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Tennøe AH, Murbræch K, Andreassen JC, Fretheim H, Midtvedt Ø, Garen T, Dalen H, Gude E, Andreassen A, Aakhus S, Molberg Ø, Hoffmann-Vold AM. Systolic Dysfunction in Systemic Sclerosis: Prevalence and Prognostic Implications. ACR Open Rheumatol 2019; 1:258-266. [PMID: 31777802 PMCID: PMC6857986 DOI: 10.1002/acr2.1037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Objective Primary cardiac involvement is presumed to account for a substantial part of disease-related mortality in systemic sclerosis (SSc). Still, there are knowledge gaps on the evolution and total burden of systolic dysfunction in SSc. Here we evaluated prospective left ventricular (LV) and right ventricular (RV) systolic function in an unselected SSc cohort and assessed the burden of systolic dysfunction on mortality. Methods From the Oslo University Hospital cohort, 277 SSc patients were included from 2003-2016 and compared with healthy controls. Serial echocardiographies were reevaluated in order to detect change in systolic function. Right heart catheterization was performed on patients suspected of pulmonary hypertension. Descriptive and regression analyses were conducted. Results At baseline, LV systolic dysfunction by ejection fraction less than 50%, or a global longitudinal strain greater than -17.0%, was found in 12% and 24%, respectively. RV systolic dysfunction measured by tricuspid annular plane systolic excursion (TAPSE) less than 17 mm was evident in 10%. Follow-up echocardiography was performed after a median of 3.3 years (interquartile range [IQR] 1.5-5.6). At follow-up, LV systolic function remained stable, whereas RV function evaluated by TAPSE deteriorated (mean 23.1 to 21.7 mm, P = 0.005) equaling a 15% prevalence of RV systolic dysfunction. RV systolic function predicted mortality in multivariable models (hazard ratio 0.41, 95% confidence interval [CI] 0.19-0.90, P value 0.027), whereas LV systolic function lost predictive significance when adjusted for TAPSE. Conclusion In this unselected and prospective study, systolic dysfunction of the LV and RV was a frequent complication of SSc. LV systolic function remained stable across the observation period, whereas RV function deteriorated and predicted mortality.
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Norum HM, Michelsen AE, Lekva T, Arora S, Otterdal K, Olsen MB, Kong XY, Gude E, Andreassen AK, Solbu D, Karason K, Dellgren G, Gullestad L, Aukrust P, Ueland T. Circulating delta-like Notch ligand 1 is correlated with cardiac allograft vasculopathy and suppressed in heart transplant recipients on everolimus-based immunosuppression. Am J Transplant 2019; 19:1050-1060. [PMID: 30312541 DOI: 10.1111/ajt.15141] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 10/02/2018] [Accepted: 10/07/2018] [Indexed: 02/06/2023]
Abstract
Cardiac allograft vasculopathy (CAV) causes heart failure after heart transplantation (HTx), but its pathogenesis is incompletely understood. Notch signaling, possibly modulated by everolimus (EVR), is essential for processes involved in CAV. We hypothesized that circulating Notch ligands would be dysregulated after HTx. We studied circulating delta-like Notch ligand 1 (DLL1) and periostin (POSTN) and CAV in de novo HTx recipients (n = 70) randomized to standard or EVR-based, calcineurin inhibitor-free immunosuppression and in maintenance HTx recipients (n = 41). Compared to healthy controls, plasma DLL1 and POSTN were elevated in de novo (P < .01; P < .001) and maintenance HTx recipients (P < .001; P < .01). Use of EVR was associated with a treatment effect for DLL1. For de novo HTx recipients, a change in DLL1 correlated with a change in CAV at 1 (P = .021) and 3 years (P = .005). In vitro, activation of T cells increased DLL1 secretion, attenuated by EVR. In vitro data suggest that also endothelial cells and vascular smooth muscle cells (VSMCs) could contribute to circulating DLL1. Immunostaining of myocardial specimens showed colocalization of DLL1 with T cells, endothelial cells, and VSMCs. Our findings suggest a role of DLL1 in CAV progression, and that the beneficial effect of EVR on CAV could reflect a suppressive effect on DLL1. Trial registration numbers-SCHEDULE trial: ClinicalTrials.gov NCT01266148; NOCTET trial: ClinicalTrials.gov NCT00377962.
