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Iversen A, Rortveit G, Wensaas KA, Gulla CO. The impact on primary care of a large waterborne campylobacter outbreak in Norway: a controlled observational study. Scand J Prim Health Care 2024; 42:187-194. [PMID: 38189827 PMCID: PMC10851797 DOI: 10.1080/02813432.2023.2299116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/20/2023] [Indexed: 01/09/2024] Open
Abstract
OBJECTIVE Document the impact of an outbreak of gastroenteritis on local primary health care services, compared to a control period. DESIGN Controlled observational study with data from the outbreak and a control period. Data obtained from electronic medical records (EMR) of general practitioners (GPs) and the out-of-hours (OOH) service. Telephone data from the OOH service's telephone records. SETTING Campylobacteriosis outbreak in Askøy municipality, Norway in 2019. Over 2000 individuals were infected. SUBJECTS Patients in contact with GPs and the OOH service during the outbreak and a control period. MAIN OUTCOME MEASURES Patient contacts with GPs and the OOH service during the outbreak and a control period. RESULTS There was a 36% increase in contacts during the outbreak compared to the control period (4798 vs. 3528), with the OOH service handling 78% of outbreak-related contacts. Telephone advice was the dominant method for managing the increase in contacts to primary care, both in OOH services and daytime general practice (OR 3.73 CI: [3.24-4.28]). Children aged 0-4 years had increased use of primary care during the outbreak (OR 1.51 CI: [1.28-1.78]). GPs referred 25% and OOH services referred 75% of 70 hospitalized cases. CONCLUSION The OOH service handled most of the patients during the outbreak, with support from daytime general practice. The outbreak caused a shift towards telephone advice as a means of providing care. Young children significantly increased their use of primary care during the outbreak.
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Affiliation(s)
- A. Iversen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Chief Medical Officer’s Staff, Askøy, Norway
| | - G. Rortveit
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - K. A. Wensaas
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - C. O. Gulla
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
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Bjerregaard CL, Olsen FJ, Lassen MCH, Svartstein ASW, Hansen TF, Galatius S, Iversen A, Pedersen S, Biering-Sørensen T. Ratio of early transmitral inflow velocity to early diastolic strain rate predicts atrial fibrillation following acute myocardial infarction. Int J Cardiovasc Imaging 2024; 40:331-340. [PMID: 37957448 PMCID: PMC10884066 DOI: 10.1007/s10554-023-02991-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/21/2023] [Indexed: 11/15/2023]
Abstract
The ratio of early transmitral filling velocity to early diastolic strain rate (E/SRe) has been proposed as a new non-invasive measurement of left ventricular filling pressure. We aimed to investigate the ability of E/SRe to predict atrial fibrillation (AF) after ST-elevation myocardial infarction (STEMI). This was a prospective cohort study of patients (n = 369) with STEMI. Patients underwent an echocardiographic examination a median of two days after pPCI. By echocardiography, transmitral early filling velocity (E) was measured by pulsed-wave Doppler, and early diastolic strain rate (SRe) was measured by speckle tracking of the left ventricle. E was indexed to SRe and the early myocardial relaxation velocity (e') to obtain the E/SRe and E/e', respectively. The endpoint was new-onset AF. During follow-up (median 5.6 years, IQR: 5.0-6.1 years), 23 (6%) of the 369 patients developed AF. In unadjusted analyses, both E/SRe and E/e' were significantly associated with AF [E/SRe: HR = 1.06; (1.03-1.10); p < 0.001, per 10 increase] and [E/e': HR = 1.11 (1.05-1.17); p < 0.001, per 1 increase] and had equal Harrell's C-statistic of 0.71. However, only E/SRe remained an independent predictor after multivariable adjustments for clinical and echocardiographic parameters [E/SRe: HR = 1.06 (1.00-1.11); p = 0.044, per 10 increase]. E/SRe was further significantly associated with AF in patients with E/e' < 14 HR = 1.09 (1.01-1.17); p = 0.030, per 10 increase), also after multivariable adjustments. E/SRe is an independent predictor of AF in STEMI patients, even in subjects with seemingly normal filling pressure.
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Affiliation(s)
- Caroline Løkke Bjerregaard
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark.
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Gentofte Hospitalsvej 8, 2900, Hellerup, Denmark.
| | - Flemming Javier Olsen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Thomas Fritz Hansen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
| | - Søren Galatius
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Allan Iversen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sune Pedersen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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Dyhr MR, Olsen FJ, Lindberg S, Modin D, Fritz-Hansen T, Pedersen S, Iversen A, Galatius S, Jespersen T, Møgelvang R, Biering-Sørensen T. Left atrial functional measurements' utility in predicting long-term risk of atrial fibrillation after isolated CABG. Echocardiography 2023. [PMID: 37335308 DOI: 10.1111/echo.15636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/31/2023] [Accepted: 06/06/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common cardiac arrhythmia following coronary artery bypass grafting (CABG). We hypothesized that measures of left atrial (LA) function would be useful in predicting AF in patients undergoing CABG. METHODS AND RESULTS In the study, 611 patients were included after CABG. All patients had echocardiograms performed preoperatively and LA functional measurements were assessed. These measurements were LA maximum volume index (LAVmax), LA minimum volume index (LAVmin) and LA emptying fraction (LAEF). The endpoint was AF occurring >14 days after surgery. During the follow-up period of a median of 3.7 years, 52 (9%) developed AF. The mean age was 67 years, 84% were male and the average left ventricle ejection fraction was 50%. Patients who developed AF had a lower CCS class and lower LAEF (40 vs. 45%), otherwise no clinical differences were observed between outcome groups. No functional LA measurements were significant predictors of AF in the whole CABG population. However, in patients with normal-sized LA (n = 532, events: 49), both LAEF and LAVmin were univariable predictors of AF. When the functional measurements were adjusted for the CHADS2 score, both LAVmin (HR = 1.07 [1.01-1.13], p = .014) and LAEF (HR: 1.02 [1.00-1.03], p = .023), remained significant predictors. CONCLUSION No echocardiographic measurements were significant predictors of AF after CABG. In patients with a normal LA size, LAVmin as well as LAEF were significant predictors of AF.
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Affiliation(s)
- Mikkel Ravn Dyhr
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte Hospital, Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Javier Olsen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte Hospital, Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Søren Lindberg
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Daniel Modin
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte Hospital, Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Fritz-Hansen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Sune Pedersen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Allan Iversen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Søren Galatius
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Thomas Jespersen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Møgelvang
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Research, Faculty of Health and Medical Sciences, University of Southern Denmark, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte Hospital, Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
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Vyff F, Johansen ND, Olsen FJ, Duus LS, Lindberg S, Fritz-Hansen T, Pedersen S, Iversen A, Galatius S, Møgelvang R, Biering-Sørensen T. Left atrial reservoir strain predicts ischaemic stroke after coronary artery bypass grafting independent of postoperative atrial fibrillation. Eur Heart J Open 2023; 3:oead045. [PMID: 37250296 PMCID: PMC10220504 DOI: 10.1093/ehjopen/oead045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/02/2023] [Accepted: 04/26/2023] [Indexed: 05/31/2023]
Abstract
Aims Measures of left atrial (LA) function are known to predict both ischaemic stroke and atrial fibrillation in specific patient groups. The aim of this study was to investigate the value of LA reservoir strain for predicting ischaemic stroke in patients undergoing coronary artery bypass grafting (CABG) and investigate whether the presence of postoperative atrial fibrillation (POAF) modified this relationship. Methods and results Patients undergoing isolated CABG were included. The primary endpoint was ischaemic stroke. The association between LA reservoir strain and ischaemic stroke was investigated in uni- and multivariable Cox proportional hazards regression models including adjustment for POAF.We included 542 patients (mean age 67.3±8.9 years, 16.4% female). During a median follow-up period of 3.9 years, 21 patients (3.9%) experienced an ischaemic stroke. In total, 96 patients (17.7%) developed POAF during the index hospitalization. In a multivariable-adjusted Cox proportional hazards regression model, LA reservoir strain was significantly associated with the development of ischaemic stroke [HR (hazard ratio) 1.09 (95% CI 1.02-1.17) per 1% decrease, P = 0.011]. The presence of POAF did not modify this association (p for interaction = 0.07). The predictive value of the LA reservoir strain persisted in multiple sensitivity analyses including restricting the analysis to patients with normal left atrial volumes (LAV<34 ml/m2), patients without POAF, patients without prior stroke, and when excluding patients who developed atrial fibrillation at any time during follow-up. Conclusion LA reservoir strain was independently associated with ischaemic stroke in CABG patients. The predictive value of LA reservoir strain was unaffected by the presence of POAF. Prospective studies are warranted to validate the potential usefulness of LA reservoir strain to predict postoperative ischaemic stroke in the setting of CABG.
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Affiliation(s)
- Frederikke Vyff
- Corresponding author. Tel: +45 60738776, Fax: +45 39 77 73 81,
| | - Niklas Dyrby Johansen
- Department of Cardiology, Copenhagen University Hospital—Herlev and Gentofte, Gentofte Hospitalsvej 8, 3.th., 2900 Hellerup, Copenhagen, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Flemming J Olsen
- Department of Cardiology, Copenhagen University Hospital—Herlev and Gentofte, Gentofte Hospitalsvej 8, 3.th., 2900 Hellerup, Copenhagen, Denmark
| | - Lisa S Duus
- Department of Cardiology, Copenhagen University Hospital—Herlev and Gentofte, Gentofte Hospitalsvej 8, 3.th., 2900 Hellerup, Copenhagen, Denmark
| | - Søren Lindberg
- Department of Cardiology, Copenhagen University Hospital—Herlev and Gentofte, Gentofte Hospitalsvej 8, 3.th., 2900 Hellerup, Copenhagen, Denmark
| | - Thomas Fritz-Hansen
- Department of Cardiology, Copenhagen University Hospital—Herlev and Gentofte, Gentofte Hospitalsvej 8, 3.th., 2900 Hellerup, Copenhagen, Denmark
| | - Sune Pedersen
- Department of Cardiology, Copenhagen University Hospital—Herlev and Gentofte, Gentofte Hospitalsvej 8, 3.th., 2900 Hellerup, Copenhagen, Denmark
| | - Allan Iversen
- Department of Cardiology, Copenhagen University Hospital—Herlev and Gentofte, Gentofte Hospitalsvej 8, 3.th., 2900 Hellerup, Copenhagen, Denmark
| | - Søren Galatius
- Department of Cardiology, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Rasmus Møgelvang
- Department of Cardiology, Copenhagen University Hospital—Rigshospitalet, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital—Herlev and Gentofte, Gentofte Hospitalsvej 8, 3.th., 2900 Hellerup, Copenhagen, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Duus LS, Olsen FJ, Lindberg S, Fritz-Hansen T, Pedersen S, Iversen A, Galatius S, Møgelvang R, Biering-Sørensen T. Right ventricular strain predicts adverse outcomes in patients undergoing coronary artery bypass grafting. Int J Cardiovasc Imaging 2022; 38:1919-1928. [PMID: 37726602 DOI: 10.1007/s10554-022-02584-1] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 02/25/2022] [Indexed: 12/01/2022]
Abstract
Patients undergoing coronary artery bypass grafting (CABG) face an elevated risk of heart failure (HF) and cardiovascular (CV) death. Detailed myocardial tissue analyses of the right ventricle are now possible and may hold prognostic value in these patients. Accordingly, we aimed to evaluate the usefulness of right ventricular (RV) layer-specific RV free wall strain (RVFWS) for predicting HF and/or CV death. Patients undergoing CABG at Gentofte Hospital from 2006 to 2011 with a preoperative echocardiogram underwent RVWFS analysis. RVFWS was obtained by speckle tracking. The outcome was defined as a composite of HF and/or CV death. Cox proportional hazards regression, Harrell's C-statistics, and competing risk regression were used to assess the prognostic value of RVFWS. Of 317 patients, 30 (9.5%) reached the endpoint at a median follow-up of 3.5 years. The mean age was 67 years, 83% were men, and the mean LVEF was 50%. In univariable analyses, endo-RVFWS (HR 1.08, P < 0.001), mid-RVFWS (HR 1.07, P = 0.002), and epi-RVFWS (HR 1.07, P = 0.004, per 1% absolute decrease) were associated with a higher risk of HF or/and CV death. Furthermore, all three layers remained independently associated with the outcome after multivariable adjustment for baseline clinical and echocardiographic measurements. Low endo-RVFWS was associated with a more than threefold increased risk of the outcome (HR = 3.04 (1.45-6.38) P = 0.003). The same was observed for mid-RVFWS (HR = 3.16 (1.45-6.91) P = 0.004), and epi-RVFWS (HR = 3.00 (1.46-6.17) P = 0.003). In patients undergoing CABG, RVFWS assessed by speckle-tracking is a predictor of adverse outcomes.
