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Young J, Lyngbakken MN, Hveem K, Røsjø H, Omland T. Systolic Blood Pressure, Diastolic Blood Pressure and Pulse Pressure and the Risk of Subclinical Myocardial Injury: The HUNT Study. J Am Heart Assoc 2024:e031107. [PMID: 38639374 DOI: 10.1161/jaha.123.031107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 03/07/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Subclinical myocardial injury expressed as higher cardiac troponin concentrations may represent an important intermediary between hypertension and the risk of cardiovascular disease. The study aimed to assess the relative strength of associations between systolic blood pressure (BP), diastolic BP, and pulse pressure, and subclinical myocardial injury, and how change in BP variables over time associates with subclinical myocardial injury. METHODS AND RESULTS cTnl (cardiac troponin I) was measured in 32 968 participants of the fourth wave of the population-based cohort HUNT4 (Trøndelag Health Study) without a history of cardiovascular disease. An additional longitudinal analysis included participants from HUNT4 with BP measurements from HUNT3 (n=18 681). Associations between BP variables and cTnI concentrations were assessed by linear and logistic regression analyses. The median cTnI concentration was 1.6 ng/L (25th-75th percentiles, 0.6-3.1 ng/L), median age was 52 years (39.1-65.6 years), and 57% were female subjects. Cross-sectionally, only systolic BP categories ≥130 mm Hg associated with higher cTnI concentrations, compared with a reference systolic BP of <110 mm Hg. All categories of diastolic BP and pulse pressure were positively associated with higher cTnI concentrations when diastolic BP 70 to 79 mm Hg and pulse pressure <40 mm Hg were used as references, respectively. When comparing systolic BP, diastolic BP, and pulse pressure as continuous variables, cross-sectionally, pulse pressure most strongly associated with cTnI concentrations (P for all comparisons <0.001), whereas longitudinally, change in diastolic BP was most strongly associated with cTnI concentrations (P for all comparisons <0.05). CONCLUSIONS Subjects with high pulse pressure and longitudinal increase in diastolic BP are at higher risk for subclinical myocardial injury.
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Affiliation(s)
- Juliet Young
- K. G. Jebsen Center for Cardiac Biomarkers Institute of Clinical Medicine, University of Oslo Oslo Norway
| | - Magnus Nakrem Lyngbakken
- K. G. Jebsen Center for Cardiac Biomarkers Institute of Clinical Medicine, University of Oslo Oslo Norway
- Department of Cardiology Akershus University Hospital Lørenskog Norway
| | - Kristian Hveem
- HUNT Research Centre, Department of Public Health and General Practice Norwegian University of Science and Technology Levanger Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust Levanger Norway
| | - Helge Røsjø
- K. G. Jebsen Center for Cardiac Biomarkers Institute of Clinical Medicine, University of Oslo Oslo Norway
- Division of Research and Innovation Akershus University Hospital Lørenskog Norway
| | - Torbjørn Omland
- K. G. Jebsen Center for Cardiac Biomarkers Institute of Clinical Medicine, University of Oslo Oslo Norway
- Department of Cardiology Akershus University Hospital Lørenskog Norway
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Aakre KM, Lyngbakken MN, Faaren AL, Røsjø H, Dalen H, Omland T. Reference intervals of circulating secretoneurin concentrations determined in a large cohort of community dwellers: the HUNT study. Clin Chem Lab Med 2024; 0:cclm-2024-0154. [PMID: 38564801 DOI: 10.1515/cclm-2024-0154] [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: 01/31/2024] [Accepted: 03/07/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES Secretoneurin (SN) is a novel cardiac biomarker that associates with the risk of mortality and dysfunctional cardiomyocyte Ca2+ handling in heart failure patients. Reference intervals for SN are unknown. METHODS SN was measured with a CE-marked ELISA in healthy community dwellers from the fourth wave of the Trøndelag Health Study (HUNT4) conducted in 2017-2019. The common, sex and age specific 90th, 95th, 97.5th and 99th percentiles were calculated using the non-parametric method and outlier exclusion according to the Reed test. The applicability of sex and age specific reference intervals were investigated using Harris and Boyd test. We also estimated the percentiles in a subset with normal findings on echocardiographic screening. RESULTS The total cohort included 887 persons (56.4 % women). After echocardiographic screening 122 persons were excluded, leaving a total of 765 persons (57.8 % women). The 97.5th percentile (95 % CI in brackets) of SN was 59.7 (57.5-62.1) pmol/L in the total population and 58.6 (57.1-62.1) pmol/L after echocardiography screening. In general, slightly higher percentiles were found in women and elderly participants, but less than 4 % in these subgroups had concentrations deviating from the common 97.5th percentile. Low BMI or eGFR was also associated with higher concentrations of SN. CONCLUSIONS Upper reference limits for SN were similar amongst healthy adult community dwellers regardless of prescreening including cardiac echocardiography or not. Women and elderly showed higher concentrations of SN, but the differences were not sufficiently large to justify age and sex stratified upper reference limits.
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Affiliation(s)
- Kristin M Aakre
- Department of Medical Biochemistry and Pharmacology, 60498 Haukeland University Hospital , Bergen, Norway
- Department of Heart Disease, 60498 Haukeland University Hospital , Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Magnus N Lyngbakken
- Department of Cardiology, Division of Medicine, 60483 Akershus University Hospital , Lørenskog, Norway
- K.G. Jebsen Centre for Cardiac Biomarkers, 60504 Institute of Clinical Medicine, University of Oslo , Oslo, Norway
| | | | - Helge Røsjø
- K.G. Jebsen Centre for Cardiac Biomarkers, 60504 Institute of Clinical Medicine, University of Oslo , Oslo, Norway
- Akershus Clinical Research Center (ACR), Division of Research and Innovation, 60483 Akershus University Hospital , Lørenskog, Norway
| | - Håvard Dalen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Cardiology, St Olav's University Hospital, Trondheim, Norway
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Torbjørn Omland
- Department of Cardiology, Division of Medicine, 60483 Akershus University Hospital , Lørenskog, Norway
- K.G. Jebsen Centre for Cardiac Biomarkers, 60504 Institute of Clinical Medicine, University of Oslo , Oslo, Norway
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Axfors C, Schmitt AM, Janiaud P, Van't Hooft J, Abd-Elsalam S, Abdo EF, Abella BS, Akram J, Amaravadi RK, Angus DC, Arabi YM, Azhar S, Baden LR, Baker AW, Belkhir L, Benfield T, Berrevoets MAH, Chen CP, Chen TC, Cheng SH, Cheng CY, Chung WS, Cohen YZ, Cowan LN, Dalgard O, de Almeida E Val FF, de Lacerda MVG, de Melo GC, Derde L, Dubee V, Elfakir A, Gordon AC, Hernandez-Cardenas CM, Hills T, Hoepelman AIM, Huang YW, Igau B, Jin R, Jurado-Camacho F, Khan KS, Kremsner PG, Kreuels B, Kuo CY, Le T, Lin YC, Lin WP, Lin TH, Lyngbakken MN, McArthur C, McVerry BJ, Meza-Meneses P, Monteiro WM, Morpeth SC, Mourad A, Mulligan MJ, Murthy S, Naggie S, Narayanasamy S, Nichol A, Novack LA, O'Brien SM, Okeke NL, Perez L, Perez-Padilla R, Perrin L, Remigio-Luna A, Rivera-Martinez NE, Rockhold FW, Rodriguez-Llamazares S, Rolfe R, Rosa R, Røsjø H, Sampaio VS, Seto TB, Shahzad M, Soliman S, Stout JE, Thirion-Romero I, Troxel AB, Tseng TY, Turner NA, Ulrich RJ, Walsh SR, Webb SA, Weehuizen JM, Velinova M, Wong HL, Wrenn R, Zampieri FG, Zhong W, Moher D, Goodman SN, Ioannidis JPA, Hemkens LG. Author Correction: Mortality outcomes with hydroxychloroquine and chloroquine in COVID-19 from an international collaborative meta-analysis of randomized trials. Nat Commun 2024; 15:1075. [PMID: 38316844 PMCID: PMC10844287 DOI: 10.1038/s41467-024-45360-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Affiliation(s)
- Cathrine Axfors
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
- Department for Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Andreas M Schmitt
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Medical Oncology, University of Basel, Basel, Switzerland
| | - Perrine Janiaud
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Janneke Van't Hooft
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
- Amsterdam University Medical Center, Amsterdam University, Amsterdam, the Netherlands
| | - Sherief Abd-Elsalam
- Tropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ehab F Abdo
- Tropical Medicine and Gastroenterology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Benjamin S Abella
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Javed Akram
- Department of Internal Medicine, Vice Chancellor, University of Health Sciences, Lahore, Punjab, Pakistan
| | - Ravi K Amaravadi
- Abramson Cancer Center and Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Derek C Angus
- Department of Critical Care Medicine, The Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, University of Pittsburgh, Pittsburgh, PA, USA
- the UPMC Health System Office of Healthcare Innovation, University of Pittsburgh Medical Centre, Pittsburgh, PA, USA
| | - Yaseen M Arabi
- Intensive Care Department, King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Shehnoor Azhar
- Department of Public Health, University of Health Sciences, Lahore, Punjab, Pakistan
| | - Lindsey R Baden
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA
| | - Arthur W Baker
- Department of Medicine, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA
| | - Leila Belkhir
- Infectious Diseases Department, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Thomas Benfield
- Center of Research & Disruption of Infectious Diseases, Department of Infectious Diseases, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | - Marvin A H Berrevoets
- Department of Internal Medicine, Elisabeth-Tweesteden hospital, Tilburg, Netherlands
| | - Cheng-Pin Chen
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Tsung-Chia Chen
- Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Shu-Hsing Cheng
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Chien-Yu Cheng
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Wei-Sheng Chung
- Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | | | | | - Olav Dalgard
- Department of Infectious Diseases, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Marcus V G de Lacerda
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil
- Instituto Leonidas e Maria Deane - ILMD, FIOCRUZ-AM, Manaus, AM, Brazil
| | - Gisely C de Melo
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil
- Universidade do Estado do Amazonas, Manaus, AM, Brazil
| | - Lennie Derde
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
- Intensive Care Centre, University Medical Center Utrecht, Utrecht, Netherlands
| | - Vincent Dubee
- Infectious and Tropical Diseases Department, Angers University Hospital, Angers, France
| | | | - Anthony C Gordon
- Department of Surgery and Cancer, Anaesthetics, Pain Medicine, and Intensive Care Medicine, Imperial College London and Imperial College Healthcare NHS Trust, London, UK
| | - Carmen M Hernandez-Cardenas
- Critical Care Department, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Ciudad de México, Mexico
| | - Thomas Hills
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Auckland City Hospital, Auckland, New Zealand
| | - Andy I M Hoepelman
- Department of Infectious Diseases, University Medical Center Utrecht, Utrecht, Netherlands
| | - Yi-Wen Huang
- Department of Internal Medicine, Chang Hua Hospital, Ministry of Health and Welfare, Changhua, Taiwan
| | | | - Ronghua Jin
- Beijing Youan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Felipe Jurado-Camacho
- Critical Care Department, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Ciudad de México, Mexico
| | - Khalid S Khan
- Department of Preventive Medicine & Public Health, University of Granada, Hospital Real, Avenida del Hospicio, Granada, Granada, Spain
| | - Peter G Kremsner
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- German Center for Infection Research, Partner Site Tübingen, Tübingen, Germany
| | - Benno Kreuels
- Department of Medicine, Division of Tropical Medicine and Division of Infectious Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Cheng-Yu Kuo
- Department of Internal Medicine, Pingtung Hospital, Ministry of Health and Welfare, Pingtung, Taiwan
| | - Thuy Le
- Department of Medicine, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA
| | - Yi-Chun Lin
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Wu-Pu Lin
- Department of Internal Medicine, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Tse-Hung Lin
