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Møller JE, Engstrøm T, Jensen LO, Eiskjær H, Mangner N, Polzin A, Schulze PC, Skurk C, Nordbeck P, Clemmensen P, Panoulas V, Zimmer S, Schäfer A, Werner N, Frydland M, Holmvang L, Kjærgaard J, Sørensen R, Lønborg J, Lindholm MG, Udesen NLJ, Junker A, Schmidt H, Terkelsen CJ, Christensen S, Christiansen EH, Linke A, Woitek FJ, Westenfeld R, Möbius-Winkler S, Wachtell K, Ravn HB, Lassen JF, Boesgaard S, Gerke O, Hassager C. Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock. N Engl J Med 2024; 390:1382-1393. [PMID: 38587239 DOI: 10.1056/nejmoa2312572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
BACKGROUND The effects of temporary mechanical circulatory support with a microaxial flow pump on mortality among patients with ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock remains unclear. METHODS In an international, multicenter, randomized trial, we assigned patients with STEMI and cardiogenic shock to receive a microaxial flow pump (Impella CP) plus standard care or standard care alone. The primary end point was death from any cause at 180 days. A composite safety end point was severe bleeding, limb ischemia, hemolysis, device failure, or worsening aortic regurgitation. RESULTS A total of 360 patients underwent randomization, of whom 355 were included in the final analysis (179 in the microaxial-flow-pump group and 176 in the standard-care group). The median age of the patients was 67 years, and 79.2% were men. Death from any cause occurred in 82 of 179 patients (45.8%) in the microaxial-flow-pump group and in 103 of 176 patients (58.5%) in the standard-care group (hazard ratio, 0.74; 95% confidence interval [CI], 0.55 to 0.99; P = 0.04). A composite safety end-point event occurred in 43 patients (24.0%) in the microaxial-flow-pump group and in 11 (6.2%) in the standard-care group (relative risk, 4.74; 95% CI, 2.36 to 9.55). Renal-replacement therapy was administered to 75 patients (41.9%) in the microaxial-flow-pump group and to 47 patients (26.7%) in the standard-care group (relative risk, 1.98; 95% CI, 1.27 to 3.09). CONCLUSIONS The routine use of a microaxial flow pump with standard care in the treatment of patients with STEMI-related cardiogenic shock led to a lower risk of death from any cause at 180 days than standard care alone. The incidence of a composite of adverse events was higher with the use of the microaxial flow pump. (Funded by the Danish Heart Foundation and Abiomed; DanGer Shock ClinicalTrials.gov number, NCT01633502.).
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Affiliation(s)
- Jacob E Møller
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.E.M., T.E., M.F., L.H., J.K., R.S., J.L., S.B., C.H.), and the Department of Clinical Medicine, University of Copenhagen (T.E., L.H., C.H.), Copenhagen, the Departments of Cardiology (J.E.M., L.O.J., N.L.J.U., A.J., J.F.L.), Anesthesiology and Intensive Care (H.S., H.B.R.), and Nuclear Medicine (O.G.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (J.E.M., L.O.J., H.B.R., J.F.L.), Odense, the Departments of Cardiology (H.E., C.J.T., E.H.C.) and Anesthesiology and Intensive Care Medicine (S.C.), Aarhus University Hospital, Aarhus, and the Department of Cardiology, Zealand University Hospital, Roskilde (P.C., M.G.L.) - all in Denmark; the Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universität Dresden, Dresden (N.M., A.L., F.J.W.), the Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, and the Cardiovascular Research Institute Düsseldorf, Düsseldorf (A.P., R.W.), the Department of Internal Medicine I, Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Jena (P.C.S., S.M.-W.), the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, and Deutsches Zentrum für Herz Kreislauf Forschung, Berlin (C.S.), the Department of Internal Medicine I, University Hospital Würzburg, Würzburg (P.N.), the Department of Cardiology, University Heart and Vascular Center, University Clinic Hamburg-Eppendorf, Hamburg (P.C.), the Department of Cardiology, University Hospital Bonn, Bonn (S.Z.), the Department of Cardiology and Angiology, Hannover Medical School, Hannover (A.S.), and the Department of Internal Medicine III, Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier (N.W.) - all in Germany; the Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom (V.P.); and the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York (K.W.)
| | - Thomas Engstrøm
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.E.M., T.E., M.F., L.H., J.K., R.S., J.L., S.B., C.H.), and the Department of Clinical Medicine, University of Copenhagen (T.E., L.H., C.H.), Copenhagen, the Departments of Cardiology (J.E.M., L.O.J., N.L.J.U., A.J., J.F.L.), Anesthesiology and Intensive Care (H.S., H.B.R.), and Nuclear Medicine (O.G.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (J.E.M., L.O.J., H.B.R., J.F.L.), Odense, the Departments of Cardiology (H.E., C.J.T., E.H.C.) and Anesthesiology and Intensive Care Medicine (S.C.), Aarhus University Hospital, Aarhus, and the Department of Cardiology, Zealand University Hospital, Roskilde (P.C., M.G.L.) - all in Denmark; the Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universität Dresden, Dresden (N.M., A.L., F.J.W.), the Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, and the Cardiovascular Research Institute Düsseldorf, Düsseldorf (A.P., R.W.), the Department of Internal Medicine I, Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Jena (P.C.S., S.M.-W.), the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, and Deutsches Zentrum für Herz Kreislauf Forschung, Berlin (C.S.), the Department of Internal Medicine I, University Hospital Würzburg, Würzburg (P.N.), the Department of Cardiology, University Heart and Vascular Center, University Clinic Hamburg-Eppendorf, Hamburg (P.C.), the Department of Cardiology, University Hospital Bonn, Bonn (S.Z.), the Department of Cardiology and Angiology, Hannover Medical School, Hannover (A.S.), and the Department of Internal Medicine III, Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier (N.W.) - all in Germany; the Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom (V.P.); and the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York (K.W.)
| | - Lisette O Jensen
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.E.M., T.E., M.F., L.H., J.K., R.S., J.L., S.B., C.H.), and the Department of Clinical Medicine, University of Copenhagen (T.E., L.H., C.H.), Copenhagen, the Departments of Cardiology (J.E.M., L.O.J., N.L.J.U., A.J., J.F.L.), Anesthesiology and Intensive Care (H.S., H.B.R.), and Nuclear Medicine (O.G.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (J.E.M., L.O.J., H.B.R., J.F.L.), Odense, the Departments of Cardiology (H.E., C.J.T., E.H.C.) and Anesthesiology and Intensive Care Medicine (S.C.), Aarhus University Hospital, Aarhus, and the Department of Cardiology, Zealand University Hospital, Roskilde (P.C., M.G.L.) - all in Denmark; the Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universität Dresden, Dresden (N.M., A.L., F.J.W.), the Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, and the Cardiovascular Research Institute Düsseldorf, Düsseldorf (A.P., R.W.), the Department of Internal Medicine I, Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Jena (P.C.S., S.M.-W.), the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, and Deutsches Zentrum für Herz Kreislauf Forschung, Berlin (C.S.), the Department of Internal Medicine I, University Hospital Würzburg, Würzburg (P.N.), the Department of Cardiology, University Heart and Vascular Center, University Clinic Hamburg-Eppendorf, Hamburg (P.C.), the Department of Cardiology, University Hospital Bonn, Bonn (S.Z.), the Department of Cardiology and Angiology, Hannover Medical School, Hannover (A.S.), and the Department of Internal Medicine III, Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier (N.W.) - all in Germany; the Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom (V.P.); and the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York (K.W.)
| | - Hans Eiskjær
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.E.M., T.E., M.F., L.H., J.K., R.S., J.L., S.B., C.H.), and the Department of Clinical Medicine, University of Copenhagen (T.E., L.H., C.H.), Copenhagen, the Departments of Cardiology (J.E.M., L.O.J., N.L.J.U., A.J., J.F.L.), Anesthesiology and Intensive Care (H.S., H.B.R.), and Nuclear Medicine (O.G.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (J.E.M., L.O.J., H.B.R., J.F.L.), Odense, the Departments of Cardiology (H.E., C.J.T., E.H.C.) and Anesthesiology and Intensive Care Medicine (S.C.), Aarhus University Hospital, Aarhus, and the Department of Cardiology, Zealand University Hospital, Roskilde (P.C., M.G.L.) - all in Denmark; the Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universität Dresden, Dresden (N.M., A.L., F.J.W.), the Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, and the Cardiovascular Research Institute Düsseldorf, Düsseldorf (A.P., R.W.), the Department of Internal Medicine I, Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Jena (P.C.S., S.M.-W.), the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, and Deutsches Zentrum für Herz Kreislauf Forschung, Berlin (C.S.), the Department of Internal Medicine I, University Hospital Würzburg, Würzburg (P.N.), the Department of Cardiology, University Heart and Vascular Center, University Clinic Hamburg-Eppendorf, Hamburg (P.C.), the Department of Cardiology, University Hospital Bonn, Bonn (S.Z.), the Department of Cardiology and Angiology, Hannover Medical School, Hannover (A.S.), and the Department of Internal Medicine III, Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier (N.W.) - all in Germany; the Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom (V.P.); and the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York (K.W.)
| | - Norman Mangner
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.E.M., T.E., M.F., L.H., J.K., R.S., J.L., S.B., C.H.), and the Department of Clinical Medicine, University of Copenhagen (T.E., L.H., C.H.), Copenhagen, the Departments of Cardiology (J.E.M., L.O.J., N.L.J.U., A.J., J.F.L.), Anesthesiology and Intensive Care (H.S., H.B.R.), and Nuclear Medicine (O.G.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (J.E.M., L.O.J., H.B.R., J.F.L.), Odense, the Departments of Cardiology (H.E., C.J.T., E.H.C.) and Anesthesiology and Intensive Care Medicine (S.C.), Aarhus University Hospital, Aarhus, and the Department of Cardiology, Zealand University Hospital, Roskilde (P.C., M.G.L.) - all in Denmark; the Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universität Dresden, Dresden (N.M., A.L., F.J.W.), the Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, and the Cardiovascular Research Institute Düsseldorf, Düsseldorf (A.P., R.W.), the Department of Internal Medicine I, Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Jena (P.C.S., S.M.-W.), the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, and Deutsches Zentrum für Herz Kreislauf Forschung, Berlin (C.S.), the Department of Internal Medicine I, University Hospital Würzburg, Würzburg (P.N.), the Department of Cardiology, University Heart and Vascular Center, University Clinic Hamburg-Eppendorf, Hamburg (P.C.), the Department of Cardiology, University Hospital Bonn, Bonn (S.Z.), the Department of Cardiology and Angiology, Hannover Medical School, Hannover (A.S.), and the Department of Internal Medicine III, Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier (N.W.) - all in Germany; the Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom (V.P.); and the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York (K.W.)
| | - Amin Polzin
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.E.M., T.E., M.F., L.H., J.K., R.S., J.L., S.B., C.H.), and the Department of Clinical Medicine, University of Copenhagen (T.E., L.H., C.H.), Copenhagen, the Departments of Cardiology (J.E.M., L.O.J., N.L.J.U., A.J., J.F.L.), Anesthesiology and Intensive Care (H.S., H.B.R.), and Nuclear Medicine (O.G.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (J.E.M., L.O.J., H.B.R., J.F.L.), Odense, the Departments of Cardiology (H.E., C.J.T., E.H.C.) and Anesthesiology and Intensive Care Medicine (S.C.), Aarhus University Hospital, Aarhus, and the Department of Cardiology, Zealand University Hospital, Roskilde (P.C., M.G.L.) - all in Denmark; the Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universität Dresden, Dresden (N.M., A.L., F.J.W.), the Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, and the Cardiovascular Research Institute Düsseldorf, Düsseldorf (A.P., R.W.), the Department of Internal Medicine I, Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Jena (P.C.S., S.M.-W.), the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, and Deutsches Zentrum für Herz Kreislauf Forschung, Berlin (C.S.), the Department of Internal Medicine I, University Hospital Würzburg, Würzburg (P.N.), the Department of Cardiology, University Heart and Vascular Center, University Clinic Hamburg-Eppendorf, Hamburg (P.C.), the Department of Cardiology, University Hospital Bonn, Bonn (S.Z.), the Department of Cardiology and Angiology, Hannover Medical School, Hannover (A.S.), and the Department of Internal Medicine III, Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier (N.W.) - all in Germany; the Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom (V.P.); and the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York (K.W.)
| | - P Christian Schulze
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.E.M., T.E., M.F., L.H., J.K., R.S., J.L., S.B., C.H.), and the Department of Clinical Medicine, University of Copenhagen (T.E., L.H., C.H.), Copenhagen, the Departments of Cardiology (J.E.M., L.O.J., N.L.J.U., A.J., J.F.L.), Anesthesiology and Intensive Care (H.S., H.B.R.), and Nuclear Medicine (O.G.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (J.E.M., L.O.J., H.B.R., J.F.L.), Odense, the Departments of Cardiology (H.E., C.J.T., E.H.C.) and Anesthesiology and Intensive Care Medicine (S.C.), Aarhus University Hospital, Aarhus, and the Department of Cardiology, Zealand University Hospital, Roskilde (P.C., M.G.L.) - all in Denmark; the Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universität Dresden, Dresden (N.M., A.L., F.J.W.), the Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, and the Cardiovascular Research Institute Düsseldorf, Düsseldorf (A.P., R.W.), the Department of Internal Medicine I, Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Jena (P.C.S., S.M.-W.), the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, and Deutsches Zentrum für Herz Kreislauf Forschung, Berlin (C.S.), the Department of Internal Medicine I, University Hospital Würzburg, Würzburg (P.N.), the Department of Cardiology, University Heart and Vascular Center, University Clinic Hamburg-Eppendorf, Hamburg (P.C.), the Department of Cardiology, University Hospital Bonn, Bonn (S.Z.), the Department of Cardiology and Angiology, Hannover Medical School, Hannover (A.S.), and the Department of Internal Medicine III, Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier (N.W.) - all in Germany; the Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom (V.P.); and the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York (K.W.)
| | - Carsten Skurk
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.E.M., T.E., M.F., L.H., J.K., R.S., J.L., S.B., C.H.), and the Department of Clinical Medicine, University of Copenhagen (T.E., L.H., C.H.), Copenhagen, the Departments of Cardiology (J.E.M., L.O.J., N.L.J.U., A.J., J.F.L.), Anesthesiology and Intensive Care (H.S., H.B.R.), and Nuclear Medicine (O.G.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (J.E.M., L.O.J., H.B.R., J.F.L.), Odense, the Departments of Cardiology (H.E., C.J.T., E.H.C.) and Anesthesiology and Intensive Care Medicine (S.C.), Aarhus University Hospital, Aarhus, and the Department of Cardiology, Zealand University Hospital, Roskilde (P.C., M.G.L.) - all in Denmark; the Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universität Dresden, Dresden (N.M., A.L., F.J.W.), the Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, and the Cardiovascular Research Institute Düsseldorf, Düsseldorf (A.P., R.W.), the Department of Internal Medicine I, Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Jena (P.C.S., S.M.-W.), the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, and Deutsches Zentrum für Herz Kreislauf Forschung, Berlin (C.S.), the Department of Internal Medicine I, University Hospital Würzburg, Würzburg (P.N.), the Department of Cardiology, University Heart and Vascular Center, University Clinic Hamburg-Eppendorf, Hamburg (P.C.), the Department of Cardiology, University Hospital Bonn, Bonn (S.Z.), the Department of Cardiology and Angiology, Hannover Medical School, Hannover (A.S.), and the Department of Internal Medicine III, Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier (N.W.) - all in Germany; the Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom (V.P.); and the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York (K.W.)
| | - Peter Nordbeck
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.E.M., T.E., M.F., L.H., J.K., R.S., J.L., S.B., C.H.), and the Department of Clinical Medicine, University of Copenhagen (T.E., L.H., C.H.), Copenhagen, the Departments of Cardiology (J.E.M., L.O.J., N.L.J.U., A.J., J.F.L.), Anesthesiology and Intensive Care (H.S., H.B.R.), and Nuclear Medicine (O.G.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (J.E.M., L.O.J., H.B.R., J.F.L.), Odense, the Departments of Cardiology (H.E., C.J.T., E.H.C.) and Anesthesiology and Intensive Care Medicine (S.C.), Aarhus University Hospital, Aarhus, and the Department of Cardiology, Zealand University Hospital, Roskilde (P.C., M.G.L.) - all in Denmark; the Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universität Dresden, Dresden (N.M., A.L., F.J.W.), the Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, and the Cardiovascular Research Institute Düsseldorf, Düsseldorf (A.P., R.W.), the Department of Internal Medicine I, Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Jena (P.C.S., S.M.-W.), the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, and Deutsches Zentrum für Herz Kreislauf Forschung, Berlin (C.S.), the Department of Internal Medicine I, University Hospital Würzburg, Würzburg (P.N.), the Department of Cardiology, University Heart and Vascular Center, University Clinic Hamburg-Eppendorf, Hamburg (P.C.), the Department of Cardiology, University Hospital Bonn, Bonn (S.Z.), the Department of Cardiology and Angiology, Hannover Medical School, Hannover (A.S.), and the Department of Internal Medicine III, Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier (N.W.) - all in Germany; the Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom (V.P.); and the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York (K.W.)
| | - Peter Clemmensen
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.E.M., T.E., M.F., L.H., J.K., R.S., J.L., S.B., C.H.), and the Department of Clinical Medicine, University of Copenhagen (T.E., L.H., C.H.), Copenhagen, the Departments of Cardiology (J.E.M., L.O.J., N.L.J.U., A.J., J.F.L.), Anesthesiology and Intensive Care (H.S., H.B.R.), and Nuclear Medicine (O.G.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (J.E.M., L.O.J., H.B.R., J.F.L.), Odense, the Departments of Cardiology (H.E., C.J.T., E.H.C.) and Anesthesiology and Intensive Care Medicine (S.C.), Aarhus University Hospital, Aarhus, and the Department of Cardiology, Zealand University Hospital, Roskilde (P.C., M.G.L.) - all in Denmark; the Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universität Dresden, Dresden (N.M., A.L., F.J.W.), the Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, and the Cardiovascular Research Institute Düsseldorf, Düsseldorf (A.P., R.W.), the Department of Internal Medicine I, Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Jena (P.C.S., S.M.-W.), the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, and Deutsches Zentrum für Herz Kreislauf Forschung, Berlin (C.S.), the Department of Internal Medicine I, University Hospital Würzburg, Würzburg (P.N.), the Department of Cardiology, University Heart and Vascular Center, University Clinic Hamburg-Eppendorf, Hamburg (P.C.), the Department of Cardiology, University Hospital Bonn, Bonn (S.Z.), the Department of Cardiology and Angiology, Hannover Medical School, Hannover (A.S.), and the Department of Internal Medicine III, Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier (N.W.) - all in Germany; the Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom (V.P.); and the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York (K.W.)
| | - Vasileios Panoulas
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.E.M., T.E., M.F., L.H., J.K., R.S., J.L., S.B., C.H.), and the Department of Clinical Medicine, University of Copenhagen (T.E., L.H., C.H.), Copenhagen, the Departments of Cardiology (J.E.M., L.O.J., N.L.J.U., A.J., J.F.L.), Anesthesiology and Intensive Care (H.S., H.B.R.), and Nuclear Medicine (O.G.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (J.E.M., L.O.J., H.B.R., J.F.L.), Odense, the Departments of Cardiology (H.E., C.J.T., E.H.C.) and Anesthesiology and Intensive Care Medicine (S.C.), Aarhus University Hospital, Aarhus, and the Department of Cardiology, Zealand University Hospital, Roskilde (P.C., M.G.L.) - all in Denmark; the Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universität Dresden, Dresden (N.M., A.L., F.J.W.), the Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, and the Cardiovascular Research Institute Düsseldorf, Düsseldorf (A.P., R.W.), the Department of Internal Medicine I, Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Jena (P.C.S., S.M.-W.), the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, and Deutsches Zentrum für Herz Kreislauf Forschung, Berlin (C.S.), the Department of Internal Medicine I, University Hospital Würzburg, Würzburg (P.N.), the Department of Cardiology, University Heart and Vascular Center, University Clinic Hamburg-Eppendorf, Hamburg (P.C.), the Department of Cardiology, University Hospital Bonn, Bonn (S.Z.), the Department of Cardiology and Angiology, Hannover Medical School, Hannover (A.S.), and the Department of Internal Medicine III, Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier (N.W.) - all in Germany; the Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom (V.P.); and the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York (K.W.)