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Affiliation(s)
- Lisa Steen Duus
- Department of Cardiology, Herlev & Gentofte Hospital, Cardiovascular Non-Invasive Imaging Research Laboratory, University of Copenhagen, Copenhagen, Denmark.
| | - Flemming Javier Olsen
- Department of Cardiology, Herlev & Gentofte Hospital, Cardiovascular Non-Invasive Imaging Research Laboratory, University of Copenhagen, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Søren Lindberg
- Department of Cardiology, Herlev & Gentofte Hospital, Cardiovascular Non-Invasive Imaging Research Laboratory, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Fritz-Hansen
- Department of Cardiology, Herlev & Gentofte Hospital, Cardiovascular Non-Invasive Imaging Research Laboratory, University of Copenhagen, Copenhagen, Denmark
| | - Sune Pedersen
- Department of Cardiology, Herlev & Gentofte Hospital, Cardiovascular Non-Invasive Imaging Research Laboratory, University of Copenhagen, Copenhagen, Denmark
| | - Allan Iversen
- Department of Cardiology, Herlev & Gentofte Hospital, Cardiovascular Non-Invasive Imaging Research Laboratory, University of Copenhagen, Copenhagen, Denmark
| | - Søren Galatius
- Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Møgelvang
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Research, Faculty of Health and Medical Sciences, University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev & Gentofte Hospital, Cardiovascular Non-Invasive Imaging Research Laboratory, University of Copenhagen, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Emberland KE, Wensaas KA, Litleskare S, Iversen A, Hanevik K, Langeland N, Rortveit G. Correction to: Clinical features of gastroenteritis during a large waterborne Campylobacter outbreak in Askøy, Norway. Infection 2022; 50:355-357. [PMID: 35060102 PMCID: PMC8942931 DOI: 10.1007/s15010-021-01746-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Knut Erik Emberland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway.
| | - K-A Wensaas
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - S Litleskare
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - A Iversen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Community Medicine, Askøy municipality, Norway
| | - K Hanevik
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Norwegian National Advisory Unit On Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - N Langeland
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - G Rortveit
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
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7
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Lassen MCH, Lindberg S, Olsen FJ, Fritz-Hansen T, Pedersen S, Iversen A, Galatius S, Møgelvang R, Biering-Sørensen T. Early diastolic strain rate in relation to long term prognosis following isolated coronary artery bypass grafting. Int J Cardiol 2021; 345:137-142. [PMID: 34688721 DOI: 10.1016/j.ijcard.2021.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/15/2021] [Accepted: 10/15/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The ratio of early mitral inflow velocity to early diastolic strain rate (E/e'sr) is a novel echocardiographic measure to estimate early left ventricular (LV) filling pressure. We hypothesize that E/e'sr is a predictor of outcome following coronary artery bypass grafting (CABG) and that it is superior to the conventionally used E/e'. METHODS & RESULTS Consecutive patients undergoing isolated CABG at Gentofte Hospital (n = 652) were included. The mean age of the study population was 67 ± 9 years, 84% were male, mean LVEF was 50 ± 11%. Prior to surgery, all patients underwent an extensive echocardiographic examination. The outcome was all-cause mortality. During follow-up (median 3.8 years [IQR: 2.7; 4.9 years]), a total of 73 (11.2%) died. Both E/e' and E/e'sr were significant predictors in univariable models. In a multivariable model, E/e'sr remained an independent predictor of outcome (HR:1.05 [1.01-1.10], p = 0.049, per 10 cm increase) whereas E/e' did not (HR:1.05 [0.99-1.11], p = 0.053, per 1-unit increase). The relationship between E/e'sr, and the outcome was significantly modified by GLS (p for interaction = 0.043). In the multivariable model, E/e'sr was still significantly associated with the outcome in patients with high GLS (≥13.6%) (HR:1.18 [1.02-1.36], p = 0.029) but not in patients with low GLS (HR 1.04 CI95%: [0.99-1.10], p = 0.14). E/e' was not a significant predictor of all-cause mortality after multivariable adjustment in neither of the groups. E/e'sr improved net reclassification with 33% when added to EuroSCOREII. CONCLUSION Following CABG, preoperative E/e'sr is an independent predictor of all-cause mortality, especially in patients with preserved systolic function and superior to E/e'.
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Affiliation(s)
- Mats C H Lassen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark.
| | - Søren Lindberg
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | - Flemming J Olsen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Thomas Fritz-Hansen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | - Sune Pedersen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | - Allan Iversen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | - Søren Galatius
- Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Denmark
| | - Rasmus Møgelvang
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Southern Denmark, Denmark; Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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8
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Davidovski FS, Lassen M, Skaarup K, Olsen FJ, Sengeloev M, Ravnkilde K, Lindberg S, Fritz-Hansen T, Pedersen S, Iversen A, Galatius S, Gislason G, Moegelvang R, Biering-Soerensen T. Prognostic value of layer-specific global longitudinal strain in patients undergoing coronary artery bypass grafting. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.018] [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
Recent improvements in speckle tracking echocardiography have made sectionalized quantification of layer-specific global longitudinal strain (GLS) possible. Prior studies have reported prognostic value of GLS in several cardiac diseases, however, the use of layer-specific strain has not been investigated in patients undergoing coronary artery bypass grafting (CABG).
Purpose
To determine the prognostic value of layer-specific GLS for predicting all-cause mortality after CABG.
Methods
In this retrospective cohort study, consecutive patients undergoing isolated CABG between 2006 and 2011 were included. The patients were followed through nation-wide registries for the endpoint of all-cause mortality. Multivariable Cox regression models adjusted for clinical and echocardiographic baseline characteristics were used to assess the association between layer-specific GLS and all-cause mortality. Cumulative survival was stratified by clinical age and gender-dependent cut-off values for the layer-specific GLS, which was obtained from a large healthy population study.
Results
Of 641 patients included (mean age 67 years, 84% male), 70 (10.9%) died during follow-up (median 3.8 years [IQR: 2.7; 4.9 years]). Patients who died during follow-up were significantly older (71 years vs. 67 years, P = <0.001) and had a lower LVEF (46% vs. 51% P = <0.001). Endocardial GLS (GLSendo) (−14.2% vs. −16.3%, P<0.001), whole wall GLS (−12.1% vs. −13.9%, P<0.001), and epicardial GLS (GLSepi) (−10.6% vs. −12.2%, P<0.001) were all reduced in patients who died during follow-up, and patients with GLS below cut-off had a more than two-fold increased risk of all-cause mortality (Figure 1). The risk of dying increased linearly with decreasing absolute GLS for all layers (p<0.0002 for all layers), (Figure 2). In multivariable models, all layer-specific strain parameters remained significantly associated with all-cause mortality; GLSepi: HR=1.14 (1.05–1.23), p=0.002; GLS: HR=1.12 (1.04–1.20), p=0.002; GLSendo: HR=1.09 (1.03–1.16), p=0.003, per 1% absolute decrease. However, only GLSepi remained significantly associated with mortality when also adjusting for echocardiographic parameters (GLSepi: HR=1.12 (1.00–1.25), p=0.049, per 1% absolute decrease) and separately also after adjusting for the EuroScore II (GLSepi: HR=1.09 (1.00–1.18), p=0.043, per 1% absolute decrease).
Conclusion
Layer-specific GLS is an independent prognosticator of all-cause mortality after CABG. In multivariable models, GLSepi provided significant prognostic value after adjusting for echocardiographic parameters and EuroScore II.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Research grant from Herlev & Gentofte University Hospital's internal research funds. Figure 1. Kaplan-Meier survival estimatesFigure 2. Incidence rate of all-cause mortality
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Affiliation(s)
- F S Davidovski
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - M Lassen
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - K Skaarup
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - F J Olsen
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - M Sengeloev
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - K Ravnkilde
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - S Lindberg
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - T Fritz-Hansen
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - S Pedersen
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - A Iversen
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - S Galatius
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - G Gislason
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - R Moegelvang
- University of Copenhagen, Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen, Denmark
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9
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Emberland KE, Wensaas KA, Litleskare S, Iversen A, Hanevik K, Langeland N, Rortveit G. Clinical features of gastroenteritis during a large waterborne Campylobacter outbreak in Askøy, Norway. Infection 2021; 50:343-354. [PMID: 34215942 PMCID: PMC8942940 DOI: 10.1007/s15010-021-01652-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/23/2021] [Indexed: 11/30/2022]
Abstract
Purpose Outbreaks of Campylobacter infection are common, but studies exploring the clinical features of acute illness in the outbreak setting are scarce in existing literature. The main purpose of the present study was to investigate the clinical features of self-reported acute illness in gastroenteritis cases during a large waterborne Campylobacter outbreak in Askøy municipality, Norway, in 2019. Methods A web-based self-administered questionnaire, and invitation to participate was sent by the municipality of Askøy as text message to mobile phones using the municipality’s warning system to the inhabitants during the ongoing outbreak. Results Out of 3624 participants, 749 (20.7%) were defined as cases, of which 177 (23.6%) reported severe gastroenteritis. The most common symptoms were loose stools (90.7%), abdominal pain (89.3%) and diarrhea (88.9%), whereas 63.8% reported fever, 50.2% joint pain and 14.2% bloody stools. Tiredness, a symptom non-specific to gastroenteritis, was the overall most common symptom (91.2%). Conclusion About one in four of the cases reported symptoms consistent with severe gastroenteritis. We found more joint pain and less bloody stools than reported in published studies of laboratory confirmed campylobacteriosis cases. Tiredness was common in the current study, although rarely described in previous literature of acute illness in the outbreak setting. Supplementary Information The online version contains supplementary material available at 10.1007/s15010-021-01652-3.