- Department of Internal Medicine, Chang Hua Hospital, Ministry of Health and Welfare, Changhua, Taiwan
| | - Magnus Nakrem Lyngbakken
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Colin McArthur
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Auckland City Hospital, Auckland, New Zealand
- School of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Bryan J McVerry
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Wuelton M Monteiro
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil
- Universidade do Estado do Amazonas, Manaus, AM, Brazil
| | | | - Ahmad Mourad
- Department of Medicine, Duke University Medical Center, Durham, NC, 27710, USA
| | - Mark J Mulligan
- Department of Microbiology, NYU Grossman School of Medicine, New York, NY, USA
- Department of Internal Medicine, Division of Infectious Diseases and Immunology, NYU Grossman School of Medicine, New York, NY, USA
| | - Srinivas Murthy
- University of British Columbia School of Medicine, Vancouver, BC, Canada
| | - Susanna Naggie
- Department of Medicine, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA
| | - Shanti Narayanasamy
- Department of Medicine, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA
| | - Alistair Nichol
- School of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
- Department of Intensive Care, Alfred Health, Melbourne, VIC, Australia
- Department of Anesthesia and Intensive Care, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - Lewis A Novack
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sean M O'Brien
- Department of Biostatistics and Bioinformatics, Duke University Medical Center and Duke Clinical Research Institute, Durham, NC, USA
| | - Nwora Lance Okeke
- Department of Medicine, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA
| | | | - Rogelio Perez-Padilla
- Department of Smoking and COPD, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Ciudad de México, Mexico
| | | | - Arantxa Remigio-Luna
- Department of Smoking and COPD, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Ciudad de México, Mexico
| | | | - Frank W Rockhold
- Department of Biostatistics and Bioinformatics, Duke University Medical Center and Duke Clinical Research Institute, Durham, NC, USA
| | - Sebastian Rodriguez-Llamazares
- Department of Smoking and COPD, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Ciudad de México, Mexico
| | - Robert Rolfe
- Department of Medicine, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA
| | | | - Helge Røsjø
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway
| | - Vanderson S Sampaio
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil
- Fundação de Vigilância em Saúde do Amazonas, Manaus, AM, Brazil
| | - Todd B Seto
- University of Hawaii John A. Burns School of Medicine, Honolulu, HI, USA
- The Queen's Medical Center, Honolulu, HI, USA
| | - Muhammad Shahzad
- Department of Pharmacology, University of Health Sciences, Lahore, Punjab, Pakistan
| | - Shaimaa Soliman
- Public Health and Community Medicine, Menoufia University, Menoufia, Egypt
| | - Jason E Stout
- Department of Medicine, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA
| | - Ireri Thirion-Romero
- Department of Smoking and COPD, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Ciudad de México, Mexico
| | - Andrea B Troxel
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Ting-Yu Tseng
- Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Nicholas A Turner
- Department of Medicine, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA
| | - Robert J Ulrich
- Department of Medicine, Division of Infectious Diseases and Immunology, NYU Grossman School of Medicine, New York, NY, USA
| | - Stephen R Walsh
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA
| | - Steve A Webb
- School of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
- St. John of God Hospital, Subiaco, WA, Australia
| | - Jesper M Weehuizen
- Department of Infectious Diseases, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Hon-Lai Wong
- Department of Internal Medicine, Keelung Hospital, Ministry of Health and Welfare, Keelung, Taiwan
| | - Rebekah Wrenn
- Department of Medicine, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA
| | - Fernando G Zampieri
- Research Institute, HCor-Hospital do Coração, São Paulo, Brazil
- Research Institute, BRICNet-Brazilian Research in Intensive Care Network, São Paulo, Brazil
- IDor Research Institute, São Paulo, Brazil
| | - Wu Zhong
- National Engineering Research Center for the Emergency Drug, Beijing Institute of Pharmacology and Toxicology, Beijing, People's Republic of China
| | - David Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Steven N Goodman
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
- Stanford University School of Medicine, Stanford, CA, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - John P A Ioannidis
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
- Stanford University School of Medicine, Stanford, CA, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA, USA
- Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany
| | - Lars G Hemkens
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA.
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.
- Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany.
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Mecinaj A, Gulati G, Ree AH, Gravdehaug B, Røsjø H, Steine K, Wisløff T, Geisler J, Omland T, Heck SL. Impact of the ESC Cardio-Oncology Guidelines Biomarker Criteria on Incidence of Cancer Therapy-Related Cardiac Dysfunction. JACC CardioOncol 2024; 6:83-95. [PMID: 38510299 PMCID: PMC10950440 DOI: 10.1016/j.jaccao.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 10/12/2023] [Accepted: 10/31/2023] [Indexed: 03/22/2024] Open
Abstract
Background The impact of recent consensus definitions of cancer therapy-related cardiac dysfunction (CTRCD) from the European Society of Cardiology cardio-oncology guidelines on the reported incidence of CTRCD has not yet been assessed. Objectives The aim of this study was to assess the: 1) cumulative incidence; 2) point prevalence during and after adjuvant therapy; and 3) prognostic value of CTRCD as defined by different asymptomatic CTRCD guideline criteria. Methods The cumulative incidence and point prevalence of CTRCD were retrospectively assessed in 118 patients participating in the PRADA (Prevention of Cardiac Dysfunction During Adjuvant Breast Cancer Therapy) trial. Asymptomatic CTRCD was assessed using alternative cardiac troponin (cTn) 99th percentile upper reference limits (URLs) to define cTnT and cTnI elevation. Results The cumulative incidence of moderate or severe CTRCD was low (1.7%), whereas the cumulative incidence of mild asymptomatic CTRCD was higher and differed markedly according to the biomarker criteria applied, ranging from 49.2% of patients when cTnT greater than the sex-specific 99th percentile URL was used to define cTn elevation to 9.3% when sex-neutral cTnI was used. The point prevalence of CTRCD was highest at the end of anthracycline therapy (47.8%) and was driven primarily by asymptomatic cTn elevation. CTRCD during adjuvant therapy was not prognostic for CTRCD at extended follow-up of 24 months (Q1-Q3: 21-29 months) after randomization. Conclusions Mild asymptomatic CTRCD during adjuvant breast cancer therapy was frequent and driven mainly by cTn elevation and was not prognostic of subsequent CTRCD. The incidence of mild, asymptomatic CTRCD differed markedly depending on the cTn assay and whether sex-neutral or sex-dependent URLs were applied. (Prevention of Cardiac Dysfunction During Adjuvant Breast Cancer Therapy [PRADA]; NCT01434134).
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Affiliation(s)
- Albulena Mecinaj
- K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Geeta Gulati
- K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Division of Medicine, Oslo University Hospital, Ullevål, Oslo, Norway
- Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway
| | - Anne Hansen Ree
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Oncology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Berit Gravdehaug
- Department of Breast and Endocrine Surgery, Division of Surgery, Akershus University Hospital, Lørenskog, Norway
| | - Helge Røsjø
- K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway
| | - Kjetil Steine
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Torbjørn Wisløff
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Health Service Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Jürgen Geisler
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Oncology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Torbjørn Omland
- K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Siri Lagethon Heck
- K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Diagnostic Imaging, Akershus University Hospital, Lørenskog, Norway
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Sourour N, Riveland E, Omland T, Kjekshus H, Larsen AI, Røsjø H, Myhre PL. Re: Detailed association between B-type natriuretic peptide levels and ventricular tachyarrhythmia. Clin Cardiol 2023; 46:1604-1605. [PMID: 37872822 PMCID: PMC10716318 DOI: 10.1002/clc.24145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 10/25/2023] Open
Affiliation(s)
- Nur Sourour
- Department of Cardiology, Division of MedicineAkershus University HospitalLørenskogNorway
- K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Egil Riveland
- Department of CardiologyStavanger University HospitalStavangerNorway
- Institute of Clinical SciencesUniversity of BergenBergenNorway
| | - Torbjørn Omland
- Department of Cardiology, Division of MedicineAkershus University HospitalLørenskogNorway
- K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Harald Kjekshus
- Department of Cardiology, Division of MedicineAkershus University HospitalLørenskogNorway
| | - Alf Inge Larsen
- Department of CardiologyStavanger University HospitalStavangerNorway
- Institute of Clinical SciencesUniversity of BergenBergenNorway
| | - Helge Røsjø
- K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical MedicineUniversity of OsloOsloNorway
- Division for Research and InnovationAkershus University HospitalLørenskogNorway
| | - Peder Langeland Myhre
- Department of Cardiology, Division of MedicineAkershus University HospitalLørenskogNorway
- K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical MedicineUniversity of OsloOsloNorway
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Ihle‐Hansen H, Vigen T, Berge T, Walle‐Hansen MM, Hagberg G, Ihle‐Hansen H, Thommessen B, Ariansen I, Røsjø H, Rønning OM, Tveit A, Lyngbakken M. Carotid Plaque Score for Stroke and Cardiovascular Risk Prediction in a Middle-Aged Cohort From the General Population. J Am Heart Assoc 2023; 12:e030739. [PMID: 37609981 PMCID: PMC10547315 DOI: 10.1161/jaha.123.030739] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/28/2023] [Accepted: 07/27/2023] [Indexed: 08/24/2023]
Abstract
Background We aimed to explore the predictive value of the carotid plaque score, compared with the Systematic Coronary Risk Evaluation 2 (SCORE2) risk prediction algorithm, on incident ischemic stroke and major adverse cardiovascular events and establish a prognostic cutoff of the carotid plaque score. Methods and Results In the prospective ACE 1950 (Akershus Cardiac Examination 1950 study), carotid plaque score was calculated with ultrasonography at inclusion in 2012 to 2015. The largest plaque diameter in each extracranial segment of the carotid artery on both sides was scored from 0 to 3 points. The sum of points in all segments provided the carotid plaque score. The cohort was followed up by linkage to national registries for incident ischemic stroke and major adverse cardiovascular events (nonfatal ischemic stroke, nonfatal myocardial infarction, and cardiovascular death) throughout 2020. Carotid plaque score was available in 3650 (98.5%) participants, with mean±SD age of 63.9±0.64 years at inclusion. Only 462 (12.7%) participants were free of plaque, and and 970 (26.6%) had a carotid plaque score of >3. Carotid plaque score predicted ischemic stroke (hazard ratio [HR], 1.25 [95% CI, 1.15-1.36]) and major adverse cardiovascular events (HR, 1.21 [95% CI, 1.14-1.27]) after adjustment for SCORE2 and provided strong incremental prognostic information to SCORE2. The best cutoff value of carotid plaque score for ischemic stroke was >3, with positive predictive value of 2.5% and negative predictive value of 99.3%. Conclusions The carotid plaque score is a strong predictor of ischemic stroke and major adverse cardiovascular events, and it provides incremental prognostic information to SCORE2 for risk prediction. A cutoff score of >3 seems to be suitable to discriminate high-risk subjects. Registration Information clinicaltrials.gov. Identifier: NCT01555411.
