, Division of Cardiology (R.H., N.W., M.F.), and Center for Resuscitation Science (L.S.), Karolinska Institutet, Södersjukhuset, and the Department of Clinical Sciences, Cardiology, Danderyd Hospital, Karolinska Institutet (T.J., R.L., M.E.), Stockholm, the Department of Medical Sciences, Cardiology (S.K.J., B.L., G.A.), and Uppsala Clinical Research Center (S.K.J., O.Ö.), Uppsala University, Uppsala, the Department of Clinical Sciences, Cardiology (D.E., D.S.), and Department of Clinical Sciences, Emergency Medicine (U.E.), Lund University, Lund, the Department of Medical and Health Sciences and Department of Cardiology, Linköping University, Linköping (J.A., L.N.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (A.R.-F., E.O., J.H.), the Department of Cardiology, Örebro University Hospital, Örebro (T.K.), the Department of Internal Medicine, Division of Cardiology, Ryhov Hospital, Jönköping (J.L.), the Department of Cardiology, Karlstad Central Hospital, Karlstad (U.H.), the Department of Cardiology, Karolinska University Hospital (J.P.), and the Department of Medicine, Karolinska Institutet (J.P., L.S.), Solna, and the Department of Health Sciences, University of Borås, Borås (J.H.) - all in Sweden
| | - Annica Ravn-Fischer
- From the Department of Clinical Science and Education, Division of Cardiology (R.H., N.W., M.F.), and Center for Resuscitation Science (L.S.), Karolinska Institutet, Södersjukhuset, and the Department of Clinical Sciences, Cardiology, Danderyd Hospital, Karolinska Institutet (T.J., R.L., M.E.), Stockholm, the Department of Medical Sciences, Cardiology (S.K.J., B.L., G.A.), and Uppsala Clinical Research Center (S.K.J., O.Ö.), Uppsala University, Uppsala, the Department of Clinical Sciences, Cardiology (D.E., D.S.), and Department of Clinical Sciences, Emergency Medicine (U.E.), Lund University, Lund, the Department of Medical and Health Sciences and Department of Cardiology, Linköping University, Linköping (J.A., L.N.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (A.R.-F., E.O., J.H.), the Department of Cardiology, Örebro University Hospital, Örebro (T.K.), the Department of Internal Medicine, Division of Cardiology, Ryhov Hospital, Jönköping (J.L.), the Department of Cardiology, Karlstad Central Hospital, Karlstad (U.H.), the Department of Cardiology, Karolinska University Hospital (J.P.), and the Department of Medicine, Karolinska Institutet (J.P., L.S.), Solna, and the Department of Health Sciences, University of Borås, Borås (J.H.) - all in Sweden
| | - Elmir Omerovic
- From the Department of Clinical Science and Education, Division of Cardiology (R.H., N.W., M.F.), and Center for Resuscitation Science (L.S.), Karolinska Institutet, Södersjukhuset, and the Department of Clinical Sciences, Cardiology, Danderyd Hospital, Karolinska Institutet (T.J., R.L., M.E.), Stockholm, the Department of Medical Sciences, Cardiology (S.K.J., B.L., G.A.), and Uppsala Clinical Research Center (S.K.J., O.Ö.), Uppsala University, Uppsala, the Department of Clinical Sciences, Cardiology (D.E., D.S.), and Department of Clinical Sciences, Emergency Medicine (U.E.), Lund University, Lund, the Department of Medical and Health Sciences and Department of Cardiology, Linköping University, Linköping (J.A., L.N.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (A.R.-F., E.O., J.H.), the Department of Cardiology, Örebro University Hospital, Örebro (T.K.), the Department of Internal Medicine, Division of Cardiology, Ryhov Hospital, Jönköping (J.L.), the Department of Cardiology, Karlstad Central Hospital, Karlstad (U.H.), the Department of Cardiology, Karolinska University Hospital (J.P.), and the Department of Medicine, Karolinska Institutet (J.P., L.S.), Solna, and the Department of Health Sciences, University of Borås, Borås (J.H.) - all in Sweden
| | - Thomas Kellerth