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Affiliation(s)
- Knut Erik Emberland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway. .,Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway.
| | - K-A Wensaas
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - S Litleskare
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - A Iversen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Community Medicine, Askøy municipality, Norway
| | - K Hanevik
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Norwegian National Advisory Unit On Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - N Langeland
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - G Rortveit
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
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10
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Olsen FJ, Lindberg S, Fritz-Hansen T, Modin D, Pedersen S, Iversen A, Galatius S, Gislason G, Møgelvang R, Biering-Sørensen T. Prognostic Value and Interplay Between Myocardial Tissue Velocities in Patients Undergoing Coronary Artery Bypass Grafting. Am J Cardiol 2021; 144:37-45. [PMID: 33383008 DOI: 10.1016/j.amjcard.2020.12.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/08/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Abstract
Early diastolic tissue velocity (e') by tissue Doppler imaging represents an early marker of left ventricular (LV) dysfunction in ischemic heart disease. We assessed the value of e' for predicting mortality in patients undergoing coronary artery bypass grafting (CABG). We retrospectively investigated patients treated with CABG between 2006-2011. Before surgery, all patients underwent an echocardiogram with tissue Doppler imaging to measure tissue velocities: systolic (s'), e', and late diastolic (a'). The primary outcome was all-cause mortality. Survival analysis was applied. Improvement of EuroSCORE-II was assessed by net reclassification index. Of 660 patients, 72 (11%) died during a median follow-up time of 3.8 years. Mean age was 68 years, LVEF 50%, and 84% were men. All tissue velocities showed a significant negative association with outcome and e' provided highest Harrell's C-statistics (c-stat=0.68). After multivariable adjustment for EuroSCORE-II, LV hypertrophy, LV internal diameter, and global longitudinal strain, declining e' was associated with a higher risk of mortality (HR=1.35 (1.12 to 1.61), p = 0.001, per 1cm/s absolute decrease). LVEF≤40% modified the relationship between both s' and e' and outcome (p for interaction=0.021 and 0.024, respectively), such that neither predicted mortality when LVEF was ≤40%. In patients with LVEF>40%, only e' remained a predictor after multivariable adjustments (HR=1.36 (1.10 to 1.69), p = 0.005, per 1cm/s absolute decrease). A net reclassification index improvement of 0.14 was observed when adding global e' to the EuroSCORE-II. In conclusion, e' is an independent predictor of all-cause mortality in patients undergoing CABG, especially in patients with LVEF>40%, and improves the predictive value of EuroSCORE-II.
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11
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Brainin P, Lindberg S, Olsen F, Pedersen S, Iversen A, Galatius S, Fritz-Hansen T, Gislason G, Soegaard P, Moegelvang R, Biering-Soresen T. Prognostic utility of early systolic lengthening by speckle tracking in patients undergoing coronary artery bypass graft. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Independent Research Fund Denmark
Background
Early systolic lengthening (ESL), a paradoxical stretch of myocardial fibers, has been linked to myocardial viability and contractile dysfunction. We assessed the long-term prognostic potential of ESL in coronary artery bypass graft (CABG) patients.
Methods
We retrospectively included patients (n = 709; mean age 68 years; 85% men) who underwent speckle tracking echocardiography (median 15 days) prior to CABG. Endpoints were cardiovascular death (CVD) and all-cause mortality. We assessed amplitude of ESL (%), defined as peak positive strain, and duration of ESL (ms), determined as time from Q-wave on the ECG to peak positive strain. We applied Cox proportional hazards models adjusted for the clinical risk tool, EuroSCORE II.
Results
During median follow-up of 3.8 years [IQR 2.7 to 4.9 years], 45 (6%) experienced CVD and 80 (11%) died. In survival analyses adjusted for EuroSCORE II, amplitude of ESL was associated with CVD (HR 1.37 [95%CI 1.13 to 1.66], P = 0.001) and all-cause mortality (HR 1.31 [95%CI 1.13 to 1.54], P = 0.001). Similar findings applied to duration of ESL and CVD (HR 1.17 [95%CI 1.08 to 1.26], P < 0.001) and all-cause mortality (HR 1.14 [95%CI 1.07 to 1.21], P < 0.001). The prognostic value of ESL amplitude was modified by sex (P interaction < 0.05), such that it was greater in women for both endpoints (Figure 1A-B). When adding ESL duration to EuroSCORE II, the net reclassification index improved significantly for both CVD and all-cause mortality.
Conclusions
Assessment of ESL provides independent and incremental prognostic information in addition to the EuroSCORE II for CVD and all-cause mortality in CABG patients. The prognostic value was greater in women.
Abstract Figure. Prognostic value of ESL amplitude by sex
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Affiliation(s)
- P Brainin
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - S Lindberg
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - F Olsen
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - S Pedersen
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - A Iversen
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - S Galatius
- Bispebjerg University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - T Fritz-Hansen
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - G Gislason
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - P Soegaard
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - R Moegelvang
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
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12
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Olsen FJ, Lindberg S, Pedersen S, Iversen A, Davidovski FS, Galatius S, Fritz-Hansen T, Gislason GH, Søgaard P, Møgelvang R, Biering-Sørensen T. Global longitudinal strain predicts cardiovascular events after coronary artery bypass grafting. Heart 2021; 107:814-821. [PMID: 33526506 DOI: 10.1136/heartjnl-2020-318462] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To determine the prognostic value of global longitudinal strain (GLS) after coronary artery bypass grafting (CABG). METHODS We performed a retrospective cohort study on patients undergoing CABG between 2006 and 2011 who had an echocardiogram available for strain analysis. The patients were followed up through nationwide registries for development of all-cause mortality, cardiovascular death (CVD) and major adverse cardiovascular events (MACEs) defined as heart failure hospitalisation and/or CVD. Multivariable Cox regression was applied to adjust for the European System for Cardiac Operative Risk Evaluation II (EuroSCORE-II). Additive value was assessed by Net Reclassification Index (NRI) improvement. RESULTS Of the 709 patients included, 80 died during a median follow-up of 3.8 years. Of these, 45 had CVD, and 72 patients experienced MACE. Mean age was 68 years and 85% were men. Left ventricular ejection fraction (LVEF) was 50% and GLS was -13%.GLS was an independent predictor when adjusted for the EuroSCORE-II (all-cause mortality: HR=1.07 (1.01-1.13), p=0.018; CVD: HR=1.11 (1.03-1.20), p=0.007; MACE: HR=1.12 (1.06-1.19), p<0.001, per 1% absolute decrease). GLS significantly improved the NRI score by 0.30 when added to the EuroSCORE-II for predicting MACE, but not significantly for the other endpoints.LVEF modified the association between GLS and outcomes (p for interaction<0.05 for CVD and MACE). GLS remained an independent predictor of outcomes in patients with preserved LVEF (LVEF≥50%) and improved the NRI score when added to the EuroSCORE-II for predicting CVD and MACE, but not all-cause mortality in these patients. CONCLUSION GLS is an independent predictor of long-term outcomes after CABG. The predictive value appears strongest among patients with preserved LVEF.
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Affiliation(s)
- Flemming Javier Olsen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Søren Lindberg
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Sune Pedersen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Allan Iversen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Filip Soeskov Davidovski
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Søren Galatius
- Department of Cardiology, Frederiksberg and Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Fritz-Hansen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Gunnar Hilmar Gislason
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.,Department of Clinical Medicine, Faculty of Healhy and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Rasmus Møgelvang
- Department of Clinical Medicine, Faculty of Healhy and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Research, Faculty of Health and Medical Sciences, University of Southern Denmark, Odense, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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13
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Ravnkilde K, Skaarup K, Modin D, Nielsen A, Falsing MM, Iversen A, Pedersen S, Hansen T, Galatius S, Jespersen T, Shah AM, Gislason G, Biering-Sorensen T. CHANGE IN GLOBAL LONGITUDINAL STRAIN AND RISK OF HEART FAILURE FOLLOWING ACUTE CORONARY SYNDROME. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32180-x] [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: 11/16/2022]
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14
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Alhakak AS, Sengeløv M, Jørgensen P, Bruun NE, Abildgaard U, Iversen A, Hansen TF, Teerlink J, Malik F, Solomon SD, Gislason G, Biering-Sorensen T. LEFT VENTRICULAR SYSTOLIC EJECTION TIME IS AN INDEPENDENT PREDICTOR OF ALL-CAUSE MORTALITY IN HEART FAILURE WITH REDUCED EJECTION FRACTION. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32403-7] [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: 11/28/2022]
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15
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Arranz I, Mischke C, Stroka J, Sizoo E, van Egmond H, Neugebauer M, Biselli S, Bonzaaijer G, Breyl I, Brodacz W, Bujara I, Burdaspal P, Cea J, Chan D, Danier J, Debreczeni L, De Girolamo A, De Rechter P, De Saeger S, Dittmar F, Esteves ME, Frohmuth G, González P, Griffin J, Hackenberg R, Hanschmann G, Iversen A, Jaus A, Just P, Lauber U, Legarda T, Li FQ, Meister U, Michelet JY, Michels K, Mrkvilova M, Nordkvist E, Nuotio K, Özkaya Ş, Patel S, Petrová J, Pittet; A, Raditschnig A, Reutter M, Ritscher M, Schenerr H, Slezarova A, Sona T, van Osenbruggen T, Van Peteghem C, Vojsová Y, Wilson P, Wisniewska-Dmytrow H, Woese K. Liquid Chromatographic Method for the Quantification of Zearalenone in Baby Food and Animal Feed: Interlaboratory Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/90.6.1598] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
An interlaboratory trial for determination of zearalenone (ZON) in baby food and animal feed was conducted. The study involved 39 participants in 16 European Union member states, as well as Turkey, Uruguay, and China, representing a cross-section of industry, and official food control and research institutes. The method is based on immunoaffinity column cleanup followed by high-performance liquid chromatography using fluorimetry (HPLC-Fl). The test portion of the sample is extracted with methanolwater (75 + 25, v/v). The sample extract is filtered, diluted, and passed over an immunoaffinity column. ZON is eluted with methanol. The separation and determination of ZON is performed by reversed-phase HPLC-Fl with an excitation wavelength of 274 nm and an emission wavelength of 446 nm. Test portions of the samples were spiked at levels of 20 and 30 g/kg ZON in baby food and at levels of 100 and 150 g/kg ZON in animal feed. Mean recoveries from each participant ranged from 78 to 119 with an average value of 92 for baby food and from 51 to 122 with an average value of 74 for animal feed. Based on results for spiked samples (blind duplicates at 2 levels), as well as naturally contaminated samples (blind duplicates at 3 levels), the relative standard deviation for repeatability (RSDr) in baby food ranged from 2.8 to 9.0. For animal feed, this value ranged from 5.7 to 9.5. The relative standard deviation for reproducibility (RSDR) in baby food ranged from 8.2 to 13.3, and for animal feed this value ranged from 15.5 to 21.4. The Horwitz ratio (HorRat) in baby food ranged from 0.3 to 0.4, and for animal feed this value ranged from 0.6 to 0.9. The method showed acceptable within-and between-laboratory precision for each matrix, as required by European legislation.