| | - Sebastian Zimmer
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.E.M., T.E., M.F., L.H., J.K., R.S., J.L., S.B., C.H.), and the Department of Clinical Medicine, University of Copenhagen (T.E., L.H., C.H.), Copenhagen, the Departments of Cardiology (J.E.M., L.O.J., N.L.J.U., A.J., J.F.L.), Anesthesiology and Intensive Care (H.S., H.B.R.), and Nuclear Medicine (O.G.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (J.E.M., L.O.J., H.B.R., J.F.L.), Odense, the Departments of Cardiology (H.E., C.J.T., E.H.C.) and Anesthesiology and Intensive Care Medicine (S.C.), Aarhus University Hospital, Aarhus, and the Department of Cardiology, Zealand University Hospital, Roskilde (P.C., M.G.L.) - all in Denmark; the Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universität Dresden, Dresden (N.M., A.L., F.J.W.), the Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, and the Cardiovascular Research Institute Düsseldorf, Düsseldorf (A.P., R.W.), the Department of Internal Medicine I, Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Jena (P.C.S., S.M.-W.), the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, and Deutsches Zentrum für Herz Kreislauf Forschung, Berlin (C.S.), the Department of Internal Medicine I, University Hospital Würzburg, Würzburg (P.N.), the Department of Cardiology, University Heart and Vascular Center, University Clinic Hamburg-Eppendorf, Hamburg (P.C.), the Department of Cardiology, University Hospital Bonn, Bonn (S.Z.), the Department of Cardiology and Angiology, Hannover Medical School, Hannover (A.S.), and the Department of Internal Medicine III, Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier (N.W.) - all in Germany; the Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom (V.P.); and the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York (K.W.)
| | - Andreas Schäfer
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.E.M., T.E., M.F., L.H., J.K., R.S., J.L., S.B., C.H.), and the Department of Clinical Medicine, University of Copenhagen (T.E., L.H., C.H.), Copenhagen, the Departments of Cardiology (J.E.M., L.O.J., N.L.J.U., A.J., J.F.L.), Anesthesiology and Intensive Care (H.S., H.B.R.), and Nuclear Medicine (O.G.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (J.E.M., L.O.J., H.B.R., J.F.L.), Odense, the Departments of Cardiology (H.E., C.J.T., E.H.C.) and Anesthesiology and Intensive Care Medicine (S.C.), Aarhus University Hospital, Aarhus, and the Department of Cardiology, Zealand University Hospital, Roskilde (P.C., M.G.L.) - all in Denmark; the Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universität Dresden, Dresden (N.M., A.L., F.J.W.), the Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, and the Cardiovascular Research Institute Düsseldorf, Düsseldorf (A.P., R.W.), the Department of Internal Medicine I, Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Jena (P.C.S., S.M.-W.), the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, and Deutsches Zentrum für Herz Kreislauf Forschung, Berlin (C.S.), the Department of Internal Medicine I, University Hospital Würzburg, Würzburg (P.N.), the Department of Cardiology, University Heart and Vascular Center, University Clinic Hamburg-Eppendorf, Hamburg (P.C.), the Department of Cardiology, University Hospital Bonn, Bonn (S.Z.), the Department of Cardiology and Angiology, Hannover Medical School, Hannover (A.S.), and the Department of Internal Medicine III, Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier (N.W.) - all in Germany; the Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom (V.P.); and the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York (K.W.)
| | - Nikos Werner
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.E.M., T.E., M.F., L.H., J.K., R.S., J.L., S.B., C.H.), and the Department of Clinical Medicine, University of Copenhagen (T.E., L.H., C.H.), Copenhagen, the Departments of Cardiology (J.E.M., L.O.J., N.L.J.U., A.J., J.F.L.), Anesthesiology and Intensive Care (H.S., H.B.R.), and Nuclear Medicine (O.G.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (J.E.M., L.O.J., H.B.R., J.F.L.), Odense, the Departments of Cardiology (H.E., C.J.T., E.H.C.) and Anesthesiology and Intensive Care Medicine (S.C.), Aarhus University Hospital, Aarhus, and the Department of Cardiology, Zealand University Hospital, Roskilde (P.C., M.G.L.) - all in Denmark; the Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universität Dresden, Dresden (N.M., A.L., F.J.W.), the Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, and the Cardiovascular Research Institute Düsseldorf, Düsseldorf (A.P., R.W.), the Department of Internal Medicine I, Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Jena (P.C.S., S.M.-W.), the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, and Deutsches Zentrum für Herz Kreislauf Forschung, Berlin (C.S.), the Department of Internal Medicine I, University Hospital Würzburg, Würzburg (P.N.), the Department of Cardiology, University Heart and Vascular Center, University Clinic Hamburg-Eppendorf, Hamburg (P.C.), the Department of Cardiology, University Hospital Bonn, Bonn (S.Z.), the Department of Cardiology and Angiology, Hannover Medical School, Hannover (A.S.), and the Department of Internal Medicine III, Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier (N.W.) - all in Germany; the Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom (V.P.); and the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York (K.W.)
| | - Martin Frydland
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.E.M., T.E., M.F., L.H., J.K., R.S., J.L., S.B., C.H.), and the Department of Clinical Medicine, University of Copenhagen (T.E., L.H., C.H.), Copenhagen, the Departments of Cardiology (J.E.M., L.O.J., N.L.J.U., A.J., J.F.L.), Anesthesiology and Intensive Care (H.S., H.B.R.), and Nuclear Medicine (O.G.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (J.E.M., L.O.J., H.B.R., J.F.L.), Odense, the Departments of Cardiology (H.E., C.J.T., E.H.C.) and Anesthesiology and Intensive Care Medicine (S.C.), Aarhus University Hospital, Aarhus, and the Department of Cardiology, Zealand University Hospital, Roskilde (P.C., M.G.L.) - all in Denmark; the Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universität Dresden, Dresden (N.M., A.L., F.J.W.), the Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, and the Cardiovascular Research Institute Düsseldorf, Düsseldorf (A.P., R.W.), the Department of Internal Medicine I, Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Jena (P.C.S., S.M.-W.), the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, and Deutsches Zentrum für Herz Kreislauf Forschung, Berlin (C.S.), the Department of Internal Medicine I, University Hospital Würzburg, Würzburg (P.N.), the Department of Cardiology, University Heart and Vascular Center, University Clinic Hamburg-Eppendorf, Hamburg (P.C.), the Department of Cardiology, University Hospital Bonn, Bonn (S.Z.), the Department of Cardiology and Angiology, Hannover Medical School, Hannover (A.S.), and the Department of Internal Medicine III, Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier (N.W.) - all in Germany; the Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom (V.P.); and the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York (K.W.)
| | - Lene Holmvang
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.E.M., T.E., M.F., L.H., J.K., R.S., J.L., S.B., C.H.), and the Department of Clinical Medicine, University of Copenhagen (T.E., L.H., C.H.), Copenhagen, the Departments of Cardiology (J.E.M., L.O.J., N.L.J.U., A.J., J.F.L.), Anesthesiology and Intensive Care (H.S., H.B.R.), and Nuclear Medicine (O.G.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (J.E.M., L.O.J., H.B.R., J.F.L.), Odense, the Departments of Cardiology (H.E., C.J.T., E.H.C.) and Anesthesiology and Intensive Care Medicine (S.C.), Aarhus University Hospital, Aarhus, and the Department of Cardiology, Zealand University Hospital, Roskilde (P.C., M.G.L.) - all in Denmark; the Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universität Dresden, Dresden (N.M., A.L., F.J.W.), the Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, and the Cardiovascular Research Institute Düsseldorf, Düsseldorf (A.P., R.W.), the Department of Internal Medicine I, Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Jena (P.C.S., S.M.-W.), the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, and Deutsches Zentrum für Herz Kreislauf Forschung, Berlin (C.S.), the Department of Internal Medicine I, University Hospital Würzburg, Würzburg (P.N.), the Department of Cardiology, University Heart and Vascular Center, University Clinic Hamburg-Eppendorf, Hamburg (P.C.), the Department of Cardiology, University Hospital Bonn, Bonn (S.Z.), the Department of Cardiology and Angiology, Hannover Medical School, Hannover (A.S.), and the Department of Internal Medicine III, Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier (N.W.) - all in Germany; the Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom (V.P.); and the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York (K.W.)
| | - Jesper Kjærgaard
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.E.M., T.E., M.F., L.H., J.K., R.S., J.L., S.B., C.H.), and the Department of Clinical Medicine, University of Copenhagen (T.E., L.H., C.H.), Copenhagen, the Departments of Cardiology (J.E.M., L.O.J., N.L.J.U., A.J., J.F.L.), Anesthesiology and Intensive Care (H.S., H.B.R.), and Nuclear Medicine (O.G.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (J.E.M., L.O.J., H.B.R., J.F.L.), Odense, the Departments of Cardiology (H.E., C.J.T., E.H.C.) and Anesthesiology and Intensive Care Medicine (S.C.), Aarhus University Hospital, Aarhus, and the Department of Cardiology, Zealand University Hospital, Roskilde (P.C., M.G.L.) - all in Denmark; the Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universität Dresden, Dresden (N.M., A.L., F.J.W.), the Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, and the Cardiovascular Research Institute Düsseldorf, Düsseldorf (A.P., R.W.), the Department of Internal Medicine I, Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Jena (P.C.S., S.M.-W.), the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, and Deutsches Zentrum für Herz Kreislauf Forschung, Berlin (C.S.), the Department of Internal Medicine I, University Hospital Würzburg, Würzburg (P.N.), the Department of Cardiology, University Heart and Vascular Center, University Clinic Hamburg-Eppendorf, Hamburg (P.C.), the Department of Cardiology, University Hospital Bonn, Bonn (S.Z.), the Department of Cardiology and Angiology, Hannover Medical School, Hannover (A.S.), and the Department of Internal Medicine III, Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier (N.W.) - all in Germany; the Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom (V.P.); and the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York (K.W.)
| | - Rikke Sørensen
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.E.M., T.E., M.F., L.H., J.K., R.S., J.L., S.B., C.H.), and the Department of Clinical Medicine, University of Copenhagen (T.E., L.H., C.H.), Copenhagen, the Departments of Cardiology (J.E.M., L.O.J., N.L.J.U., A.J., J.F.L.), Anesthesiology and Intensive Care (H.S., H.B.R.), and Nuclear Medicine (O.G.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (J.E.M., L.O.J., H.B.R., J.F.L.), Odense, the Departments of Cardiology (H.E., C.J.T., E.H.C.) and Anesthesiology and Intensive Care Medicine (S.C.), Aarhus University Hospital, Aarhus, and the Department of Cardiology, Zealand University Hospital, Roskilde (P.C., M.G.L.) - all in Denmark; the Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universität Dresden, Dresden (N.M., A.L., F.J.W.), the Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, and the Cardiovascular Research Institute Düsseldorf, Düsseldorf (A.P., R.W.), the Department of Internal Medicine I, Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Jena (P.C.S., S.M.-W.), the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, and Deutsches Zentrum für Herz Kreislauf Forschung, Berlin (C.S.), the Department of Internal Medicine I, University Hospital Würzburg, Würzburg (P.N.), the Department of Cardiology, University Heart and Vascular Center, University Clinic Hamburg-Eppendorf, Hamburg (P.C.), the Department of Cardiology, University Hospital Bonn, Bonn (S.Z.), the Department of Cardiology and Angiology, Hannover Medical School, Hannover (A.S.), and the Department of Internal Medicine III, Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier (N.W.) - all in Germany; the Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom (V.P.); and the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York (K.W.)
| | - Jacob Lønborg
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.E.M., T.E., M.F., L.H., J.K., R.S., J.L., S.B., C.H.), and the Department of Clinical Medicine, University of Copenhagen (T.E., L.H., C.H.), Copenhagen, the Departments of Cardiology (J.E.M., L.O.J., N.L.J.U., A.J., J.F.L.), Anesthesiology and Intensive Care (H.S., H.B.R.), and Nuclear Medicine (O.G.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (J.E.M., L.O.J., H.B.R., J.F.L.), Odense, the Departments of Cardiology (H.E., C.J.T., E.H.C.) and Anesthesiology and Intensive Care Medicine (S.C.), Aarhus University Hospital, Aarhus, and the Department of Cardiology, Zealand University Hospital, Roskilde (P.C., M.G.L.) - all in Denmark; the Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universität Dresden, Dresden (N.M., A.L., F.J.W.), the Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, and the Cardiovascular Research Institute Düsseldorf, Düsseldorf (A.P., R.W.), the Department of Internal Medicine I, Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Jena (P.C.S., S.M.-W.), the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, and Deutsches Zentrum für Herz Kreislauf Forschung, Berlin (C.S.), the Department of Internal Medicine I, University Hospital Würzburg, Würzburg (P.N.), the Department of Cardiology, University Heart and Vascular Center, University Clinic Hamburg-Eppendorf, Hamburg (P.C.), the Department of Cardiology, University Hospital Bonn, Bonn (S.Z.), the Department of Cardiology and Angiology, Hannover Medical School, Hannover (A.S.), and the Department of Internal Medicine III, Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier (N.W.) - all in Germany; the Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom (V.P.); and the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York (K.W.)
| | - Matias G Lindholm
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.E.M., T.E., M.F., L.H., J.K., R.S., J.L., S.B., C.H.), and the Department of Clinical Medicine, University of Copenhagen (T.E., L.H., C.H.), Copenhagen, the Departments of Cardiology (J.E.M., L.O.J., N.L.J.U., A.J., J.F.L.), Anesthesiology and Intensive Care (H.S., H.B.R.), and Nuclear Medicine (O.G.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (J.E.M., L.O.J., H.B.R., J.F.L.), Odense, the Departments of Cardiology (H.E., C.J.T., E.H.C.) and Anesthesiology and Intensive Care Medicine (S.C.), Aarhus University Hospital, Aarhus, and the Department of Cardiology, Zealand University Hospital, Roskilde (P.C., M.G.L.) - all in Denmark; the Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universität Dresden, Dresden (N.M., A.L., F.J.W.), the Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, and the Cardiovascular Research Institute Düsseldorf, Düsseldorf (A.P., R.W.), the Department of Internal Medicine I, Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Jena (P.C.S., S.M.-W.), the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, and Deutsches Zentrum für Herz Kreislauf Forschung, Berlin (C.S.), the Department of Internal Medicine I, University Hospital Würzburg, Würzburg (P.N.), the Department of Cardiology, University Heart and Vascular Center, University Clinic Hamburg-Eppendorf, Hamburg (P.C.), the Department of Cardiology, University Hospital Bonn, Bonn (S.Z.), the Department of Cardiology and Angiology, Hannover Medical School, Hannover (A.S.), and the Department of Internal Medicine III, Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier (N.W.) - all in Germany; the Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom (V.P.); and the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York (K.W.)
| | - Nanna L J Udesen
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.E.M., T.E., M.F., L.H., J.K., R.S., J.L., S.B., C.H.), and the Department of Clinical Medicine, University of Copenhagen (T.E., L.H., C.H.), Copenhagen, the Departments of Cardiology (J.E.M., L.O.J., N.L.J.U., A.J., J.F.L.), Anesthesiology and Intensive Care (H.S., H.B.R.), and Nuclear Medicine (O.G.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (J.E.M., L.O.J., H.B.R., J.F.L.), Odense, the Departments of Cardiology (H.E., C.J.T., E.H.C.) and Anesthesiology and Intensive Care Medicine (S.C.), Aarhus University Hospital, Aarhus, and the Department of Cardiology, Zealand University Hospital, Roskilde (P.C., M.G.L.) - all in Denmark; the Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universität Dresden, Dresden (N.M., A.L., F.J.W.), the Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, and the Cardiovascular Research Institute Düsseldorf, Düsseldorf (A.P., R.W.), the Department of Internal Medicine I, Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Jena (P.C.S., S.M.-W.), the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, and Deutsches Zentrum für Herz Kreislauf Forschung, Berlin (C.S.), the Department of Internal Medicine I, University Hospital Würzburg, Würzburg (P.N.), the Department of Cardiology, University Heart and Vascular Center, University Clinic Hamburg-Eppendorf, Hamburg (P.C.), the Department of Cardiology, University Hospital Bonn, Bonn (S.Z.), the Department of Cardiology and Angiology, Hannover Medical School, Hannover (A.S.), and the Department of Internal Medicine III, Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier (N.W.) - all in Germany; the Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom (V.P.); and the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York (K.W.)
| | - Anders Junker
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.E.M., T.E., M.F., L.H., J.K., R.S., J.L., S.B., C.H.), and the Department of Clinical Medicine, University of Copenhagen (T.E., L.H., C.H.), Copenhagen, the Departments of Cardiology (J.E.M., L.O.J., N.L.J.U., A.J., J.F.L.), Anesthesiology and Intensive Care (H.S., H.B.R.), and Nuclear Medicine (O.G.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (J.E.M., L.O.J., H.B.R., J.F.L.), Odense, the Departments of Cardiology (H.E., C.J.T., E.H.C.) and Anesthesiology and Intensive Care Medicine (S.C.), Aarhus University Hospital, Aarhus, and the Department of Cardiology, Zealand University Hospital, Roskilde (P.C., M.G.L.) - all in Denmark; the Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universität Dresden, Dresden (N.M., A.L., F.J.W.), the Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, and the Cardiovascular Research Institute Düsseldorf, Düsseldorf (A.P., R.W.), the Department of Internal Medicine I, Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Jena (P.C.S., S.M.-W.), the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, and Deutsches Zentrum für Herz Kreislauf Forschung, Berlin (C.S.), the Department of Internal Medicine I, University Hospital Würzburg, Würzburg (P.N.), the Department of Cardiology, University Heart and Vascular Center, University Clinic Hamburg-Eppendorf, Hamburg (P.C.), the Department of Cardiology, University Hospital Bonn, Bonn (S.Z.), the Department of Cardiology and Angiology, Hannover Medical School, Hannover (A.S.), and the Department of Internal Medicine III, Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier (N.W.) - all in Germany; the Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom (V.P.); and the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York (K.W.)
| | - Henrik Schmidt
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.E.M., T.E., M.F., L.H., J.K., R.S., J.L., S.B., C.H.), and the Department of Clinical Medicine, University of Copenhagen (T.E., L.H., C.H.), Copenhagen, the Departments of Cardiology (J.E.M., L.O.J., N.L.J.U., A.J., J.F.L.), Anesthesiology and Intensive Care (H.S., H.B.R.), and Nuclear Medicine (O.G.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (J.E.M., L.O.J., H.B.R., J.F.L.), Odense, the Departments of Cardiology (H.E., C.J.T., E.H.C.) and Anesthesiology and Intensive Care Medicine (S.C.), Aarhus University Hospital, Aarhus, and the Department of Cardiology, Zealand University Hospital, Roskilde (P.C., M.G.L.) - all in Denmark; the Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universität Dresden, Dresden (N.M., A.L., F.J.W.), the Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, and the Cardiovascular Research Institute Düsseldorf, Düsseldorf (A.P., R.W.), the Department of Internal Medicine I, Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Jena (P.C.S., S.M.-W.), the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, and Deutsches Zentrum für Herz Kreislauf Forschung, Berlin (C.S.), the Department of Internal Medicine I, University Hospital Würzburg, Würzburg (P.N.), the Department of Cardiology, University Heart and Vascular Center, University Clinic Hamburg-Eppendorf, Hamburg (P.C.), the Department of Cardiology, University Hospital Bonn, Bonn (S.Z.), the Department of Cardiology and Angiology, Hannover Medical School, Hannover (A.S.), and the Department of Internal Medicine III, Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier (N.W.) - all in Germany; the Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom (V.P.); and the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York (K.W.)
| | - Christian J Terkelsen
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.E.M., T.E., M.F., L.H., J.K., R.S., J.L., S.B., C.H.), and the Department of Clinical Medicine, University of Copenhagen (T.E., L.H., C.H.), Copenhagen, the Departments of Cardiology (J.E.M., L.O.J., N.L.J.U., A.J., J.F.L.), Anesthesiology and Intensive Care (H.S., H.B.R.), and Nuclear Medicine (O.G.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (J.E.M., L.O.J., H.B.R., J.F.L.), Odense, the Departments of Cardiology (H.E., C.J.T., E.H.C.) and Anesthesiology and Intensive Care Medicine (S.C.), Aarhus University Hospital, Aarhus, and the Department of Cardiology, Zealand University Hospital, Roskilde (P.C., M.G.L.) - all in Denmark; the Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universität Dresden, Dresden (N.M., A.L., F.J.W.), the Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, and the Cardiovascular Research Institute Düsseldorf, Düsseldorf (A.P., R.W.), the Department of Internal Medicine I, Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Jena (P.C.S., S.M.-W.), the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, and Deutsches Zentrum für Herz Kreislauf Forschung, Berlin (C.S.), the Department of Internal Medicine I, University Hospital Würzburg, Würzburg (P.N.), the Department of Cardiology, University Heart and Vascular Center, University Clinic Hamburg-Eppendorf, Hamburg (P.C.), the Department of Cardiology, University Hospital Bonn, Bonn (S.Z.), the Department of Cardiology and Angiology, Hannover Medical School, Hannover (A.S.), and the Department of Internal Medicine III, Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier (N.W.) - all in Germany; the Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom (V.P.); and the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York (K.W.)