- From the Department of Clinical Science and Education, Division of Cardiology (R.H., N.W., M.F.), and Center for Resuscitation Science (L.S.), Karolinska Institutet, Södersjukhuset, and the Department of Clinical Sciences, Cardiology, Danderyd Hospital, Karolinska Institutet (T.J., R.L., M.E.), Stockholm, the Department of Medical Sciences, Cardiology (S.K.J., B.L., G.A.), and Uppsala Clinical Research Center (S.K.J., O.Ö.), Uppsala University, Uppsala, the Department of Clinical Sciences, Cardiology (D.E., D.S.), and Department of Clinical Sciences, Emergency Medicine (U.E.), Lund University, Lund, the Department of Medical and Health Sciences and Department of Cardiology, Linköping University, Linköping (J.A., L.N.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (A.R.-F., E.O., J.H.), the Department of Cardiology, Örebro University Hospital, Örebro (T.K.), the Department of Internal Medicine, Division of Cardiology, Ryhov Hospital, Jönköping (J.L.), the Department of Cardiology, Karlstad Central Hospital, Karlstad (U.H.), the Department of Cardiology, Karolinska University Hospital (J.P.), and the Department of Medicine, Karolinska Institutet (J.P., L.S.), Solna, and the Department of Health Sciences, University of Borås, Borås (J.H.) - all in Sweden
| | - David Sparv
- From the Department of Clinical Science and Education, Division of Cardiology (R.H., N.W., M.F.), and Center for Resuscitation Science (L.S.), Karolinska Institutet, Södersjukhuset, and the Department of Clinical Sciences, Cardiology, Danderyd Hospital, Karolinska Institutet (T.J., R.L., M.E.), Stockholm, the Department of Medical Sciences, Cardiology (S.K.J., B.L., G.A.), and Uppsala Clinical Research Center (S.K.J., O.Ö.), Uppsala University, Uppsala, the Department of Clinical Sciences, Cardiology (D.E., D.S.), and Department of Clinical Sciences, Emergency Medicine (U.E.), Lund University, Lund, the Department of Medical and Health Sciences and Department of Cardiology, Linköping University, Linköping (J.A., L.N.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (A.R.-F., E.O., J.H.), the Department of Cardiology, Örebro University Hospital, Örebro (T.K.), the Department of Internal Medicine, Division of Cardiology, Ryhov Hospital, Jönköping (J.L.), the Department of Cardiology, Karlstad Central Hospital, Karlstad (U.H.), the Department of Cardiology, Karolinska University Hospital (J.P.), and the Department of Medicine, Karolinska Institutet (J.P., L.S.), Solna, and the Department of Health Sciences, University of Borås, Borås (J.H.) - all in Sweden
| | - Ulf Ekelund
- From the Department of Clinical Science and Education, Division of Cardiology (R.H., N.W., M.F.), and Center for Resuscitation Science (L.S.), Karolinska Institutet, Södersjukhuset, and the Department of Clinical Sciences, Cardiology, Danderyd Hospital, Karolinska Institutet (T.J., R.L., M.E.), Stockholm, the Department of Medical Sciences, Cardiology (S.K.J., B.L., G.A.), and Uppsala Clinical Research Center (S.K.J., O.Ö.), Uppsala University, Uppsala, the Department of Clinical Sciences, Cardiology (D.E., D.S.), and Department of Clinical Sciences, Emergency Medicine (U.E.), Lund University, Lund, the Department of Medical and Health Sciences and Department of Cardiology, Linköping University, Linköping (J.A., L.N.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (A.R.-F., E.O., J.H.), the Department of Cardiology, Örebro University Hospital, Örebro (T.K.), the Department of Internal Medicine, Division of Cardiology, Ryhov Hospital, Jönköping (J.L.), the Department of Cardiology, Karlstad Central Hospital, Karlstad (U.H.), the Department of Cardiology, Karolinska University Hospital (J.P.), and the Department of Medicine, Karolinska Institutet (J.P., L.S.), Solna, and the Department of Health Sciences, University of Borås, Borås (J.H.) - all in Sweden
| | - Rickard Linder
- From the Department of Clinical Science and Education, Division of Cardiology (R.H., N.W., M.F.), and Center for Resuscitation Science (L.S.), Karolinska Institutet, Södersjukhuset, and the Department of Clinical Sciences, Cardiology, Danderyd Hospital, Karolinska Institutet (T.J., R.L., M.E.), Stockholm, the Department of Medical Sciences, Cardiology (S.K.J., B.L., G.A.), and Uppsala Clinical Research Center (S.K.J., O.Ö.), Uppsala University, Uppsala, the Department of Clinical Sciences, Cardiology (D.E., D.S.), and Department of Clinical Sciences, Emergency Medicine (U.E.), Lund University, Lund, the Department of Medical and Health Sciences and Department of Cardiology, Linköping University, Linköping (J.A., L.N.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (A.R.-F., E.O., J.H.), the Department of Cardiology, Örebro University Hospital, Örebro (T.K.), the Department of Internal Medicine, Division of Cardiology, Ryhov Hospital, Jönköping (J.L.), the Department of Cardiology, Karlstad Central Hospital, Karlstad (U.H.), the Department of Cardiology, Karolinska University Hospital (J.P.), and the Department of Medicine, Karolinska Institutet (J.P., L.S.), Solna, and the Department of Health Sciences, University of Borås, Borås (J.H.) - all in Sweden