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Affiliation(s)
- Isabel Arranz
- Institute for Reference Materials and Measurements, European CommissionJoint Research Center, Food Safety and Quality Unit, Retieseweg 111, B-2440 Geel, Belgium
| | - Carsten Mischke
- Institute for Reference Materials and Measurements, European CommissionJoint Research Center, Food Safety and Quality Unit, Retieseweg 111, B-2440 Geel, Belgium
| | - Joerg Stroka
- Institute for Reference Materials and Measurements, European CommissionJoint Research Center, Food Safety and Quality Unit, Retieseweg 111, B-2440 Geel, Belgium
| | - Eric Sizoo
- National Institute for Public Health and the Environment, Laboratory for Food and Residue Analysis, PO Box 1, 3720 Bilthoven, The Netherlands
| | - Hans van Egmond
- National Institute for Public Health and the Environment, Laboratory for Food and Residue Analysis, PO Box 1, 3720 Bilthoven, The Netherlands
| | - Michael Neugebauer
- University of Bonn, Pharmaceutical Chemistry, An der Immenburg 4, D-53121 Bonn, Germany
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16
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Tahri JB, Hansen TF, Storkås HS, Lauridsen TK, Olsen FJ, Iversen A, Lindhardt TB, Bruun NE, Søgaard P, Risum N. Interlead electrical delays and scar tissue: Response to cardiac resynchronization therapy in patients with ischemic cardiomyopathy. Pacing Clin Electrophysiol 2019; 42:530-536. [DOI: 10.1111/pace.13652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 01/31/2019] [Accepted: 02/22/2019] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | | | | | - Allan Iversen
- Department of CardiologyGentofte University Hospital Copenhagen Denmark
| | - Tommi Bo Lindhardt
- Department of CardiologyCopenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Niels Eske Bruun
- Department of Cardiology, Herlev and Gentofte HospitalUniversity of Copenhagen Copenhagen Denmark
- Clinical InstituteAalborg University Aalborg Denmark
| | - Peter Søgaard
- Department of CardiologyAalborg University Hospital Aalborg Denmark
| | - Niels Risum
- Department of CardiologyCopenhagen University Hospital Rigshospitalet Copenhagen Denmark
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17
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Brainin P, Skaarup K, Iversen A, Godsk P, Platz E, Jensen JS, Biering-Sorensen T. 2235Post-systolic shortening relates to prognosis and degree of stenosis in acute coronary syndrome. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.2235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- P Brainin
- Brigham and Women's Hospital, Department of Emergency Medicine, Boston, United States of America
| | - K Skaarup
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - A Iversen
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - P Godsk
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - E Platz
- Brigham and Women's Hospital, Department of Emergency Medicine, Boston, United States of America
| | - J S Jensen
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
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18
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Skaarup KG, Iversen A, Jørgensen PG, Olsen FJ, Grove GL, Jensen JS, Biering-Sørensen T. Association between layer-specific global longitudinal strain and adverse outcomes following acute coronary syndrome. Eur Heart J Cardiovasc Imaging 2018; 19:1334-1342. [DOI: 10.1093/ehjci/jey004] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 01/08/2018] [Indexed: 12/28/2022] Open
Affiliation(s)
- Kristoffer Grundtvig Skaarup
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, Copenhage Denmark
| | - Allan Iversen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, Copenhage Denmark
| | - Peter Godsk Jørgensen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, Copenhage Denmark
| | - Flemming Javier Olsen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, Copenhage Denmark
| | - Gabriela Llado Grove
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, Copenhage Denmark
- Cardiovascular Medicine Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA, USA
| | - Jan Skov Jensen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, Copenhage Denmark
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen N., Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, Copenhage Denmark
- Cardiovascular Medicine Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA, USA
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19
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Nordberg V, Jonsson K, Giske CG, Iversen A, Aspevall O, Jonsson B, Camporeale A, Norman M, Navér L. Neonatal intestinal colonization with extended-spectrum β-lactamase-producing Enterobacteriaceae-a 5-year follow-up study. Clin Microbiol Infect 2018; 24:1004-1009. [PMID: 29326011 DOI: 10.1016/j.cmi.2017.12.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 07/12/2017] [Revised: 12/14/2017] [Accepted: 12/28/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To analyse Klebsiella pneumoniae (KP) isolates from an outbreak of extended-spectrum β-lactamase (ESBL)-producing KP and Escherichia coli (EC) among infants admitted to neonatal intensive care units and to determine the duration of the intestinal colonization. METHODS We performed a prospective cohort study of intestinal ESBL-KP/ESBL-EC colonized neonates after a 5-month outbreak in two neonatal intensive care units. Whole genome sequencing, multilocus sequence typing, core genome multilocus sequence typing, pulsed-field electrophoresis and PCR for blaCTX-M were performed on the first isolates. Stool cultures were performed every second month after discharge until 2 years after discharge and at 5 years of age. The last positive samples were analysed with pulsed-field gel electrophoresis and PCR for blaCTX-M. The intestinal relative dominance of ESBL-producing Enterobacteriaceae was determined. RESULTS Thirteen of 17 patients colonized with ESBL-KP/ESBL-EC survived. Isolates from 16 of 17 patients were available for analysis and featured the same strain type of ESBL-KP: sequence type 101. The strain had capsule type K29 and harboured blaCTX-M-15. The virulence genes irp1, irp2, iutA, kfu and mrk were detected in all isolates. The median length of colonization was 12.5 months (range, 5-68 months). After 2 years, two of 13 patients were carriers of ESBL-KP and one of 13 of ESBL-EC. At 5 years of age, one neonate was colonized with ESBL-EC. No infant experienced an ESBL-KP/EC-infection during follow-up. CONCLUSIONS Two years after discharge, almost one fourth of the study participants were ESBL/KP-EC carriers. ESBL-KP sequence type 101 persisted in two of 13 children for 23 to 26 months. One patient was colonized with ESBL-EC at age 5 years.
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Affiliation(s)
- V Nordberg
- Department of Neonatal Medicine, Karolinska University Hospital, Sweden; Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Paediatrics, Karolinska Institutet, Sweden.
| | - K Jonsson
- Department of Neonatal Medicine, Karolinska University Hospital, Sweden
| | - C G Giske
- Department of Clinical Microbiology, Karolinska University Hospital, Sweden; Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet, Sweden
| | - A Iversen
- Department of Clinical Microbiology, Karolinska University Hospital, Sweden; Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet, Sweden
| | - O Aspevall
- The Public Health Agency of Sweden, Stockholm, Sweden
| | - B Jonsson
- Department of Neonatal Medicine, Karolinska University Hospital, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Sweden
| | - A Camporeale
- Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet, Sweden
| | - M Norman
- Department of Neonatal Medicine, Karolinska University Hospital, Sweden; Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Paediatrics, Karolinska Institutet, Sweden
| | - L Navér
- Department of Neonatal Medicine, Karolinska University Hospital, Sweden; Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Paediatrics, Karolinska Institutet, Sweden
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Iversen A, Busk M, Bertelsen L, Laustsen C, Munch O, Nielsen T, Wittenborn T, Bussink J, Lok J, Stødkilde-Jørgensen H, Horsman M. PV-0369: The potential of hyperpolarized 13 C MRS to monitor the effect of vascular disrupting agents. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30811-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Vading M, Kabir MH, Kalin M, Iversen A, Wiklund S, Nauclér P, Giske CG. Frequent acquisition of low-virulence strains of ESBL-producing Escherichia coli in travellers. J Antimicrob Chemother 2016; 71:3548-3555. [PMID: 27566312 DOI: 10.1093/jac/dkw335] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 07/08/2016] [Accepted: 07/19/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES International travel is a risk factor for intestinal colonization with ESBL-producing Enterobacteriaceae (EPE). This prospective cohort study focuses on molecular features of and risk factors for travel-acquired EPE. METHODS Rectal swabs and survey data were collected from 188 Swedes travelling to four regions of high EPE prevalence. Samples were plated onto selective agars. ESBL producers were determined using phenotypic methods. Molecular characterization regarding virulence factors and phylogenetic grouping of ESBL-producing Escherichia coli was done using PCR. Isolates were also screened for the plasmid-mediated colistin resistance gene mcr-1. RESULTS Among 175 pre-travel EPE-negative participants, 32% were positive upon return. No carbapenemase-producing Enterobacteriaceae were found, but one CTX-M-producing E. coli harboured mcr-1 (travel to Thailand). Most E. coli strains (43.1%) belonged to phylogroup A and were rarely associated with extraintestinal infections and a few (9.2%) expressed uropathogenicity pap genes. During 10-26 months of follow-up, no clinical infections were observed. Colonization rates varied by visited region: the Indian subcontinent, 49.2%; northern Africa, 44.0%; South-East Asia, 19.1%; and Turkey, 9.5%. Travellers' diarrhoea (OR 2.5, P = 0.04) or antimicrobial treatment during the trip (OR 5.9, P = 0.02) were both independent risk factors for EPE colonization. CONCLUSIONS EPE acquired during travel have seemingly low pathogenicity, possibly indicating a low risk of clinical infection. Pre-travel advice should emphasize avoiding unnecessary antibiotic treatment during travel.
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Affiliation(s)
- M Vading
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden .,Department of Infectious Diseases, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - M H Kabir
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - M Kalin
- Department of Medicine Solna, Infectious Diseases Unit, Karolinska Institutet, Stockholm, Sweden
| | - A Iversen
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - S Wiklund
- Department of Medicine Solna, Infectious Diseases Unit, Karolinska Institutet, Stockholm, Sweden.,Department of Infection Control and Hospital Hygiene, Stockholm County Council, Stockholm, Sweden
| | - P Nauclér
- Department of Infectious Diseases, Karolinska University Hospital, SE-171 76 Stockholm, Sweden.,Department of Medicine Solna, Infectious Diseases Unit, Karolinska Institutet, Stockholm, Sweden
| | - C G Giske
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
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Nochioka K, Biering-Sørensen T, Hansen KW, Sørensen R, Pedersen S, Jørgensen PG, Iversen A, Shimokawa H, Jeger R, Kaiser C, Pfisterer M, Galatius S. Long-term outcomes in patients with rheumatologic disorders undergoing percutaneous coronary intervention: a BAsel Stent Kosten-Effektivitäts Trial-PROspective Validation Examination (BASKET-PROVE) sub-study. European Heart Journal: Acute Cardiovascular Care 2016; 6:778-786. [DOI: 10.1177/2048872616649860] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kotaro Nochioka
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Clinical Research, Innovation and Education Center, Tohoku University Hospital, Sendai, Japan
| | | | - Kim Wadt Hansen
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Rikke Sørensen
- Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark
| | - Sune Pedersen
- Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark
| | | | - Allan Iversen
- Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Clinical Research, Innovation and Education Center, Tohoku University Hospital, Sendai, Japan
| | - Raban Jeger
- Department of Cardiology, University Hospital, Basel, Switzerland
| | - Christoph Kaiser
- Department of Cardiology, University Hospital, Basel, Switzerland
| | | | - Søren Galatius
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
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Iversen A, Vendelbo M, Gormsen L, Jessen N, Horsman M, Busk M. PO-0994: Assessment of [11C]-metformin PET for identification of patients suitable for metformin treatment. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32244-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Iversen A, Garm C, Jakobsen S, Jessen N, Sundelin E, Frøkiær J, Horsman M, Busk M. OC-0542: Biguanides and cancer: microenvironmental and antiproliferative effects at in vivo achievable concentrations. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40537-7] [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]
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Pedersen SH, Pfisterer M, Kaiser C, Jensen JS, Alber H, Rickenbacher P, Sørensen R, Iversen A, Jensen MT, Wadt K, Galatius S. Drug-eluting stents and bare metal stents in patients with NSTE-ACS: 2-year outcome from the randomised BASKET-PROVE trial. EUROINTERVENTION 2015; 10:58-64. [PMID: 24694667 DOI: 10.4244/eijv10i1a11] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The use of drug-eluting stents (DES) in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) is controversial and not yet endorsed in clinical guidelines. METHODS AND RESULTS This was an a priori planned post hoc analysis involving 754 NSTE-ACS patients from the randomised BASKET-PROVE trial (sirolimus-eluting stent vs. everolimus-eluting stent vs. bare metal stent in large-vessel stenting). The primary endpoint was the combined two-year rate of cardiovascular death or non-fatal myocardial infarction (MI). Secondary endpoints were each component of the primary endpoint, and clinically indicated target vessel revascularisation (TVR) and stent thrombosis. Compared to patients with BMS, those treated with SES and EES had a strong trend towards lower two-year rates of the primary endpoint (HR: 0.31 [CI: 0.11-0.90], p=0.03, and HR: 0.74 [CI: 0.44-1.24], p=0.25), and of TVR (HR: 0.58 [CI: 0.29-1.15], p=0.12) and (HR: 0.52 [CI: 0.34-0.78], p=0.002). When the SES and EES groups were combined and compared to BMS, significant reductions in both cardiovascular death/MI and TVR were found. CONCLUSIONS Compared with BMS, use of DES in NSTE-ACS patients undergoing stent implantation in large vessels was associated with a reduction in both TVR and the combined endpoint consisting of cardiovascular death/MI. Thus, DES use improves both efficacy and safety. These findings support the use of DES in NSTE-ACS patients.