| | - Steffen Christensen
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.E.M., T.E., M.F., L.H., J.K., R.S., J.L., S.B., C.H.), and the Department of Clinical Medicine, University of Copenhagen (T.E., L.H., C.H.), Copenhagen, the Departments of Cardiology (J.E.M., L.O.J., N.L.J.U., A.J., J.F.L.), Anesthesiology and Intensive Care (H.S., H.B.R.), and Nuclear Medicine (O.G.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (J.E.M., L.O.J., H.B.R., J.F.L.), Odense, the Departments of Cardiology (H.E., C.J.T., E.H.C.) and Anesthesiology and Intensive Care Medicine (S.C.), Aarhus University Hospital, Aarhus, and the Department of Cardiology, Zealand University Hospital, Roskilde (P.C., M.G.L.) - all in Denmark; the Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universität Dresden, Dresden (N.M., A.L., F.J.W.), the Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, and the Cardiovascular Research Institute Düsseldorf, Düsseldorf (A.P., R.W.), the Department of Internal Medicine I, Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Jena (P.C.S., S.M.-W.), the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, and Deutsches Zentrum für Herz Kreislauf Forschung, Berlin (C.S.), the Department of Internal Medicine I, University Hospital Würzburg, Würzburg (P.N.), the Department of Cardiology, University Heart and Vascular Center, University Clinic Hamburg-Eppendorf, Hamburg (P.C.), the Department of Cardiology, University Hospital Bonn, Bonn (S.Z.), the Department of Cardiology and Angiology, Hannover Medical School, Hannover (A.S.), and the Department of Internal Medicine III, Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier (N.W.) - all in Germany; the Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom (V.P.); and the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York (K.W.)
| | - Evald H Christiansen
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.E.M., T.E., M.F., L.H., J.K., R.S., J.L., S.B., C.H.), and the Department of Clinical Medicine, University of Copenhagen (T.E., L.H., C.H.), Copenhagen, the Departments of Cardiology (J.E.M., L.O.J., N.L.J.U., A.J., J.F.L.), Anesthesiology and Intensive Care (H.S., H.B.R.), and Nuclear Medicine (O.G.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (J.E.M., L.O.J., H.B.R., J.F.L.), Odense, the Departments of Cardiology (H.E., C.J.T., E.H.C.) and Anesthesiology and Intensive Care Medicine (S.C.), Aarhus University Hospital, Aarhus, and the Department of Cardiology, Zealand University Hospital, Roskilde (P.C., M.G.L.) - all in Denmark; the Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universität Dresden, Dresden (N.M., A.L., F.J.W.), the Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, and the Cardiovascular Research Institute Düsseldorf, Düsseldorf (A.P., R.W.), the Department of Internal Medicine I, Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Jena (P.C.S., S.M.-W.), the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, and Deutsches Zentrum für Herz Kreislauf Forschung, Berlin (C.S.), the Department of Internal Medicine I, University Hospital Würzburg, Würzburg (P.N.), the Department of Cardiology, University Heart and Vascular Center, University Clinic Hamburg-Eppendorf, Hamburg (P.C.), the Department of Cardiology, University Hospital Bonn, Bonn (S.Z.), the Department of Cardiology and Angiology, Hannover Medical School, Hannover (A.S.), and the Department of Internal Medicine III, Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier (N.W.) - all in Germany; the Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom (V.P.); and the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York (K.W.)
| | - Axel Linke
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.E.M., T.E., M.F., L.H., J.K., R.S., J.L., S.B., C.H.), and the Department of Clinical Medicine, University of Copenhagen (T.E., L.H., C.H.), Copenhagen, the Departments of Cardiology (J.E.M., L.O.J., N.L.J.U., A.J., J.F.L.), Anesthesiology and Intensive Care (H.S., H.B.R.), and Nuclear Medicine (O.G.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (J.E.M., L.O.J., H.B.R., J.F.L.), Odense, the Departments of Cardiology (H.E., C.J.T., E.H.C.) and Anesthesiology and Intensive Care Medicine (S.C.), Aarhus University Hospital, Aarhus, and the Department of Cardiology, Zealand University Hospital, Roskilde (P.C., M.G.L.) - all in Denmark; the Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universität Dresden, Dresden (N.M., A.L., F.J.W.), the Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, and the Cardiovascular Research Institute Düsseldorf, Düsseldorf (A.P., R.W.), the Department of Internal Medicine I, Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Jena (P.C.S., S.M.-W.), the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, and Deutsches Zentrum für Herz Kreislauf Forschung, Berlin (C.S.), the Department of Internal Medicine I, University Hospital Würzburg, Würzburg (P.N.), the Department of Cardiology, University Heart and Vascular Center, University Clinic Hamburg-Eppendorf, Hamburg (P.C.), the Department of Cardiology, University Hospital Bonn, Bonn (S.Z.), the Department of Cardiology and Angiology, Hannover Medical School, Hannover (A.S.), and the Department of Internal Medicine III, Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier (N.W.) - all in Germany; the Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom (V.P.); and the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York (K.W.)
| | - Felix J Woitek
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.E.M., T.E., M.F., L.H., J.K., R.S., J.L., S.B., C.H.), and the Department of Clinical Medicine, University of Copenhagen (T.E., L.H., C.H.), Copenhagen, the Departments of Cardiology (J.E.M., L.O.J., N.L.J.U., A.J., J.F.L.), Anesthesiology and Intensive Care (H.S., H.B.R.), and Nuclear Medicine (O.G.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (J.E.M., L.O.J., H.B.R., J.F.L.), Odense, the Departments of Cardiology (H.E., C.J.T., E.H.C.) and Anesthesiology and Intensive Care Medicine (S.C.), Aarhus University Hospital, Aarhus, and the Department of Cardiology, Zealand University Hospital, Roskilde (P.C., M.G.L.) - all in Denmark; the Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universität Dresden, Dresden (N.M., A.L., F.J.W.), the Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, and the Cardiovascular Research Institute Düsseldorf, Düsseldorf (A.P., R.W.), the Department of Internal Medicine I, Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Jena (P.C.S., S.M.-W.), the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, and Deutsches Zentrum für Herz Kreislauf Forschung, Berlin (C.S.), the Department of Internal Medicine I, University Hospital Würzburg, Würzburg (P.N.), the Department of Cardiology, University Heart and Vascular Center, University Clinic Hamburg-Eppendorf, Hamburg (P.C.), the Department of Cardiology, University Hospital Bonn, Bonn (S.Z.), the Department of Cardiology and Angiology, Hannover Medical School, Hannover (A.S.), and the Department of Internal Medicine III, Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier (N.W.) - all in Germany; the Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom (V.P.); and the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York (K.W.)
| | - Ralf Westenfeld
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.E.M., T.E., M.F., L.H., J.K., R.S., J.L., S.B., C.H.), and the Department of Clinical Medicine, University of Copenhagen (T.E., L.H., C.H.), Copenhagen, the Departments of Cardiology (J.E.M., L.O.J., N.L.J.U., A.J., J.F.L.), Anesthesiology and Intensive Care (H.S., H.B.R.), and Nuclear Medicine (O.G.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (J.E.M., L.O.J., H.B.R., J.F.L.), Odense, the Departments of Cardiology (H.E., C.J.T., E.H.C.) and Anesthesiology and Intensive Care Medicine (S.C.), Aarhus University Hospital, Aarhus, and the Department of Cardiology, Zealand University Hospital, Roskilde (P.C., M.G.L.) - all in Denmark; the Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universität Dresden, Dresden (N.M., A.L., F.J.W.), the Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, and the Cardiovascular Research Institute Düsseldorf, Düsseldorf (A.P., R.W.), the Department of Internal Medicine I, Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Jena (P.C.S., S.M.-W.), the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, and Deutsches Zentrum für Herz Kreislauf Forschung, Berlin (C.S.), the Department of Internal Medicine I, University Hospital Würzburg, Würzburg (P.N.), the Department of Cardiology, University Heart and Vascular Center, University Clinic Hamburg-Eppendorf, Hamburg (P.C.), the Department of Cardiology, University Hospital Bonn, Bonn (S.Z.), the Department of Cardiology and Angiology, Hannover Medical School, Hannover (A.S.), and the Department of Internal Medicine III, Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier (N.W.) - all in Germany; the Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom (V.P.); and the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York (K.W.)
| | - Sven Möbius-Winkler
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.E.M., T.E., M.F., L.H., J.K., R.S., J.L., S.B., C.H.), and the Department of Clinical Medicine, University of Copenhagen (T.E., L.H., C.H.), Copenhagen, the Departments of Cardiology (J.E.M., L.O.J., N.L.J.U., A.J., J.F.L.), Anesthesiology and Intensive Care (H.S., H.B.R.), and Nuclear Medicine (O.G.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (J.E.M., L.O.J., H.B.R., J.F.L.), Odense, the Departments of Cardiology (H.E., C.J.T., E.H.C.) and Anesthesiology and Intensive Care Medicine (S.C.), Aarhus University Hospital, Aarhus, and the Department of Cardiology, Zealand University Hospital, Roskilde (P.C., M.G.L.) - all in Denmark; the Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universität Dresden, Dresden (N.M., A.L., F.J.W.), the Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, and the Cardiovascular Research Institute Düsseldorf, Düsseldorf (A.P., R.W.), the Department of Internal Medicine I, Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Jena (P.C.S., S.M.-W.), the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, and Deutsches Zentrum für Herz Kreislauf Forschung, Berlin (C.S.), the Department of Internal Medicine I, University Hospital Würzburg, Würzburg (P.N.), the Department of Cardiology, University Heart and Vascular Center, University Clinic Hamburg-Eppendorf, Hamburg (P.C.), the Department of Cardiology, University Hospital Bonn, Bonn (S.Z.), the Department of Cardiology and Angiology, Hannover Medical School, Hannover (A.S.), and the Department of Internal Medicine III, Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier (N.W.) - all in Germany; the Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom (V.P.); and the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York (K.W.)
| | - Kristian Wachtell
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.E.M., T.E., M.F., L.H., J.K., R.S., J.L., S.B., C.H.), and the Department of Clinical Medicine, University of Copenhagen (T.E., L.H., C.H.), Copenhagen, the Departments of Cardiology (J.E.M., L.O.J., N.L.J.U., A.J., J.F.L.), Anesthesiology and Intensive Care (H.S., H.B.R.), and Nuclear Medicine (O.G.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (J.E.M., L.O.J., H.B.R., J.F.L.), Odense, the Departments of Cardiology (H.E., C.J.T., E.H.C.) and Anesthesiology and Intensive Care Medicine (S.C.), Aarhus University Hospital, Aarhus, and the Department of Cardiology, Zealand University Hospital, Roskilde (P.C., M.G.L.) - all in Denmark; the Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universität Dresden, Dresden (N.M., A.L., F.J.W.), the Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, and the Cardiovascular Research Institute Düsseldorf, Düsseldorf (A.P., R.W.), the Department of Internal Medicine I, Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Jena (P.C.S., S.M.-W.), the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, and Deutsches Zentrum für Herz Kreislauf Forschung, Berlin (C.S.), the Department of Internal Medicine I, University Hospital Würzburg, Würzburg (P.N.), the Department of Cardiology, University Heart and Vascular Center, University Clinic Hamburg-Eppendorf, Hamburg (P.C.), the Department of Cardiology, University Hospital Bonn, Bonn (S.Z.), the Department of Cardiology and Angiology, Hannover Medical School, Hannover (A.S.), and the Department of Internal Medicine III, Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier (N.W.) - all in Germany; the Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom (V.P.); and the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York (K.W.)
| | - Hanne B Ravn
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.E.M., T.E., M.F., L.H., J.K., R.S., J.L., S.B., C.H.), and the Department of Clinical Medicine, University of Copenhagen (T.E., L.H., C.H.), Copenhagen, the Departments of Cardiology (J.E.M., L.O.J., N.L.J.U., A.J., J.F.L.), Anesthesiology and Intensive Care (H.S., H.B.R.), and Nuclear Medicine (O.G.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (J.E.M., L.O.J., H.B.R., J.F.L.), Odense, the Departments of Cardiology (H.E., C.J.T., E.H.C.) and Anesthesiology and Intensive Care Medicine (S.C.), Aarhus University Hospital, Aarhus, and the Department of Cardiology, Zealand University Hospital, Roskilde (P.C., M.G.L.) - all in Denmark; the Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universität Dresden, Dresden (N.M., A.L., F.J.W.), the Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, and the Cardiovascular Research Institute Düsseldorf, Düsseldorf (A.P., R.W.), the Department of Internal Medicine I, Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Jena (P.C.S., S.M.-W.), the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, and Deutsches Zentrum für Herz Kreislauf Forschung, Berlin (C.S.), the Department of Internal Medicine I, University Hospital Würzburg, Würzburg (P.N.), the Department of Cardiology, University Heart and Vascular Center, University Clinic Hamburg-Eppendorf, Hamburg (P.C.), the Department of Cardiology, University Hospital Bonn, Bonn (S.Z.), the Department of Cardiology and Angiology, Hannover Medical School, Hannover (A.S.), and the Department of Internal Medicine III, Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier (N.W.) - all in Germany; the Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom (V.P.); and the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York (K.W.)
| | - Jens F Lassen
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.E.M., T.E., M.F., L.H., J.K., R.S., J.L., S.B., C.H.), and the Department of Clinical Medicine, University of Copenhagen (T.E., L.H., C.H.), Copenhagen, the Departments of Cardiology (J.E.M., L.O.J., N.L.J.U., A.J., J.F.L.), Anesthesiology and Intensive Care (H.S., H.B.R.), and Nuclear Medicine (O.G.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (J.E.M., L.O.J., H.B.R., J.F.L.), Odense, the Departments of Cardiology (H.E., C.J.T., E.H.C.) and Anesthesiology and Intensive Care Medicine (S.C.), Aarhus University Hospital, Aarhus, and the Department of Cardiology, Zealand University Hospital, Roskilde (P.C., M.G.L.) - all in Denmark; the Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universität Dresden, Dresden (N.M., A.L., F.J.W.), the Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, and the Cardiovascular Research Institute Düsseldorf, Düsseldorf (A.P., R.W.), the Department of Internal Medicine I, Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Jena (P.C.S., S.M.-W.), the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, and Deutsches Zentrum für Herz Kreislauf Forschung, Berlin (C.S.), the Department of Internal Medicine I, University Hospital Würzburg, Würzburg (P.N.), the Department of Cardiology, University Heart and Vascular Center, University Clinic Hamburg-Eppendorf, Hamburg (P.C.), the Department of Cardiology, University Hospital Bonn, Bonn (S.Z.), the Department of Cardiology and Angiology, Hannover Medical School, Hannover (A.S.), and the Department of Internal Medicine III, Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier (N.W.) - all in Germany; the Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom (V.P.); and the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York (K.W.)
| | - Søren Boesgaard
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.E.M., T.E., M.F., L.H., J.K., R.S., J.L., S.B., C.H.), and the Department of Clinical Medicine, University of Copenhagen (T.E., L.H., C.H.), Copenhagen, the Departments of Cardiology (J.E.M., L.O.J., N.L.J.U., A.J., J.F.L.), Anesthesiology and Intensive Care (H.S., H.B.R.), and Nuclear Medicine (O.G.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (J.E.M., L.O.J., H.B.R., J.F.L.), Odense, the Departments of Cardiology (H.E., C.J.T., E.H.C.) and Anesthesiology and Intensive Care Medicine (S.C.), Aarhus University Hospital, Aarhus, and the Department of Cardiology, Zealand University Hospital, Roskilde (P.C., M.G.L.) - all in Denmark; the Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universität Dresden, Dresden (N.M., A.L., F.J.W.), the Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, and the Cardiovascular Research Institute Düsseldorf, Düsseldorf (A.P., R.W.), the Department of Internal Medicine I, Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Jena (P.C.S., S.M.-W.), the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, and Deutsches Zentrum für Herz Kreislauf Forschung, Berlin (C.S.), the Department of Internal Medicine I, University Hospital Würzburg, Würzburg (P.N.), the Department of Cardiology, University Heart and Vascular Center, University Clinic Hamburg-Eppendorf, Hamburg (P.C.), the Department of Cardiology, University Hospital Bonn, Bonn (S.Z.), the Department of Cardiology and Angiology, Hannover Medical School, Hannover (A.S.), and the Department of Internal Medicine III, Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier (N.W.) - all in Germany; the Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom (V.P.); and the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York (K.W.)
| | - Oke Gerke
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.E.M., T.E., M.F., L.H., J.K., R.S., J.L., S.B., C.H.), and the Department of Clinical Medicine, University of Copenhagen (T.E., L.H., C.H.), Copenhagen, the Departments of Cardiology (J.E.M., L.O.J., N.L.J.U., A.J., J.F.L.), Anesthesiology and Intensive Care (H.S., H.B.R.), and Nuclear Medicine (O.G.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (J.E.M., L.O.J., H.B.R., J.F.L.), Odense, the Departments of Cardiology (H.E., C.J.T., E.H.C.) and Anesthesiology and Intensive Care Medicine (S.C.), Aarhus University Hospital, Aarhus, and the Department of Cardiology, Zealand University Hospital, Roskilde (P.C., M.G.L.) - all in Denmark; the Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universität Dresden, Dresden (N.M., A.L., F.J.W.), the Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, and the Cardiovascular Research Institute Düsseldorf, Düsseldorf (A.P., R.W.), the Department of Internal Medicine I, Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Jena (P.C.S., S.M.-W.), the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, and Deutsches Zentrum für Herz Kreislauf Forschung, Berlin (C.S.), the Department of Internal Medicine I, University Hospital Würzburg, Würzburg (P.N.), the Department of Cardiology, University Heart and Vascular Center, University Clinic Hamburg-Eppendorf, Hamburg (P.C.), the Department of Cardiology, University Hospital Bonn, Bonn (S.Z.), the Department of Cardiology and Angiology, Hannover Medical School, Hannover (A.S.), and the Department of Internal Medicine III, Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier (N.W.) - all in Germany; the Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom (V.P.); and the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York (K.W.)
| | - Christian Hassager
- From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.E.M., T.E., M.F., L.H., J.K., R.S., J.L., S.B., C.H.), and the Department of Clinical Medicine, University of Copenhagen (T.E., L.H., C.H.), Copenhagen, the Departments of Cardiology (J.E.M., L.O.J., N.L.J.U., A.J., J.F.L.), Anesthesiology and Intensive Care (H.S., H.B.R.), and Nuclear Medicine (O.G.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (J.E.M., L.O.J., H.B.R., J.F.L.), Odense, the Departments of Cardiology (H.E., C.J.T., E.H.C.) and Anesthesiology and Intensive Care Medicine (S.C.), Aarhus University Hospital, Aarhus, and the Department of Cardiology, Zealand University Hospital, Roskilde (P.C., M.G.L.) - all in Denmark; the Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universität Dresden, Dresden (N.M., A.L., F.J.W.), the Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, and the Cardiovascular Research Institute Düsseldorf, Düsseldorf (A.P., R.W.), the Department of Internal Medicine I, Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Jena (P.C.S., S.M.-W.), the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, and Deutsches Zentrum für Herz Kreislauf Forschung, Berlin (C.S.), the Department of Internal Medicine I, University Hospital Würzburg, Würzburg (P.N.), the Department of Cardiology, University Heart and Vascular Center, University Clinic Hamburg-Eppendorf, Hamburg (P.C.), the Department of Cardiology, University Hospital Bonn, Bonn (S.Z.), the Department of Cardiology and Angiology, Hannover Medical School, Hannover (A.S.), and the Department of Internal Medicine III, Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier (N.W.) - all in Germany; the Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom (V.P.); and the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York (K.W.)
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Zohori Bahrami HS, Hasselbalch RB, Søholm H, Thomsen JH, Sørgaard M, Kofoed KF, Valeur N, Boesgaard S, Sarah Fry NA, Møller JE, Raja AA, Køber L, Iversen K, Rasmussen H, Bundgaard H. First-in-man trial of β3-adrenoceptor agonist treatment in chronic heart failure - impact on diastolic function. J Cardiovasc Pharmacol 2024:00005344-990000000-00294. [PMID: 38452283 DOI: 10.1097/fjc.0000000000001545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/10/2024] [Indexed: 03/09/2024]
Abstract
Diastolic dysfunction (DD) in heart failure (HF) is associated with increased myocardial cytosolic calcium, and calcium-efflux via the sodium-calcium-exchanger depends on the sodium gradient. Beta-3-adrenoceptor (β3-AR) agonists lower cytosolic sodium and have reversed organ congestion. Accordingly, β3-AR agonists might improve diastolic function, which we aimed to assess. In a first-in-man, randomized, double-blinded trial, we assigned 70 patients with HF with reduced ejection fraction (HFrEF), NYHA II-III, and LVEF<40% to receive the β3-AR agonist mirabegron (300 mg/day) or placebo for six months, in addition to recommended HF therapy. We performed echocardiography and cardiac computed tomography (CCT) and measured N-terminal pro-brain natriuretic peptide (NT-proBNP) at baseline and follow-up. DD was graded per multiple renowned algorithms. Baseline and follow-up data were available in 57 patients (59±11 years, 88% male, 49% ischemic heart disease). No clinically significant changes in diastolic measurements were found within or between groups by echocardiography (E/e' placebo: 13±7 to 13±5, p=0.21 vs mirabegron: 12±6 to 13±8, p=0.74, between group follow-up difference 0.2 [95% CI -3 to 4], p=0.89), or CCT (left atrial volume index: between group follow-up difference 9 ml/m2 [95% CI -3 to 19], p=0.15). DD gradings did not change within or between groups following two algorithms (p=0.72, p=0.75). NT-proBNP remained unchanged in both groups (p=0.74, p=0.64). In patients with HFrEF, no changes were identified in diastolic measurements, gradings or biomarker after β3-AR stimulation compared to placebo. The findings add to previous literature questioning the role of impaired Na+-Ca2+ mediated calcium-export as a major culprit in DD. NCT01876433.