| | - Mattias Ekström
- From the Department of Clinical Science and Education, Division of Cardiology (R.H., N.W., M.F.), and Center for Resuscitation Science (L.S.), Karolinska Institutet, Södersjukhuset, and the Department of Clinical Sciences, Cardiology, Danderyd Hospital, Karolinska Institutet (T.J., R.L., M.E.), Stockholm, the Department of Medical Sciences, Cardiology (S.K.J., B.L., G.A.), and Uppsala Clinical Research Center (S.K.J., O.Ö.), Uppsala University, Uppsala, the Department of Clinical Sciences, Cardiology (D.E., D.S.), and Department of Clinical Sciences, Emergency Medicine (U.E.), Lund University, Lund, the Department of Medical and Health Sciences and Department of Cardiology, Linköping University, Linköping (J.A., L.N.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (A.R.-F., E.O., J.H.), the Department of Cardiology, Örebro University Hospital, Örebro (T.K.), the Department of Internal Medicine, Division of Cardiology, Ryhov Hospital, Jönköping (J.L.), the Department of Cardiology, Karlstad Central Hospital, Karlstad (U.H.), the Department of Cardiology, Karolinska University Hospital (J.P.), and the Department of Medicine, Karolinska Institutet (J.P., L.S.), Solna, and the Department of Health Sciences, University of Borås, Borås (J.H.) - all in Sweden
| | - Jörg Lauermann
- From the Department of Clinical Science and Education, Division of Cardiology (R.H., N.W., M.F.), and Center for Resuscitation Science (L.S.), Karolinska Institutet, Södersjukhuset, and the Department of Clinical Sciences, Cardiology, Danderyd Hospital, Karolinska Institutet (T.J., R.L., M.E.), Stockholm, the Department of Medical Sciences, Cardiology (S.K.J., B.L., G.A.), and Uppsala Clinical Research Center (S.K.J., O.Ö.), Uppsala University, Uppsala, the Department of Clinical Sciences, Cardiology (D.E., D.S.), and Department of Clinical Sciences, Emergency Medicine (U.E.), Lund University, Lund, the Department of Medical and Health Sciences and Department of Cardiology, Linköping University, Linköping (J.A., L.N.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (A.R.-F., E.O., J.H.), the Department of Cardiology, Örebro University Hospital, Örebro (T.K.), the Department of Internal Medicine, Division of Cardiology, Ryhov Hospital, Jönköping (J.L.), the Department of Cardiology, Karlstad Central Hospital, Karlstad (U.H.), the Department of Cardiology, Karolinska University Hospital (J.P.), and the Department of Medicine, Karolinska Institutet (J.P., L.S.), Solna, and the Department of Health Sciences, University of Borås, Borås (J.H.) - all in Sweden
| | - Urban Haaga
- From the Department of Clinical Science and Education, Division of Cardiology (R.H., N.W., M.F.), and Center for Resuscitation Science (L.S.), Karolinska Institutet, Södersjukhuset, and the Department of Clinical Sciences, Cardiology, Danderyd Hospital, Karolinska Institutet (T.J., R.L., M.E.), Stockholm, the Department of Medical Sciences, Cardiology (S.K.J., B.L., G.A.), and Uppsala Clinical Research Center (S.K.J., O.Ö.), Uppsala University, Uppsala, the Department of Clinical Sciences, Cardiology (D.E., D.S.), and Department of Clinical Sciences, Emergency Medicine (U.E.), Lund University, Lund, the Department of Medical and Health Sciences and Department of Cardiology, Linköping University, Linköping (J.A., L.N.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (A.R.-F., E.O., J.H.), the Department of Cardiology, Örebro University Hospital, Örebro (T.K.), the Department of Internal Medicine, Division of Cardiology, Ryhov Hospital, Jönköping (J.L.), the Department of Cardiology, Karlstad Central Hospital, Karlstad (U.H.), the Department of Cardiology, Karolinska University Hospital (J.P.), and the Department of Medicine, Karolinska Institutet (J.P., L.S.), Solna, and the Department of Health Sciences, University of Borås, Borås (J.H.) - all in Sweden
| | - John Pernow