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Rolid K, Andreassen A, Yardley M, Gude E, Bjørkelund E, Authen A, Grov I, Pettersen K, Dall C, Prescott E, Karason K, Gullestad L, Nytrøen K. Associations between Self-Reported Physical Function and Exercise Capacity in De Novo Heart Transplant Recipients. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Nelson L, Andreassen A, Arora S, Andersson B, Gude E, Eiskjær H, Rådegran G, Dellgren G, Gullestad L, Gustafsson F. Mild Acute Cellular Rejection is Not Associated with Development of Cardiac Allograft Vasculopathy Assessed by Intravascular Ultrasound and Coronary Angiography in Heart Transplant Recipients - A Substudy of the SCHEDULE Trial. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Rolid K, Andreassen A, Yardley M, Gude E, Bjørkelund E, Authen A, Grov I, Pettersen K, Dall C, Prescott E, Karason K, Gullestad L, Nytrøen K. Effect of High Intensity Interval Training on Health Related Quality of Life in De Novo Heart Transplant Recipients-The HITTS Study. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Brautaset K, Østby C, Vartdal T, Rolid K, Gude E, Andreassen A, Gullestad L, Broch K. Intravenous Iron Supplement for Iron Deficiency in Cardiac Transplant Recipients (IronIC): Rationale and Design of a Randomized, Controlled Trial. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Smiseth OA, Kjeldsen SE, Andersen ØS, Mistry N, Westheim AS, Skulstad H, Gude E. Heart failure with preserved ejection fraction. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2019; 139:18-0523. [PMID: 30917641 DOI: 10.4045/tidsskr.18.0523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Approximately one half of all patients with heart failure have normal ejection fraction in the left ventricle, and heart failure is attributed to stiffness of the cardiac muscle. The most common cause is hypertension with ventricular hypertrophy. MATERIAL AND METHOD Literature searches were conducted in PubMed. After we made our selection, a total of 15 articles on heart failure with normal ejection fraction were included. In addition, we included nine articles from our own literature archive. RESULTS The diagnosis of heart failure with normal ejection fraction presupposes clinical findings consistent with heart failure and objective signs of diastolic dysfunction. The main objective sign is increased left ventricular filling pressure estimated by echocardiography. Ventricular hypertrophy and increased natriuretic peptides support the diagnosis. INTERPRETATION Underlying conditions and symptoms are treated, and in general the same drugs are used as for heart failure with reduced ejection fraction.
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Inoue K, Remme E, Andersen ØS, Gude E, Skulstad H, Smiseth O. REDUCED LEFT ATRIAL RESERVOIR STRAIN AT REST PREDICTS ELEVATED LEFT VENTRICULAR FILLING PRESSURE DURING EXERCISE. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32045-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Inoue K, Remme E, Andersen ØS, Gude E, Skulstad H, Smiseth O. LEFT ATRIAL STRAIN AS A SURROGATE MARKER OF ATRIAL CHAMBER STIFFNESS. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32132-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Nagueh SF, Smiseth OA, Dokainish H, Andersen OS, Abudiab MM, Schutt RC, Kumar A, Gude E, Sato K, Harb SC, Klein AL. Mean Right Atrial Pressure for Estimation of Left Ventricular Filling Pressure in Patients with Normal Left Ventricular Ejection Fraction: Invasive and Noninvasive Validation. J Am Soc Echocardiogr 2018; 31:799-806. [DOI: 10.1016/j.echo.2018.01.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Indexed: 01/06/2023]
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Broch K, Massey R, Murbræch K, Gude E, Andreassen A, Gullestad L. Longitudinal Development in Left Ventricular Volume, Mass and Function in Heart Transplant Recipients - Results From the NOCTET Trial. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Arora S, Karason K, Gustafsson F, Eiskjær H, Rådegran G, Aaberge L, Gude E, Solbu D, Dellgren G, Andreassen A, Gullestad L. The Effect of Everolimus Initiation and Early Calcineurin Inhibitor Withdrawal on Allograft Vasculopathy in De-Novo Heart Transplant Recipients: Results of the Schedule Trial after 6 Years. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Murbraech K, Massey R, Karason K, Gustafsson F, Eiskjær H, Rådegran G, Solbu D, Broch K, Gude E, Andreassen A, Gullestad L. The Effect of Everolimus vs Calcineurin Inhibitors on Left Ventricular Mass in De Novo Heart Transplant Recipients After 3 Years Follow-Up - Results From the Randomized Controlled SCHEDULE Trial. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Nytrøen K, Rolid K, Andreassen A, Yardley M, Bjørkelund E, Authen A, Grov I, Gude E, Wigh J, Dall C, Gustafsson F, Karason K, Gullestad L. Effect of High-Intensity Interval Training in De Novo Heart Transplant Recipients - 1 Year Follow Up (The HITTS Study). J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Relbo Authen A, Grov I, Karason K, Gustafsson F, Eiskjær H, Rådegran G, Gude E, Jansson K, Solbu D, Arora S, Dellgren G, Andreassen A, Gullestad L. The Effect of Everolimus vs Calcineurin Inhibitors on Quality of Life During 5-6 Years Follow-up After Heart Transplantation: The Results of a Randomized Controlled Trial (SCHEDULE). J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Bürker B, Gullestad L, Gude E, Havik O, Grov I, Relbo Authen A, Andreassen A, Hebold Haraldsen I, Fiane A, Dew M, Andersson S, Malt U. Is Depression After Heart Transplantation (HTx) Associated With Impaired Survival During Long-term Follow-up? J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Hoffmann-Vold AM, Fretheim H, Midtvedt Ø, Kilian K, Angelshaug M, Chaudhary A, Gunnarsson R, Brunborg C, Garen T, Andreassen AK, Gude E, Molberg Ø. Frequencies of borderline pulmonary hypertension before and after the DETECT algorithm: results from a prospective systemic sclerosis cohort. Rheumatology (Oxford) 2017; 57:480-487. [DOI: 10.1093/rheumatology/kex435] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Indexed: 11/13/2022] Open
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Rizvi SMH, Aagnes B, Holdaas H, Gude E, Boberg KM, Bjørtuft Ø, Helsing P, Leivestad T, Møller B, Gjersvik P. Long-term Change in the Risk of Skin Cancer After Organ Transplantation: A Population-Based Nationwide Cohort Study. JAMA Dermatol 2017; 153:1270-1277. [PMID: 29049612 PMCID: PMC5817449 DOI: 10.1001/jamadermatol.2017.2984] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 06/20/2017] [Indexed: 12/19/2022]
Abstract
Importance The high risk of skin cancer after organ transplantation is a major clinical challenge and well documented, but reports on temporal trends in the risk of posttransplant cutaneous squamous cell carcinoma (SCC) are few and appear contradictory. Objective To study temporal trends for the risk of skin cancer, particularly SCC, after organ transplantation. Design, Setting, and Participants Population-based, nationwide, prospective cohort study of 8026 patients receiving a kidney, heart, lung, or liver transplant in Norway from 1968 through 2012 using patient data linked to a national cancer registry. The study was conducted in a large organ transplantation center that serves the entire Norwegian population of approximately 5.2 million. Exposures Receiving a solid organ transplant owing to late-stage organ failure, followed by long-term immunosuppressive treatment according to graft-specific treatment protocols. Main Outcomes and Measures Occurrence of first posttransplant SCC, melanoma, or Kaposi sarcoma of the skin. Risk of skin cancer was analyzed using standardized incidence ratios (SIRs) and, for SCC, multivariable Poisson regression analysis of SIR ratios, adjusting for 5-year time period of transplantation, different follow-up time, age, sex, and type of organ. Results The study cohort included 8026 organ transplant recipients, 5224 men (65.1%), with a mean age at transplantation of 48.5 years. Median follow-up time was 6.7 years per recipient; total follow-up time, 69 590 person-years. The overall SIRs for SCC, melanoma, and Kaposi sarcoma were 51.9 (95% CI, 48.4-55.5), 2.4 (95% CI, 1.9-3.0), and 54.9 (95% CI, 27.4-98.2), respectively. In those who underwent transplantation in the 1983-1987 period, the unadjusted SIR for SCC was 102.7 (95%, 85.8-122.1), declining to 21.6 (95% CI, 16.8-27.0) in those who underwent transplantation in the 2003-2007 period. Adjusting for different follow-up times and background population risks, as well as age, graft organ, and sex, a decline in the SIR for SCC was found, with SIR peaking in patients who underwent transplantation in the 1983-1987 period and later declining to less than half in patients who underwent transplantation in the 1998-2002, 2003-2007, and 2008-2012 periods, with the relative SIRs being 0.42 (95% CI, 0.32-0.55), 0.31 (95% CI, 0.22-0.42), and 0.44 (95% CI, 0.30-0.66), respectively. Conclusions and Relevance The risk of SCC after organ transplantation has declined significantly since the mid-1980s in Norway. Less aggressive and more individualized immunosuppressive treatment and close clinical follow-up may explain the decline. Still, the risk of SCC in organ transplant recipients remains much higher than in the general population and should be of continuous concern for dermatologists, transplant physicians, and patients.