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Affiliation(s)
- Hashmat Sayed Zohori Bahrami
- Department of Cardiology, Copenhagen University Hospital Hvidovre, Denmark. Kettegård Alle 30, 2650 Hvidovre
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Blegdamsvej 9, 2100 Copenhagen
| | - Rasmus Bo Hasselbalch
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Blegdamsvej 9, 2100 Copenhagen
| | - Helle Søholm
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Blegdamsvej 9, 2100 Copenhagen
- Department of Cardiology, Zealand University Hospital, Denmark. Sygehusvej 10, 4000 Roskilde
| | - Jakob Hartvig Thomsen
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Blegdamsvej 9, 2100 Copenhagen
| | - Mathias Sørgaard
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Blegdamsvej 9, 2100 Copenhagen
| | - Klaus Fuglsang Kofoed
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Blegdamsvej 9, 2100 Copenhagen
| | - Nana Valeur
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg-Frederiksberg, Denmark. Bispebjerg Bakke 23, 2400 Copenhagen
| | - Søren Boesgaard
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Blegdamsvej 9, 2100 Copenhagen
| | - Natasha Alexandria Sarah Fry
- Department of Cardiology, Royal North Shore Hospital and University of Sydney, Australia. Reserve Rd, St Leonards NSW 2065
| | - Jacob Eifer Møller
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Blegdamsvej 9, 2100 Copenhagen
| | - Anna Axelsson Raja
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Blegdamsvej 9, 2100 Copenhagen
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Blegdamsvej 9, 2100 Copenhagen
| | - Kasper Iversen
- Department of Emergency Medicine, Copenhagen University Hospital Herlev-Gentofte, Denmark. Borgmester Ib Juuls Vej 1, 2730 Herlev
| | - Helge Rasmussen
- Department of Cardiology, Royal North Shore Hospital and University of Sydney, Australia. Reserve Rd, St Leonards NSW 2065
| | - Henning Bundgaard
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Blegdamsvej 9, 2100 Copenhagen
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Grand J, Møller JE, Hassager C, Schmidt H, Mølstrøm S, Boesgaard S, Meyer MAS, Josiassen J, Højgaard HF, Frydland M, Dahl JS, Obling LER, Bak M, Lind Jørgensen V, Thomsen JH, Wiberg S, Madsen SA, Nyholm B, Kjaergaard J. Impact of blood pressure targets on central hemodynamics during intensive care after out-of-hospital cardiac arrest. Resuscitation 2024; 194:110094. [PMID: 38103857 DOI: 10.1016/j.resuscitation.2023.110094] [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] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/11/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVES The aim was to investigate the advanced hemodynamic effects of the two MAP-targets during intensive care on systemic hemodynamics in comatose patients after cardiac arrest. DESIGN Secondary analysis of a randomized controlled trial. SETTING Primary vasopressor used was per protocol norepinephrine. Hemodynamic monitoring was done with pulmonary artery catheters (PAC) and measurements were made on predefined time points. The primary endpoint of this substudy was the difference in cardiac index within 48 h from a repeated measurements-mixed model. Secondary endpoints included systemic vascular resistance index (SVRI), heart rate, and stroke volume index. PATIENTS Comatose survivors after out-of-hospital cardiac arrest. INTERVENTIONS The "Blood pressure and oxygenations targets after out-of-hospital cardiac arrest (BOX)"-trial was a randomized, controlled, double-blinded, multicenter-study comparing targeted mean arterial pressure (MAP) of 63 mmHg (MAP63) vs 77 mmHg (MAP77). MEASUREMENTS AND MAIN RESULTS Among 789 randomized patients, 730 (93%) patients were included in the hemodynamic substudy. From PAC-insertion (median 1 hours after ICU-admission) and the next 48 hours, the MAP77-group received significantly higher doses of norepinephrine (mean difference 0.09 µg/kg/min, 95% confidence interval (CI) 0.07-0.11, pgroup < 0.0001). Cardiac index was significantly increased (0.20 L/min/m2 (CI 0.12-0.28), pgroup < 0.0001) as was SVRI with an overall difference of (43 dynes m2/s/cm5 (CI 7-79); pgroup = 0.02). Heart rate was increased in the MAP77-group (4 beats/minute; CI 2-6, pgroup < 0.003), but stroke volume index was not (pgroup = 0.10). CONCLUSIONS Targeted MAP at 77 mmHg compared to 63 mmHg resulted in a higher dose of norepinephrine, increased cardiac index and SVRI. Heart rate was also increased, but stroke volume index was not affected by a higher blood pressure target.
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Affiliation(s)
- Johannes Grand
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital, Amager-Hvidovre, Copenhagen, Denmark.
| | - Jacob E Møller
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Cardiology, Odense University Hospital, 5000 C Odense, Denmark; Clinical Institute University of Southern Denmark, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Schmidt
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, 5000 Odense C, Denmark
| | - Simon Mølstrøm
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, 5000 Odense C, Denmark
| | - Søren Boesgaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Jakob Josiassen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Martin Frydland
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jordi S Dahl
- Department of Cardiology, Odense University Hospital, 5000 C Odense, Denmark; Clinical Institute University of Southern Denmark, Denmark
| | | | - Mikkel Bak
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, 5000 Odense C, Denmark
| | - Vibeke Lind Jørgensen
- Department of Cardiothoracic Anaesthesiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jakob Hartvig Thomsen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Sebastian Wiberg
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Cardiothoracic Anaesthesiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Søren Aalbæk Madsen
- Department of Cardiothoracic Anaesthesiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Benjamin Nyholm
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Hassager C, Schmidt H, Møller JE, Grand J, Mølstrøm S, Beske RP, Boesgaard S, Borregaard B, Bekker-Jensen D, Dahl JS, Frydland MS, Høfsten DE, Isse YA, Josiassen J, Lind Jørgensen VR, Kondziella D, Lindholm MG, Moser E, Nyholm BC, Obling LER, Sarkisian L, Søndergaard FT, Thomsen JH, Thune JJ, Venø S, Wiberg SC, Winther-Jensen M, Meyer MAS, Kjaergaard J. Duration of Device-Based Fever Prevention after Cardiac Arrest. N Engl J Med 2023; 388:888-897. [PMID: 36342119 DOI: 10.1056/nejmoa2212528] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Guidelines recommend active fever prevention for 72 hours after cardiac arrest. Data from randomized clinical trials of this intervention have been lacking. METHODS We randomly assigned comatose patients who had been resuscitated after an out-of-hospital cardiac arrest of presumed cardiac cause to device-based temperature control targeting 36°C for 24 hours followed by targeting of 37°C for either 12 or 48 hours (for total intervention times of 36 and 72 hours, respectively) or until the patient regained consciousness. The primary outcome was a composite of death from any cause or hospital discharge with a Cerebral Performance Category of 3 or 4 (range, 1 to 5, with higher scores indicating more severe disability; a category of 3 or 4 indicates severe cerebral disability or coma) within 90 days after randomization. Secondary outcomes included death from any cause and the Montreal Cognitive Assessment score (range, 0 to 30, with higher scores indicating better cognitive ability) at 3 months. RESULTS A total of 393 patients were randomly assigned to temperature control for 36 hours, and 396 patients were assigned to temperature control for 72 hours. At 90 days after randomization, a primary end-point event had occurred in 127 of 393 patients (32.3%) in the 36-hour group and in 133 of 396 patients (33.6%) in the 72-hour group (hazard ratio, 0.99; 95% confidence interval, 0.77 to 1.26; P = 0.70) and mortality was 29.5% in the 36-hour group and 30.3% in the 72-hour group. At 3 months, the median Montreal Cognitive Assessment score was 26 (interquartile range, 24 to 29) and 27 (interquartile range, 24 to 28), respectively. There was no significant between-group difference in the incidence of adverse events. CONCLUSIONS Active device-based fever prevention for 36 or 72 hours after cardiac arrest did not result in significantly different percentages of patients dying or having severe disability or coma. (Funded by the Novo Nordisk Foundation; BOX ClinicalTrials.gov number, NCT03141099.).
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Affiliation(s)
- Christian Hassager
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Henrik Schmidt
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Jacob E Møller
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Johannes Grand
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Simon Mølstrøm
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Rasmus P Beske
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Søren Boesgaard
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Britt Borregaard
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Ditte Bekker-Jensen
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Jordi S Dahl
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Martin S Frydland
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Dan E Høfsten
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Yusuf A Isse
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Jakob Josiassen
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Vibeke R Lind Jørgensen
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Daniel Kondziella
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Matias G Lindholm
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Emil Moser
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Benjamin C Nyholm
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Laust E R Obling
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Laura Sarkisian
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Frederik T Søndergaard
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Jakob H Thomsen
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Jens J Thune
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Søren Venø
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Sebastian C Wiberg
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Matilde Winther-Jensen
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Martin A S Meyer
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
| | - Jesper Kjaergaard
- From the Departments of Cardiology (C.H., J.G., R.P.B., S.B., M.S.F., D.E.H., Y.A.I., J.J., M.G.L., B.C.N., L.E.R.O., F.T.S., J.H.T., S.C.W., M.W.-J., M.A.S.M., J.K.) and Neurology (D.K.), Rigshospitalet, Copenhagen University Hospital, the Departments of Clinical Medicine (C.H., D.K., J.K.) and Cardiothoracic Anesthesiology (V.R.L.J.), University of Copenhagen, and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Department of Clinical Research, University of Southern Denmark (C.H., H.S., J.E.M., B.B., J.S.D.), and the Departments of Anesthesiology and Intensive Care (H.S., S.M., E.M., S.V.) and Cardiology (J.E.M., B.B., D.B.-J., J.S.D., L.S.), Odense University Hospital, Odense - all in Denmark
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Schmidt H, Kjaergaard J, Hassager C, Mølstrøm S, Grand J, Borregaard B, Roelsgaard Obling LE, Venø S, Sarkisian L, Mamaev D, Jensen LO, Nyholm B, Høfsten DE, Josiassen J, Thomsen JH, Thune JJ, Lindholm MG, Stengaard Meyer MA, Winther-Jensen M, Sørensen M, Frydland M, Beske RP, Frikke-Schmidt R, Wiberg S, Boesgaard S, Lind Jørgensen V, Møller JE. Oxygen Targets in Comatose Survivors of Cardiac Arrest. N Engl J Med 2022; 387:1467-1476. [PMID: 36027567 DOI: 10.1056/nejmoa2208686] [Citation(s) in RCA: 77] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The appropriate oxygenation target for mechanical ventilation in comatose survivors of out-of-hospital cardiac arrest is unknown. METHODS In this randomized trial with a 2-by-2 factorial design, we randomly assigned comatose adults with out-of-hospital cardiac arrest in a 1:1 ratio to either a restrictive oxygen target of a partial pressure of arterial oxygen (Pao2) of 9 to 10 kPa (68 to 75 mm Hg) or a liberal oxygen target of a Pao2 of 13 to 14 kPa (98 to 105 mm Hg); patients were also assigned to one of two blood-pressure targets (reported separately). The primary outcome was a composite of death from any cause or hospital discharge with severe disability or coma (Cerebral Performance Category [CPC] of 3 or 4; categories range from 1 to 5, with higher values indicating more severe disability), whichever occurred first within 90 days after randomization. Secondary outcomes were neuron-specific enolase levels at 48 hours, death from any cause, the score on the Montreal Cognitive Assessment (ranging from 0 to 30, with higher scores indicating better cognitive ability), the score on the modified Rankin scale (ranging from 0 to 6, with higher scores indicating greater disability), and the CPC at 90 days. RESULTS A total of 789 patients underwent randomization. A primary-outcome event occurred in 126 of 394 patients (32.0%) in the restrictive-target group and in 134 of 395 patients (33.9%) in the liberal-target group (hazard ratio, 0.95; 95% confidence interval, 0.75 to 1.21; P = 0.69). At 90 days, death had occurred in 113 patients (28.7%) in the restrictive-target group and in 123 (31.1%) in the liberal-target group. On the CPC, the median category was 1 in the two groups; on the modified Rankin scale, the median score was 2 in the restrictive-target group and 1 in the liberal-target group; and on the Montreal Cognitive Assessment, the median score was 27 in the two groups. At 48 hours, the median neuron-specific enolase level was 17 μg per liter in the restrictive-target group and 18 μg per liter in the liberal-target group. The incidence of adverse events was similar in the two groups. CONCLUSIONS Targeting of a restrictive or liberal oxygenation strategy in comatose patients after resuscitation for cardiac arrest resulted in a similar incidence of death or severe disability or coma. (Funded by the Novo Nordisk Foundation; BOX ClinicalTrials.gov number, NCT03141099.).
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Affiliation(s)
- Henrik Schmidt
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Jesper Kjaergaard
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Christian Hassager
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Simon Mølstrøm
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Johannes Grand
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Britt Borregaard
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Laust E Roelsgaard Obling
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Søren Venø
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Laura Sarkisian
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Dmitry Mamaev
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Lisette O Jensen
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Benjamin Nyholm
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Dan E Høfsten
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Jakob Josiassen
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Jakob H Thomsen
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Jens J Thune
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Matias G Lindholm
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Martin A Stengaard Meyer
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Matilde Winther-Jensen
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Marc Sørensen
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Martin Frydland
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Rasmus P Beske
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Ruth Frikke-Schmidt
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Sebastian Wiberg
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Søren Boesgaard
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Vibeke Lind Jørgensen
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
| | - Jacob E Møller
- From the Departments of Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.) and Cardiology (B.B., L.S., L.O.J., J.E.M.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (H.S., C.H., B.B., L.O.J., J.E.M.), Odense, and the Departments of Cardiology (J.K., C.H., J.G., L.E.R.O., B.N., D.E.H., J.J., J.H.T., M.G.L., M.A.S.M., M.F., M.W.-J., R.P.B., R.F.-S., S.W., S.B., J.E.M.) and Cardiothoracic Anesthesiology (M.S., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., C.H., R.F.-S.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen - all in Denmark
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Kjaergaard J, Møller JE, Schmidt H, Grand J, Mølstrøm S, Borregaard B, Venø S, Sarkisian L, Mamaev D, Jensen LO, Nyholm B, Høfsten DE, Josiassen J, Thomsen JH, Thune JJ, Obling LER, Lindholm MG, Frydland M, Meyer MAS, Winther-Jensen M, Beske RP, Frikke-Schmidt R, Wiberg S, Boesgaard S, Madsen SA, Jørgensen VL, Hassager C. Blood-Pressure Targets in Comatose Survivors of Cardiac Arrest. N Engl J Med 2022; 387:1456-1466. [PMID: 36027564 DOI: 10.1056/nejmoa2208687] [Citation(s) in RCA: 77] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Evidence to support the choice of blood-pressure targets for the treatment of comatose survivors of out-of-hospital cardiac arrest who are receiving intensive care is limited. METHODS In a double-blind, randomized trial with a 2-by-2 factorial design, we evaluated a mean arterial blood-pressure target of 63 mm Hg as compared with 77 mm Hg in comatose adults who had been resuscitated after an out-of-hospital cardiac arrest of presumed cardiac cause; patients were also assigned to one of two oxygen targets (reported separately). The primary outcome was a composite of death from any cause or hospital discharge with a Cerebral Performance Category (CPC) of 3 or 4 within 90 days (range, 0 to 5, with higher categories indicating more severe disability; a category of 3 or 4 indicates severe disability or coma). Secondary outcomes included neuron-specific enolase levels at 48 hours, death from any cause, scores on the Montreal Cognitive Assessment (range, 0 to 30, with higher scores indicating better cognitive ability) and the modified Rankin scale (range, 0 to 6, with higher scores indicating greater disability) at 3 months, and the CPC at 3 months. RESULTS A total of 789 patients were included in the analysis (393 in the high-target group and 396 in the low-target group). A primary-outcome event occurred in 133 patients (34%) in the high-target group and in 127 patients (32%) in the low-target group (hazard ratio, 1.08; 95% confidence interval [CI], 0.84 to 1.37; P = 0.56). At 90 days, 122 patients (31%) in the high-target group and 114 patients (29%) in the low-target group had died (hazard ratio, 1.13; 95% CI, 0.88 to 1.46). The median CPC was 1 (interquartile range, 1 to 5) in both the high-target group and the low-target group; the corresponding median modified Rankin scale scores were 1 (interquartile range, 0 to 6) and 1 (interquartile range, 0 to 6), and the corresponding median Montreal Cognitive Assessment scores were 27 (interquartile range, 24 to 29) and 26 (interquartile range, 24 to 29). The median neuron-specific enolase level at 48 hours was also similar in the two groups. The percentages of patients with adverse events did not differ significantly between the groups. CONCLUSIONS Targeting a mean arterial blood pressure of 77 mm Hg or 63 mm Hg in patients who had been resuscitated from cardiac arrest did not result in significantly different percentages of patients dying or having severe disability or coma. (Funded by the Novo Nordisk Foundation; BOX ClinicalTrials.gov number, NCT03141099.).
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Affiliation(s)
- Jesper Kjaergaard
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Jacob E Møller
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Henrik Schmidt
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Johannes Grand
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Simon Mølstrøm
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Britt Borregaard
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Søren Venø
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Laura Sarkisian
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Dmitry Mamaev
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Lisette O Jensen
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Benjamin Nyholm
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Dan E Høfsten
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Jakob Josiassen
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Jakob H Thomsen
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Jens J Thune
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Laust E R Obling
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Matias G Lindholm
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Martin Frydland
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Martin A S Meyer
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Matilde Winther-Jensen
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Rasmus P Beske
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Ruth Frikke-Schmidt
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Sebastian Wiberg
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Søren Boesgaard
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Søren A Madsen
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Vibeke L Jørgensen
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
| | - Christian Hassager
- From the Departments of Cardiology (J.K., J.E.M., J.G., B.N., D.E.H., J.J., J.H.T., L.E.R.O., M.G.L., M.F., M.A.S.M., M.W.-J., R.P.B., S.W., S.B., C.H.) and Cardiothoracic Anesthesiology (S.A.M., V.L.J.), the Heart Center, and the Department of Clinical Biochemistry, Center of Diagnostic Investigation (R.F.-S.), Copenhagen University Hospital Rigshospitalet, the Department of Clinical Medicine, University of Copenhagen (J.K., R.F.-S., C.H.), and the Department of Cardiology, Copenhagen University Hospital Bispebjerg (J.J.T.), Copenhagen, and the Departments of Cardiology (J.E.M., B.B., L.S., L.O.J.) and Anesthesiology and Intensive Care (H.S., S.M., S.V., D.M.), Odense University Hospital, and the Department of Clinical Medicine, University of Southern Denmark (J.E.M., B.B., L.O.J., C.H.), Odense - all in Denmark
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7
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Bahrami H, Hasselbalch R, Soeholm H, Thomsen J, Soegaard M, Kofoed K, Valeur N, Boesgaard S, Fry N, Moeller J, Raja A, Koeber L, Iversen K, Rasmussen H, Bundgaard H. First-in-man trial of b3-adrenoreceptor agonist treatment in chronic heart failure – impact on diastolic function. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.955] [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
Diastolic dysfunction (DD) in heart failure (HF) is associated with increased myocardial cytosolic calcium, and calcium-efflux via the sodium-calcium-exchanger depends on the sodium gradient. Beta-3-adrenoceptor (β3-AR)-agonist lowers cytosolic sodium and has been shown to reverse organ congestion.
Purpose
To assess whether β3-AR-agonist treatment improves DD.
Methods
In a first-in-man randomized controlled, double-blind trial, we assigned 70 patients with HF with reduced ejection fraction (HFrEF) (NYHA II–III) and LVEF <40% to receive mirabegron (300 mg/day) or placebo for 6 months, in addition to recommended HF-therapy. Patients were assessed with echocardiography and cardiac computed tomography (CCT) at baseline and follow-up. DD was graded according to the current American/European guidelines.
Results
Baseline and follow-up echocardiographic data were available in 57 patients (59±11 years, 88% male, 49% ischemic heart disease). Baseline LVEF was 34%±8%. No significant change in DD grade was found between the groups at follow-up, p=0.72. Neither was there any clinical differences in any singular diastolic parameters within or between groups by echocardiography (E/e' placebo: 13.3±6.9 to 12.6±5.1, p=0.19 vs. mirabegron: 12.0±5.7 to 12.8±7.9, p=0.67, mean difference 1.12 [95% CI −1.68 to 4.3], p=0.37), or CCT (left atrial max volume index: between group mean difference 0.2 [95% CI −6.2 to 5.6] ml/m2, p=0.91).