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Affiliation(s)
- Sune Haahr Pedersen
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
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Titelman E, Hasan C, Iversen A, Nauclér P, Kais M, Kalin M, Giske C. Faecal carriage of extended-spectrum β-lactamase-producing Enterobacteriaceae is common 12 months after infection and is related to strain factors. Clin Microbiol Infect 2014; 20:O508-15. [DOI: 10.1111/1469-0691.12559] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 11/13/2013] [Accepted: 12/15/2013] [Indexed: 11/30/2022]
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Cakmak H, Ural E, Sahin T, Al N, Emre E, Saracoglu E, Akbulut T, Ural D, Rangel I, Goncalves A, Sousa C, Rodrigues J, Macedo F, Silva-Cardoso J, Maciel M, Iliuta L, Nagata Y, Takeuchi M, Kuwaki H, Hasyashi A, Otani K, Yoshitani H, Osuji Y, Haberka M, Liszka J, Kozyra A, Tabor Z, Finik M, Gasior Z, Hasselberg N, Haugaa K, Brunet A, Kongsgaard E, Donal E, Edvardsen T, Sugano A, Seo Y, Sato K, Atsumi A, Yamamoto M, Machino T, Harimura Y, Kawamura R, Ishizu T, Aonuma K, Biering-Sorensen T, Hoffmann S, Mogelvang R, Iversen A, Fritz-Hansen T, Bech J, Jensen J, Flarup Dons M, Biering-Soerensen T, Skov Jensen J, Fritz Hansen T, Bech J, Chantal De Knegt M, Sivertsen J, Moegelvang R. Moderated Posters session * The prognostic value of myocardial deformation imaging in cardiomyopathy: 12/12/2013, 08:30-12:30 * Location: Moderated Poster area. Eur Heart J Cardiovasc Imaging 2013. [DOI: 10.1093/ehjci/jet228] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Habeeb MA, Haque A, Iversen A, Giske CG. Occurrence of virulence genes, 16S rRNA methylases, and plasmid-mediated quinolone resistance genes in CTX-M-producing Escherichia coli from Pakistan. Eur J Clin Microbiol Infect Dis 2013; 33:399-409. [PMID: 24036893 DOI: 10.1007/s10096-013-1970-1] [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] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 08/28/2013] [Indexed: 10/26/2022]
Abstract
The aim of the study was to conduct a comprehensive molecular characterization of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli collected from Pakistan. Genetic relatedness among 98 ESBL-producing E. coli was measured by pulsed-field gel electrophoresis (PFGE). The presence of genes encoding ESBLs, virulence factors (VFs), 16S rRNA methylases, plasmid-mediated quinolone resistance (PMQR) encoding elements, plasmid replicon types, phylogenetic groups of E. coli, prevalence of the worldwide disseminated clone E. coli ST131, and phylogrouping of CTX-M enzymes was investigated by polymerase chain reaction (PCR). All isolates carried bla CTX-M genes and, except for one isolate from CTX-M phylogroup 9, they all belonged to CTX-M phylogroup 1. The isolates were genetically diverse with PFGE. Phylogenetic group D (36 %) was most abundant in this collection of E. coli, whereas isolates belonging to B2 (22 %) had the highest content of virulence genes. PMQR genes were found in 84.6 % of the isolates; among them, 93 % isolates were positive for variants of acetyltransferases (aac(6')-lb-cr), whereas qnrB, qepA, and qnrS were present in 11 %, 5 %, and 4 % of the isolates, respectively. Only 3 % of the isolates contained genes encoding 16S rRNA methylases. The most abundant replicon type was IncF (96 %), and 18 % of the isolates belonged to the ST131 clone. Out of 34 investigated VFs, 24 genes encoding different types of adhesins, protectins, toxins, siderophores, and other VFs were found. Although the isolates in this collection were highly resistant to many antimicrobials, susceptibility to amikacin and meropenem was retained.
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Affiliation(s)
- M A Habeeb
- Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering (NIBGE), P.O. Box 577, Jhang Road, Faisalabad, Pakistan
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Jensen MT, Kaiser C, Sandsten KE, Alber H, Wanitschek M, Iversen A, Jensen JS, Pedersen S, Soerensen R, Rickli H, Zurek M, Fahrni G, Bertel O, De Servi S, Erne P, Pfisterer M, Galatius S. Heart rate at discharge and long-term prognosis following percutaneous coronary intervention in stable and acute coronary syndromes--results from the BASKET PROVE trial. Int J Cardiol 2013; 168:3802-6. [PMID: 23849965 DOI: 10.1016/j.ijcard.2013.06.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 06/20/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND Elevated heart rate (HR) is associated with mortality in a number of heart diseases. We examined the long-term prognostic significance of HR at discharge in a contemporary population of patients with stable angina (SAP), non-ST-segment elevation acute coronary syndromes (NSTE-ACS), and ST-segment elevation myocardial infarction (STEMI) revascularized with percutaneous coronary intervention (PCI). METHODS Patients from the BASKET-PROVE trial, an 11-center randomized all-comers trial comparing bare-metal and drug-eluting stenting in large coronary vessels, were included. Discharge HR was determined from a resting ECG. Long-term outcomes (7 days to 2 years) were evaluated for all-cause mortality and cardiovascular death and non-fatal myocardial infarction. RESULTS A total of 2029 patients with sinus rhythm were included, 722 (35.6%) SAP, 647 (31.9%) NSTE-ACS, and 660 (32.5%) STEMI. Elevated discharge HR was associated significantly with all-cause mortality: when compared to a reference of <60 beats per minute (bpm), the adjusted hazard ratios were (95% CI) 4.5 (1.5-13.5, p=0.006) for 60-69 bpm, 3.8 (1.2-11.9, p=0.022) for 70-79 bpm, 4.3 (1.2-15.6, p=0.025) for 80-89 bpm, and 16.9 (5.2-55.0, p<0.001) for >90 bpm. For cardiovascular death/myocardial infarction, a discharge HR >90 bpm was associated with a hazard ratio of 6.2 (2.5-15.5, p<0.001) compared to a HR <60 bpm. No interaction was found for disease presentation, diabetes or betablocker use. CONCLUSION In patients revascularized with PCI for stable angina or acute coronary syndromes an elevated discharge HR was independently associated with poor prognosis. Conversely, a HR <60 bpm at discharge was associated with a good long-term prognosis irrespective of indication for PCI.
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Wanitschek M, Pfisterer M, Hvelplund A, De Servi S, Bertel O, Jeger R, Rickenbacher P, Iversen A, Jensen JS, Galatius S, Kaiser C, Alber H. Long-term benefits and risks of drug-eluting compared to bare-metal stents in patients with versus without chronic kidney disease. Int J Cardiol 2013; 168:2381-8. [PMID: 23453439 DOI: 10.1016/j.ijcard.2013.01.257] [Citation(s) in RCA: 13] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 01/21/2013] [Indexed: 12/20/2022]
Abstract
AIMS Chronic kidney disease (CKD) is associated with worse outcomes in patients with coronary artery disease (CAD). How CKD influences the benefit-risk balance of drug-eluting stents (DES) versus bare-metal stents (BMS) is less known. METHODS AND RESULTS In the multicentre BASKET-PROVE trial, 2314 patients in need of large coronary stenting (≥ 3.0mm) were randomised 2:1 to DES or BMS. In an a priori planned secondary analysis, outcomes were evaluated according to renal function defined by estimated glomerular filtration rates (eGFR; normal: eGFR ≥ 60 ml/min/1.73 m(2); CKD: eGFR<60 ml/min/1.73 m(2)). The primary endpoint was the first major adverse cardiac event (MACE: cardiac death, myocardial infarction, target vessel revascularisation) up to 2 years. A Cox proportional-hazard model was used to evaluate adjusted relative risks (hazard rates, HRs) for BMS versus DES. The interaction of stent type and renal function was tested. CKD patients (189 (11.2%)/1681 with such data) had a 2-year MACE rate of 8.5% versus 7.4% in those without CKD [HR 0.98 (0.56-1.72), p=0.95] with cardiac mortalities of 5.3% and 1.5%, respectively (p=0.002, non-significant after baseline adjustments). The MACE rate was lower in CKD patients with DES than with BMS [4.9% versus 15.2%, p=0.017, HR 0.29(0.10-0.80)] as was the MACE rate in patients without CKD [5.6% with DES versus 11.1% with BMS, p<0.0001, HR 0.51(0.35-0.75)]. No significant interaction between stent type and renal function was found. CONCLUSIONS This analysis of patients needing large coronary artery stenting confirms the increased mortality of CKD patients and documents a long-term benefit of DES compared to BMS irrespective of kidney function.
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Frydenberg H, Flote VG, Iversen A, Finstad SE, Furberg AS, Fagerland M, Wist EA, Schlichting E, Ellison PT, McTiernan A, Ursin G, Thune I. Abstract P3-01-01: Insulin, Insulin-like Growth Factor-1 and cycling estrogen predict premenopausal mammographic density. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p3-01-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Mammographic density, a strong biomarker for breast cancer risk, represents epithelial and stromal proliferation. Insulin and insulin-like growth factor (IGF)-1 are suggested to influence cellular proliferation, while estrogen is a key factor in breast cancer development. However, whether the effects of these hormones among premenopausal women are mediated through mammographic density is less known.
Material and Methods: Fasting serum insulin, IGF-1, and IGF binding protein (IGFBP)-3 were assessed among 202 healthy premenopausal women (Norwegian Energy Balance and Breast cancer Aspects study-I (EBBA-I). Daily salivary levels of 17β-estradiol throughout an entire menstrual cycle were measured at the reproductive Ecology Laboratory, Harvard University, USA. Computer-assisted mammographic density (Madena) was obtained from digitized mammograms taken at day 7–12 of the menstrual cycle. Uni- and multivariable regression models were used to study the associations between hormones and premenopausal percent mammographic density.