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Affiliation(s)
- Håkon Ihle‐Hansen
- Department of Medical ResearchBærum Hospital, Vestre Viken Hospital TrustGjettumNorway
| | - Thea Vigen
- Division of Medicine, Department of NeurologyAkershus University HospitalLørenskogNorway
| | - Trygve Berge
- Department of Medical ResearchBærum Hospital, Vestre Viken Hospital TrustGjettumNorway
| | - Marte M. Walle‐Hansen
- Department of Medical ResearchBærum Hospital, Vestre Viken Hospital TrustGjettumNorway
| | - Guri Hagberg
- Department of Medical ResearchBærum Hospital, Vestre Viken Hospital TrustGjettumNorway
- Stroke Unit, Department of NeurologyOslo University HospitalOsloNorway
| | - Hege Ihle‐Hansen
- Department of Medical ResearchBærum Hospital, Vestre Viken Hospital TrustGjettumNorway
- Stroke Unit, Department of NeurologyOslo University HospitalOsloNorway
| | - Bente Thommessen
- Division of Medicine, Department of NeurologyAkershus University HospitalLørenskogNorway
| | - Inger Ariansen
- Department of Chronic DiseasesNorwegian Institute of Public HealthOsloNorway
| | - Helge Røsjø
- K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway
- Division of Research and InnovationAkershus University HospitalLørenskogNorway
| | - Ole Morten Rønning
- Division of Medicine, Department of NeurologyAkershus University HospitalLørenskogNorway
- Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway
| | - Arnljot Tveit
- Department of Medical ResearchBærum Hospital, Vestre Viken Hospital TrustGjettumNorway
- Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway
| | - Magnus Lyngbakken
- K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway
- Division of Medicine, Department of CardiologyAkershus University HospitalLørenskogNorway
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7
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Lyngbakken MN, Kimenai DM, Hveem K, Dalen H, Røsjø H, Omland T. Patterns of Cardiac Troponin I Concentrations as Risk Predictors of Cardiovascular Disease and Death: The Trøndelag Health Study. Am J Med 2023; 136:902-909.e4. [PMID: 37225115 DOI: 10.1016/j.amjmed.2023.05.009] [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: 03/24/2023] [Revised: 04/28/2023] [Accepted: 05/15/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Concentrations of cardiac troponin predict risk of cardiovascular disease and death in the general population. There is limited evidence on changing patterns of cardiac troponin in the years preceding cardiovascular events. METHODS We analyzed cardiac troponin I (cTnI) with a high-sensitivity assay in 3272 participants in the Trøndelag Health (HUNT) Study at study visit 4 (2017-2019). Of these, 3198 had measurement of cTnI at study visit 2 (1995-1997), 2661 at study visit 3, and 2587 at all 3 study visits. We assessed the trajectories of cTnI concentrations in the years prior to cardiovascular events using a generalized linear mixed model, with adjustment for age, sex, cardiovascular risk factors, and comorbidities. RESULTS At HUNT4 baseline, median age was 64.8 (range 39.4-101.3) years, and 55% were women. Study participants who were admitted because of heart failure or died from cardiovascular cause on follow-up had a steeper increase in cTnI compared with study participants with no events (P < .001). The average yearly change in cTnI was 0.235 (95% confidence interval, 0.192-0.289) ng/L for study participants with heart failure or cardiovascular death, and -0.022 (95% confidence interval, -0.022 to -0.023) ng/L for study participants with no events. Study participants who experienced myocardial infarction, ischemic stroke, or noncardiovascular mortality exhibited similar cTnI patterns. CONCLUSIONS Fatal and nonfatal cardiovascular events are preceded by slowly increasing concentrations of cardiac troponin, independently of established cardiovascular risk factors. Our results support the use of cTnI measurements to identify at-risk subjects who progress to subclinical and later overt cardiovascular disease.
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Affiliation(s)
- Magnus Nakrem Lyngbakken
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway; K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway.
| | - Dorien M Kimenai
- BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom
| | - Kristian Hveem
- HUNT Research Centre, Department of Public Health and General Practice, Norwegian University of Science and Technology, Levanger, Norway; Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Håvard Dalen
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway
| | - Helge Røsjø
- K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway; Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway
| | - Torbjørn Omland
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway; K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
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8
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Bhatnagar R, Berge K, Røysland R, Høiseth AD, Brynildsen J, Christensen G, Omland T, Røsjø H, Lyngbakken MN. Cardiac Troponin T and NT-proBNP for Prediction of 30-Day Readmission or Death in Patients with Acute Dyspnea: Data from the Akershus Cardiac Examination 2 Study. Cardiology 2023; 148:506-516. [PMID: 37544298 PMCID: PMC10733942 DOI: 10.1159/000533266] [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: 02/10/2023] [Accepted: 07/24/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION N-terminal pro-B-type natriuretic peptide (NT-proBNP) and cardiac troponin T (cTnT) measurements are recommended in patients with acute dyspnea. We aimed to assess the prognostic merit of cTnT compared to NT-proBNP for 30-day readmission or death in patients hospitalized with acute dyspnea. METHODS We measured cTnT and NT-proBNP within 24 h in 314 patients hospitalized with acute dyspnea and adjudicated the cause of the index admission. Time to first event of readmission or death ≤30 days after hospital discharge was recorded, and cTnT and NT-proBNP measurements were compared head-to-head. RESULTS Patients who died (12/314) or were readmitted (71/314) within 30 days had higher cTnT concentrations (median: 32.6, Q1-Q3: 18.4-74.2 ng/L vs. median: 19.4, Q1-Q3: 8.4-36.1 ng/L; p for comparison <0.001) and NT-proBNP concentrations (median: 1,753.6, Q1-Q3: 464.2-6,862.0 ng/L vs. median 984, Q1-Q3 201-3,600 ng/L; for comparison p = 0.027) compared to patients who survived and were not readmitted. cTnT concentrations were associated with readmission or death within 30 days after discharge both in the total cohort (adjusted hazard ratio [aHR]: 1.64, 95% confidence interval [CI]: 1.30-2.05) and in patients with heart failure (HF) (aHR: 1.58, 95% CI: 1.14-2.18). In contrast, NT-proBNP concentrations were not associated with short-term events, neither in the total cohort (aHR: 1.10, 95% CI: 0.94-1.30) nor in patients with adjudicated HF (aHR: 1.06, 95% CI: 0.80-1.40). CONCLUSION cTnT concentrations are associated with 30-day readmission or death in patients hospitalized with acute dyspnea, as well as in patients adjudicated HF.
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Affiliation(s)
- Rahul Bhatnagar
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway,
- K.G. Jebsen Center for Cardiac Biomarkers, University of Oslo, Oslo, Norway,
| | - Kristian Berge
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- K.G. Jebsen Center for Cardiac Biomarkers, University of Oslo, Oslo, Norway
| | - Ragnhild Røysland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division for Diagnostics and Technology, Akershus University Hospital, Lørenskog, Norway
| | - Arne Didrik Høiseth
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Jon Brynildsen
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Geir Christensen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Torbjørn Omland
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- K.G. Jebsen Center for Cardiac Biomarkers, University of Oslo, Oslo, Norway
| | - Helge Røsjø
- K.G. Jebsen Center for Cardiac Biomarkers, University of Oslo, Oslo, Norway
- Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway
| | - Magnus Nakrem Lyngbakken
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- K.G. Jebsen Center for Cardiac Biomarkers, University of Oslo, Oslo, Norway
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9
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Sourour N, Riveland E, Næsgaard P, Kjekshus H, Larsen AI, Omland T, Røsjø H, Myhre PL. N-terminal pro-B-type natriuretic peptide for prediction of ventricular arrhythmias: Data from the SMASH study. Clin Cardiol 2023; 46:989-996. [PMID: 37400982 PMCID: PMC10436794 DOI: 10.1002/clc.24074] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 11/15/2022] [Accepted: 06/09/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations predict heart failure (HF) and mortality, but whether NT-proBNP predicts ventricular arrhythmias (VA) is not clear. HYPOTHESIS We hypothesize that high NT-proBNP concentrations associate with the risk of incident VA, defined as adjudicated ventricular fibrillation or sustained ventricular tachycardia. METHODS In a prospective, observational study of patients treated with implantable cardioverter defibrillator (ICD), we analyzed NT-proBNP concentrations at baseline and after mean 1.4 years in association to incident VA. RESULTS We included 490 patients (age 66 ± 12 years, 83% men) out of whom 51% had a primary prevention ICD indication. The median NT-proBNP concentration was 567 (25-75 percentile 203-1480) ng/L and patients with higher concentrations were older with more HF and ICD for primary prevention. During mean 3.1 ± 0.7 years, 137 patients (28%) had ≥1 VA. Baseline NT-proBNP concentrations were associated with the risk of incident VA (hazard ratio [HR]: 1.39, 95% confidence interval [95% CI]: 1.22-1.58, p < .001), HF hospitalizations (HR: 3.11, 95% CI: 2.53-3.82, p < .001), and all-cause mortality (HR: 2.49, 95% CI: 2.04-3.03, p < .001), which persisted after adjusting for age, sex, body mass index, coronary artery disease, HF, renal function, and left ventricular ejection fraction. The association with VA was stronger in secondary versus primary prevention ICD indication: HR: 1.59 (95% CI: 1.34-1.88 C-statistics 0.71) versus HR: 1.24, 95% CI: 1.02-1.51, C-statistics 0.55), p-for-interaction = 0.06. Changes in NT-proBNP during the first 1.4 years did not associate with subsequent VA. CONCLUSIONS NT-proBNP concentrations are associated with the risk of incident VA after adjustment for established risk factors, with the strongest association in patients with a secondary prevention ICD indication.
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Affiliation(s)
- N. Sourour
- Department of Cardiology, Division of MedicineAkershus University HospitalLørenskogNorway
- K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical MedicineOsloNorway
| | - E. Riveland
- Department of CardiologyStavanger University HospitalStavangerNorway
- Institute of Clinical SciencesUniversity of BergenBergenNorway
| | - P. Næsgaard
- Department of CardiologyStavanger University HospitalStavangerNorway
| | - H. Kjekshus
- Department of Cardiology, Division of MedicineAkershus University HospitalLørenskogNorway
| | - A. I. Larsen
- Department of CardiologyStavanger University HospitalStavangerNorway
- Institute of Clinical SciencesUniversity of BergenBergenNorway
| | - T. Omland
- Department of Cardiology, Division of MedicineAkershus University HospitalLørenskogNorway
- K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical MedicineOsloNorway
| | - H. Røsjø
- K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical MedicineOsloNorway
- Division for Research and InnovationAkershus University HospitalLørenskogNorway
| | - P. L. Myhre
- Department of Cardiology, Division of MedicineAkershus University HospitalLørenskogNorway
- K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical MedicineOsloNorway
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Røsjø H, Meessen J, Ottesen AH, Latini R, Omland T. Prognostic value of secretoneurin in chronic heart failure. Data from the GISSI-Heart Failure trial. Clin Biochem 2023:110595. [PMID: 37277028 DOI: 10.1016/j.clinbiochem.2023.110595] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/11/2023] [Accepted: 05/31/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Circulating secretoneurin (SN) concentrations have been found to provide prognostic information in patients with acute heart failure. We wanted to assess whether SN would improve prognostication also in patients with chronic heart failure (HF) in a large multicenter trial. METHODS We measured plasma SN concentrations at randomization (n=1224) and after 3 months (n=1103) in patients with chronic, stable HF from the GISSI-HF study. The co-primary endpoints were (1) time to death or (2) admission to hospital for cardiovascular reasons. RESULTS Mean age was 67 years and 80% were male. Median (quartile 1-3) SN concentrations were 42.6 (35.0-62.8) pmol/L on randomization and 42.0 (34.5-53.1) pmol/L after 3 months, which are higher than SN concentrations in healthy subjects. Higher SN concentrations at randomization were associated with lower body-mass index (BMI), lower systolic blood pressure, lower estimated glomerular filtration rate (eGFR), higher B-type natriuretic peptide (BNP) concentrations, and diagnosis of chronic obstructive pulmonary disease. During median follow-up of 3.9 years, 344 patients (27.0%) died. After adjusting for age, sex, left ventricular ejection fraction, BMI, functional class, ischemic etiology, heart rate, blood pressure, eGFR, bilirubin, comorbidities, and BNP concentrations, logarithmically transformed SN concentrations on randomization were associated with mortality (HR 2.60 (95% CI 1.01-6.70), p=0.047). SN concentrations were also associated with admission to hospital for cardiovascular reasons, but the association was attenuated and no longer significant in multivariable analysis. CONCLUSION Plasma SN concentrations provided incremental prognostic information to established risk indices and biomarkers in a large cohort of chronic HF patients.