Conclusions
In patients with HFrEF, no improvement nor worsening in DD gradings or singular diastolic parameters after β3-AR stimulation compared to placebo were identified. The findings add to previous literature questioning the role of impaired Na+-Ca2+ mediated Ca2+ export as a major culprit in DD.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The Heart Centre Research Foundation, RigshospitaletThe Novo Nordic Foundation
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Affiliation(s)
- H Bahrami
- Copenhagen University Hospital Amager&Hvidovre, Department of Cardiology , Copenhagen , Denmark
| | - R Hasselbalch
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - H Soeholm
- Zealand university hospital, Department of Cardiology , Copenhagen , Denmark
| | - J Thomsen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - M Soegaard
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - K Kofoed
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - N Valeur
- Bispebjerg University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - S Boesgaard
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - N Fry
- Royal North Shore Hospital, Department of Cardiology , Sydney , Australia
| | - J Moeller
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - A Raja
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - L Koeber
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - K Iversen
- Copenhagen University Hospital Herlev&Gentofte, Department of Emergency Medicine , Copenhagen , Denmark
| | - H Rasmussen
- Royal North Shore Hospital, Department of Cardiology , Sydney , Australia
| | - H Bundgaard
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
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8
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Pérez-Hernández M, van Opbergen CJM, Bagwan N, Vissing CR, Marrón-Liñares GM, Zhang M, Torres Vega E, Sorrentino A, Drici L, Sulek K, Zhai R, Hansen FB, Christensen AH, Boesgaard S, Gustafsson F, Rossing K, Small EM, Davies MJ, Rothenberg E, Sato PY, Cerrone M, Jensen THL, Qvortrup K, Bundgaard H, Delmar M, Lundby A. Loss of Nuclear Envelope Integrity and Increased Oxidant Production Cause DNA Damage in Adult Hearts Deficient in PKP2: A Molecular Substrate of ARVC. Circulation 2022; 146:851-867. [PMID: 35959657 PMCID: PMC9474627 DOI: 10.1161/circulationaha.122.060454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 06/30/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Arrhythmogenic right ventricular cardiomyopathy (ARVC) is characterized by high propensity to life-threatening arrhythmias and progressive loss of heart muscle. More than 40% of reported genetic variants linked to ARVC reside in the PKP2 gene, which encodes the PKP2 protein (plakophilin-2). METHODS We describe a comprehensive characterization of the ARVC molecular landscape as determined by high-resolution mass spectrometry, RNA sequencing, and transmission electron microscopy of right ventricular biopsy samples obtained from patients with ARVC with PKP2 mutations and left ventricular ejection fraction >45%. Samples from healthy relatives served as controls. The observations led to experimental work using multiple imaging and biochemical techniques in mice with a cardiac-specific deletion of Pkp2 studied at a time of preserved left ventricular ejection fraction and in human induced pluripotent stem cell-derived PKP2-deficient myocytes. RESULTS Samples from patients with ARVC present a loss of nuclear envelope integrity, molecular signatures indicative of increased DNA damage, and a deficit in transcripts coding for proteins in the electron transport chain. Mice with a cardiac-specific deletion of Pkp2 also present a loss of nuclear envelope integrity, which leads to DNA damage and subsequent excess oxidant production (O2.- and H2O2), the latter increased further under mechanical stress (isoproterenol or exercise). Increased oxidant production and DNA damage is recapitulated in human induced pluripotent stem cell-derived PKP2-deficient myocytes. Furthermore, PKP2-deficient cells release H2O2 into the extracellular environment, causing DNA damage and increased oxidant production in neighboring myocytes in a paracrine manner. Treatment with honokiol increases SIRT3 (mitochondrial nicotinamide adenine dinucleotide-dependent protein deacetylase sirtuin-3) activity, reduces oxidant levels and DNA damage in vitro and in vivo, reduces collagen abundance in the right ventricular free wall, and has a protective effect on right ventricular function. CONCLUSIONS Loss of nuclear envelope integrity and subsequent DNA damage is a key substrate in the molecular pathology of ARVC. We show transcriptional downregulation of proteins of the electron transcript chain as an early event in the molecular pathophysiology of the disease (before loss of left ventricular ejection fraction <45%), which associates with increased oxidant production (O2.- and H2O2). We propose therapies that limit oxidant formation as a possible intervention to restrict DNA damage in ARVC.
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Affiliation(s)
- Marta Pérez-Hernández
- The Leon H. Charney Division of Cardiology, NYU-Grossman School of Medicine, New York (M.P.-H., C.J.M.v.O., G.M.M.-L., M.Z., M.C., M.D.)
| | - Chantal J M van Opbergen
- The Leon H. Charney Division of Cardiology, NYU-Grossman School of Medicine, New York (M.P.-H., C.J.M.v.O., G.M.M.-L., M.Z., M.C., M.D.)
| | - Navratan Bagwan
- Department of Biomedical Sciences (N.B., E.T.V., A.S., F.B.H., M.J.D., K.Q., A.L.), University of Copenhagen, Denmark
| | - Christoffer Rasmus Vissing
- Faculty of Health and Medical Sciences, and Department of Clinical Medicine (C.R.V., A.H.C., S.B., F.G., K.R., T.H.L.J., H.B.), University of Copenhagen, Denmark
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark (C.R.V., A.H.C., S.B., F.G., K.R., T.H.L.J., H.B.)
| | - Grecia M Marrón-Liñares
- The Leon H. Charney Division of Cardiology, NYU-Grossman School of Medicine, New York (M.P.-H., C.J.M.v.O., G.M.M.-L., M.Z., M.C., M.D.)
| | - Mingliang Zhang
- The Leon H. Charney Division of Cardiology, NYU-Grossman School of Medicine, New York (M.P.-H., C.J.M.v.O., G.M.M.-L., M.Z., M.C., M.D.)
| | - Estefania Torres Vega
- Department of Biomedical Sciences (N.B., E.T.V., A.S., F.B.H., M.J.D., K.Q., A.L.), University of Copenhagen, Denmark
| | - Andrea Sorrentino
- Department of Biomedical Sciences (N.B., E.T.V., A.S., F.B.H., M.J.D., K.Q., A.L.), University of Copenhagen, Denmark
| | - Lylia Drici
- The Novo Nordisk Foundation Center for Protein Research (L.D., K.S.), University of Copenhagen, Denmark
| | - Karolina Sulek
- The Novo Nordisk Foundation Center for Protein Research (L.D., K.S.), University of Copenhagen, Denmark
| | - Ruxu Zhai
- College of Medicine, Drexel University, Philadelphia, PA (R.Z., P.Y.S.)
| | - Finn B Hansen
- Department of Biomedical Sciences (N.B., E.T.V., A.S., F.B.H., M.J.D., K.Q., A.L.), University of Copenhagen, Denmark
| | - Alex H Christensen
- Faculty of Health and Medical Sciences, and Department of Clinical Medicine (C.R.V., A.H.C., S.B., F.G., K.R., T.H.L.J., H.B.), University of Copenhagen, Denmark
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark (C.R.V., A.H.C., S.B., F.G., K.R., T.H.L.J., H.B.)
- Department of Cardiology, Copenhagen University Hospital-Herlev-Gentofte Hospital, Denmark (A.H.C.)
| | - Søren Boesgaard
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark (C.R.V., A.H.C., S.B., F.G., K.R., T.H.L.J., H.B.)
- College of Medicine, Drexel University, Philadelphia, PA (R.Z., P.Y.S.)
| | - Finn Gustafsson
- Faculty of Health and Medical Sciences, and Department of Clinical Medicine (C.R.V., A.H.C., S.B., F.G., K.R., T.H.L.J., H.B.), University of Copenhagen, Denmark
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark (C.R.V., A.H.C., S.B., F.G., K.R., T.H.L.J., H.B.)
| | - Kasper Rossing
- Faculty of Health and Medical Sciences, and Department of Clinical Medicine (C.R.V., A.H.C., S.B., F.G., K.R., T.H.L.J., H.B.), University of Copenhagen, Denmark
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark (C.R.V., A.H.C., S.B., F.G., K.R., T.H.L.J., H.B.)
| | - Eric M Small
- Aab Cardiovascular Research Institute, Department of Medicine, University of Rochester School of Medicine and Dentistry, NY (E.M.S.)
| | - Michael J Davies
- Department of Biomedical Sciences (N.B., E.T.V., A.S., F.B.H., M.J.D., K.Q., A.L.), University of Copenhagen, Denmark
| | - Eli Rothenberg
- Division of Pharmacology, NYU School of Medicine, New York (E.R.)
| | - Priscila Y Sato
- College of Medicine, Drexel University, Philadelphia, PA (R.Z., P.Y.S.)
| | - Marina Cerrone
- The Leon H. Charney Division of Cardiology, NYU-Grossman School of Medicine, New York (M.P.-H., C.J.M.v.O., G.M.M.-L., M.Z., M.C., M.D.)
| | - Thomas Hartvig Lindkær Jensen
- Faculty of Health and Medical Sciences, and Department of Clinical Medicine (C.R.V., A.H.C., S.B., F.G., K.R., T.H.L.J., H.B.), University of Copenhagen, Denmark
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark (C.R.V., A.H.C., S.B., F.G., K.R., T.H.L.J., H.B.)
| | - Klaus Qvortrup
- Department of Biomedical Sciences (N.B., E.T.V., A.S., F.B.H., M.J.D., K.Q., A.L.), University of Copenhagen, Denmark
| | - Henning Bundgaard
- Faculty of Health and Medical Sciences, and Department of Clinical Medicine (C.R.V., A.H.C., S.B., F.G., K.R., T.H.L.J., H.B.), University of Copenhagen, Denmark
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark (C.R.V., A.H.C., S.B., F.G., K.R., T.H.L.J., H.B.)
| | - Mario Delmar
- The Leon H. Charney Division of Cardiology, NYU-Grossman School of Medicine, New York (M.P.-H., C.J.M.v.O., G.M.M.-L., M.Z., M.C., M.D.)
| | - Alicia Lundby
- Department of Biomedical Sciences (N.B., E.T.V., A.S., F.B.H., M.J.D., K.Q., A.L.), University of Copenhagen, Denmark
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9
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Bundgaard H, Axelsson Raja A, Iversen K, Valeur N, Tønder N, Schou M, Christensen AH, Bruun NE, Søholm H, Ghanizada M, Fry NAS, Hamilton EJ, Boesgaard S, Møller MB, Wolsk E, Rossing K, Køber L, Rasmussen HH, Vissing CR. Hemodynamic Effects of Cyclic Guanosine Monophosphate-Dependent Signaling Through β3 Adrenoceptor Stimulation in Patients With Advanced Heart Failure: A Randomized Invasive Clinical Trial. Circ Heart Fail 2022; 15:e009120. [PMID: 35758031 DOI: 10.1161/circheartfailure.121.009120] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND β3-AR (β3-adrenergic receptor) stimulation improved systolic function in a sheep model of systolic heart failure (heart failure with reduced ejection fraction [HFrEF]). Exploratory findings in patients with New York Heart Association functional class II HFrEF treated with the β3-AR-agonist mirabegron supported this observation. Here, we measured the hemodynamic response to mirabegron in patients with severe HFrEF. METHODS In this randomized, double-blind, placebo-controlled trial we assigned patients with New York Heart Association functional class III-IV HFrEF, left ventricular ejection fraction <35% and increased NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels to receive mirabegron (300 mg daily) or placebo orally for a week, as add on to recommended HF therapy. Invasive hemodynamic measurements during rest and submaximal exercise at baseline, 3 hours after first study dose and repeated after 1 week's treatment were obtained. Predefined parameters for analyses were changes in cardiac- and stroke volume index, pulmonary and systemic vascular resistance, heart rate, and blood pressure. RESULTS We randomized 22 patients (age 66±11 years, 18 men, 16, New York Heart Association functional class III), left ventricular ejection fraction 20±7%, median NT-proBNP 1953 ng/L. No significant changes were seen after 3 hours, but after 1 week, there was a significantly larger increase in cardiac index in the mirabegron group compared with the placebo group (mean difference, 0.41 [CI, 0.07-0.75] L/min/BSA; P=0.039). Pulmonary vascular resistance decreased significantly more in the mirabegron group compared with the placebo group (-1.6 [CI, -0.4 to -2.8] Wood units; P=0.02). No significant differences were seen during exercise. There were no differences in changes in heart rate, systemic vascular resistance, blood pressure, or renal function between groups. Mirabegron was well-tolerated. CONCLUSIONS Oral treatment with the β3-AR-agonist mirabegron for 1 week increased cardiac index and decreased pulmonary vascular resistance in patients with moderate to severe HFrEF. Mirabegron may be useful in patients with worsening or terminal HF. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: 2016-002367-34.
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Affiliation(s)
- Henning Bundgaard
- Department of Cardiology, Rigshospitalet (H.B., A.A.R., A.H.C., H.S., M.G., S.B., M.B.M, E.W., K.R., L.K., C.R.V.), Copenhagen University Hospital, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark (H.B., A.A.R., K.I., N.V., N.T., M.S., A.H.C., N.E.B., H.S., M.G., S.B., M.B.M., E.W., K.R., L.K., H.H.R., C.R.V.)
| | - Anna Axelsson Raja
- Department of Cardiology, Rigshospitalet (H.B., A.A.R., A.H.C., H.S., M.G., S.B., M.B.M, E.W., K.R., L.K., C.R.V.), Copenhagen University Hospital, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark (H.B., A.A.R., K.I., N.V., N.T., M.S., A.H.C., N.E.B., H.S., M.G., S.B., M.B.M., E.W., K.R., L.K., H.H.R., C.R.V.)
| | - Kasper Iversen
- Department of Cardiology, Herlev-Gentofte Hospital (K.I., M.S., A.H.C., E.W.), Copenhagen University Hospital, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark (H.B., A.A.R., K.I., N.V., N.T., M.S., A.H.C., N.E.B., H.S., M.G., S.B., M.B.M., E.W., K.R., L.K., H.H.R., C.R.V.)
| | - Nana Valeur
- Department of Cardiology, Bispebjerg Hospital (N.V.), Copenhagen University Hospital, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark (H.B., A.A.R., K.I., N.V., N.T., M.S., A.H.C., N.E.B., H.S., M.G., S.B., M.B.M., E.W., K.R., L.K., H.H.R., C.R.V.)
| | - Niels Tønder
- Department of Cardiology, North Zealand Hospital (N.T.), Copenhagen University Hospital, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark (H.B., A.A.R., K.I., N.V., N.T., M.S., A.H.C., N.E.B., H.S., M.G., S.B., M.B.M., E.W., K.R., L.K., H.H.R., C.R.V.)
| | - Morten Schou
- Department of Cardiology, Herlev-Gentofte Hospital (K.I., M.S., A.H.C., E.W.), Copenhagen University Hospital, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark (H.B., A.A.R., K.I., N.V., N.T., M.S., A.H.C., N.E.B., H.S., M.G., S.B., M.B.M., E.W., K.R., L.K., H.H.R., C.R.V.)
| | - Alex Hørby Christensen
- Department of Cardiology, Rigshospitalet (H.B., A.A.R., A.H.C., H.S., M.G., S.B., M.B.M, E.W., K.R., L.K., C.R.V.), Copenhagen University Hospital, Denmark.,Department of Cardiology, Herlev-Gentofte Hospital (K.I., M.S., A.H.C., E.W.), Copenhagen University Hospital, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark (H.B., A.A.R., K.I., N.V., N.T., M.S., A.H.C., N.E.B., H.S., M.G., S.B., M.B.M., E.W., K.R., L.K., H.H.R., C.R.V.)
| | - Niels Eske Bruun
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (N.E.B., H.S.).,Department of Clinical Medicine, University of Copenhagen, Denmark (H.B., A.A.R., K.I., N.V., N.T., M.S., A.H.C., N.E.B., H.S., M.G., S.B., M.B.M., E.W., K.R., L.K., H.H.R., C.R.V.)
| | - Helle Søholm
- Department of Cardiology, Rigshospitalet (H.B., A.A.R., A.H.C., H.S., M.G., S.B., M.B.M, E.W., K.R., L.K., C.R.V.), Copenhagen University Hospital, Denmark.,Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (N.E.B., H.S.).,Department of Clinical Medicine, University of Copenhagen, Denmark (H.B., A.A.R., K.I., N.V., N.T., M.S., A.H.C., N.E.B., H.S., M.G., S.B., M.B.M., E.W., K.R., L.K., H.H.R., C.R.V.)
| | - Muzhda Ghanizada
- Department of Cardiology, Rigshospitalet (H.B., A.A.R., A.H.C., H.S., M.G., S.B., M.B.M, E.W., K.R., L.K., C.R.V.), Copenhagen University Hospital, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark (H.B., A.A.R., K.I., N.V., N.T., M.S., A.H.C., N.E.B., H.S., M.G., S.B., M.B.M., E.W., K.R., L.K., H.H.R., C.R.V.)
| | - Natasha A S Fry
- Department of Cardiology, Royal North Shore Hospital, and University of Sydney, Australia (N.A.S.F., E.J.H., H.H.R.)
| | - Elisha J Hamilton
- Department of Cardiology, Royal North Shore Hospital, and University of Sydney, Australia (N.A.S.F., E.J.H., H.H.R.)
| | - Søren Boesgaard
- Department of Cardiology, Rigshospitalet (H.B., A.A.R., A.H.C., H.S., M.G., S.B., M.B.M, E.W., K.R., L.K., C.R.V.), Copenhagen University Hospital, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark (H.B., A.A.R., K.I., N.V., N.T., M.S., A.H.C., N.E.B., H.S., M.G., S.B., M.B.M., E.W., K.R., L.K., H.H.R., C.R.V.)
| | - Mathias B Møller
- Department of Cardiology, Rigshospitalet (H.B., A.A.R., A.H.C., H.S., M.G., S.B., M.B.M, E.W., K.R., L.K., C.R.V.), Copenhagen University Hospital, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark (H.B., A.A.R., K.I., N.V., N.T., M.S., A.H.C., N.E.B., H.S., M.G., S.B., M.B.M., E.W., K.R., L.K., H.H.R., C.R.V.)
| | - Emil Wolsk
- Department of Cardiology, Rigshospitalet (H.B., A.A.R., A.H.C., H.S., M.G., S.B., M.B.M, E.W., K.R., L.K., C.R.V.), Copenhagen University Hospital, Denmark.,Department of Cardiology, Herlev-Gentofte Hospital (K.I., M.S., A.H.C., E.W.), Copenhagen University Hospital, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark (H.B., A.A.R., K.I., N.V., N.T., M.S., A.H.C., N.E.B., H.S., M.G., S.B., M.B.M., E.W., K.R., L.K., H.H.R., C.R.V.)
| | - Kasper Rossing
- Department of Cardiology, Rigshospitalet (H.B., A.A.R., A.H.C., H.S., M.G., S.B., M.B.M, E.W., K.R., L.K., C.R.V.), Copenhagen University Hospital, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark (H.B., A.A.R., K.I., N.V., N.T., M.S., A.H.C., N.E.B., H.S., M.G., S.B., M.B.M., E.W., K.R., L.K., H.H.R., C.R.V.)
| | - Lars Køber
- Department of Cardiology, Rigshospitalet (H.B., A.A.R., A.H.C., H.S., M.G., S.B., M.B.M, E.W., K.R., L.K., C.R.V.), Copenhagen University Hospital, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark (H.B., A.A.R., K.I., N.V., N.T., M.S., A.H.C., N.E.B., H.S., M.G., S.B., M.B.M., E.W., K.R., L.K., H.H.R., C.R.V.)
| | - Helge H Rasmussen
- Department of Cardiology, Royal North Shore Hospital, and University of Sydney, Australia (N.A.S.F., E.J.H., H.H.R.).,Department of Clinical Medicine, University of Copenhagen, Denmark (H.B., A.A.R., K.I., N.V., N.T., M.S., A.H.C., N.E.B., H.S., M.G., S.B., M.B.M., E.W., K.R., L.K., H.H.R., C.R.V.)
| | - Christoffer Rasmus Vissing
- Department of Cardiology, Rigshospitalet (H.B., A.A.R., A.H.C., H.S., M.G., S.B., M.B.M, E.W., K.R., L.K., C.R.V.), Copenhagen University Hospital, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark (H.B., A.A.R., K.I., N.V., N.T., M.S., A.H.C., N.E.B., H.S., M.G., S.B., M.B.M., E.W., K.R., L.K., H.H.R., C.R.V.)