Results: Among women with a mean age of 30,7 years, a mean premenopausal percent mammographic density of 29.8 % was observed. Throughout the menstrual cycle when comparing women with a high percent mammographic density (≥28.5%) to women with a low percent mammographic density (<28.5%), we observed insulin, IGF-1 and IGFBP-3 independently and in combination with cycling 17β-estradiol to predict premenopausal percent mammographic density. We observed among women with either serum insulin ≥89 pmol/, IGF-1 ≥24 nmol/l, IGFBP-3 ≥ 100 nmol/l, having a high (≥28.5%) versus a low (<28.5%) percent mammographic density was associated with an increase in overall average 17β-estradiol of 4.0 %, 10.9 % and 14.9%, respectively. Moreover, we observed a higher adjusted Odds Ratio (OR) for having a high percent mammographic density for each standard deviation (SD) increase in overall average 17β -estradiol, insulin, IGF-1 and IGFBP-3: 17β-estradiol, 1.55 (1.06–2.27); insulin, 1.62 (0.76–3.48), IGF-1, 1.90 (1.10–3.27); IGFBP-3, 1.88 (1.05–3.37) (adjusted for age, body mass index-BMI kg/m2)).
Conclusion: Our study supports that insulin, IGF-1 and IGFBP-3 independently, and in combination with cycling estrogen, predicts premenopausal mammographic density. These hormones may be important biomarkers in breast cancer control and clinical practice.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-01-01.
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Affiliation(s)
- H Frydenberg
- Oslo University Hospital, Oslo, Norway; University of Tromsø, Norway; Harvard University, Cambridge, MA; Fred Hutchinson Cancer Research Center, Seattle, WA; The Norwegian Cancer Registry, Oslo, Norway
| | - VG Flote
- Oslo University Hospital, Oslo, Norway; University of Tromsø, Norway; Harvard University, Cambridge, MA; Fred Hutchinson Cancer Research Center, Seattle, WA; The Norwegian Cancer Registry, Oslo, Norway
| | - A Iversen
- Oslo University Hospital, Oslo, Norway; University of Tromsø, Norway; Harvard University, Cambridge, MA; Fred Hutchinson Cancer Research Center, Seattle, WA; The Norwegian Cancer Registry, Oslo, Norway
| | - SE Finstad
- Oslo University Hospital, Oslo, Norway; University of Tromsø, Norway; Harvard University, Cambridge, MA; Fred Hutchinson Cancer Research Center, Seattle, WA; The Norwegian Cancer Registry, Oslo, Norway
| | - A-S Furberg
- Oslo University Hospital, Oslo, Norway; University of Tromsø, Norway; Harvard University, Cambridge, MA; Fred Hutchinson Cancer Research Center, Seattle, WA; The Norwegian Cancer Registry, Oslo, Norway
| | - M Fagerland
- Oslo University Hospital, Oslo, Norway; University of Tromsø, Norway; Harvard University, Cambridge, MA; Fred Hutchinson Cancer Research Center, Seattle, WA; The Norwegian Cancer Registry, Oslo, Norway
| | - EA Wist
- Oslo University Hospital, Oslo, Norway; University of Tromsø, Norway; Harvard University, Cambridge, MA; Fred Hutchinson Cancer Research Center, Seattle, WA; The Norwegian Cancer Registry, Oslo, Norway
| | - E Schlichting
- Oslo University Hospital, Oslo, Norway; University of Tromsø, Norway; Harvard University, Cambridge, MA; Fred Hutchinson Cancer Research Center, Seattle, WA; The Norwegian Cancer Registry, Oslo, Norway
| | - PT Ellison
- Oslo University Hospital, Oslo, Norway; University of Tromsø, Norway; Harvard University, Cambridge, MA; Fred Hutchinson Cancer Research Center, Seattle, WA; The Norwegian Cancer Registry, Oslo, Norway
| | - A McTiernan
- Oslo University Hospital, Oslo, Norway; University of Tromsø, Norway; Harvard University, Cambridge, MA; Fred Hutchinson Cancer Research Center, Seattle, WA; The Norwegian Cancer Registry, Oslo, Norway
| | - G Ursin
- Oslo University Hospital, Oslo, Norway; University of Tromsø, Norway; Harvard University, Cambridge, MA; Fred Hutchinson Cancer Research Center, Seattle, WA; The Norwegian Cancer Registry, Oslo, Norway
| | - I Thune
- Oslo University Hospital, Oslo, Norway; University of Tromsø, Norway; Harvard University, Cambridge, MA; Fred Hutchinson Cancer Research Center, Seattle, WA; The Norwegian Cancer Registry, Oslo, Norway
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Mogelvang R, Haahr-Pedersen S, Bjerre M, Frystyk J, Iversen A, Galatius S, Flyvbjerg A, Jensen JS. Osteoprotegerin improves risk detection by traditional cardiovascular risk factors and hsCRP. Heart 2012; 99:106-10. [DOI: 10.1136/heartjnl-2012-302240] [Citation(s) in RCA: 25] [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: 11/03/2022] Open
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Gang UJO, Hvelplund A, Pedersen S, Iversen A, Jons C, Abildstrom SZ, Haarbo J, Jensen JS, Thomsen PEB. High-degree atrioventricular block complicating ST-segment elevation myocardial infarction in the era of primary percutaneous coronary intervention. Europace 2012; 14:1639-45. [DOI: 10.1093/europace/eus161] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Pedersen S, Mogelvang R, Bjerre M, Frystyk J, Flyvbjerg A, Galatius S, Sørensen TB, Iversen A, Hvelplund A, Jensen JS. Osteoprotegerin Predicts Long-Term Outcome in Patients with ST-Segment Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention. Cardiology 2012; 123:31-8. [DOI: 10.1159/000339880] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 03/19/2012] [Indexed: 01/05/2023]
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Ploug KB, Amrutkar DV, Baun M, Ramachandran R, Iversen A, Lund TM, Gupta S, Hay-Schmidt A, Olesen J, Jansen-Olesen I. K(ATP) channel openers in the trigeminovascular system. Cephalalgia 2011; 32:55-65. [PMID: 22144717 DOI: 10.1177/0333102411430266] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The ATP-sensitive K(+) (K(ATP)) channel openers levcromakalim and pinacidil are vasodilators that induce headache in healthy people. The neuropeptide calcitonin gene-related peptide (CGRP) induces headache in healthy people and migraine in migraineurs, potentially through a mechanism that involves opening of vascular or neuronal K(ATP) channels and mast cell degranulation. Using rat as a model, we studied the molecular presence of K(ATP) channels in the trigeminovascular system. Furthermore, we examined whether K(ATP) channel openers stimulate the in vitro release of CGRP and whether they degranulate dural mast cells. METHODS mRNA and protein expression of K(ATP) channel subunits were studied in the trigeminal ganglion (TG) and trigeminal nucleus caudalis (TNC) by qPCR and western blotting. In vitro CGRP release was studied after application of levcromakalim (1 µM) and diazoxide (10 µM) to freshly isolated rat dura mater, TG and TNC. Rat dural mast cells were challenged in situ with levcromakalim (10(-5) M) to study its potential degranulation effect. RESULTS mRNA and protein of K(ATP) channel subunits Kir6.1, Kir6.2, SUR1 and SUR2B were identified in the TG and TNC. K(ATP) channel openers did not release or inhibit capsaicin-induced CGRP release from dura mater, TG or TNC. They did also not induce dural mast cell degranulation. CONCLUSIONS K(ATP) channel openers do not interact with CGRP release or mast cell degranulation. Activation of these channels in the CNS is antinociceptive and therefore cannot explain the headache induced by K(ATP) channel openers. Thus, they are likely to induce headache by interaction with extracerebral K(ATP) channels, probably the SUR2B isoforms.
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Affiliation(s)
- K B Ploug
- Glostrup Research Institute, Denmark
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Pedersen S, Galatius S, Mogelvang R, Abildstrom SZ, Sorensen R, Galloe A, Abildgaard U, Hansen P, Davidsen U, Iversen A, Bech J, Madsen JK, Jensen JS. Long-term clinical outcome in STEMI patients treated with primary PCI and drug-eluting or bare-metal stents: insights from a high-volume single-center registry. J Invasive Cardiol 2011; 23:328-333. [PMID: 21828395] [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: 05/31/2023]
Abstract
OBJECTIVE Use of drug-eluting stents (DES) in patients with ST-elevation myocardial infarction (STEMI) during routine primary percutaneous coronary intervention (pPCI) is controversial. METHODS From January 2004 to July 2008, a total of 2,155 STEMI patients were treated with pPCI [DES or bare-metal stent (BMS)] at a single high-volume invasive center. We present 4-year outcomes in this observational registry study. RESULTS A total of 1,725 were treated with DES and 430 with BMS. Patients treated with DES were younger and had more complex angiographic characteristics compared to BMS patients. Patients treated with DES had lower adjusted risk of target lesion revascularization (TLR) [hazard ratio (HR) = 0.68; 95% confidence interval (CI): 0.40-0.98; p = 0.04], but had a trend toward increased risk of definite stent thrombosis (HR = 1.96; 95% CI: 0.83-4.61; p = 0.12). No difference was found when evaluating all-cause mortality and non-fatal myocardial infarction. CONCLUSIONS In this study, we set out to evaluate the independent impact of DES or BMS treatment on long-term clinical outcomes in STEMI patients treated with pPCI in a real-life setting. DES use was associated with a reduced risk of TLR, but a trend toward increased risk of stent thrombosis was found. However, this safety issue did not translate into an increased risk of death or overall non-fatal myocardial infarction for DES patients.
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Affiliation(s)
- Sune Pedersen
- Department of Cardiology P, Gentofte University Hospital, Niels Andersens Vej 65, DK-2900, Copenhagen Denmark.
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Iversen A, Galatius S, Jensen JS. The Optimal Route of Administration of the Glycoprotein IIb/IIIa Receptor Antagonist Abciximab During Percutaneous Coronary Intervention; Intravenous Versus Intracoronary. Curr Cardiol Rev 2011; 4:293-9. [PMID: 20066137 PMCID: PMC2801861 DOI: 10.2174/157340308786349480] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Revised: 06/02/2008] [Accepted: 06/02/2008] [Indexed: 01/05/2023] Open
Abstract
The use of the glycoprotein (GP) IIb/IIIa receptor antagonist Abciximab has over the years become an important part of the anticoagulant regimen in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Abciximab is a potent inhibitor of platelet aggregation and thrombus formation, but other mechanisms, such as suppression of the inflammatory pathways, have also been proposed to contribute to the benefits of Abciximab. The optimal route of administration, i.e. intravenous versus intracoronary, of the first dose has been questioned, but only tested in small, non-randomised and retrospective studies or studies with short follow-up. No definite conclusion can be made based on these studies. In this review we present the current knowledge published about the intracoronary administration of Abciximab including the mechanisms behind the potential beneficial effects, and the safety. The emphasis will be on clinical trials rather than on studies on the pharmacological mechanisms, as the latter have been reviewed thoroughly elsewhere. Our conclusion from this present review is that randomized trials of intracoronary versus intravenous bolus of Abciximab are needed.