- From the Department of Clinical Science and Education, Division of Cardiology (R.H., N.W., M.F.), and Center for Resuscitation Science (L.S.), Karolinska Institutet, Södersjukhuset, and the Department of Clinical Sciences, Cardiology, Danderyd Hospital, Karolinska Institutet (T.J., R.L., M.E.), Stockholm, the Department of Medical Sciences, Cardiology (S.K.J., B.L., G.A.), and Uppsala Clinical Research Center (S.K.J., O.Ö.), Uppsala University, Uppsala, the Department of Clinical Sciences, Cardiology (D.E., D.S.), and Department of Clinical Sciences, Emergency Medicine (U.E.), Lund University, Lund, the Department of Medical and Health Sciences and Department of Cardiology, Linköping University, Linköping (J.A., L.N.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (A.R.-F., E.O., J.H.), the Department of Cardiology, Örebro University Hospital, Örebro (T.K.), the Department of Internal Medicine, Division of Cardiology, Ryhov Hospital, Jönköping (J.L.), the Department of Cardiology, Karlstad Central Hospital, Karlstad (U.H.), the Department of Cardiology, Karolinska University Hospital (J.P.), and the Department of Medicine, Karolinska Institutet (J.P., L.S.), Solna, and the Department of Health Sciences, University of Borås, Borås (J.H.) - all in Sweden
| | - Ollie Östlund
- From the Department of Clinical Science and Education, Division of Cardiology (R.H., N.W., M.F.), and Center for Resuscitation Science (L.S.), Karolinska Institutet, Södersjukhuset, and the Department of Clinical Sciences, Cardiology, Danderyd Hospital, Karolinska Institutet (T.J., R.L., M.E.), Stockholm, the Department of Medical Sciences, Cardiology (S.K.J., B.L., G.A.), and Uppsala Clinical Research Center (S.K.J., O.Ö.), Uppsala University, Uppsala, the Department of Clinical Sciences, Cardiology (D.E., D.S.), and Department of Clinical Sciences, Emergency Medicine (U.E.), Lund University, Lund, the Department of Medical and Health Sciences and Department of Cardiology, Linköping University, Linköping (J.A., L.N.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (A.R.-F., E.O., J.H.), the Department of Cardiology, Örebro University Hospital, Örebro (T.K.), the Department of Internal Medicine, Division of Cardiology, Ryhov Hospital, Jönköping (J.L.), the Department of Cardiology, Karlstad Central Hospital, Karlstad (U.H.), the Department of Cardiology, Karolinska University Hospital (J.P.), and the Department of Medicine, Karolinska Institutet (J.P., L.S.), Solna, and the Department of Health Sciences, University of Borås, Borås (J.H.) - all in Sweden
| | - Johan Herlitz
- From the Department of Clinical Science and Education, Division of Cardiology (R.H., N.W., M.F.), and Center for Resuscitation Science (L.S.), Karolinska Institutet, Södersjukhuset, and the Department of Clinical Sciences, Cardiology, Danderyd Hospital, Karolinska Institutet (T.J., R.L., M.E.), Stockholm, the Department of Medical Sciences, Cardiology (S.K.J., B.L., G.A.), and Uppsala Clinical Research Center (S.K.J., O.Ö.), Uppsala University, Uppsala, the Department of Clinical Sciences, Cardiology (D.E., D.S.), and Department of Clinical Sciences, Emergency Medicine (U.E.), Lund University, Lund, the Department of Medical and Health Sciences and Department of Cardiology, Linköping University, Linköping (J.A., L.N.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (A.R.-F., E.O., J.H.), the Department of Cardiology, Örebro University Hospital, Örebro (T.K.), the Department of Internal Medicine, Division of Cardiology, Ryhov Hospital, Jönköping (J.L.), the Department of Cardiology, Karlstad Central Hospital, Karlstad (U.H.), the Department of Cardiology, Karolinska University Hospital (J.P.), and the Department of Medicine, Karolinska Institutet (J.P., L.S.), Solna, and the Department of Health Sciences, University of Borås, Borås (J.H.) - all in Sweden
| | - Leif Svensson
- From the Department of Clinical Science and Education, Division of Cardiology (R.H., N.W., M.F.), and Center for Resuscitation Science (L.S.), Karolinska Institutet, Södersjukhuset, and the Department of Clinical Sciences, Cardiology, Danderyd Hospital, Karolinska Institutet (T.J., R.L., M.E.), Stockholm, the Department of Medical Sciences, Cardiology (S.K.J., B.L., G.A.), and Uppsala Clinical Research Center (S.K.J., O.Ö.), Uppsala University, Uppsala, the Department of Clinical Sciences, Cardiology (D.E., D.S.), and Department of Clinical Sciences, Emergency Medicine (U.E.), Lund University, Lund, the Department of Medical and Health Sciences and Department of Cardiology, Linköping University, Linköping (J.A., L.N.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (A.R.-F., E.O., J.H.), the Department of Cardiology, Örebro University Hospital, Örebro (T.K.), the Department of Internal Medicine, Division of Cardiology, Ryhov Hospital, Jönköping (J.L.), the Department of Cardiology, Karlstad Central Hospital, Karlstad (U.H.), the Department of Cardiology, Karolinska University Hospital (J.P.), and the Department of Medicine, Karolinska Institutet (J.P., L.S.), Solna, and the Department of Health Sciences, University of Borås, Borås (J.H.) - all in Sweden