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10
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Nelson LM, Rossing K, Boesgaard S, Møller-Sørensen H, Møller CH, Gustafsson F, Olsen PS. Three decades of heart transplantation: experience and long-term outcome. SCAND CARDIOVASC J 2022; 56:65-72. [PMID: 35481404 DOI: 10.1080/14017431.2022.2061726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objectives. Heart transplantation (HTx) has become an established treatment option in patients with end-stage heart failure. The aim of this study was to report on long-term outcome over the past three decades. Design. Consecutive adult patients receiving first-time and isolated HTx from October 3, 1990, to November 2, 2020, at Rigshospitalet, Copenhagen, Denmark, were retrospectively evaluated. Data were obtained from the Scandinavian Transplant Registry and patient medical records. Recipients were grouped by time of transplantation (early era: 1990-1999; mid era: 2000-2009; recent era: 2010-2020). Results. A total of 384 recipients (77% men, median age 50 [IQR: 40-57]) were included. Median number of HTx procedures per year was 12 (10-14). Overall, 22% of patients were bridged to HTx with a mechanical circulatory support device. Median survival for the whole cohort was 13.8 years and improved numerically from the early era (12.6 years) to the mid era (14.9 years). Median survival conditional on survival to 1-year follow-up after HTx was 16.1 years. Survival probability by Kaplan-Meier method improved significantly from the mid to the recent era (log-rank p = .02). Conclusions. Heart transplantation remains an excellent treatment for selected patients with end-stage heart failure and long-term outcome has improved significantly over the past decades.
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Affiliation(s)
- Lærke Marie Nelson
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kasper Rossing
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Søren Boesgaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Hasse Møller-Sørensen
- Department of Cardiothoracic Anaesthesiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Holdflod Møller
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Peter Skov Olsen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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11
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Larsson J, Kristensen SL, Madelaire C, Schou M, Rossing K, Boesgaard S, Køber L, Gustafsson F. Socioeconomic Disparities in Referral for Invasive Hemodynamic Evaluation for Advanced Heart Failure: A Nationwide Cohort Study. Circ Heart Fail 2021; 14:e008662. [PMID: 34461745 DOI: 10.1161/circheartfailure.121.008662] [Citation(s) in RCA: 4] [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: 12/13/2022]
Abstract
BACKGROUND Factors determining referral for advanced heart failure (HF) evaluation are poorly studied. We studied the influence of socioeconomic aspects on the referral process in Denmark, which has a taxpayer-funded national health care system. METHODS We identified all patients aged 18 to 75 years with a first diagnosis of HF during 2010 to 2018. Hospitalized patients had to be discharged alive and were then followed for the outcome of undergoing a right heart catheterization (RHC) used as a surrogate marker of advanced HF work-up. RESULTS Of 36 637 newly diagnosed patients with HF, 680 (1.9%) underwent RHC during the follow-up period (median time to RHC of 280 days [interquartile range, 73-914]). Factors associated with a higher likelihood of RHC included the highest versus lowest household income quartile (HR, 1.56 [95% CI, 1.19-2.06]; P=0.001), being diagnosed with HF at a tertiary versus nontertiary hospital (HR, 1.68 [95% CI, 1.37-2.05]; P<0.001) and during a hospitalization versus outpatient visit (HR, 1.67 [95% CI, 1.42-1.95]; P<0.001). Level of education, occupational status, and distance to tertiary hospital were not independently associated with RHC. Older age, cancer, and a psychiatric diagnosis were independently associated with a decreased probability of RHC. CONCLUSIONS Higher household income, HF diagnosis during hospitalization, and first admission at a tertiary hospital were associated with increased likelihood of subsequent referral for RHC independent of other demographic and clinical variables. Greater attention may be required to ensure timely referral for advanced HF therapies in lower income groups.
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Affiliation(s)
- Johan Larsson
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark (J.L., S.L.K., K.R., S.B., L.K., F.G.)
| | - Søren L Kristensen
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark (J.L., S.L.K., K.R., S.B., L.K., F.G.)
| | | | - Morten Schou
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen, Denmark (M.S.)
| | - Kasper Rossing
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark (J.L., S.L.K., K.R., S.B., L.K., F.G.)
| | - Søren Boesgaard
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark (J.L., S.L.K., K.R., S.B., L.K., F.G.)
| | - Lars Køber
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark (J.L., S.L.K., K.R., S.B., L.K., F.G.)
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark (J.L., S.L.K., K.R., S.B., L.K., F.G.)
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12
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Nelson LM, Rossing K, Ihlemann N, Boesgaard S, Engstrøm T, Gustafsson F. Intravascular ultrasound-guided selection for early noninvasive cardiac allograft vasculopathy screening in heart transplant recipients. Clin Transplant 2020; 34:e14124. [PMID: 33068292 DOI: 10.1111/ctr.14124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/30/2020] [Accepted: 10/10/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Noninvasive screening for cardiac allograft vasculopathy (CAV) instead of invasive coronary angiography (ICA) within the first 3 to 5 years after heart transplantation (HTx) is controversial. We evaluated a strategy of intravascular ultrasound (IVUS)-guided conversion to early noninvasive screening post-HTx. METHODS A single-center study of 103 consecutive HTx recipients from 2008 to 2018 undergoing ICA at 1 year post-HTx. Of 88 patients with normal 1-year ICA, sixty-six patients underwent IVUS examination for risk stratification by maximal intimal thickness (MIT) into (i) low-risk group (MIT < 0.5 mm) (n = 41, 62%) followed noninvasively versus (ii) high-risk group (MIT ≥ 0.5 mm) (n = 25, 38%) followed with yearly ICA. Both groups underwent ICA at year 5 post-HTx. We evaluated a combined endpoint of angiographic CAV and death at 5-year follow-up post-HTx. RESULTS Median (IQR) age was 51 (33-60) years, and 62% were male. Follow-up was 1443 (1125-1456) days. Survival free from angiographic CAV (Kaplan-Meier) differed significantly between groups (log-rank p < .0001). A subgroup of 27 patients completed ICA at year 5, and the proportion of angiographic CAV was significantly lower in low-risk patients (p < .0001). CONCLUSION IVUS-guided selection for early noninvasive CAV screening appears to be safe and holds promise as a novel strategy for early risk stratification and CAV surveillance post-HTx.
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Affiliation(s)
- Laerke Marie Nelson
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kasper Rossing
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Nikolaj Ihlemann
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Søren Boesgaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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13
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Deis T, Balling L, Rossing K, Boesgaard S, Kistorp CM, Wolsk E, Gøtze JP, Rehfeld JF, Gustafsson F. Plasma Somatostatin in Advanced Heart Failure: Association with Cardiac Filling Pressures and Outcome. Cardiology 2020; 145:769-778. [PMID: 33027795 DOI: 10.1159/000510284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 07/15/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Somatostatin inhibits intestinal motility and hormonal secretion and is a potent arterial vasoconstrictor of the splanchnic blood flow. It is unknown if somatostatin concentrations are associated with central hemodynamic measurements in patients with advanced heart failure (HF). METHODS A prospective study of HF patients with a left ventricular ejection fraction (LVEF) <45% referred to right heart catheterization (RHC) for evaluation for heart transplantation (HTX) or left ventricular assist device (LVAD). RESULTS Fifty-three patients were included with mean LVEF 18 ± 8% and majority in NYHA-class III-IV (79%). Median plasma somatostatin concentration was 18 pmol/L. In univariable regression analysis, log(somatostatin) was associated with increased central venous pressure (CVP; r2 = 0.14, p = 0.003) and a reduced cardiac index (CI; r2 = 0.15, p = 0.004). When adjusted for selected clinical variables (age, gender, LVEF, eGFR and BMI), log(somatostatin) remained a significant predictor of CVP (p = 0.044). Increased somatostatin concentrations predicted mortality in multivariable models (hazard ratio: 5.2 [1.2-22.2], p = 0.026) but not the combined endpoint of death, LVAD implantation or HTX. CONCLUSIONS Somatostatin concentrations were associated with CVP and CI in patients with HF. The pathophysiological mechanism may be related to congestion and/or hypoperfusion of the intestine. Somatostatin was an independent predictor of mortality in advanced HF.
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Affiliation(s)
- Tania Deis
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark,
| | - Louise Balling
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Kasper Rossing
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Søren Boesgaard
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Caroline Michaela Kistorp
- Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Emil Wolsk
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Jens Peter Gøtze
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
| | | | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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14
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Grand J, Møller JE, Boesgaard S, Gustafsson F, Køber L, Kjærgaard J, Hassager C. [Acute heart failure]. Ugeskr Laeger 2020; 182:V04200296. [PMID: 33046187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Acute heart failure is a common and severe condition in Danish emergency hospitals. Hypertensive pulmonary oedema, cardiogenic shock and congestive heart failure are the most common phenotypes. The aim of this review is to summarise the most recent international guidelines for acute triage and treatment of acute heart failure. Afterload is reduced with nitrates, congestion is treated with intravenous loop-diuretics, and in selected patients, cardiac output could be increased by inotropic drugs or mechanical support devices.
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15
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Grand J, Hassager C, Bro-Jeppesen J, Gustafsson F, Møller JE, Boesgaard S, Nielsen N, Kjaergaard J. Impact of Hypothermia on Oxygenation Variables and Metabolism in Survivors of Out-of-Hospital Cardiac Arrest Undergoing Targeted Temperature Management at 33°C Versus 36°C. Ther Hypothermia Temp Manag 2020; 11:170-178. [PMID: 32584698 DOI: 10.1089/ther.2020.0013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Targeted temperature management (TTM) exerts substantial impact on hemodynamic function in out-of-hospital cardiac arrest (OHCA) patients. Whole-body oxygen consumption (VO2) and delivery (DO2) have not previously been investigated in a clinical setting during TTM at different levels of temperature after OHCA. A substudy of 151 patients randomized at a single center in the TTM-trial, where patients were randomly assigned TTM at 33°C (TTM33) or 36°C (TTM36) for 24 hours. We calculated VO2 according to the principle of Fick (VO2 = cardiac output*arteriovenous oxygen content difference). DO2 was calculated as cardiac output*arterial oxygen content. Cardiac output was measured by pulmonary artery catheter with thermodilution. Arteriovenous oxygen content difference was calculated from arterial and mixed venous oxygen saturation and hemoglobin. Oxygen extraction ratio = VO2/DO2. At 24 hours, the VO2 was 169 ± 59 mL O2 per minute in TTM33 and 217 ± 53 mL O2 per minute in TTM36 (p < 0.0001). During 24 hours of TTM, the overall difference was 53 mL O2 minute (95% confidence interval [CI]: 31-74, pgroup < 0.0001). After rewarming at 36 and 48 hours, there was no difference in VO2 between the groups. DO2 was overall 277 mL O2 per minute (95% CI: 175-379, pgroup < 0.0001) higher in the TTM36-group during TTM. Oxygen extraction ratio during TTM was not significantly different between the two groups (2% [95% CI: -0.1 to 5, pgroup = 0.09]). VO2 during the first 36 hours after OHCA correlated significantly with temperature, and VO2 was 19 mL O2 per minute lower per degree reduction in temperature (95% CI: 15-22), p < 0.0001. TTM at 33°C compared to 36°C after OHCA is associated with significantly lower VO2 and DO2, however, oxygen extraction ratio was not significantly different. For each degree lower body temperature, the VO2 fell by 19 mL O2 per minute.
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Affiliation(s)
- Johannes Grand
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - John Bro-Jeppesen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Søren Boesgaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Niklas Nielsen
- Department of Anaesthesia and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden
| | - Jesper Kjaergaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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16
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Vishram-Nielsen JKK, Deis T, Balling L, Sabbah M, Boesgaard S, Rossing K, Wolsk E, Gustafsson F. Relationship between invasive hemodynamics and liver function in advanced heart failure. SCAND CARDIOVASC J 2019; 53:235-246. [PMID: 31327253 DOI: 10.1080/14017431.2019.1646972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective. To examine how liver function (LF) relates to invasive hemodynamics cross-sectionally and longitudinally, in advanced heart failure (AHF) patients treated with maximally tolerated medical HF therapy. Design. A retrospective study of 309 consecutive AHF patients with a left ventricular ejection fraction < 45% treated with maximally tolerated medical HF therapy who were referred for AHF therapies. All patients underwent right heart catheterization (RHC) using Swan-Ganz catheters. Cardiac output was measured using thermodilution. Measurements of pulmonary capillary wedge pressure (PCWP), central venous pressure (CVP), cardiac index (CI) and mean arterial pressure (MAP) were obtained. RHC and evaluation of LF were repeated (median (IQR) = 186.5 (150-208) days) in 33 patients. Results. Mean (SD) age was 50 (±13) years, and 239 (77%) were men. Only 22 (7%) were treated with inotropes, and none were receiving mechanical circulatory support. Median (IQR) plasma alanine transaminase (ALT) was 32 (22-53) U/l, alkaline phosphatase (ALP) 82 (63-122) U/l, bilirubin 14 (9-22) µmol/l, albumin 39 (35-43) g/l, lactate dehydrogenase 212 (175-275) U/l, and the prothrombin time/International Normalized Ratio (PT/INR) 1.1 (1.0-1.3). In multivariate analyses significant associations between LF tests and hemodynamics were seen for CVP: ALP (β = 0.031, p = .0002), bilirubin (β = 0.027, p = .004), and INR (β = 0.013, p = .002). PCWP (β = 0.020, p = .002) and CI (β = -0.17, p = .005) were also associated with bilirubin. Over time, changes in bilirubin correlated positively with changes in CVP (β = 1.496, p = .005). Conclusion. In optimally treated AHF patients, CVP was associated with both markers of biliary excretion and liver synthesis function, whereas changes in CVP were associated with changes in markers of biliary excretion. Decongestion may improve measures of LF in AHF.
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Affiliation(s)
- Julie K K Vishram-Nielsen
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, University Hospital of Copenhagen , Copenhagen , Denmark
| | - Tania Deis
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, University Hospital of Copenhagen , Copenhagen , Denmark
| | - Louise Balling
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, University Hospital of Copenhagen , Copenhagen , Denmark
| | - Muhammad Sabbah
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, University Hospital of Copenhagen , Copenhagen , Denmark
| | - Søren Boesgaard
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, University Hospital of Copenhagen , Copenhagen , Denmark
| | - Kasper Rossing
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, University Hospital of Copenhagen , Copenhagen , Denmark
| | - Emil Wolsk
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, University Hospital of Copenhagen , Copenhagen , Denmark
| | - Finn Gustafsson
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, University Hospital of Copenhagen , Copenhagen , Denmark.,Department of Medicine, University of Copenhagen , Copenhagen , Denmark
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17
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Deis T, Balling L, Boesgaard S, Rossing K, Schou M, Oturai P, Wolsk E, Gustafsson F. Relation between invasive hemodynamics and measured glomerular filtration rate by 51Cr-EDTA clearance in advanced heart failure. Scand J Clin Lab Invest 2019; 79:194-201. [PMID: 30784338 DOI: 10.1080/00365513.2019.1576221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 01/14/2019] [Accepted: 01/27/2019] [Indexed: 06/09/2023]
Abstract
The interaction between hemodynamics and kidney function in heart failure (HF) is incompletely understood. We investigated the association between invasive hemodynamic parameters and measured glomerular filtration rate (mGFR) by plasma clearance of 51-chromium-labeled ethylenediamine tetra-acetic acid (51Cr-EDTA) in patients with advanced HF and tested the hypothesis that patients with reduced mGFR have lower cardiac index (CI) and mean arterial pressure (MAP) as well as higher central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP). We retrospectively studied 242 patients (mean age 50 ± 13 years) referred for evaluation for heart transplantation or implantation of a left ventricular assist device with a left ventricular ejection fraction < 45% on optimal medical therapy, who underwent right heart catheterization (RHC) and measurement of 51Cr-EDTA clearance. Mean mGFR was 63 ± 21 mL/min/1.73 m2, CI was 2.3 ± 0.7 L/min/m2, PCWP was 21 ± 9 mmHg, and CVP was 10.3 ± 5.2 mmHg. Univariate analysis demonstrated a significant correlation between mGFR and CI (r2 = 0.030, p = .007) and CVP (r2 = 0.017, p = .049) but not between mGFR and MAP or PCWP. In multivariate analyses, none of the hemodynamic variables remained significantly associated with mGFR. While CVP and CI were correlated with mGFR in univariate analysis the results of analyses adjusted for multiple covariates suggest that hemodynamics are only correlated to renal function in advanced HF to a modest degree challenging the hypothesis that renal dysfunction in HF mainly is a consequence of renal congestion.
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Affiliation(s)
- Tania Deis
- a Department of Cardiology , Rigshopsitalet , Copenhagen , Denmark
| | - Louise Balling
- a Department of Cardiology , Rigshopsitalet , Copenhagen , Denmark
| | - Søren Boesgaard
- a Department of Cardiology , Rigshopsitalet , Copenhagen , Denmark
| | - Kasper Rossing
- a Department of Cardiology , Rigshopsitalet , Copenhagen , Denmark
| | - Morten Schou
- b Department of Cardiology , Herlev-Gentofte Hospital , Copenhagen , Denmark
| | - Peter Oturai
- c Department of Clinical Physiology and Nuclear Medicine , Rigshospitalet , Copenhagen , Denmark
| | - Emil Wolsk
- a Department of Cardiology , Rigshopsitalet , Copenhagen , Denmark
| | - Finn Gustafsson
- a Department of Cardiology , Rigshopsitalet , Copenhagen , Denmark
- d Department of Clinical Medicine , University of Copenhagen , Copenhagen , Denmark
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Balling L, Thomsen JH, Wolsk E, Hassager C, Boesgaard S, Goldsmith SR, Gustafsson F. Hemodynamic effects of short-term infusion of a vasopressin V1A/V2 receptor antagonist conivaptan in patients withchronic heart failure during submaximal exercise. Am Heart J 2018; 203:101-104. [PMID: 30057012 DOI: 10.1016/j.ahj.2018.05.015] [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] [Received: 01/01/2018] [Accepted: 05/14/2018] [Indexed: 11/26/2022]
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Bundgaard H, Axelsson A, Hartvig Thomsen J, Sørgaard M, Kofoed KF, Hasselbalch R, Fry NAS, Valeur N, Boesgaard S, Gustafsson F, Køber L, Iversen K, Rasmussen HH. The first-in-man randomized trial of a beta3 adrenoceptor agonist in chronic heart failure: the BEAT-HF trial. Eur J Heart Fail 2016; 19:566-575. [PMID: 27990717 DOI: 10.1002/ejhf.714] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [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] [Received: 08/21/2016] [Revised: 10/21/2016] [Accepted: 11/14/2016] [Indexed: 12/22/2022] Open
Abstract
AIMS The third isotype of beta adrenergic receptors (β3 ARs) has distinctly different effects on cardiomyocytes compared with β1 and β2 ARs. Stimulation of β3 ARs may reduce cardiomyocyte Na+ overload and reduce oxidative stress in heart failure (HF). We examined if treatment with the β3 AR agonist mirabegron increases LVEF in patients with HF. METHODS AND RESULTS In a double-blind trial we randomly assigned 70 patients with NYHA class II-III HF and LVEF <40% at screening-echocardiography to receive mirabegron or placebo for 6 months as add-on to optimized standard therapy. The primary endpoint was an increase in LVEF after 6 months as measured by computed tomography (CT). Changes in LVEF after 6 months between treatment groups were not significantly different (0.4%, -3.5 to 3.8%, P = 0.82). In an exploratory analysis, based on an expectation that the pathophysiological substrate targeted with treatment is dependent on the baseline LVEF, patients with LVEF <40% by CT given mirabegron had a significant increase in LVEF while no increase was seen in patients given placebo. The changes were significantly different between groups (5.5%, 0.6-10.4%, P < 0.03). Additionally, there was interaction between baseline LVEF and change in LVEF in the entire group of patients treated with mirabegron (R2 = 0.40, β = -0.63, P < 0.001), but not in the placebo group (R2 = 0.00, β = -0.01, P = 0.95). Treatment was generally well tolerated. Three patients in each group had fatal or life-threatening events. CONCLUSIONS The primary endpoint was not reached. Exploratory analysis indicated that β3 AR stimulation by mirabegron increased LVEF in patients with severe HF. Treatment appeared safe. Additional studies in severe HF are needed. TRIAL REGISTRATION NCT01876433.
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Affiliation(s)
- Henning Bundgaard
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anna Axelsson
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Hartvig Thomsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Mathias Sørgaard
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Klaus F Kofoed
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Radiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Hasselbalch
- Department of Cardiology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Nana Valeur
- Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Søren Boesgaard
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kasper Iversen
- Department of Cardiology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Helge H Rasmussen
- Department of Cardiology, Royal North Shore Hospital and University of Sydney, Sydney, Australia
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Balling L, Gustafsson F, Goetze JP, Dalsgaard M, Nielsen H, Boesgaard S, Bay M, Kirk V, Nielsen OW, Køber L, Iversen K. Hyponatraemia at hospital admission is a predictor of overall mortality. Intern Med J 2015; 45:195-202. [PMID: 25370908 DOI: 10.1111/imj.12623] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 10/22/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hyponatraemia is a prognostic marker of increased mortality and morbidity in selected groups of hospitalised patients. The aim of the present study was to examine the prevalence and prognostic significance of hyponatraemia at hospital admission in an unselected population with a broad spectrum of medical and surgical diagnoses. METHODS Consecutive patients >40 years of age admitted to a general district hospital in Greater Copenhagen between 1 April 1998 and 31 March 1999. Median follow-up time was 5.16 years (range 0-4372 days). Plasma sodium measurements were available in 2960 patients, and hyponatraemia defined as P-Na(+) <137 mmol/L at hospital admission was present in 1105 (37.3 %) patients. RESULTS One-year mortality was higher for hyponatraemic patients than for normonatraemic patients: 27.5% versus 17.7%. Moreover, hyponatraemia was an independent predictor of short and long-term all-cause mortality after 1 year and after the entire observation period respectively: hazard ratio (HR) 1.6 (95 % confidence interval (CI) 1.4-1.9, P < 0.0001) and HR 1.4 (95 % CI 1.3-1.6, P < 0.0001). Patients with hyponatraemia had longer hospitalisations than patients with normonatraemia: 7.6 (±0.38) days vs 5.6 (±0.21) days, P < 0.001. There was no interaction between hyponatraemia at admission and any admission diagnoses (P > 0.05 for all interaction analyses). CONCLUSION Hyponatraemia is associated with increased all-cause mortality and longer admission length independently of diagnosis and clinical variables.