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Affiliation(s)
- Allan Iversen
- Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark
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Iversen A, Thune I, McTiernan A, Emaus A, Finstad SE, Flote V, Wilsgaard T, Lipson SF, Ellison PT, Jasienska G, Furberg AS. Ovarian hormones and reproductive risk factors for breast cancer in premenopausal women: the Norwegian EBBA-I study. Hum Reprod 2011; 26:1519-29. [PMID: 21467202 PMCID: PMC3096559 DOI: 10.1093/humrep/der081] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Ovarian hormones, parity and length of ‘menarche-to-first birth’ time interval are known risk factors for breast cancer, yet the associations between 17β-estradiol, progesterone and these reproductive factors remain unclear. METHODS A total of 204 women (25–35 years) who participated in the Norwegian EBBA-I study collected daily saliva samples for one complete menstrual cycle, and filled in a reproductive history questionnaire. Anthropometry was measured and saliva samples were analyzed for ovarian hormones. Associations between parity, the interval and ovarian hormones, and effects of hormone-related lifestyle factors were studied in linear regression models. RESULTS Mean age was 30.7 years, and age of menarche 13.1 years. Parous women had on average 1.9 births, and age at first birth was 24.5 years. No association was observed between parity and ovarian steroids. In nulliparous women, higher waist circumference (≥77.75 cm) and longer oral contraceptive (OC) use (≥3 years) were associated with higher levels of 17β-estradiol. Short (<10 years) versus long (>13.5 years) ‘menarche-to-first birth’ interval was associated with higher overall mean (Ptrend = 0.029), 47% higher maximum peak and 30% higher mid-cycle levels of 17β-estradiol. We observed a 2.6% decrease in overall mean salivary 17β-estradiol with each 1-year increase in the interval. CONCLUSIONS Nulliparous women may be more susceptible to lifestyle factors, abdominal overweight and past OC use, influencing metabolic and hormonal profiles and thus breast cancer risk. Short time between ‘menarche-to-first birth’ is linked to higher ovarian hormone levels among regularly cycling women, suggesting that timing of first birth is related to fecundity.
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Affiliation(s)
- A Iversen
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, N-9037 Tromsø, Norway.
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Woodhead C, Rona RJ, Iversen A, MacManus D, Hotopf M, Dean K, McManus S, Meltzer H, Brugha T, Jenkins R, Wessely S, Fear NT. Mental health and health service use among post-national service veterans: results from the 2007 Adult Psychiatric Morbidity Survey of England. Psychol Med 2011; 41:363-372. [PMID: 20406527 DOI: 10.1017/s0033291710000759] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [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: 11/07/2022]
Abstract
BACKGROUND There is concern surrounding the psychological health and uptake of treatment services among veterans of the UK Armed Forces. METHOD Data from a cross-sectional, nationally representative sample were used to compare health outcomes and treatment seeking among 257 post-national service veterans aged 16-64 years and 504 age and sex frequency-matched non-veterans living in the community in England. Early leavers (<4 years service) were compared with longer serving veterans. RESULTS Male veterans reported more childhood adversity and were more likely to have experienced a major trauma in adulthood than non-veterans. There was no association between any measure of mental health and veteran status in males, except reporting more violent behaviours [adjusted odds ratio (aOR) 1.44, 95% confidence interval (CI) 1.01-2.06]. In females, a significant association was found between veteran status and ever having suicidal thoughts (aOR 2.82, 95% CI 1.13-7.03). No differences in treatment-seeking behaviour were identified between veterans and non-veterans with any mental disorder. Early service leavers were more likely to be heavy drinkers (aOR 4.16, 95% CI 1.08-16.00), to have had suicidal thoughts (aOR 2.37, 95% CI 1.21-4.66) and to have self-harmed (aOR 12.36, 95% CI 1.61-94.68) than longer serving veterans. CONCLUSIONS The findings of this study do not suggest that being a veteran is associated with adversity in terms of mental health, social disadvantage or reluctance to seek treatment compared with the general population. Some evidence implies that early service leavers may experience more mental health problems than longer-serving veterans.
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Affiliation(s)
- C Woodhead
- Academic Centre for Defence Mental Health, King's College London, UK
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41
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Taskiran M, Iversen A, Klausen K, Jensen GB, Jensen JS. The association of microalbuminuria with mortality in patients with acute myocardial infarction. A ten-year follow-up study. Heart Int 2010; 5:e2. [PMID: 21977287 PMCID: PMC3184708 DOI: 10.4081/hi.2010.e2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 01/15/2010] [Accepted: 01/15/2010] [Indexed: 11/24/2022] Open
Abstract
Our study evaluates the long-term effect of microalbuminuria on mortality among patients with acute myocardial infarction. We followed 151 patients from 1996 to 2007 to investigate if microalbuminuria is a risk factor in coronary heart disease. All patients admitted with acute myocardial infarction in 1996 were included. At baseline, we recorded urinary albumin/creatinine concentration ratio, body mass index, blood pressure, left ventricle ejection fraction by echocardiography, smoking status, medication, diabetes, age, and gender. Deaths were traced in 2007 by means of the Danish Personal Identification Register. Microalbuminuria, defined as a urinary albumin/creatinine concentration ratio above 0.65 mg/mmoL, occurred in 50% of the patients and was associated with increased all-cause mortality. Thus, 68% of the patients with microalbuminuria versus 48% of the patients without microalbuminuria had died during the 10 years of follow-up (P=0.04). The crude hazard ratio for death associated with microalbuminuria was 1.78 (CI: 1.18–2.68) (P=0.006), whereas the gender- and age-adjusted hazard ratio was 1.71 (CI: 1.03–2.83) (P=0.04). We concluded that microalbuminuria in hospitalized patients with acute myocardial infarction is prognostic for increased long-term mortality. We recommend measurement of microalbuminuria to be included as a baseline risk factor in patients with acute myocardial infarction and in future trials in patients with coronary heart disease.
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Hansen PR, Iversen A, Abdulla J. Improved clinical outcomes with intracoronary compared to intravenous abciximab in patients with acute coronary syndromes undergoing percutaneous coronary intervention: a systematic review and meta-analysis. J Invasive Cardiol 2010; 22:278-282. [PMID: 20516508] [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: 05/29/2023]
Abstract
BACKGROUND Intracoronary (IC) administration of abciximab may increase local drug levels by several orders of magnitude compared to intravenous (IV) treatment and may improve clinical outcomes in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI). In the absence of results from large multicenter, randomized trials, we performed a systematic review and meta-analysis of available studies comparing IC to IV abciximab in these patients. METHODS Eight studies were identified, including five randomized trials and three retrospective studies. Data from 2,301 patients, including 997 with ST-segment-elevation myocardial infarction (STEMI) and 1,304 with non-STEMI or unstable angina, were analyzed. RESULTS The studies were conducted from 1996-2008, 24% of patients had diabetes and thienopyridine pretreatment was frequently suboptimal, compared to the current standard of care. Pooled analysis of the data demonstrated significantly reduced mortality (odds ratio [OR] 0.57, 95% confidence interval [CI] 0.35-0.94; p = 0.028), and a trend toward a reduction of major adverse cardiac events (MACE, OR 0.62, 95% CI 0.38-1.03; p = 0.066) during up to 12 months of follow up with IC compared to IV abciximab. Metaregression analysis of important covariables showed heterogeneity of individual study results because of different follow-up periods and inclusion of patients without STEMI. Subanalyses showed significant MACE reduction after 1 month of follow up, and in studies exclusively composed of patients with STEMI, respectively. CONCLUSIONS This first systematic review and meta-analysis of available studies suggests that compared to standard IV administration, IC abciximab can improve clinical outcomes in patients with ACS undergoing PCI, especially patients with STEMI undergoing primary PCI.
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Affiliation(s)
- Peter Riis Hansen
- Department of Cardiology P, Gentofte University Hospital, Niels Andersensvej 65, DK-2900 Hellerup, Denmark.
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Henderson HJ, Maddock L, Andrews S, Trail P, Loades N, Purcell B, Iversen A, Llewelyn MJ, Cassell JA. How is diarrhoea managed in UK care homes? A survey with implications for recognition and control of Clostridium difficile infection. J Public Health (Oxf) 2010; 32:472-8. [DOI: 10.1093/pubmed/fdq036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) has been called one of the signature injuries of the Iraq War. In this review prevalence estimates of PTSD are summarized and discrepancies are discussed in relation to methodological differences between studies. METHOD We searched for population-based studies with a minimum sample size of 300. Studies based on help-seeking samples were excluded. We identified 60 possible papers, of which 19 fulfilled the inclusion criteria. Prevalence estimates and study characteristics were examined graphically with forest plots, but because of high levels of heterogeneity between studies, overall estimates of PTSD prevalence were not discussed. RESULTS The prevalence of PTSD in personnel deployed to Iraq varied between 1.4% and 31%. Stratifying studies by PTSD measure only slightly reduced the variability in prevalence. Anonymous surveys of line infantry units reported higher levels of PTSD compared to studies that are representative of the entire deployed population. UK studies tend to report lower prevalence of PTSD compared with many US studies; however, when comparisons are restricted to studies with random samples, prevalences are similar. US studies that have assessed personnel more than once since return from deployment have shown that PTSD prevalence increases over the 12 months following deployment. CONCLUSIONS Differences in methodologies and samples used should be considered when making comparisons of PTSD prevalence between studies. Further studies based on longitudinal samples are needed to understand how the prevalence of PTSD changes over time.
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Affiliation(s)
- J Sundin
- Academic Centre for Defence Mental Health, Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK.
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Pedersen S, Galatius S, Mogelvang R, Davidsen U, Galloe A, Abildstrom SZ, Abildgaard U, Hansen PR, Bech J, Iversen A, Jorgensen E, Kelbaek H, Saunamaki K, Madsen JK, Jensen JS. Long-Term Prognosis in an ST-Segment Elevation Myocardial Infarction Population Treated With Routine Primary Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2009; 2:392-400. [DOI: 10.1161/circinterventions.108.845636] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [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: 11/16/2022]
Abstract
Background—
We sought to describe the long-term prognosis after routine primary percutaneous coronary intervention (pPCI) in a contemporary consecutive population of patients with presumed ST-segment elevation myocardial infarction, compare it with similar results from the landmark DANAMI-2 trial, and to identify a possible impact of time of presentation and referral pattern.
Methods and Results—
Long-term prognosis in 1019 presumed ST-segment elevation myocardial infarction patients, treated according to modern routine pPCI during the year 2004, was analyzed and compared with similar data from the DANAMI-2 trial. Furthermore, we analyzed the impact of patient presentation to the angioplasty center during “off hours” (4
pm
to 8
am
plus weekends and holidays) and the impact of being referred from noninvasive hospitals. At 3 years, 20.4% in the routinely treated population versus 19.6% in the DANAMI-2 trial reached the combined end point of death, reinfarction, or stroke (
P
=0.68), whereas the all-cause mortality was 13.0% and 13.7%, respectively (
P
=0.65). Patients admitted during off hours had the same risk of reaching the combined end point of death, reinfarction, or stroke compared with patients admitted during office hours (hazards ratio, 1.04; 95% CI, 0.8 to 1.5;
P
=0.81). Door-to-balloon times of less than 90 minutes were achieved in 60% among patients admitted directly to an invasive center but only in 40% among transferred patients (
P
<0.001). Despite this difference, no difference in unadjusted or adjusted long-term prognosis was found between the 2 groups.
Conclusions—
This study shows that ST-segment elevation myocardial infarction patients treated with contemporary routine pPCI achieve a similar long-term prognosis as patients in the landmark randomized pPCI trial (DANAMI-2). Furthermore, the long-term prognosis was the same regardless of whether the pPCI was performed during off hours or office hours. Thus, pPCI including transportation of patients from noninvasive centers can be applied successfully in a real-life population.