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Ljung L, Lindahl B, Eggers K, Frick M, Linder R, Martinsson A, Melki D, Sarkar N, Svensson P, Jernberg T. 2272A rapid rule-out strategy based on high sensitive troponin and HEART score implemented in clinical routine is safe and reduces admission to hospital. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.2272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Daniel M, Agewall S, Caidahl K, Collste O, Ekenbäck C, Frick M, Y-Hassan S, Henareh L, Jernberg T, Malmqvist K, Schenck-Gustafsson K, Sörensson P, Sundin Ö, Hofman-Bang C, Tornvall P. Effect of Myocardial Infarction With Nonobstructive Coronary Arteries on Physical Capacity and Quality-of-Life. Am J Cardiol 2017; 120:341-346. [PMID: 28610801 DOI: 10.1016/j.amjcard.2017.05.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 05/03/2017] [Accepted: 05/03/2017] [Indexed: 11/29/2022]
Abstract
Patients with myocardial infarction with nonobstructive coronary arteries (MINOCA), including Takotsubo syndrome (TS), are considered to have a better survival compared with those with coronary heart disease (CHD). Studies of patients with MINOCA measuring physical and mental function including matched control groups are lacking. The aim of this study was to determine the physical capacity and quality of life in patients with MINOCA. One-hundred patients with MINOCA along with TS (25%) were investigated from 2007 to 2011. A bicycle exercise stress test was performed 6 weeks after hospitalization and QoL was investigated by the Short Form Survey 36 at 3 months' follow-up. Both a healthy and a CHD group that were age and gender matched were used as controls. The MINOCA group had a lower physical capacity (139 ± 42 W) compared with the healthy control group (167 ± 53 W, p <0.001) but better than the CHD control group (124 ± 39 W, p = 0.023). Patients with MINOCA had lower physical and mental component summary scores compared with the healthy controls (p <0.001) and lower mental component summary (p = 0.012), mental health (p = 0.016), and vitality (p = 0.008) scores compared with the CHD controls. In conclusion, the findings of this first study on exercise capacity and QoL in patients with MINOCA showed both physical and mental distress from 6 weeks to 3 months after the acute event similar to CHD controls and in some perspectives even lower scores especially in the mental component of QoL.
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Affiliation(s)
- Maria Daniel
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
| | - Stefan Agewall
- Department of Cardiology, Institute of Clinical Sciences, University of Oslo, Oslo, Norway
| | - Kenneth Caidahl
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Olov Collste
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Christina Ekenbäck
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Mats Frick
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Shams Y-Hassan
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Logman Henareh
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Tomas Jernberg
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Karin Malmqvist
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Karin Schenck-Gustafsson
- Cardiac Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Gender Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Peder Sörensson
- Cardiac Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Örjan Sundin
- Department of Psychology, Mid Sweden University, Östersund, Sweden
| | - Claes Hofman-Bang
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Per Tornvall
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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Chinniah C, Aguarin L, Cheng P, DeCesaris C, Cutillo A, Berman A, Frick M, Levin W, Cengel K, Hahn S, Dorsey J, Kao G, Simone C. Prospective Trial of Circulating Tumor Cells as a Biomarker for Early Detection of Recurrence in Patients with Locally Advanced Non–Small Cell Lung Cancer Treated with Chemoradiation Therapy. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.01.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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