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Affiliation(s)
- L Balling
- Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
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Rossing K, Jung MH, Junge MH, Sander K, Olsen PS, Hansen PB, Boesgaard S, Gustafsson F. Outcomes and hospital admissions during long-term support with a HeartMate II. SCAND CARDIOVASC J 2015; 49:367-75. [PMID: 26400060 DOI: 10.3109/14017431.2015.1086016] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Continuous-flow left ventricular assist devices like the HeartMate II (HMII) improves survival in severe heart failure but little is known about the incidence and causes of hospitalizations during long-term support which was evaluated in this study. DESIGN Observational follow-up study comprising all patients who received a HMII at our institution either as bridge-to-transplantation (BTT) or destination therapy (DT). All patients were followed from HMII implantation to transplantation, device explantation, death, or May 2015. RESULTS The HMII was implanted in 66(44 BTT, 22 DT) patients with a median (range) duration of support since implantation of 329(2-2707) days with 260(2-1080) days in the BTT group and 608(6-2707) days in the DT group. Thirty-day mortality was 12% and one-year survival 76%, comparable for DT and BTT. Among 56 (19 DT and 37 BTT) patients discharged alive with a HMII there were 161 hospital readmissions during a follow-up of 336(37-2682) days corresponding to a hospitalization rate of 1.3(0-19) per patient year and with a length of stay of 5(2-72) days per admission. Most frequent cause of readmission was infections (29%). A history of atrial fibrillation was the only independent factor associated with increased readmission rates. CONCLUSIONS Our single-center study demonstrated encouraging survival following HMII implantation. Hospital readmissions were frequent, mostly of short duration, mainly due to infections and increased in patients with atrial fibrillation.
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Affiliation(s)
- Kasper Rossing
- a Department of Cardiology , The Heart Center, Rigshospitalet, Copenhagen University Hospital , Denmark
| | - Mette Holme Jung
- a Department of Cardiology , The Heart Center, Rigshospitalet, Copenhagen University Hospital , Denmark
| | | | - Kaare Sander
- b Cardiothoracic Surgery , The Heart Center, Rigshospitalet, Copenhagen University Hospital , Denmark
| | - Peter Skov Olsen
- b Cardiothoracic Surgery , The Heart Center, Rigshospitalet, Copenhagen University Hospital , Denmark
| | - Peter Bo Hansen
- c Cardiothoracic Anesthesia , The Heart Center, Rigshospitalet, Copenhagen University Hospital , Denmark
| | - Søren Boesgaard
- a Department of Cardiology , The Heart Center, Rigshospitalet, Copenhagen University Hospital , Denmark
| | - Finn Gustafsson
- a Department of Cardiology , The Heart Center, Rigshospitalet, Copenhagen University Hospital , Denmark
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Thomsen JH, Hassager C, Bro-Jeppesen J, Køber L, Boesgaard S, Møller JE, Nielsen N, Wanscher M, Kjærgaard J. Legislation hampers medical research in acute situations. Dan Med J 2015; 62:A5037. [PMID: 25748868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Informed consent in incapacitated adults is permitted in the form of proxy consent by both the patients' closest relative (next of kin, NOK) and general practitioner (GP). In research in acute situations not involving pharmaceuticals, Danish legislation allows for randomisation and subsequent proxy consent, as soon as possible. The aim of this study was to describe the delay associated with obtaining consent and to assess whether consent from NOK or GP/Danish Health and Medicines Authority is obtained with delays beyond the intervention. METHODS In a prospective study, 171 comatose out-of-hospital cardiac arrest (OHCA) patients were randomised to targeted temperature management. Patients were randomised before NOK could be informed, and proxy consent was obtained as soon as possible. Written consent from NOK and GP were our study data. RESULTS We obtained all legally required consent: 169 cases of consent were obtained from NOK, two patients gave consent before NOK, in no cases was consent denied by the proxy. Consent from NOK was obtained with a median delay of zero days (interquartile range (IQR): 0-1, max. 128 days). Delay from NOK consent to GP consent was a median of nine days (IQR: 6-23, max. 527 days). CONCLUSION NOK fully accepted participation in a clinical trial after OHCA with short delays in consent. Consent from GPs was associated with long delays beyond the intervention, which make GPs less appropriate for proxy consent of incapacitated adults in acute situations. The Ethics Committees' approval of the trial justified by their competence and authority, combined with the NOK´s insight into the patient's wishes may be a relevant and feasible alternative to the current consent procedure. FUNDING This work was supported by the European Regional Development Fund through the Interreg IV A OKS programme (NYPS ID: 167157) with regards to authors JHT, CH, NN and JK. TRIAL REGISTRATION not relevant.
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Affiliation(s)
- Jakob Hartvig Thomsen
- Hjertemedicinsk Klinik B, 2142, Hjertecentret, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.
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Iversen K, Gøtze JP, Dalsgaard M, Nielsen H, Boesgaard S, Bay M, Kirk V, Nielsen OW, Køber L. Risk stratification in emergency patients by copeptin. BMC Med 2014; 12:80. [PMID: 24884642 PMCID: PMC4053286 DOI: 10.1186/1741-7015-12-80] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [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: 01/10/2014] [Accepted: 04/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rapid risk stratification is a core task in emergency medicine. Identifying patients at high and low risk shortly after admission could help clinical decision-making regarding treatment, level of observation, allocation of resources and post discharge follow-up. The purpose of the present study was to determine short-, mid- and long-term mortality by plasma measurement of copeptin in unselected admitted patients. METHOD Consecutive patients >40-years-old admitted to an inner-city hospital were included. Within the first 24 hours after admission, a structured medical interview was conducted and self-reported medical history was recorded. All patients underwent a clinical examination, an echocardiographic evaluation and collection of blood for later measurement of risk markers. RESULTS Plasma for copeptin measurement was available from 1,320 patients (average age 70.5 years, 59.4% women). Median follow-up time was 11.5 years (range 11.0 to 12.0 years). Copeptin was elevated (that is, above the 97.5 percentile in healthy individuals).Mortality within the first week was 2.7% (17/627) for patients with elevated copeptin (above the 97.5 percentile, that is, >11.3 pmol/L) compared to 0.1% (1/693) for patients with normal copeptin concentrations (that is, ≤11.3 pmol/L) (P <0.01). Three-month mortality was 14.5% (91/627) for patients with elevated copeptin compared to 3.2% (22/693) for patients with normal copeptin. Similar figures for one-year mortality and for the entire observation period were 27.6% (173/627) versus 8.7% (60/693) and 82.9% (520/527) versus 57.5% (398/693) (P <0.01 for both), respectively.Using multivariable Cox regression analyses shows that elevated copeptin was significantly and independently related to short-, mid- and long-term mortality. Adjusted hazard ratios were 2.4 for three-month mortality, 1.9 for one-year mortality and 1.4 for mortality in the entire observation period. CONCLUSIONS In patients admitted to an inner-city hospital, copeptin was strongly associated with short-, mid- and long-term mortality. The results suggest that rapid copeptin measurement could be a useful tool for both disposition in an emergency department and for mid- and long-term risk assessment.
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Affiliation(s)
- Kasper Iversen
- Departments of Cardiology and Endocrinology, Hillerød Hospital, Hillerød, Denmark.
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Jung M, Hansen P, Sander K, Olsen P, Rossing K, Russell S, Boesgaard S, Gustafsson F. Increasing Pump Speed During Exercise Improves Peak Oxygen Consumption in Heart Failure Patients Supported With Continuous-Flow Left Ventricular Assist Devices - A Double-Blind Randomized Study. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.061] [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: 10/25/2022] Open
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Lindholm MG, Boesgaard S, Thune JJ, Kelbaek H, Andersen HR, Kober L. Percutaneous coronary intervention for acute MI does not prevent in-hospital development of cardiogenic shock compared to fibrinolysis. Eur J Heart Fail 2014; 10:668-74. [DOI: 10.1016/j.ejheart.2008.04.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Revised: 04/08/2008] [Accepted: 04/28/2008] [Indexed: 11/28/2022] Open
Affiliation(s)
- Matias G. Lindholm
- Medical Department B, Division of Cardiology; Rigshospitalet, University Hospital of Copenhagen; Denmark
| | - Søren Boesgaard
- Medical Department B, Division of Cardiology; Rigshospitalet, University Hospital of Copenhagen; Denmark
| | - Jens Jakob Thune
- Medical Department B, Division of Cardiology; Rigshospitalet, University Hospital of Copenhagen; Denmark
| | - Henning Kelbaek
- Medical Department B, Division of Cardiology; Rigshospitalet, University Hospital of Copenhagen; Denmark
| | - Henning Rud Andersen
- Department of Cardiology, Skejby Hospital; University Hospital of Aarhus; Denmark
| | - Lars Kober
- Medical Department B, Division of Cardiology; Rigshospitalet, University Hospital of Copenhagen; Denmark
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Nielsen N, Wetterslev J, Cronberg T, Erlinge D, Gasche Y, Hassager C, Horn J, Hovdenes J, Kjaergaard J, Kuiper M, Pellis T, Stammet P, Wanscher M, Wise MP, Åneman A, Al-Subaie N, Boesgaard S, Bro-Jeppesen J, Brunetti I, Bugge JF, Hingston CD, Juffermans NP, Koopmans M, Køber L, Langørgen J, Lilja G, Møller JE, Rundgren M, Rylander C, Smid O, Werer C, Winkel P, Friberg H. Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med 2013; 369:2197-206. [PMID: 24237006 DOI: 10.1056/nejmoa1310519] [Citation(s) in RCA: 1965] [Impact Index Per Article: 178.6] [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] [Indexed: 12/11/2022]
Abstract
BACKGROUND Unconscious survivors of out-of-hospital cardiac arrest have a high risk of death or poor neurologic function. Therapeutic hypothermia is recommended by international guidelines, but the supporting evidence is limited, and the target temperature associated with the best outcome is unknown. Our objective was to compare two target temperatures, both intended to prevent fever. METHODS In an international trial, we randomly assigned 950 unconscious adults after out-of-hospital cardiac arrest of presumed cardiac cause to targeted temperature management at either 33°C or 36°C. The primary outcome was all-cause mortality through the end of the trial. Secondary outcomes included a composite of poor neurologic function or death at 180 days, as evaluated with the Cerebral Performance Category (CPC) scale and the modified Rankin scale. RESULTS In total, 939 patients were included in the primary analysis. At the end of the trial, 50% of the patients in the 33°C group (235 of 473 patients) had died, as compared with 48% of the patients in the 36°C group (225 of 466 patients) (hazard ratio with a temperature of 33°C, 1.06; 95% confidence interval [CI], 0.89 to 1.28; P=0.51). At the 180-day follow-up, 54% of the patients in the 33°C group had died or had poor neurologic function according to the CPC, as compared with 52% of patients in the 36°C group (risk ratio, 1.02; 95% CI, 0.88 to 1.16; P=0.78). In the analysis using the modified Rankin scale, the comparable rate was 52% in both groups (risk ratio, 1.01; 95% CI, 0.89 to 1.14; P=0.87). The results of analyses adjusted for known prognostic factors were similar. CONCLUSIONS In unconscious survivors of out-of-hospital cardiac arrest of presumed cardiac cause, hypothermia at a targeted temperature of 33°C did not confer a benefit as compared with a targeted temperature of 36°C. (Funded by the Swedish Heart-Lung Foundation and others; TTM ClinicalTrials.gov number, NCT01020916.).
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Lauridsen BK, Iversen K, Hunter I, Bay M, Kirk V, Nielsen OW, Nielsen H, Boesgaard S, Køber L, Goetze JP. ProANP plasma measurement predicts all-cause mortality in acutely hospitalised patients: a cohort study. BMJ Open 2013; 3:e003288. [PMID: 24282239 PMCID: PMC3845039 DOI: 10.1136/bmjopen-2013-003288] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
IMPORTANCE The association of natriuretic peptide measurement with all-cause mortality in a broad selection of acutely admitted patients has not yet been examined. OBJECTIVE To test the risk association between pro-atrial natriuretic peptide (ANP) and short-term and long-term mortality and its predictive value in acutely hospitalised patients and compare this to N-terminal B-type natriuretic peptide (NT-proBNP). DESIGN, SETTING AND PATIENTS Participants were selected from the Copenhagen Hospital Heart Failure Study (n=3644). Medical history, satisfactory echocardiography and blood samples were available on 2193 participants in 1998-1999 where NT-proBNP was measured. Vital status after discharge was obtained from national central data registers. A total of 1337 participants with eligible blood samples were selected in 2010-2011 for proANP measurement. Among these, 1255 (94%) were acutely hospitalised in 1998-1999. MAIN OUTCOME MEASURE(S) 1-year and long-term mortality. RESULTS Median follow-up period was 11.5 years. At the end of follow-up, 926 patients had died, 239 during the first year. ProANP quartiles to 2-4 (median proANP levels 594 pmol/L, 990 pmol/L and 2052 pmol/L, respectively) associated with a stepwise increase in risk of 1-year and long-term mortality compared to the first quartile (336 pmol/L) in multivariable adjusted Cox proportional regression models (HR 1.53 95% CI 1.30 to 1.81 and HR 1.26 95% CI 1.17 to 1.36, respectively). An addition of NT-proBNP attenuated proANP's association with mortality in the models (HR 1.24 95% CI 1.01 to 1.53 and 1.14 95% CI 1.03 to 1.26, respectively). The increased risk was observed in participants with the highest proANP levels (fourth quartile). Similar results were observed in subgroups of participants with no evidence of cardiovascular disease (CVD). ProANP in quartiles improved discrimination when added to traditional risk factors in prediction models for 1-year (integrated discrimination improvement (IDI) 0.141 95% CI 0.085 to 0.197; C-index 0.753 95% CI 0.724 to 0.783, P for improvement 0.003) and long-term mortality (IDI 0.053 95% CI 0.032 to 0.074; C-index 0.736 95% CI 0.720 to 0.752, P for improvement <0.001) with similar results in subgroups. Discrimination was best in a combined model with proANP as well as NT-proBNP included. CONCLUSIONS AND RELEVANCE High plasma proANP concentrations are associated with and predict short-term and long-term all-cause mortality in acutely hospitalised patients irrespective of CVD status at admission.
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Affiliation(s)
- Bo K Lauridsen
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
| | - Kasper Iversen
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Ingrid Hunter
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
| | - Morten Bay
- Department of Cardiology, Frederiksberg Hospital, Copenhagen, Denmark
| | - Vibeke Kirk
- Department of Oncology, Herlev Hospital, Herlev, Denmark
| | - Olav W Nielsen
- Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Henrik Nielsen
- Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Søren Boesgaard
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Jens P Goetze
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
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Cordtz J, Nilsson JC, Hansen PB, Sander K, Olesen PS, Boesgaard S, Gustafsson F. Right ventricular failure after implantation of a continuous-flow left ventricular assist device: early haemodynamic predictors. Eur J Cardiothorac Surg 2013; 45:847-53. [DOI: 10.1093/ejcts/ezt519] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Iversen K, Køber L, Gøtze JP, Dalsgaard M, Nielsen H, Boesgaard S, Bay M, Kirk V, Nielsen OW. Troponin T is a strong marker of mortality in hospitalized patients. Int J Cardiol 2013; 168:818-24. [DOI: 10.1016/j.ijcard.2012.10.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 06/21/2012] [Accepted: 10/07/2012] [Indexed: 10/27/2022]
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Andersen KH, Kjaergaard J, Iversen MP, Boesgaard S, Carlsen J. Pulmonary venous hypertension in end-stage chronic obstructive pulmonary disease with preserved systolic left ventricular function. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Andersen MJ, Ersbøll M, Gustafsson F, Axelsson A, Hassager C, Køber L, Boesgaard S, Pellikka PA, Møller JE. Exercise-induced changes in left ventricular filling pressure after myocardial infarction assessed with simultaneous right heart catheterization and Doppler echocardiography. Int J Cardiol 2013; 168:2803-10. [PMID: 23628301 DOI: 10.1016/j.ijcard.2013.03.122] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [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: 10/01/2012] [Revised: 03/07/2013] [Accepted: 03/26/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND To assess whether changes in E/e´ (the ratio between peak early mitral inflow velocity (E) and peak early mitral annulus velocity (e´)) during exercise reflect changes in filling pressure in patients with a recent myocardial infarction (MI) and mild to moderate diastolic dysfunction at rest. A low E/e´ ratio is associated with low filling pressures while a high E/e´ ratio is associated with high filling pressures. In the intermediate range of E/e´ guidelines suggest additional measurements during exercise in order to determine filling pressures. METHODS AND RESULTS Sixty-one patients with a recent MI and left ventricular ejection fraction (LVEF) ≥ 45%, left atrium (LA)>34 ml/m(2) and E/e´ between 8 and 15, underwent simultaneous right heart catheterization and Doppler echocardiography during a symptom limited semi supine cycle exercise test. E velocity increased from 75 ± 16 to 139 ± 27 cm/s and e´ increased from 7.1 ± 1.4 to 16.1 ± 3.6 cm/s with exercise. Thus, E/e´ decreased from 10.5 ± 1.7 to 9.3 ± 2.3 while pulmonary capillary wedge pressure (PCWP) increased from 13 ± 4 to 33 ± 8 mmHg. There was no correlation between LV filling pressure and E/e´ at rest, at 4 METS, at peak exercise or 5 min after termination of exercise. Neither was there any correlation between changes in PCWP and changes in E/e´. CONCLUSION For post-MI patients with resting E/e´ in the intermediate range changes in E/e´ with physical exercise does not reflect changes in LV filling pressures.
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Affiliation(s)
- Mads J Andersen
- Department of Cardiology, the Heart Centre, Rigshospitalet&Copenhagen University, Denmark.
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Mygind ND, Iversen K, Køber L, Goetze JP, Nielsen H, Boesgaard S, Bay M, Johansen JS, Nielsen OW, Kirk V, Kastrup J. The inflammatory biomarker YKL-40 at admission is a strong predictor of overall mortality. J Intern Med 2013; 273:205-16. [PMID: 23140269 DOI: 10.1111/joim.12006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [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: 12/25/2022]
Abstract
OBJECTIVES YKL-40 is an inflammatory biomarker associated with disease activity and mortality in patients with diseases characterized by inflammation and tissue remodelling. The aim of this study was to describe the prognostic value of YKL-40 in an unselected patient population. DESIGN In consecutive patients admitted to hospital during a 1-year period, blood was collected and information regarding final diagnosis and mortality was collected. Median follow-up time was 11.5 years. SETTING District hospital, Copenhagen, Denmark. PATIENTS A total of 1407 patients >40 years of age were admitted acutely. MAIN OUTCOME MEASURE All-cause mortality. RESULTS Median YKL-40 was increased in patients (157 μg L(-1) , range 13-7704 μg L(-1) ) compared to healthy controls (40 μg L(-1) , range 29-58 μg L(-1) ; P < 0.001). Patients with YKL-40 in the highest quartile had a hazard ratio (HR) of 7.1 [95% confidence interval (CI) 4.2-12.0] for all-cause mortality in the first year and 3.4 (95% CI 2.8-4.2) in the total study period, compared to those in the lowest quartile (HR = 1). The HR for death for all patients with YKL-40 above the normal age-corrected 95th percentile was 2.1 (95% CI 1.6-2.7) after 1 year and 1.5 (95% CI 1.3-1.7) during the total study period, compared to patients with YKL-40 below the age-corrected 95th percentile. The results of multivariable analysis showed that YKL-40 was an independent biomarker of mortality; this was most significant in the first year. YKL-40 was a marker of prognosis in all disease categories. The HR for death was increased in patients with YKL-40 above the normal age-corrected 95th percentile in healthy subjects independent of type of disease (all P < 0.001). CONCLUSION The level of YKL-40 at admission is a strong predictor of overall mortality, independent of diagnosis and could be useful as a biomarker in the acute evaluation of all patients.