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Bürker BS, Gude E, Gullestad L, Grov I, Relbo Authen A, Andreassen AK, Havik OE, Dew MA, Fiane AE, Haraldsen IR, Malt UF, Andersson S. Cognitive function among long-term survivors of heart transplantation. Clin Transplant 2017; 31. [PMID: 29055147 DOI: 10.1111/ctr.13143] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND Cognitive impairment is documented early after heart transplantation (HTx), but we lack data on cognitive function beyond the fourth year post-transplant. Against the background of good long-term survival, this knowledge is necessary to improve clinical care throughout the entire post-transplant period. METHODS We assessed cognitive function with a neuropsychological test battery in a sample of HTx recipients ≥16 years post-transplant. To improve clinical utility, we also applied adapted consensus criteria for Mild Cognitive Impairment (MCI). Furthermore, we explored sociodemographic and clinical characteristics possibly related to cognitive function. RESULTS Thirty-seven subjects were included 20.3 (±3.8) years after HTx. Mean age was 57.5 (±14.2) years, and 18.9% were women. Up to 38.9% exhibited impaired test performance (ie, performance at least 1.5 standard deviations below the normative mean) on several individual cognitive measures, especially on measures of processing speed, executive functions, memory, and language functions. One subject was diagnosed with dementia, and 30.1% qualified for MCI. Those with MCI had lower hemoglobin than those without. CONCLUSIONS A substantial proportion of long-term survivors of HTx might be cognitively impaired. The level of impairment appears comparable to what is defined as MCI in the literature. Modifiable factors related to cognitive impairment might exist.
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Günther A, Andersen R, Gude E, Jakobsen J, Edvardsen T, Sandvik L, Abildgaard A, Aaberge L, Gullestad L. The predictive value of coronary artery calcium detected by computed tomography in a prospective study on cardiac allograft vasculopathy in heart transplant patients. Transpl Int 2017; 31:82-91. [DOI: 10.1111/tri.13057] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/10/2017] [Accepted: 08/30/2017] [Indexed: 11/26/2022]
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Broch K, Gude E, Andreassen AK, Gullestad L. Newer Immunosuppression and Strategies on the Horizon in Heart Transplantation. CURRENT TRANSPLANTATION REPORTS 2017. [DOI: 10.1007/s40472-017-0159-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Relbo Authen A, Grov I, Karason K, Gustafsson F, Eiskjaer H, Rådegran G, Gude E, Jansson K, Dellgren G, Solbu D, Arora S, Andreassen AK, Gullestad L. Effect of everolimus vs calcineurin inhibitors on quality of life in heart transplant recipients during a 3-year follow-up: Results of a randomized controlled trial (SCHEDULE). Clin Transplant 2017. [DOI: 10.1111/ctr.13038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Andersen OS, Smiseth OA, Dokainish H, Abudiab MM, Schutt RC, Kumar A, Sato K, Harb S, Gude E, Remme EW, Andreassen AK, Ha JW, Xu J, Klein AL, Nagueh SF. Estimating Left Ventricular Filling Pressure by Echocardiography. J Am Coll Cardiol 2017; 69:1937-1948. [DOI: 10.1016/j.jacc.2017.01.058] [Citation(s) in RCA: 208] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 01/23/2017] [Accepted: 01/31/2017] [Indexed: 02/08/2023]
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Arora S, Gude E, Karason K, Andersson B, Bartfay S, Solbu D, Dellgren G, Andreassen A, Gullestad L. The Effect of Everolimus Initiation and Early Calcineurin Inhibitor Withdrawal on Exercise Capacity in De-Novo Heart Transplant Recipients: Results of the SCHEDULE Trial After 36 Months. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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