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Affiliation(s)
- Helge Røsjø
- Division of Research and Innovation, Akershus University Hospital, Lorenskog, Norway; K. G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jennifer Meessen
- Department of Cardiovascular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Anett Hellebø Ottesen
- Division of Research and Innovation, Akershus University Hospital, Lorenskog, Norway; K. G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Roberto Latini
- Department of Cardiovascular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Torbjørn Omland
- K. G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Cardiology, Division of Medicine, Akershus University Hospital, Lorenskog, Norway.
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11
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Lyngbakken MN, Rønningen PS, Solberg MG, Berge T, Brynildsen J, Aagaard EN, Kvisvik B, Røsjø H, Steine K, Tveit A, Omland T. Prediction of incident atrial fibrillation with cardiac biomarkers and left atrial volumes. Heart 2023; 109:356-363. [PMID: 36261282 DOI: 10.1136/heartjnl-2022-321608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/29/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Atrial fibrillation is a common arrhythmia associated with risk of stroke, heart failure and death. We aimed to elucidate the associations of cardiac biomarkers, echocardiographic left atrial volumetric indices and risk of prevalent and incident atrial fibrillation in the general population. METHODS We assessed cardiac troponin T (cTnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), growth differentiation factor 15 (GDF-15), maximum (LAVimax) and minimum (LAVimin) indexed left atrial volumes and left atrial emptying fraction (LAEF) in subjects born in 1950 participating in the prospective observational cohort, Akershus Cardiac Examination 1950 Study. The Cohorts for Heart and Ageing Research in Genomic Epidemiology for Atrial Fibrillation risk score and sex was used to adjust for residual risk of atrial fibrillation. RESULTS Out of 3487 subjects, 157 (4.5%) had prevalent and 123 (3.5%) had incident atrial fibrillation. Echocardiographic left atrial volumes and cardiac biomarkers associated with prevalent atrial fibrillation, but GDF-15 was non-significant in adjusted analysis. Incident atrial fibrillation was predicted by LAVimax (adjusted HR 1.51, 95% CI 1.30 to 1.75), LAVimin (adjusted HR 1.52, 95% CI 1.35 to 1.72), LAEF (adjusted HR 1.24, 95% CI 1.04 to 1.48) and NT-proBNP (adjusted HR 1.57, 95% CI 1.32 to 1.85). cTnT and NT-proBNP provided incremental prognostic information to left atrial volumes, but GDF-15 demonstrated no prognostic value for incident atrial fibrillation. CONCLUSIONS In the general population, echocardiographic left atrial volumetric indices and NT-proBNP, but not cTnT and GDF-15, associate with prevalent atrial fibrillation and with risk of incident atrial fibrillation. cTnT and NT-proBNP provide incremental prognostic information to echocardiography.
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Affiliation(s)
- Magnus Nakrem Lyngbakken
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lorenskog, Norway .,K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Peter Selmer Rønningen
- Department of Medical Research, Bærum sykehus, Gjettum, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Magnar Gangås Solberg
- Department of Medical Research, Bærum sykehus, Gjettum, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Trygve Berge
- Department of Medical Research, Bærum sykehus, Gjettum, Norway
| | - Jon Brynildsen
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lorenskog, Norway
| | - Erika Nerdrum Aagaard
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lorenskog, Norway.,K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Brede Kvisvik
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lorenskog, Norway.,K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Helge Røsjø
- K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Research and Innovation, Akershus University Hospital, Lorenskog, Norway
| | - Kjetil Steine
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lorenskog, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Arnljot Tveit
- Department of Medical Research, Bærum sykehus, Gjettum, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Torbjørn Omland
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lorenskog, Norway.,K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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12
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Lyngbakken MN, Kvisvik B, Berge T, Pervez MO, Aagaard EN, Ariansen I, Omland T, Tveit A, Steine K, Røsjø H. Serial blood pressure measurements, left ventricular remodelling and cardiovascular outcomes. Eur J Clin Invest 2023; 53:e13876. [PMID: 36120822 PMCID: PMC10078318 DOI: 10.1111/eci.13876] [Citation(s) in RCA: 1] [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: 07/09/2022] [Revised: 09/07/2022] [Accepted: 09/15/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Hypertension is a risk factor for the development of cardiovascular disease. Whether serial blood pressure (BP) measurements are more closely associated with subclinical left ventricular (LV) remodelling and better predict risk of cardiovascular events over individual BP measurements are not known. METHODS We assessed systolic BP, diastolic BP and pulse pressure at several time points during adulthood in 1333 women and 1211 men participating in the Akershus Cardiac Examination 1950 Study. We defined serial BP measurements as the sum of averaged BPs from adjacent consecutive visits indexed to total exposure time between measurements. We assessed the associations between serial and individual BP measurements and (1) LV structure, function and volumes and (2) incident myocardial infarction, ischemic stroke, heart failure and cardiovascular death. RESULTS All indices of higher serial BP measurements were associated with increased indexed LV mass, and the associations were stronger than those of individual BP measurements. Serial diastolic BP pressure was strongly and inversely associated with LV systolic function, while higher serial systolic BP was primarily associated with higher LV volumes. Both serial systolic (incidence rate ratio [IRR] 1.10, 95% CI 1.03 to 1.17) and diastolic BPs (IRR 1.14, 95% CI 1.02 to 1.27) were associated with increased incidence of clinical events. CONCLUSION In healthy community dwellers without established cardiovascular disease, different serial BP indices associate strongly with LV remodelling and cardiovascular outcomes. Whether the use of serial BP indices for guiding treatment is superior to individual measurements should be explored in additional prospective studies.
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Affiliation(s)
- Magnus Nakrem Lyngbakken
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Brede Kvisvik
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Trygve Berge
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Medical Research, Baerum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
| | - Mohammad Osman Pervez
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Erika Nerdrum Aagaard
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Torbjørn Omland
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Arnljot Tveit
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Medical Research, Baerum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
| | - Kjetil Steine
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Helge Røsjø
- K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway
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13
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Lång M, Jakob SM, Takala R, Lyngbakken MN, Turpeinen A, Omland T, Merz TM, Wiegand J, Grönlund J, Rahi M, Valtonen M, Koivisto T, Røsjø H, Bendel S. The prevalence of cardiac complications and their impact on outcomes in patients with non-traumatic subarachnoid hemorrhage. Sci Rep 2022; 12:20109. [PMID: 36418906 PMCID: PMC9684538 DOI: 10.1038/s41598-022-24675-8] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022] Open
Abstract
Subarachnoid hemorrhage (SAH) is a serious condition, and a myocardial injury or dysfunction could contribute to the outcome. We assessed the prevalence and prognostic impact of cardiac involvement in a cohort with SAH. This is a prospective observational multicenter study. We included 192 patients treated for non-traumatic subarachnoid hemorrhage. We performed ECG recordings, echocardiographic examinations, and blood sampling within 24 h of admission and on days 3 and 7 and at 90 days. The primary endpoint was the evidence of cardiac involvement at 90 days, and the secondary endpoint was to examine the prevalence of a myocardial injury or dysfunction. The median age was 54.5 (interquartile range [IQR] 48.0-64.0) years, 44.3% were male and the median World Federation of Neurological Surgeons (WFNS) score was 2 (IQR 1-4). At day 90, 22/125 patients (17.6%) had left ventricular ejection fractions ≤ 50%, and 2/121 patients (1.7%) had evidence of a diastolic dysfunction as defined by mitral peak E-wave velocity by peak e' velocity (E/e') > 14. There was no prognostic impact from echocardiographic evidence of cardiac complications on neurological outcomes. The overall prevalence of cardiac dysfunction was modest. We found no demographic or SAH-related factors associated with 90 days cardiac dysfunction.
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Affiliation(s)
- Maarit Lång
- grid.9668.10000 0001 0726 2490Department of Intensive Care Medicine, Kuopio University Hospital, University of Eastern Finland, PO BOX 100, 70029 KYS Kuopio, Finland
| | - Stephan M. Jakob
- grid.5734.50000 0001 0726 5157Department of Intensive Care Medicine, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Riikka Takala
- grid.1374.10000 0001 2097 1371Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital, Anaesthesiology, Intensive Care, Emergency Care and Pain Medicine, University of Turku, Turku, Finland
| | - Magnus N. Lyngbakken
- grid.5510.10000 0004 1936 8921Division of Medicine, Department of Cardiology, Akershus University Hospital, Lørenskog, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anu Turpeinen
- grid.410705.70000 0004 0628 207XDepartment of Cardiology, Kuopio University Hospital, University of Eastern Finad, Kuopio, Finland
| | - Torbjørn Omland
- grid.5510.10000 0004 1936 8921Division of Medicine, Department of Cardiology, Akershus University Hospital, Lørenskog, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Tobias M. Merz
- grid.5734.50000 0001 0726 5157Department of Intensive Care Medicine, University Hospital of Bern, University of Bern, Bern, Switzerland ,grid.414055.10000 0000 9027 2851Present Address: Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
| | - Jan Wiegand
- grid.5734.50000 0001 0726 5157Department of Intensive Care Medicine, University Hospital of Bern, University of Bern, Bern, Switzerland ,grid.415941.c0000 0004 0509 4333Present Address: Intensive Care Unit, Lindenhofspital, Bern, Switzerland
| | - Juha Grönlund
- grid.1374.10000 0001 2097 1371Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital, Anaesthesiology, Intensive Care, Emergency Care and Pain Medicine, University of Turku, Turku, Finland
| | - Melissa Rahi
- grid.1374.10000 0001 2097 1371Neurocenter, Department of Neurosurgery, Turku University Hospital, University of Turku, Turku, Finland
| | - Mika Valtonen
- grid.1374.10000 0001 2097 1371Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital, Anaesthesiology, Intensive Care, Emergency Care and Pain Medicine, University of Turku, Turku, Finland
| | - Timo Koivisto
- grid.9668.10000 0001 0726 2490Department of Neurosurgery, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Helge Røsjø
- grid.5510.10000 0004 1936 8921Division for Research and Innovation, Akershus University Hospital, Lørenskog, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Stepani Bendel
- grid.9668.10000 0001 0726 2490Department of Intensive Care Medicine, Kuopio University Hospital, University of Eastern Finland, PO BOX 100, 70029 KYS Kuopio, Finland
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14
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Figtree GA, Vernon ST, Hadziosmanovic N, Sundström J, Alfredsson J, Nicholls SJ, Chow CK, Psaltis P, Røsjø H, Leósdóttir M, Hagström E. Mortality and Cardiovascular Outcomes in Patients Presenting With Non-ST Elevation Myocardial Infarction Despite No Standard Modifiable Risk Factors: Results From the SWEDEHEART Registry. J Am Heart Assoc 2022; 11:e024818. [PMID: 35876409 PMCID: PMC9375489 DOI: 10.1161/jaha.121.024818] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background A significant proportion of patients with ST-segment-elevation myocardial infarction (MI) have no standard modifiable cardiovascular risk factors (SMuRFs) and have unexpected worse 30-day outcomes compared with those with SMuRFs. The aim of this article is to examine outcomes of patients with non-ST-segment-elevation MI in the absence of SMuRFs. Methods and Results Presenting features, management, and outcomes of patients with non-ST-segment-elevation MI without SmuRFs (hypertension, diabetes, hypercholesterolemia, smoking) were compared with those with SmuRFs in the Swedish MI registry SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies; 2005-2018). Cox proportional hazard models were used. Out of 99 718 patients with non-ST-segment-elevation MI, 11 131 (11.2%) had no SMuRFs. Patients without SMuRFs had higher all-cause and cardiovascular mortality at 30 days (hazard ratio [HR], 1.20 [95% CI, 1.10-1.30], P<0.0001; and HR, 1.25 [95% CI, 1.13-1.38]), a difference that remained after adjustment for age and sex. SMuRF-less patients were less likely to receive secondary prevention statins (76% versus 82%); angiotensin-converting enzyme inhibitors/angiotensin receptor blockade (54% versus 72%); or β-blockers (81% versus 87%, P for all <0.0001), with lowest rates observed in women without SMuRFs. In patients who survived to 30 days, rates of all-cause and cardiovascular death were lower in patients without SMuRFs compared with those with risk factors, over 12 years. Conclusions One in 10 patients presenting with non-ST-segment-elevation MI present without traditional risk factors. The excess 30-day mortality rate in this group emphasizes the need for both improved population-based strategies for prevention of MI, as well as the need for equitable evidence-based treatment at the time of an MI.