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Affiliation(s)
- N D Mygind
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
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Søholm H, Wachtell K, Nielsen SL, Bro-Jeppesen J, Pedersen F, Wanscher M, Boesgaard S, Møller JE, Hassager C, Kjaergaard J. Tertiary centres have improved survival compared to other hospitals in the Copenhagen area after out-of-hospital cardiac arrest. Resuscitation 2013; 84:162-7. [DOI: 10.1016/j.resuscitation.2012.06.029] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 06/19/2012] [Accepted: 06/22/2012] [Indexed: 11/26/2022]
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Kjærgaard J, Bro-Jeppesen J, Møller JE, Søholm H, Holmvang L, Wanscher M, Lippert F, Boesgaard S, Hassager C. [Acute coronary angiography should be considered in patients with ST segment elevation after out-of-hospital cardiac arrest]. Ugeskr Laeger 2013; 175:202-205. [PMID: 23347739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Guidelines suggest that acute coronary angiography (CAG) is considered in patients resuscitated from out-of-hospital cardiac arrest with presumed cardiac aetiology. Since specialized post-resuscitation care, including therapeutic hypothermia, has proved beneficial in randomized studies, CAG should be offered to patients with a high likelihood of thrombotic coronary lesions, i.e. patients with ST-segment elevation in electrocardiogram (ECG) following resuscitation. This article suggests a triage and referral based on electronic transmission of ECG and teleconference with specialized centres in all patients.
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Affiliation(s)
- Jesper Kjærgaard
- Hjertemedicinsk Klinik B, B2142, Hjertecentret, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Denmark.
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Andersen MJ, Ersbøll M, Bro-Jeppesen J, Gustafsson F, Hassager C, Køber L, Borlaug BA, Boesgaard S, Kjærgaard J, Møller JE. Exercise Hemodynamics in Patients With and Without Diastolic Dysfunction and Preserved Ejection Fraction After Myocardial Infarction. Circ Heart Fail 2012; 5:444-51. [DOI: 10.1161/circheartfailure.112.967919] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [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: 01/03/2023]
Affiliation(s)
- Mads J. Andersen
- From the Department of Cardiology, the Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.J.A., M.E., J.B-J., F.G., C.H., L.K., S.B., J.K., J.E.M.); and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (B.A.B.)
| | - Mads Ersbøll
- From the Department of Cardiology, the Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.J.A., M.E., J.B-J., F.G., C.H., L.K., S.B., J.K., J.E.M.); and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (B.A.B.)
| | - John Bro-Jeppesen
- From the Department of Cardiology, the Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.J.A., M.E., J.B-J., F.G., C.H., L.K., S.B., J.K., J.E.M.); and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (B.A.B.)
| | - Finn Gustafsson
- From the Department of Cardiology, the Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.J.A., M.E., J.B-J., F.G., C.H., L.K., S.B., J.K., J.E.M.); and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (B.A.B.)
| | - Christian Hassager
- From the Department of Cardiology, the Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.J.A., M.E., J.B-J., F.G., C.H., L.K., S.B., J.K., J.E.M.); and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (B.A.B.)
| | - Lars Køber
- From the Department of Cardiology, the Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.J.A., M.E., J.B-J., F.G., C.H., L.K., S.B., J.K., J.E.M.); and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (B.A.B.)
| | - Barry A. Borlaug
- From the Department of Cardiology, the Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.J.A., M.E., J.B-J., F.G., C.H., L.K., S.B., J.K., J.E.M.); and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (B.A.B.)
| | - Søren Boesgaard
- From the Department of Cardiology, the Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.J.A., M.E., J.B-J., F.G., C.H., L.K., S.B., J.K., J.E.M.); and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (B.A.B.)
| | - Jasper Kjærgaard
- From the Department of Cardiology, the Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.J.A., M.E., J.B-J., F.G., C.H., L.K., S.B., J.K., J.E.M.); and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (B.A.B.)
| | - Jacob E. Møller
- From the Department of Cardiology, the Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.J.A., M.E., J.B-J., F.G., C.H., L.K., S.B., J.K., J.E.M.); and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (B.A.B.)
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Brassard P, Jensen AS, Nordsborg N, Gustafsson F, Møller JE, Hassager C, Boesgaard S, Hansen PB, Olsen PS, Sander K, Secher NH, Madsen PL. Central and Peripheral Blood Flow During Exercise With a Continuous-Flow Left Ventricular Assist Device. Circ Heart Fail 2011; 4:554-60. [DOI: 10.1161/circheartfailure.110.958041] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [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: 11/16/2022]
Affiliation(s)
- Patrice Brassard
- From the Departments of Anesthesia (P.B., N.N., N.H.S.), Cardiology (P.B., A.S.J., F.G., J.E.M., C.H., S.B., P.L.M.), and Cardiothoracic Surgery (P.B.H., P.O., K.S.), The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark
| | - Annette S. Jensen
- From the Departments of Anesthesia (P.B., N.N., N.H.S.), Cardiology (P.B., A.S.J., F.G., J.E.M., C.H., S.B., P.L.M.), and Cardiothoracic Surgery (P.B.H., P.O., K.S.), The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark
| | - Nikolai Nordsborg
- From the Departments of Anesthesia (P.B., N.N., N.H.S.), Cardiology (P.B., A.S.J., F.G., J.E.M., C.H., S.B., P.L.M.), and Cardiothoracic Surgery (P.B.H., P.O., K.S.), The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark
| | - Finn Gustafsson
- From the Departments of Anesthesia (P.B., N.N., N.H.S.), Cardiology (P.B., A.S.J., F.G., J.E.M., C.H., S.B., P.L.M.), and Cardiothoracic Surgery (P.B.H., P.O., K.S.), The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark
| | - Jacob E. Møller
- From the Departments of Anesthesia (P.B., N.N., N.H.S.), Cardiology (P.B., A.S.J., F.G., J.E.M., C.H., S.B., P.L.M.), and Cardiothoracic Surgery (P.B.H., P.O., K.S.), The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark
| | - Christian Hassager
- From the Departments of Anesthesia (P.B., N.N., N.H.S.), Cardiology (P.B., A.S.J., F.G., J.E.M., C.H., S.B., P.L.M.), and Cardiothoracic Surgery (P.B.H., P.O., K.S.), The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark
| | - Søren Boesgaard
- From the Departments of Anesthesia (P.B., N.N., N.H.S.), Cardiology (P.B., A.S.J., F.G., J.E.M., C.H., S.B., P.L.M.), and Cardiothoracic Surgery (P.B.H., P.O., K.S.), The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark
| | - Peter Bo Hansen
- From the Departments of Anesthesia (P.B., N.N., N.H.S.), Cardiology (P.B., A.S.J., F.G., J.E.M., C.H., S.B., P.L.M.), and Cardiothoracic Surgery (P.B.H., P.O., K.S.), The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark
| | - Peter Skov Olsen
- From the Departments of Anesthesia (P.B., N.N., N.H.S.), Cardiology (P.B., A.S.J., F.G., J.E.M., C.H., S.B., P.L.M.), and Cardiothoracic Surgery (P.B.H., P.O., K.S.), The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark
| | - Kåre Sander
- From the Departments of Anesthesia (P.B., N.N., N.H.S.), Cardiology (P.B., A.S.J., F.G., J.E.M., C.H., S.B., P.L.M.), and Cardiothoracic Surgery (P.B.H., P.O., K.S.), The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark
| | - Niels H. Secher
- From the Departments of Anesthesia (P.B., N.N., N.H.S.), Cardiology (P.B., A.S.J., F.G., J.E.M., C.H., S.B., P.L.M.), and Cardiothoracic Surgery (P.B.H., P.O., K.S.), The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark
| | - Per Lav Madsen
- From the Departments of Anesthesia (P.B., N.N., N.H.S.), Cardiology (P.B., A.S.J., F.G., J.E.M., C.H., S.B., P.L.M.), and Cardiothoracic Surgery (P.B.H., P.O., K.S.), The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark
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Bomholt T, Moser C, Sander K, Boesgaard S, Køber L, Olsen PS, Hansen PB, Mortensen SA, Gustafsson F. Driveline infections in patients supported with a HeartMate II: incidence, aetiology and outcome. SCAND CARDIOVASC J 2011; 45:273-8. [PMID: 21539474 DOI: 10.3109/14017431.2011.577236] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [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]
Abstract
OBJECTIVES To investigate the incidence and outcome of driveline infections in patients supported with a continuous flow left ventricular assist device (HeartMate II (HMII)) and to study the microbiological aetiology. DESIGN Retrospective analysis of 31 patients who received an implantation of a HMII. Follow-up was from implantation to either device explantation, death or closure of the study. Clinical signs of infections were divided into superficial, deep or systemic and compared to culture and gram stain, the clinical course and infectious parameters. RESULTS The incidence of driveline infections was 1.65 episodes per patient per year. Staphylococcus aureus and Escherichia coli were the most common bacterial aetiology. More than two weeks of treatment was required in 81% of the patients. In terms of detecting superficial driveline infections, leucocyte count demonstrated a sensitivity of 27% and C-reactive protein (CRP) a sensitivity of 28%. In 22 cases of driveline infections plasma pro-calcitonin was found to be normal. CONCLUSION Driveline infections are common in HMII recipients but primarily remain superficial and are reasonably easy to manage. Infectious agents mostly originate from the skin and gastrointestinal tract. Blood biomarkers did not appear to be helpful in detecting driveline infections.
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Affiliation(s)
- Tobias Bomholt
- Rigshospitalet, Department of Cardiology, University Hospital of Copenhagen, Denmark
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Boesgaard S, Bundgaard H, Hassager C. [Screening, conflict of interest--yellow card]. Ugeskr Laeger 2011; 173:218; author reply 218. [PMID: 21299028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Hermann T, Dall C, Christensen S, Boesgaard S, Gustafsson F. 146: High-Intensity Aerobic Exercise Improves Forearm Flow Mediated Dilatation and Blood Pressure Control Late after Cardiac Transplantation. J Heart Lung Transplant 2010. [DOI: 10.1016/j.healun.2009.11.155] [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: 11/26/2022] Open
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40
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Andersen M, Videbæk R, Boesgaard S, Sander K, Hansen PB, Gustafsson F. Incidence of Ventricular Arrhythmias in Patients on Long-term Support With a Continuous-flow Assist Device (HeartMate II). J Heart Lung Transplant 2009; 28:733-5. [DOI: 10.1016/j.healun.2009.03.011] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Revised: 01/31/2009] [Accepted: 03/05/2009] [Indexed: 11/30/2022] Open
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Jensen A, Brassard P, Nordsborg N, Gustafsson F, Moeller J, Hassager C, Boesgaard S, Hansen P, Sander K, Olsen P, Secher N, Madsen P. 252: Increasing Pump-Speed of a Continuous Flow Left Ventricular Assist Device during Exercise Is Safe and Elevates Cardiac Output in Patients with End-Stage Heart Failure: A Double-Blind, Randomized Trial. J Heart Lung Transplant 2009. [DOI: 10.1016/j.healun.2008.11.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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42
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Andersen M, Videbaek R, Boesgaard S, Sander K, Hansen P, Gustafsson F. 191: Occurrence of Ventricular Arrhythmias in Patients with a Continous Flow Left Ventricular Assist Device (Heartmate II). J Heart Lung Transplant 2009. [DOI: 10.1016/j.healun.2008.11.198] [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: 11/26/2022] Open
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43
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Sander K, Andersen CB, Boesgaard S, Gustafsson F, Hansen P, Mortensen S, Olsen P. 615: Good Outcome for LVAD Patients Supported by the HeartMate II for a Mean Time of Almost One Year. J Heart Lung Transplant 2009. [DOI: 10.1016/j.healun.2008.11.622] [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: 11/16/2022] Open
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44
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Lindholm MG, Engstrøm T, Boesgaard S, Hassager C. [A new percutan assist device for treatment of fulminant myocarditis]. Ugeskr Laeger 2007; 169:3303-3304. [PMID: 17953892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Several fulminant myocarditis (FM) resulting in early death from intractable cardiogenic shock have been reported. FM is characterized by the onset of cardiac symptoms in otherwise young healthy patients, rapidly resulting in severe ventricular dysfunction and cardiogenic shock. Complete recovery is possible if the patient is successfully supported by mechanical circulatory support during the acute phase of the illness. We report the case of a young patient with viral myocarditis who was successfully weaned from an Impella Recover LP 2.5 assist device with the recovery of myocardial function.
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45
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Lindholm MG, Engstrøm T, Wachtell K, Boesgaard S, Sander K, Hassager C. [Percutaneous assist device during acute heart failure]. Ugeskr Laeger 2007; 169:3282-3286. [PMID: 17953886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
International guidelines recommend the intraaortic balloon pump (IABP) as an assist of the left ventricle. Assist devices other than the IABP have become available. To improve the overall treatment of patients with heart failure, basic knowledge of assist devices in referral department is crucial. The TandemHeart increases flow and decreases metabolic demands. Several complications have been reported. Technological advances during the last few years have produced a smaller assist device. The Impella Recover LP 2.5 has been proved safe and able to perform a flow increase of 2.5 l/min and decrease metabolic demands.
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46
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Sander K, Andersen CB, Boesgaard S, Eliasen KR, Gustafsson F, Hansen PB, Mortensen SA, Olsen PS. [The Mechanical Heart--HeartMate 1--Danish results]. Ugeskr Laeger 2007; 169:3290-3294. [PMID: 17953888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
INTRODUCTION In 1998 the Heart Centre at the Danish National University Hospital implemented a new programme with long-term mechanical circulatory assist to patients with terminal heart failure who could not wait for a donor heart. A so-called Mechanical Heart, HeartMate 1, was to replace a failing left ventricle so that the patient could be resuscitated and await heart transplantation. The aim of the present study is to describe the results of this new treatment in Denmark. MATERIALS AND METHODS A total of 28 patients with a mean age of 41 years were treated with the HeartMate 1 system in the period 1998 to 2006. Two patients had the system changed to a new HeartMate 1 due to mechanical problems. Both patients were later successfully heart transplanted. A third patient had the system successfully changed to a HeartMate 2 and he is waiting for a donor heart. RESULTS Hemodynamic observations reveal fast improvement after implantation of the HeartMate system. Patients who were later heart transplanted had the HeartMate system implanted for a mean of 220 days. About 90% of those that were transplanted later improved due to the system from New York Heart Associations class IV to class I-II and they could often be discharged to a normal social life with a well-functioning HeartMate. Calculated 1-year survival with the HeartMate system was 82%. CONCLUSION Patients with terminal heart failure can be treated and improved by implantation of the HeartMate system and await successful heart transplantation. Permanent advanced assist systems do exist today and these can be applied as a final treatment in selected patients--so-called destination therapy with mechanical circulatory support. The present study shows that it is very likely that the Heart Centre at the Danish National University Hospital will be able to establish a well-functioning programme for destination therapy.
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Affiliation(s)
- Kåre Sander
- Rigshospitalet, Hjertecentret, Thoraxkirurgisk Afdeling, Kardiologisk Afdeling, København Ø.
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Olsen PS, Sander K, Hansen PB, Mortensen SA, Gustafsson F, Boesgaard S. [Destination therapy in end-stage heart failure. A possible alternative to heart transplantation?]. Ugeskr Laeger 2007; 169:3287-3289. [PMID: 17953887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The incidence of heart failure continues to increase but the number of available heart donors is limited. Implantation of circulatory assist devices as a permanent alternative to heart transplantation has become a promising new alternative in patients not eligible for heart transplantation (destination therapy). New technical advances have increased the durability of the devices and reduced complications.New generations of rotator pumps are smaller and more durable and will expand the use of these devices for destination therapy. This review discusses the current state of knowledge and indications for destination therapy in end-stage heart failure.
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Affiliation(s)
- Peter Skov Olsen
- Rigshospitalet, Hjertecentret, Thoraxkirurgisk Klinisk, København
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Hejmdal A, Boesgaard S, Lindholm MG, Goetze JP. B-type natriuretic peptide and its molecular precursor in myocardial infarction complicated by cardiogenic shock. J Card Fail 2007; 13:184-8. [PMID: 17448415 DOI: 10.1016/j.cardfail.2006.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2006] [Revised: 11/18/2006] [Accepted: 11/21/2006] [Indexed: 01/08/2023]
Abstract
BACKGROUND Plasma measurement of cardiac natriuretic peptides and their biosynthetic precursors is helpful in chronic heart failure patients. In contrast, information on circulating B-type natriuretic peptide (BNP) and its molecular precursor (proBNP) in patients with cardiogenic shock is scarce. We therefore examined proBNP-derived peptides in plasma from patients with myocardial infarction complicated by cardiogenic shock. METHODS AND RESULTS Patients were referred for early, invasive therapy because of myocardial infarction complicated by cardiogenic shock (n = 13). Plasma proBNP was measured with an automated assay (NT-proBNP) and an in-house radioimmunoassay (proBNP); BNP concentrations were quantitated with an immunoradiometric assay. The median NT-proBNP concentration was 8.2-fold higher than the corresponding BNP concentration (873 pmol/L [range 41-12,486] versus 107 pmol/L [1-1041], P < .001). Moreover, the NT-proBNP concentration was 3.3-fold higher compared with proBNP (268 pmol/L [19-12,220], P < .01). Despite the molar differences, there was a strong correlation between NT-proBNP and proBNP (r = 0.84, P < .0001) and BNP (r = 0.82, P < .0001) concentrations. Gel filtration chromatography suggested that the proBNP immunoreactivity reflect a molecular form larger than the N-terminal 1-76 fragment. CONCLUSIONS The study reveals the plasma profile of proBNP-derived peptides during myocardial infarction complicated by cardiogenic shock. Peripheral concentrations of NT-proBNP, proBNP, and BNP were highly correlated despite marked differences between assays. The results also suggest an increase in cardiac proBNP processing after myocardial infarction and cardiogenic shock.
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Affiliation(s)
- Anders Hejmdal
- Department of Medicine, Division of Cardiology, University of Copenhagen, Denmark
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Burton CM, Andersen CB, Jensen AS, Iversen M, Milman N, Boesgaard S, Arendrup H, Eliasen K, Carlsen J. The incidence of acute cellular rejection after lung transplantation: a comparative study of anti-thymocyte globulin and daclizumab. J Heart Lung Transplant 2006; 25:638-47. [PMID: 16730569 DOI: 10.1016/j.healun.2006.01.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2005] [Revised: 01/13/2006] [Accepted: 01/24/2006] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE This study examined the effects of anti-thymocyte globulin (ATG) and daclizumab immunosuppressive induction therapy on the frequency and severity of acute cellular rejection in lung transplantation patients. METHOD A retrospective analysis was conducted of 335 lung transplantation patients from a single center in the period 1992 to 2003. Patients completed standard ATG (Merieux, 2.5 mg/kg/day, or ATGAM, 12.5 mg/kg/day, for 3 consecutive days) (n = 151) or daclizumab (5 fortnightly treatments at a dose of 1 mg/kg) (n = 151) induction therapy. End points included acute cellular rejection requiring treatment (> or = A2), and moderate/severe acute cellular rejection (A3/A4). RESULTS The percentage of patients free of rejection requiring treatment (< A2) was 32% at 3 months and 26% at 2 years after transplantation in the ATG group and 9% and 0%, respectively, in the daclizumab group (p < 0.0001). Compared with the ATG group, a significantly higher proportion of patients in the daclizumab group experienced 3 or more episodes of acute cellular rejection > or = A2 during the first 3 months (p < 0.0001) and the entire 2-year follow-up (p < 0.0001). The daclizumab group also experienced more moderate/severe acute cellular rejection episodes compared with the ATG group during the first 3 months (p = 0.005). Cox regression analysis demonstrated ATG induction therapy was independently associated with a significantly longer duration of freedom from acute cellular rejection requiring treatment (> or = A2) (p < 0.001). CONCLUSION After lung transplantation, ATG induction appears to be superior to daclizumab induction in the reduction in the incidence and severity of acute cellular rejection.
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Affiliation(s)
- Christopher M Burton
- Division of Lung Transplantation, Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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Iversen KK, Teisner AS, Bay M, Kirk V, Boesgaard S, Nielsen H. [Heart murmur and echocardiographic findings in 2,907 non-selected patients admitted to hospital]. Ugeskr Laeger 2006; 168:2551-4. [PMID: 16824409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
INTRODUCTION Since the introduction and increased availability of echocardiography, the importance of heart auscultation in diagnosing valvular heart disease has been reduced. Nevertheless, auscultation is still important when deciding whether to refer a patient for further examination. MATERIALS AND METHODS A retrospective analysis was done of 2,907 consecutive patients admitted to a hospital in Copenhagen from 1 April 1998 to 31 March 1999. Auscultation, clinical history and echocardiography were performed within 24 hours of admittance. RESULTS The prevalence of heart murmurs was 20.5%. The sensitivity and specificity of murmur found by auscultation and echocardiographic findings were 0.52 and 0.93, respectively. We found a positive predictive value of auscultation of 0.76 and a negative predictive value of 0.82. CONCLUSION The relationship between auscultation and echocardiography in diagnosing heart murmurs in non-selected patients admitted to hospital has not previously been described. Auscultation has a high specificity, indicating that such patients should be referred for echocardiography. Its sensitivity, however, is low, indicating that it is insufficient as a means of screening for valvular heart disease.
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