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Affiliation(s)
- Sune Pedersen
- From the Department of Cardiology (S.P., S.G., R.M., U.D., A.G., U.A., P.R.H., J.B., A.I., J.K.M., J.S.J.), Gentofte University Hospital, Copenhagen, Cardiovascular Research Unit, Department of Internal Medicine, Copenhagen University Hospital Glostrup, Glostrup (S.Z.A.); and Department of Cardiology (E.J., H.K., K.S.), Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Soren Galatius
- From the Department of Cardiology (S.P., S.G., R.M., U.D., A.G., U.A., P.R.H., J.B., A.I., J.K.M., J.S.J.), Gentofte University Hospital, Copenhagen, Cardiovascular Research Unit, Department of Internal Medicine, Copenhagen University Hospital Glostrup, Glostrup (S.Z.A.); and Department of Cardiology (E.J., H.K., K.S.), Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Rasmus Mogelvang
- From the Department of Cardiology (S.P., S.G., R.M., U.D., A.G., U.A., P.R.H., J.B., A.I., J.K.M., J.S.J.), Gentofte University Hospital, Copenhagen, Cardiovascular Research Unit, Department of Internal Medicine, Copenhagen University Hospital Glostrup, Glostrup (S.Z.A.); and Department of Cardiology (E.J., H.K., K.S.), Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Ulla Davidsen
- From the Department of Cardiology (S.P., S.G., R.M., U.D., A.G., U.A., P.R.H., J.B., A.I., J.K.M., J.S.J.), Gentofte University Hospital, Copenhagen, Cardiovascular Research Unit, Department of Internal Medicine, Copenhagen University Hospital Glostrup, Glostrup (S.Z.A.); and Department of Cardiology (E.J., H.K., K.S.), Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Anders Galloe
- From the Department of Cardiology (S.P., S.G., R.M., U.D., A.G., U.A., P.R.H., J.B., A.I., J.K.M., J.S.J.), Gentofte University Hospital, Copenhagen, Cardiovascular Research Unit, Department of Internal Medicine, Copenhagen University Hospital Glostrup, Glostrup (S.Z.A.); and Department of Cardiology (E.J., H.K., K.S.), Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Steen Z. Abildstrom
- From the Department of Cardiology (S.P., S.G., R.M., U.D., A.G., U.A., P.R.H., J.B., A.I., J.K.M., J.S.J.), Gentofte University Hospital, Copenhagen, Cardiovascular Research Unit, Department of Internal Medicine, Copenhagen University Hospital Glostrup, Glostrup (S.Z.A.); and Department of Cardiology (E.J., H.K., K.S.), Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Ulrik Abildgaard
- From the Department of Cardiology (S.P., S.G., R.M., U.D., A.G., U.A., P.R.H., J.B., A.I., J.K.M., J.S.J.), Gentofte University Hospital, Copenhagen, Cardiovascular Research Unit, Department of Internal Medicine, Copenhagen University Hospital Glostrup, Glostrup (S.Z.A.); and Department of Cardiology (E.J., H.K., K.S.), Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Peter Riis Hansen
- From the Department of Cardiology (S.P., S.G., R.M., U.D., A.G., U.A., P.R.H., J.B., A.I., J.K.M., J.S.J.), Gentofte University Hospital, Copenhagen, Cardiovascular Research Unit, Department of Internal Medicine, Copenhagen University Hospital Glostrup, Glostrup (S.Z.A.); and Department of Cardiology (E.J., H.K., K.S.), Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Jan Bech
- From the Department of Cardiology (S.P., S.G., R.M., U.D., A.G., U.A., P.R.H., J.B., A.I., J.K.M., J.S.J.), Gentofte University Hospital, Copenhagen, Cardiovascular Research Unit, Department of Internal Medicine, Copenhagen University Hospital Glostrup, Glostrup (S.Z.A.); and Department of Cardiology (E.J., H.K., K.S.), Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Allan Iversen
- From the Department of Cardiology (S.P., S.G., R.M., U.D., A.G., U.A., P.R.H., J.B., A.I., J.K.M., J.S.J.), Gentofte University Hospital, Copenhagen, Cardiovascular Research Unit, Department of Internal Medicine, Copenhagen University Hospital Glostrup, Glostrup (S.Z.A.); and Department of Cardiology (E.J., H.K., K.S.), Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Erik Jorgensen
- From the Department of Cardiology (S.P., S.G., R.M., U.D., A.G., U.A., P.R.H., J.B., A.I., J.K.M., J.S.J.), Gentofte University Hospital, Copenhagen, Cardiovascular Research Unit, Department of Internal Medicine, Copenhagen University Hospital Glostrup, Glostrup (S.Z.A.); and Department of Cardiology (E.J., H.K., K.S.), Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Henning Kelbaek
- From the Department of Cardiology (S.P., S.G., R.M., U.D., A.G., U.A., P.R.H., J.B., A.I., J.K.M., J.S.J.), Gentofte University Hospital, Copenhagen, Cardiovascular Research Unit, Department of Internal Medicine, Copenhagen University Hospital Glostrup, Glostrup (S.Z.A.); and Department of Cardiology (E.J., H.K., K.S.), Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Kari Saunamaki
- From the Department of Cardiology (S.P., S.G., R.M., U.D., A.G., U.A., P.R.H., J.B., A.I., J.K.M., J.S.J.), Gentofte University Hospital, Copenhagen, Cardiovascular Research Unit, Department of Internal Medicine, Copenhagen University Hospital Glostrup, Glostrup (S.Z.A.); and Department of Cardiology (E.J., H.K., K.S.), Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Jan Kyst Madsen
- From the Department of Cardiology (S.P., S.G., R.M., U.D., A.G., U.A., P.R.H., J.B., A.I., J.K.M., J.S.J.), Gentofte University Hospital, Copenhagen, Cardiovascular Research Unit, Department of Internal Medicine, Copenhagen University Hospital Glostrup, Glostrup (S.Z.A.); and Department of Cardiology (E.J., H.K., K.S.), Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Jan Skov Jensen
- From the Department of Cardiology (S.P., S.G., R.M., U.D., A.G., U.A., P.R.H., J.B., A.I., J.K.M., J.S.J.), Gentofte University Hospital, Copenhagen, Cardiovascular Research Unit, Department of Internal Medicine, Copenhagen University Hospital Glostrup, Glostrup (S.Z.A.); and Department of Cardiology (E.J., H.K., K.S.), Rigshospitalet University Hospital, Copenhagen, Denmark
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Greenberg N, Thomas SL, Iversen A, Unwin C, Hull L, Wessely S. Do military peacekeepers want to talk about their experiences? Perceived psychological support of UK military peacekeepers on return from deployment. J Ment Health 2009. [DOI: 10.1080/09638230310001627928] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Iversen A, Jensen JS, Scharling H, Schnohr P. Hypercholesterolaemia and risk of coronary heart disease in the elderly: impact of age: the Copenhagen City Heart Study. Eur J Intern Med 2009; 20:139-44. [PMID: 19327601 DOI: 10.1016/j.ejim.2008.06.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [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] [Received: 12/04/2007] [Revised: 05/08/2008] [Accepted: 06/09/2008] [Indexed: 11/17/2022]
Abstract
BACKGROUND Population and interventional studies have shown that high plasma-cholesterol is a risk factor of coronary heart disease (CHD). However, in most of the studies elderly people were excluded. AIM This paper assesses whether the effect of total plasma-cholesterol on the risk of incident CHD decreases with age in a healthy population. METHODS Within the Copenhagen City Heart Study in 1981-1983, 4647 men and 5829 women, aged 40-93 years, underwent a cardiovascular health examination including measurement of plasma-cholesterol. The cohort was followed with respect to incident CHD until 1994, i.e. before statins were introduced in Denmark. RESULTS In people below 60 years of age plasma-cholesterol levels on 5-6; 6-8; and >8 mmol/L were associated with relative risks of CHD on 2.0 (95% confidence interval (CI) 1.2-3.2, P=0.004); 3.1 (CI 2.0-5.0, P<0.001); and 5.1 (CI 2.8-9.3, P<0.001), respectively (reference group: plasma-cholesterol <5 mmol/L). In people aged 60-70 years a plasma-cholesterol level on 5-6 mmol/L was not associated with increased risk, whereas plasma-cholesterol on 6-8 mmol/L and >8 mmol/L was associated with relative risks on 1.3 (CI 1.0-1.8, P=0.03), and 2.3 (CI 1.6-3.4, P<0.001), respectively. In people aged 70-80 years only plasma-cholesterol >8 mmol/L conferred increased relative risk on 1.6 (CI 1.2-2.4, P=0.007). In people above 80 years of age increased plasma-cholesterol was not associated with increased risk of incident CHD. CONCLUSION The risk of incident CHD associated with high plasma-cholesterol declines with age. This finding should be considered in future recommendations of plasma-cholesterol levels in elderly people without atherosclerotic cardiovascular disease.
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Affiliation(s)
- Allan Iversen
- The Copenhagen City Heart Study, Bispebjerg University Hospital, Denmark.
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Abstract
For the majority service in the Armed Forces is beneficial and, in the main, military veterans have successful lives. However, a minority have a bleaker outlook as a result of on-going ill health and social exclusion. Whilst the media focuses on Post Traumatic Stress Disorder, in reality the most frequent mental health problems for veterans are alcohol problems, depression and anxiety disorders. These difficulties are difficult to manage as veterans, particularly those who are unwell, demonstrate a reticence to seek help for mental health problems. Another issue is that many veterans are now reserve personnel who have been found to be at greater risk of developing mental health problems than their regular counterparts. Steps to improve the knowledge and expertise of primary care services about veteran's mental health issues and increasing the availability of treatment options are important and are underway.
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Affiliation(s)
- D Murphy
- King's Centre for Military Health Research, King's College London
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Browne T, Iversen A, Hull L, Workman L, Barker C, Horn O, Jones M, Murphy D, Greenberg N, Rona R, Hotopf M, Wessely S, Fear NT. How do experiences in Iraq affect alcohol use among male UK armed forces personnel? Occup Environ Med 2008; 65:628-33. [DOI: 10.1136/oem.2007.036830] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Cassell JA, Leach M, Poltorak MS, Mercer CH, Iversen A, Fairhead JR. Is the cultural context of MMR rejection a key to an effective public health discourse? Public Health 2006; 120:783-94. [PMID: 16828492 DOI: 10.1016/j.puhe.2006.03.011] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [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: 08/09/2005] [Revised: 02/04/2006] [Accepted: 03/02/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES (1) To explore the social and cultural influences, and health beliefs associated with low uptake of MMR (measles, mumps and rubella vaccine). (2) To describe and explore the prevalence of health beliefs associated with non-compliance with MMR, with a view to improving the personal relevance and impact of information for parents, in the context of persisting low uptake following public controversy. METHODS We undertook a survey of mothers' experiences of and attitudes to the MMR, developed through ethnographic study, which was linked to maternal and child information on the Child Health Database in Brighton, England. RESULTS Mothers interpret MMR risk through concepts of child health embedded in family health history, with a majority both of compliers and non-compliers holding that each child's immune system is unique. Cultural 'risk factors' for non-compliance relate strongly to the use of complementary healthcare, such as homeopathy, with evidence that rejection of vitamin K is associated with MMR non-compliance. Forty per cent, both of compliers and non-compliers, did not consider the possible benefits to other children of MMR. CONCLUSIONS These findings have paradoxical and challenging consequences for the promotion of immunization in the policy context of increasing emphasis on healthy choices. They demonstrate the need for immunization information that acknowledges and addresses lay concepts of immunity.
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Affiliation(s)
- J A Cassell
- Department of Primary Care and Population Sciences, Royal Free and University College Medical School, Rowland Hill Street, London NW2 2PF, UK.
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