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Affiliation(s)
- Gemma A Figtree
- Kolling Institute, Royal North Shore Hospital and University of Sydney Sydney Australia.,Department of Cardiology Royal North Shore Hospital Sydney Australia
| | - Stephen T Vernon
- Kolling Institute, Royal North Shore Hospital and University of Sydney Sydney Australia.,Department of Cardiology Royal North Shore Hospital Sydney Australia
| | | | - Johan Sundström
- Department of Medical Sciences Uppsala University Uppsala Sweden.,The George Institute for Global Health UNSW Sydney Sydney Australia
| | - Joakim Alfredsson
- Faculty of Medicine and Health Sciences Linköping University Linköping Sweden
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre Victorian Heart Institute, Monash University Clayton Australia
| | - Clara K Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health University of Sydney Australia.,Department of Cardiology Westmead Hospital Sydney Australia
| | - Peter Psaltis
- Vascular Research Centre South Australian Health and Medical Research Institute; Adelaide Medical School, University of Adelaide Australia
| | - Helge Røsjø
- Akershus University Hospital Lørenskog Norway.,University of Oslo Norway.,Uppsala Clinical Research Centre Uppsala Sweden
| | - Margrét Leósdóttir
- Department of Clinical Sciences, Faculty of Medicine Lund University Malmö Sweden
| | - Emil Hagström
- Department of Cardiology Royal North Shore Hospital Sydney Australia.,Uppsala Clinical Research Centre Uppsala Sweden
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15
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Sourour N, Riveland E, Rømo T, Naesgaard P, Kjekshus H, Larsen AI, Omland T, Røsjø H, Myhre PL. QRS fragmentation is associated with increased risk of ventricular arrhythmias in high-risk patients; Data from the SMASH 1 Study. Ann Noninvasive Electrocardiol 2022; 27:e12985. [PMID: 35839068 PMCID: PMC9484029 DOI: 10.1111/anec.12985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 05/23/2022] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION QRS fragmentation (fQRS), defined as the presence of additional spikes within the QRS complex, has been associated with myocardial conduction abnormalities and arrhythmogenicity. OBJECTIVE We aimed to assess whether fQRS is associated with incident ventricular arrhythmias (VA) in high-risk patients treated with implantable cardioverter-defibrillator (ICD) for primary and secondary prevention. METHODS In a prospective observational multicenter study, we included 495 patients treated with ICD. fQRS was analyzed according to previously validated criteria, by two physicians blinded for outcome data. Incident VA were obtained from ICD recordings. RESULTS ECG recordings interpretable for fQRS were available in 459 patients (93%), aged 66 ± 12 years with left ventricular ejection fraction 40% ± 13%. fQRS was present in 52 patients (11%) with comparable baseline characteristics to patients without fQRS, except higher age, higher prevalence of coronary artery disease (CAD), lower prevalence of cardiomyopathy, and more frequently a secondary prevention ICD indication. Among patients with native QRS, those with fQRS had similar QRS duration and axis to those without fQRS. During 3.1 ± 0.7 years follow-up, 126 patients (28%) had ≥1 VA . fQRS was associated with increased risk of VA (HR 3.41 [95% CI 2.27-5.13], p < .001), which persisted after adjusting for age, gender, sex, BMI, CAD, heart failure, renal function, ICD indication, QRS duration, QRS axis, Q waves, and bundle branch block. fQRS was more strongly associated with VA in patients with a primary (HR 6.05 [95% CI 3.16-11.60]) versus secondary (HR 2.39 [95% CI 1.41-4.04]) ICD indication (p-for-interaction = .047). CONCLUSIONS fQRS is associated with threefold increased risk of VA in high-risk patients, independent of established risk factors.
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Affiliation(s)
- Nur Sourour
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Egil Riveland
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway.,Institute of Clinical Sciences, University of Bergen, Bergen, Norway
| | - Terje Rømo
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Patrycja Naesgaard
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Harald Kjekshus
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Alf Inge Larsen
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway.,Institute of Clinical Sciences, University of Bergen, Bergen, Norway
| | - Torbjørn Omland
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Helge Røsjø
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division for Research and Innovation, Akershus University Hospital, Lørenskog, Norway
| | - Peder Langeland Myhre
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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16
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Myhre PL, Claggett B, Yu B, Skali H, Solomon SD, Røsjø H, Omland T, Wiggins KL, Psaty BM, Floyd JS, Selvin E, Ballantyne CM, Shah AM. Sex and Race Differences in N-Terminal Pro-B-type Natriuretic Peptide Concentration and Absolute Risk of Heart Failure in the Community. JAMA Cardiol 2022; 7:623-631. [PMID: 35476049 PMCID: PMC9047747 DOI: 10.1001/jamacardio.2022.0680] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [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: 12/14/2022]
Abstract
Importance Sex- and race-based differences in N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations are poorly understood. Clinical decisions are often informed by absolute-as opposed to relative-risk, but absolute risk of incident heart failure (HF) associated with NT-proBNP concentration across these important demographic categories is unclear. Objective To determine whether physiologic determinants of NT-proBNP concentrations account for sex and race differences, and to more uniformly predict HF risk using NT-proBNP in these demographic subgroups. Design, Setting, and Participants In the longitudinal Atherosclerosis Risk in Communities epidemiologic prospective community-based cohort study, the association of NT-proBNP concentration with relative and absolute risk of HF by sex- and race-based categories was assessed at study visit 2 (1990-1992) and study visit 5 (2011-2013) using Cox and Poisson regression. These data were analyzed from June 2018 to October 2021. The contribution of clinical, anthropometric, echocardiographic, and laboratory parameters to sex- and race-based differences in NT-proBNP concentration was assessed at visit 5 using linear regression. Participants included were free of HF in midlife (visit 2; a total of 12 750 participants) and late life (visit 5; a total of 5191 participants). Exposures NT-proBNP concentration. Main Outcomes and Measures Incident HF or death. Results Among the 5191 HF-free participants at visit 5, the mean (SD) age was 76.0 (5.2) years, 2104 (41%) were male, 1043 (20%) were Black, and the median (IQR) NT-proBNP concentration was 124 (64-239) pg/. In both midlife and late life, NT-proBNP concentration was lowest in Black men (median [IQR] concentration: visit 2, 30 [14-67] pg/mL; visit 5, 74 [34-153] pg/mL) and highest in White women (median [IQR] concentration: visit 2, 70 [42-111] pg/mL; visit, 5, 154 [82-268] pg/mL). Sex and race differences in NT-proBNP concentration persisted after accounting for age, income, education, area deprivation index, cardiovascular diseases, left ventricular structure (LV), LV function, LV wall stress, weight and fat mass, and estimated glomerular filtration rate. Substantial differences in the absolute risk of incident HF or death existed across the sex- and race-based categories at any NT-proBNP concentration (eg, 7-fold [rate ratio, 6.7; 95% CI, 4.6-9.9] and 3-fold [rate ratio, 2.7; 95% CI, 1.7-4.1] difference at visit 2 and visit 5, respectively, at guideline-recommended thresholds) with higher risk consistently observed among Black men and lower risk in White women. Results were replicated in a cohort of participants from the Cardiovascular Health Study. Conclusions and Relevance In this study, sex- and race-based differences in NT-proBNP persisted after accounting for known physiologic determinants. Absolute risk associated with a given value of NT-proBNP varied substantially by sex and race. Consideration of NT-proBNP values in the context of sex and race allows for more uniform prediction of absolute risk across important demographic subgroups.
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Affiliation(s)
- Peder L. Myhre
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts,Division of Medicine, Akershus University Hospital and University of Oslo, Oslo, Norway
| | - Brian Claggett
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Bing Yu
- School of Public Health, The University of Texas Health Science Center at Houston, Houston
| | - Hicham Skali
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Scott D. Solomon
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Helge Røsjø
- Division of Medicine, Akershus University Hospital and University of Oslo, Oslo, Norway
| | - Torbjørn Omland
- Division of Medicine, Akershus University Hospital and University of Oslo, Oslo, Norway
| | - Kerri L. Wiggins
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle
| | - Bruce M. Psaty
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle,Department of Epidemiology, University of Washington, Seattle,Department of Health Systems and Population Health, University of Washington, Seattle
| | - James S. Floyd
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Christie M. Ballantyne
- Center for Cardiovascular Disease Prevention, Baylor College of Medicine, Houston, Texas
| | - Amil M. Shah
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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17
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Rønningen PS, Berge T, Solberg MG, Enger S, Pervez MO, Orstad EB, Kvisvik B, Aagaard EN, Lyngbakken MN, Ariansen I, Røsjø H, Steine K, Tveit A. Impact of Blood Pressure in the Early 40s on Left Atrial Volumes in the Mid-60s: Data From the ACE 1950 Study. J Am Heart Assoc 2022; 11:e023738. [PMID: 35621203 PMCID: PMC9238725 DOI: 10.1161/jaha.121.023738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Echocardiographic measures of left atrial volumes are powerful predictors of cardiovascular events and important for assessing diastolic dysfunction. Despite this, there is limited knowledge of factors influencing left atrial remodeling. In particular, the impact of blood pressure in those in their early 40s on left atrial volumes later in life has not been sufficiently elucidated. Methods and Results We linked data from individuals born in 1950 who participated in the Age 40 Program, and the ACE (Akershus Cardiac Examination) 1950 Study. We divided the study population into quartiles of systolic blood pressure in their early 40s and assessed the proportion of individuals with an enlarged left atrium in their mid‐60s. The associations between blood pressure and left atrial volumes were assessed in linear regression analyses. Of the 2591 individuals included in this study, 1302 (50.3%) were women, and the mean age in the Age 40 Program was 40.1±0.3 years. Systolic blood pressure was 128.1±13.6 mm Hg and diastolic blood pressure was 78.3±9.5 mm Hg. Mean age in the ACE 1950 Study was 64.0±0.6 years. The proportion of individuals with an enlarged left atrium increased across the quartiles of systolic blood pressure (P=0.001). Systolic blood pressure was independently associated with left atrial volumes; the end‐systolic volume was 0.09 mL (95% CI, 0.04–0.14 mL) larger per 1‐mm Hg higher systolic blood pressure. Conclusions Our findings suggest that increased blood pressure in those in their early 40s is relevant for left atrial remodeling later in life. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01555411.
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Affiliation(s)
- Peter Selmer Rønningen
- Department of Medical Research Bærum HospitalVestre Viken Hospital Trust Gjettum Norway.,Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Trygve Berge
- Department of Medical Research Bærum HospitalVestre Viken Hospital Trust Gjettum Norway
| | - Magnar Gangås Solberg
- Department of Medical Research Bærum HospitalVestre Viken Hospital Trust Gjettum Norway.,Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Steve Enger
- Department of Medical Research Bærum HospitalVestre Viken Hospital Trust Gjettum Norway
| | - Mohammad Osman Pervez
- Division of Medicine Department of Cardiology Akershus University Hospital Lørenskog Norway
| | - Eivind Bjørkan Orstad
- Division of Medicine Department of Cardiology Akershus University Hospital Lørenskog Norway
| | - Brede Kvisvik
- Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway.,Division of Medicine Department of Cardiology Akershus University Hospital Lørenskog Norway
| | - Erika Nerdrum Aagaard
- Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway.,Division of Medicine Department of Cardiology Akershus University Hospital Lørenskog Norway
| | - Magnus Nakrem Lyngbakken
- Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway.,Division of Medicine Department of Cardiology Akershus University Hospital Lørenskog Norway
| | - Inger Ariansen
- Deparment of Chronic Diseases and Ageing Norwegian Institute of Public Health Oslo Norway
| | - Helge Røsjø
- Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway.,Division for Research and Innovation Akershus University Hospital Lørenskog Norway
| | - Kjetil Steine
- Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway.,Division of Medicine Department of Cardiology Akershus University Hospital Lørenskog Norway
| | - Arnljot Tveit
- Department of Medical Research Bærum HospitalVestre Viken Hospital Trust Gjettum Norway.,Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway
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18
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Caspersen NF, Søyseth V, Lyngbakken MN, Berge T, Ariansen I, Tveit A, Røsjø H, Einvik G. Treatable Traits in Misdiagnosed Chronic Obstructive Pulmonary Disease: Data from the Akershus Cardiac Examination 1950 Study. Chronic Obstr Pulm Dis 2022; 9:165-180. [PMID: 35158418 PMCID: PMC9166336 DOI: 10.15326/jcopdf.2021.0265] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/10/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is often misdiagnosed. We aimed to estimate the prevalence of misdiagnosed COPD in middle-aged Norwegians, and to assess potentially treatable clinical traits in over- and undiagnosed individuals. METHODS AND FINDINGS The Akershus Cardiac Examination (ACE) 1950 Study is a population-based study of the 1950 birth cohort of Akershus county including 3706 participants aged 62-65 years at baseline. COPD was defined as a forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) ratio < lower limit of normal (LLN). Misdiagnosed COPD was defined according to self-reported COPD. A total of 259 (7.1%) participants had spirometry confirmed COPD. Of these, only 72 (28%) reported having COPD, thus 187 (72%) were undiagnosed. A total of 92 (2.5%) of the 164 particpants who reported having COPD had an FEV1/FVC ratio ≥ LLN and were overdiagnosed. They had lower lung function, and more respiratory symptoms, self-reported asthma, eosinophils, and sleep apnea than other non-COPD participants . The main predictor of being overdiagnosed was overweight. Spirometry in participants reporting wheezing or cough and current smokers or participants with ≥20 tobacco pack-year history would have identified 85% of the undiagnosed cases. CONCLUSION Both over- and underdiagnosis of COPD is frequent. Undiagnosed individuals have better lung function and less symptoms, but similar prevalence of comorbidities and systemic inflammation. Overdiagnosed individuals have treatable traits including asthma, eosinophilic inflammation, and sleep apnea. The main predictor of being overdiagnosed was being overweight.
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Affiliation(s)
- Nina Faksvåg Caspersen
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Vidar Søyseth
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Magnus Nakrem Lyngbakken
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Trygve Berge
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
| | - Inger Ariansen
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Arnljot Tveit
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
| | - Helge Røsjø
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division for Research and Innovation, Akershus University Hospital, Lørenskog, Norway
| | - Gunnar Einvik
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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19
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Berge K, Brynildsen J, Røysland R, Strand H, Christensen G, Høiseth AD, Omland T, Røsjø H, Lyngbakken MN. Prognostic value of cardiac biomarkers and National Early Warning Score 2 in acute dyspnoea. Open Heart 2022; 9:openhrt-2021-001938. [PMID: 35387863 PMCID: PMC8987755 DOI: 10.1136/openhrt-2021-001938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/22/2022] [Indexed: 11/29/2022] Open
Abstract
Objective Patients hospitalised with acute dyspnoea due to acute heart failure (AHF) have a grave prognosis, but the European Society of Cardiology guidelines recommend no system to risk stratify these patients. The prognostic value of combining National Early Warning Score (NEWS) 2 and established cardiac biomarkers is not known. Methods We measured high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) and calculated NEWS2 in 314 patients with acute dyspnoea within 24 hours of hospitalisation. Their prognostic merits were assessed in the total cohort and for the subgroup with AHF separately. Results The median age was 73 (quartile (Q) 1–3, 63–81) years, 48% were women and 143 patients (46%) were hospitalised with AHF. The 114 patients (36%) who died during follow-up (median 823 days, Q1–3, 471–998) had higher concentrations of hs-cTnT (62 vs 33 ng/L, p<0.001) and NT-proBNP (6995 vs 2605 ng/L, p<0.001), and higher NEWS2 (6.1 vs 4.5 points, p<0.001), compared with survivors. Patients with increased vs low NEWS2 clinical risk had higher mortality rates in adjusted analyses in the total cohort (HR 2.11, 95% CI 1.28 to 3.48) and in patients with AHF (HR 2.00, 95% CI 1.54 to 2.60). NEWS2 provided incremental prognostic information compared with biomarkers alone for the total cohort: area under the curve 0.72 vs 0.70, p=0.042, and for the subpopulation with AHF: 0.70 vs 0.67, p=0.014. Conclusion NEWS2 predicts long-term mortality in patients hospitalised due to acute dyspnoea and the subgroup with AHF and provide incremental prognostic information to hs-cTnT and NT-proBNP.
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Affiliation(s)
- Kristian Berge
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jon Brynildsen
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ragnhild Røysland
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway.,Multidisciplinary Laboratory Medicine and Medical Biochemistry, Akershus University Hospital, Lørenskog, Norway
| | - Heidi Strand
- Multidisciplinary Laboratory Medicine and Medical Biochemistry, Akershus University Hospital, Lørenskog, Norway
| | - Geir Christensen
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway.,Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Arne Didrik Høiseth
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Torbjorn Omland
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Helge Røsjø
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway
| | - Magnus Nakrem Lyngbakken
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway .,Institute for Clinical Medicine, University of Oslo, Oslo, Norway
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20
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Aagaard EN, Lyngbakken MN, Kvisvik B, Berge T, Pervez MO, Ariansen I, Tveit A, Steine K, Røsjø H, Omland T. Associations between cardiovascular risk factors, biomarkers, and left ventricular mechanical dispersion: insights from the ACE 1950 Study. European Heart Journal Open 2022; 2:oeac006. [PMID: 35919126 PMCID: PMC9242045 DOI: 10.1093/ehjopen/oeac006] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/22/2022] [Indexed: 11/14/2022]
Abstract
Aims Mechanical dispersion measures left ventricular contraction heterogeneity and is associated with the risk of sudden cardiac death. However, the associations between mechanical dispersion and cardiovascular risk factors in early mid-life, and established biomarkers of sub-clinical myocardial injury and dysfunction are not known. We aimed to examine this in the general population. Methods and results During 2012–15, we included 2527 Norwegian individuals from the general population born in 1950, with measurements of mechanical dispersion by 2D speckle tracking echocardiography and concentrations of high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) available. Mechanical dispersion was calculated as the standard deviation of the contraction duration of 17 strain segments. We assessed the associations between mechanical dispersion, concentrations of hs-cTnT and NT-proBNP, and cardiovascular risk factors collected at a national health screening survey two decades earlier. At echocardiography baseline, median age was 64 (interquartile range 63.5–64.5) years, 49.8% were women, 59.1% had hypertension, and 5.9% reported established coronary artery disease. Median mechanical dispersion was 38.0 (29.5–47.0) ms, median hs-cTnT concentration 6 (4–8) ng/L, and the median NT-proBNP concentration 54 (34–93) ng/L. Mechanical dispersion was associated with both hs-cTnT and NT-proBNP concentrations in multivariable models adjusted for clinical and echocardiographic variables. High body mass index, serum triglyceride concentrations, and low resting heart rate at Age 40 were independently associated with increased mechanical dispersion two decades later. Conclusion Established risk factors at Age 40 are associated with mechanical dispersion two decades later, and mechanical dispersion is cross-sectionally associated with biomarkers of subclinical myocardial injury and dysfunction.
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Affiliation(s)
- Erika N Aagaard
- Division of Medicine, Department of Cardiology, Akershus University Hospital , Lørenskog, Norway
- Faculty of Medicine, Institute for Clinical Medicine, University of Oslo , Oslo, Norway
| | - Magnus N Lyngbakken
- Division of Medicine, Department of Cardiology, Akershus University Hospital , Lørenskog, Norway
- Faculty of Medicine, Institute for Clinical Medicine, University of Oslo , Oslo, Norway
| | - Brede Kvisvik
- Division of Medicine, Department of Cardiology, Akershus University Hospital , Lørenskog, Norway
- Faculty of Medicine, Institute for Clinical Medicine, University of Oslo , Oslo, Norway
| | - Trygve Berge
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust , Norway
| | - Mohammad O Pervez
- Division of Medicine, Department of Cardiology, Akershus University Hospital , Lørenskog, Norway
| | - Inger Ariansen
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health , Oslo, Norway
| | - Arnljot Tveit
- Faculty of Medicine, Institute for Clinical Medicine, University of Oslo , Oslo, Norway
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust , Norway
| | - Kjetil Steine
- Division of Medicine, Department of Cardiology, Akershus University Hospital , Lørenskog, Norway
- Faculty of Medicine, Institute for Clinical Medicine, University of Oslo , Oslo, Norway
| | - Helge Røsjø
- Faculty of Medicine, Institute for Clinical Medicine, University of Oslo , Oslo, Norway
- Division of Research and Innovation, Akershus University Hospital , Sykehusveien 25, 1478 Lørenskog, Norway
| | - Torbjørn Omland
- Division of Medicine, Department of Cardiology, Akershus University Hospital , Lørenskog, Norway
- Faculty of Medicine, Institute for Clinical Medicine, University of Oslo , Oslo, Norway
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21
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Lyngbakken MN, de Lemos JA, Hveem K, Røsjø H, Omland T. Lifetime obesity trends are associated with subclinical myocardial injury: The Trøndelag health study. J Intern Med 2022; 291:317-326. [PMID: 34668255 DOI: 10.1111/joim.13391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Obesity is associated with subclinical myocardial injury as quantified by concentrations of cardiac troponin T, but whether lifetime excess weight history is associated with increased concentrations of cardiac troponin I (cTnI) and how indices of abdominal adiposity and glycemic dysregulation affect these associations remain unclear. METHODS We analyzed cTnI with a high-sensitivity assay in 9739 participants in the Trøndelag Health (HUNT) Study at study visit 4 (2017-2019). BMI was assessed at study Visit 1 (1984-1986), 2 (1995-1997), 3 (2006-2008), and 4. RESULTS Median age at visit 4 was 68.7 years and 59% were women. Concentrations of cTnI were detectable in 84.1% of study participants, with a median of 2.5 (1.5-4.5 ng/L). We identified three clusters of BMI trajectories from visit 1 to 4, (1) stable normal weight, (2) stable overweight, and (3) stable obesity. Participants in clusters 2 and 3 were at increased risk of elevated concentrations of cTnI at visit 4 (odds ratio 1.27, 95% CI 1.09-1.47, and odds ratio 1.70, 95% CI 1.33-2.17, p for trend <0.001). Participants in cluster 3 had 22.0 (95% CI 14.1-29.9) higher concentrations of cTnI compared to participants in cluster 1 (p for trend <0.001). Dysregulated glucose metabolism and abdominal obesity did not influence our results. CONCLUSIONS Individuals with stable overweight or obesity are at increased risk of subclinical myocardial injury, independently of glycemic dysregulation and abdominal adiposity. Our data support a direct detrimental effect of long-standing obesity on cardiovascular health.
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Affiliation(s)
- Magnus Nakrem Lyngbakken
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - James A de Lemos
- Cardiology Division, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kristian Hveem
- HUNT Research Centre, Department of Public Health and General Practice, Norwegian University of Science and Technology, Levanger, Norway.,Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Helge Røsjø
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway
| | - Torbjørn Omland
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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22
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Abstract
Background Cardiac troponins represent a sensitive index of subclinical myocardial injury and are associated with increased risk of cardiovascular events in the general population. Despite positive associations with cardiovascular risk of both cardiac troponins and cigarette smoking, concentrations of cardiac troponin I measured by high‐sensitivity assays (hs‐cTnI) are paradoxically lower in current smokers than in never‐smokers. The impact of smoking intensity and time from smoking cessation on hs‐cTnI remains unknown. Methods and Results hs‐cTnI concentrations were measured in 32028 subjects free from cardiovascular disease enrolled in the prospective, population‐based HUNT (Trøndelag Health Study). Tobacco habits were self‐reported and classified as never (n=14 559), former (n=14 248), and current (n=3221) smokers. Current smokers exhibited significantly lower concentrations of hs‐cTnI than never‐smokers (P<0.001). In adjusted models, both current smoking (−17.3%; 95% CI, −20.6 to −13.9%) and former smoking (−6.6%; 95% CI, −8.7 to −4.5%) were associated with significantly lower hs‐cTnI concentrations. Among former smokers, higher smoking burden (>10 pack‐years) were associated with lower concentrations of hs‐cTnI. Time since smoking cessation was associated with increasing concentrations of hs‐cTnI in a dose‐dependent manner (P for trend<0.001), and subjects who quit smoking >30 years ago had concentrations of hs‐cTnI comparable with those of never‐smokers. Conclusions In the general population, both current and former cigarette smoking is associated with lower concentrations of hs‐cTnI. In former smokers, there was a dose‐response relationship between pack‐years of smoking, and hs‐cTnI. Time since smoking cessation was associated with increasing concentrations of hs‐cTnI, indicating a continuum of hs‐cTnI from current smoker to never‐smokers.
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Affiliation(s)
- Julia Brox Skranes
- Department of Cardiology Division of Medicine Akershus University Hospital Lørenskog Norway.,Division of Research and Innovation Akershus University Hospital Lørenskog Norway
| | - Magnus Nakrem Lyngbakken
- Department of Cardiology Division of Medicine Akershus University Hospital Lørenskog Norway.,Division of Research and Innovation Akershus University Hospital Lørenskog Norway
| | - Kristian Hveem
- Institute of Clinical MedicineUniversity of Oslo Oslo Norway.,K.G. Jebsen Center for Genetic Epidemiology Department of Public Health and Nursing Norwegian University of Science and Technology Trondheim Norway.,Department of Medicine Levanger HospitalNord-Trøndelag Hospital Trust Levanger Norway
| | - Helge Røsjø
- Division of Research and Innovation Akershus University Hospital Lørenskog Norway.,HUNT Research Centre Department of Public Health and General Practice Norwegian University of Science and Technology Levanger Norway
| | - Torbjørn Omland
- Department of Cardiology Division of Medicine Akershus University Hospital Lørenskog Norway.,Division of Research and Innovation Akershus University Hospital Lørenskog Norway
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23
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Lyngbakken MN, Hveem K, Røsjø H, Omland T. Subclinical myocardial injury and risk of COVID-19 in the general population: The Trøndelag Health Study. Clin Chem 2021; 68:473-475. [PMID: 34878096 PMCID: PMC9383106 DOI: 10.1093/clinchem/hvab267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/18/2021] [Indexed: 11/14/2022]
Affiliation(s)
- Magnus Nakrem Lyngbakken
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kristian Hveem
- HUNT Research Centre, Department of Public Health and General Practice, Norwegian University of Science and Technology, Levanger, Norway.,Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Helge Røsjø
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway
| | - Torbjørn Omland
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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24
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Aakre KM, Ottesen AH, Strand H, Faaren AL, Alaour B, Torsvik J, Sylte MS, Marber M, Christensen G, Røsjø H, Omland T. Biological variation of secretoneurin; a novel cardiovascular biomarker implicated in arrhythmogenesis. Clin Biochem 2021; 98:74-77. [PMID: 34624255 DOI: 10.1016/j.clinbiochem.2021.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/24/2021] [Accepted: 09/30/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Secretoneurin is a novel prognostic biomarker that may predict mortality in heart failure and the occurrence of ventricular arrhythmias. This study reports the within subject variation (CVI), between subject variation (CVG), reference change values (RCV) and index of individuality (II) of secretoneurin. METHODS Thirty healthy volunteers were included. Non-fasting samples were obtained between 8 and 10 am once a week for ten weeks. Secretoneurin was analyzed in duplicate using ELISA. No outliers were present according to Burnett and Reeds' criteria. Simple linear regression did not identify significant trends. Variance homogeneity in the analytical variance and CVI were tested using Cochrane's and Bartlett's tests and four participants were excluded. Calculation of CVI, CVG and RCV were done on ln transformed data as described by Fokkema, the II was calculated using retransformed data. RESULTS The median age of the participants was 36 years and 53% were female. Non-fasting glucose, eGFR(CKD-EPI), cTnT and NT-proBNP concentrations were within the normal range. Median secretoneurin concentrations were 38 pmol/L (women) and 33 pmol/L (men), p-value < 0.001. CVI and CVG were 9.8% (CI 8.7% to 11.0%) and 20.0 (CI 15.4% to 28.0%), respectively. RCV were 38.7% (CI 35.5% to 42.7%) and -27.9 (CI -29.9 to -26.2) and the II were 0.60 (CI 0.42-0.78). No gender differences were present. CONCLUSION Secretoneurin has a fairly low CVI, CVG, RCV and II, indicating that it could be suitable as a diagnostic or prognostic biomarker and that delta values in serial samplings may be preferable for identifying clinical changes.
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Affiliation(s)
- Kristin M Aakre
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway; Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway.
| | - Anett H Ottesen
- Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Heidi Strand
- Multidisciplinary Laboratory Medicine and Medical Biochemistry, Akershus University Hospital, Lørenskog, Norway
| | | | - Bashir Alaour
- School of Cardiovascular Medicine and Sciences, King's College London, United Kingdom
| | - Janniche Torsvik
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Marit S Sylte
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Michael Marber
- School of Cardiovascular Medicine and Sciences, King's College London, United Kingdom
| | - Geir Christensen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Institute for Experimental Medical Research, Oslo University Hospital, Oslo, Norway
| | - Helge Røsjø
- Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Torbjørn Omland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
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25
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Moksnes MR, Røsjø H, Richmond A, Lyngbakken MN, Graham SE, Hansen AF, Wolford BN, Gagliano Taliun SA, LeFaive J, Rasheed H, Thomas LF, Zhou W, Aung N, Surakka I, Douville NJ, Campbell A, Porteous DJ, Petersen SE, Munroe PB, Welsh P, Sattar N, Smith GD, Fritsche LG, Nielsen JB, Åsvold BO, Hveem K, Hayward C, Willer CJ, Brumpton BM, Omland T. Genome-wide association study of cardiac troponin I in the general population. Hum Mol Genet 2021; 30:2027-2039. [PMID: 33961016 PMCID: PMC8522636 DOI: 10.1093/hmg/ddab124] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 04/23/2021] [Accepted: 04/27/2021] [Indexed: 11/16/2022] Open
Abstract
Circulating cardiac troponin proteins are associated with structural heart disease and predict incident cardiovascular disease in the general population. However, the genetic contribution to cardiac troponin I (cTnI) concentrations and its causal effect on cardiovascular phenotypes are unclear. We combine data from two large population-based studies, the Trøndelag Health Study and the Generation Scotland Scottish Family Health Study, and perform a genome-wide association study of high-sensitivity cTnI concentrations with 48 115 individuals. We further use two-sample Mendelian randomization to investigate the causal effects of circulating cTnI on acute myocardial infarction (AMI) and heart failure (HF). We identified 12 genetic loci (8 novel) associated with cTnI concentrations. Associated protein-altering variants highlighted putative functional genes: CAND2, HABP2, ANO5, APOH, FHOD3, TNFAIP2, KLKB1 and LMAN1. Phenome-wide association tests in 1688 phecodes and 83 continuous traits in UK Biobank showed associations between a genetic risk score for cTnI and cardiac arrhythmias, metabolic and anthropometric measures. Using two-sample Mendelian randomization, we confirmed the non-causal role of cTnI in AMI (5948 cases, 355 246 controls). We found indications for a causal role of cTnI in HF (47 309 cases and 930 014 controls), but this was not supported by secondary analyses using left ventricular mass as outcome (18 257 individuals). Our findings clarify the biology underlying the heritable contribution to circulating cTnI and support cTnI as a non-causal biomarker for AMI in the general population. Using genetically informed methods for causal inference helps inform the role and value of measuring cTnI in the general population.
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Affiliation(s)
- Marta R Moksnes
- Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology, NTNU - Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Helge Røsjø
- Division of Research and Innovation, Akershus University Hospital, 1478 Lørenskog, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, 0316 Oslo, Norway
| | - Anne Richmond
- MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Magnus N Lyngbakken
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, 0316 Oslo, Norway
- Division of Medicine, Department of Cardiology, Akershus University Hospital, 1478 Lørenskog, Norway
| | - Sarah E Graham
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Ailin Falkmo Hansen
- Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology, NTNU - Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Brooke N Wolford
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Sarah A Gagliano Taliun
- Faculty of Medicine, Université de Montréal, Montréal, QC H3T 1J4, Canada
- Montréal Heart Institute, Montréal, QC H1T 1C8, Canada
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
- Center for Statistical Genetics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Jonathon LeFaive
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
- Center for Statistical Genetics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Humaira Rasheed
- Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology, NTNU - Norwegian University of Science and Technology, 7491 Trondheim, Norway
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol BS8 2BN, UK
| | - Laurent F Thomas
- Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology, NTNU - Norwegian University of Science and Technology, 7491 Trondheim, Norway
- Department of Clinical and Molecular Medicine, NTNU - Norwegian University of Science and Technology, 7491 Trondheim, Norway
- BioCore - Bioinformatics Core Facility, NTNU - Norwegian University of Science and Technology, 7491 Trondheim. Norway
- Clinic of Laboratory Medicine, St. Olavs Hospital, Trondheim University Hospital, 7491 Trondheim, Norway
| | - Wei Zhou
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI 48109, USA
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
| | - Nay Aung
- William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- National Institute for Health Research Barts Cardiovascular Biomedical Research Centre, Queen Mary University of London, London E1 4NS, UK
- Barts Heart Centre, St. Bartholomew’s Hospital, Barts Health NHS Trust, London EC1A 7BE, UK
| | - Ida Surakka
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Nicholas J Douville
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Archie Campbell
- Medical Genetics Section, CGEM, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - David J Porteous
- Medical Genetics Section, CGEM, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Steffen E Petersen
- William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- National Institute for Health Research Barts Cardiovascular Biomedical Research Centre, Queen Mary University of London, London E1 4NS, UK
- Barts Heart Centre, St. Bartholomew’s Hospital, Barts Health NHS Trust, London EC1A 7BE, UK
| | - Patricia B Munroe
- William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- National Institute for Health Research Barts Cardiovascular Biomedical Research Centre, Queen Mary University of London, London E1 4NS, UK
| | - Paul Welsh
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8TA, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8TA, UK
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol BS8 2BN, UK
| | - Lars G Fritsche
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
- Center for Statistical Genetics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Jonas B Nielsen
- Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology, NTNU - Norwegian University of Science and Technology, 7491 Trondheim, Norway
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Epidemiology Research, Statens Serum Institute, 2300 Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Bjørn Olav Åsvold
- Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology, NTNU - Norwegian University of Science and Technology, 7491 Trondheim, Norway
- Department of Public Health and Nursing, HUNT Research Centre, NTNU - Norwegian University of Science and Technology, 7600 Levanger, Norway
- Department of Endocrinology, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Kristian Hveem
- Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology, NTNU - Norwegian University of Science and Technology, 7491 Trondheim, Norway
- Department of Public Health and Nursing, HUNT Research Centre, NTNU - Norwegian University of Science and Technology, 7600 Levanger, Norway
| | - Caroline Hayward
- MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Cristen J Willer
- Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology, NTNU - Norwegian University of Science and Technology, 7491 Trondheim, Norway
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Human Genetics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Ben M Brumpton
- Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology, NTNU - Norwegian University of Science and Technology, 7491 Trondheim, Norway
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol BS8 2BN, UK
- Clinic of Thoracic and Occupational Medicine, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Torbjørn Omland
- Division of Research and Innovation, Akershus University Hospital, 1478 Lørenskog, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, 0316 Oslo, Norway
- Division of Medicine, Department of Cardiology, Akershus University Hospital, 1478 Lørenskog, Norway
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26
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Sigurdardottir FD, Lyngbakken MN, Hveem K, Strøm HH, Røsjø H, Redline S, Omland T. Insomnia symptoms and subclinical myocardial injury: Data from the Nord-Trøndelag Health (HUNT) study. J Sleep Res 2021; 30:e13299. [PMID: 33629480 PMCID: PMC8382789 DOI: 10.1111/jsr.13299] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/10/2021] [Accepted: 01/15/2021] [Indexed: 11/29/2022]
Abstract
Insomnia symptoms are associated with increased risk of heart failure (HF) and cardiovascular (CV) mortality. We hypothesised that insomnia symptoms are cross-sectionally associated with increased cardiac troponin I (cTnI), a biomarker of subclinical myocardial injury, and that phenotyping by insomnia symptoms and cTnI enhances longitudinal risk stratification in the general population. In a population-based study, cTnI was measured in 8,398 participants (median age 49 years, 55% women), who had answered questionnaires regarding insomnia symptoms. Association between cTnI and insomnia symptoms was assessed by linear regression analysis for each response category of a sleep questionnaire. Insomnia symptoms were defined as having difficulty falling asleep almost every night, difficulty maintaining sleep almost every night, and/or non-restorative sleep once a week or more. The primary outcome measure was a composite endpoint of CV mortality or first admission for HF. In all, 844 participants reported insomnia symptoms, 585 (69%) were women. Those with insomnia symptoms had marginally, but significantly higher median cTnI than those without insomnia symptoms, (median [interquartile range] 3.4 [2.4-5.2] ng/L versus 3.2 [2.2-4.9] ng/L; p = .014), but there was no association between any insomnia symptom and cTnI in unadjusted linear regression models (β 0.06, 95% confidence interval [CI] -0.01 to 0.12). In adjusted analyses, participants with insomnia symptoms and increased cTnI were at increased risk of the composite endpoint (hazard ratio 1.71, 95% CI 1.04-2.79) compared to participants with insomnia symptoms and low cTnI. In the general population, insomnia symptoms are not associated with biochemical evidence of subclinical myocardial injury.
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Affiliation(s)
- Fjola D. Sigurdardottir
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
- Cardiovascular Research Group, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Magnus N. Lyngbakken
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
- Cardiovascular Research Group, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kristian Hveem
- HUNT Research Centre, Department of Public Health and General Practice, Norwegian University of Science and Technology, Levanger, Norway
| | - Harald Hrubos Strøm
- Division of Surgery, department of Ear, Nose and Throat, Akershus University Hospital, Lørenskog, Norway
- University of Oslo, Medical faculty, Institute of basic medical sciences, department of behavioural sciences
| | - Helge Røsjø
- Cardiovascular Research Group, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Torbjørn Omland
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
- Cardiovascular Research Group, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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27
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Lundin KEA, Røsjø H, Myhren H, Kvale D, Rosvold EO. Medical education and training during a pandemic. Tidsskr Nor Laegeforen 2021; 141:21-0581. [PMID: 34505488 DOI: 10.4045/tidsskr.21.0581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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28
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Myhre PL, Ottesen AH, Faaren AL, Tveit SH, Springett J, Pyylampi J, Stridsberg M, Christensen G, Høiseth AD, Omland T, Røsjø H. Performance of a Novel Research-Use-Only Secretoneurin ELISA in Patients with Suspected Acute Coronary Syndrome: Comparison with an Established Secretoneurin Radioimmunoassay. Cardiology 2021; 146:566-574. [PMID: 34284402 DOI: 10.1159/000517444] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/30/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Circulating secretoneurin (SN) concentrations, as measured by established radioimmunoassay (RIA), risk stratify patients with cardiovascular disease. We now report data for a recently developed research-use-only SN enzyme-linked immunosorbent assay (ELISA) in patients with suspected acute coronary syndrome (ACS). METHODS SN ELISA was developed according to industry standards and tested in 401 unselected chest pain patients. Blood samples were drawn <24 h from admission, and we adjudicated all hospitalizations as ACS or non-ACS. The mean follow-up was 6.2 years. RESULTS SN ELISA with 2 monoclonal sheep anti-SN antibodies has a measuring range of 10-250 pmol/L and demonstrates excellent analytical precision and accuracy across the range of SN concentrations. SN measured by ELISA and RIA correlated in the chest pain patients: rho = 0.39, p < 0.001. SN concentrations were higher in ACS patients (n = 161 [40%]) than in non-ACS patients (n = 240) for both assays, with an area under the curve (AUC) of 0.66 (95% CI: 0.61-0.71) for ELISA and 0.59 (0.54-0.65) for RIA. SN concentrations were also higher in nonsurvivors (n = 65 [16%]) than survivors, with an AUC of 0.72 (0.65-0.79) for ELISA versus 0.64 (0.56-0.72) for RIA, p = 0.007, for difference between assays. Adjusting for age, sex, blood pressure, previous myocardial infarction, atrial fibrillation, and heart failure in multivariable analysis, SN concentrations as measured by ELISA, but not RIA, remained associated with mortality, with a hazard ratio of 1.71 (1.03-2.84), p = 0.038. CONCLUSIONS The novel SN ELISA has excellent performance, higher AUC for diagnosis, and superior prognostic accuracy compared to the established RIA in chest pain patients.
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Affiliation(s)
- Peder L Myhre
- Division of Medicine, Department of Cardiology, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anett H Ottesen
- Division for Research and Innovation, Akershus University Hospital, Lørenskog, Norway.,Institute for Experimental Medical Research, Oslo University Hospital, Ullevål, Oslo, Norway
| | | | - Sjur H Tveit
- Division of Medicine, Department of Cardiology, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | | | - Mats Stridsberg
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Geir Christensen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Institute for Experimental Medical Research, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Arne Didrik Høiseth
- Division of Medicine, Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
| | - Torbjørn Omland
- Division of Medicine, Department of Cardiology, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Helge Røsjø
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division for Research and Innovation, Akershus University Hospital, Lørenskog, Norway
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29
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Lyngbakken MN, Kvisvik B, Aagaard EN, Berge T, Pervez MO, Brynildsen J, Tveit A, Steine K, Røsjø H, Omland T. B-Type Natriuretic Peptide Is Associated with Indices of Left Ventricular Dysfunction in Healthy Subjects from the General Population: The Akershus Cardiac Examination 1950 Study. Clin Chem 2021; 67:204-215. [PMID: 33279958 DOI: 10.1093/clinchem/hvaa257] [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] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 10/12/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Concentrations of B-type natriuretic peptide (BNP) reflect myocardial distension and stress, and are associated with poor prognosis in patients with cardiovascular disease. Accordingly, we hypothesized that concentrations of BNP would be associated with indices of adverse left ventricular (LV) remodeling and early stages of LV systolic and diastolic dysfunction in healthy participants from the general population. METHODS We measured BNP in 1757 women and 1677 men free from known coronary heart disease participating in the prospective observational Akershus Cardiac Examination 1950 Study. All study participants underwent extensive cardiovascular phenotyping at baseline, including detailed echocardiography with assessment of indexed LV mass (LVMI), diastolic [tissue Doppler e', E/e' ratio, indexed left atrial volume (LAVI), maximal tricuspid regurgitation velocity (TRVmax), and E/A ratio], and systolic [global longitudinal strain (GLS) and LV ejection fraction (LVEF)] function. RESULTS Study participants with the highest BNP concentrations had higher GLS, LVMI, e', E/e' ratio, LAVI, TRVmax, and E/A ratio. In adjusted analyses, both GLS and LVEF exhibited significant nonlinear associations with BNP, with reduced LV systolic function observed in both the low and high concentration range of BNP. CONCLUSIONS In healthy participants recruited from the general population, concentrations of BNP exhibit nonlinear associations with LV systolic function, and both low and high concentrations are associated with reduced LV systolic function. This supports the notion that natriuretic peptides are beneficial and elicit cardioprotective effects, and may have important implications for the interpretation of BNP measurements in the general population.
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Affiliation(s)
- Magnus Nakrem Lyngbakken
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Brede Kvisvik
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Erika Nerdrum Aagaard
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Trygve Berge
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
| | - Mohammad Osman Pervez
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jon Brynildsen
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Arnljot Tveit
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
| | - Kjetil Steine
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Helge Røsjø
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway
| | - Torbjørn Omland
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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30
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Aagaard EN, Kvisvik B, Pervez MO, Lyngbakken MN, Berge T, Enger S, Orstad EB, Smith P, Omland T, Tveit A, Røsjø H, Steine K. Left ventricular mechanical dispersion in a general population: Data from the Akershus Cardiac Examination 1950 study. Eur Heart J Cardiovasc Imaging 2021; 21:183-190. [PMID: 31504360 DOI: 10.1093/ehjci/jez210] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/22/2019] [Indexed: 12/24/2022] Open
Abstract
AIMS Increased left ventricular mechanical dispersion by 2D speckle tracking echocardiography predicts ventricular arrhythmias in ischaemic heart disease and heart failure. However, little is known about mechanical dispersion in the general population. We aimed to study mechanical dispersion in the general population and in diseases associated with increased risk of cardiovascular disease. METHODS AND RESULTS The present cross-sectional study consists of 2529 subjects born in 1950 included in the Akershus Cardiac Examination (ACE) 1950 study. Global longitudinal strain (GLS) was assessed from 17 strain segments, and mechanical dispersion calculated as the standard deviation of contraction duration of all segments. The cohort was divided according to the median value of mechanical dispersion, and multivariable linear regression models were performed with mechanical dispersion as the dependent variable. The prevalence of coronary artery disease (CAD), hypertension, obesity, and diabetes (P < 0.01 for all) was significantly higher in subjects with supra-median mechanical dispersion. In a multivariable clinical model, CAD (B = 7.05), hypertension (B = 4.15; both P < 0.001), diabetes (B = 3.39), and obesity (B = 1.89; both P < 0.05) were independently associated with increasing mechanical dispersion. When echocardiographic indices were added to the multivariable model, CAD (B = 4.38; P < 0.01) and hypertension (B = 2.86; P < 0.001) remained significant in addition to peak early diastolic tissue velocity e' (B = -2.00), GLS (B = 1.68), and ejection fraction (B = 0.22; P < 0.001 for all). CONCLUSION In a general middle-aged population, prevalent CAD and hypertension were associated with increasing mechanical dispersion, possibly indicating elevated risk of fatal arrhythmias and sudden cardiac death. Albeit weaker, systolic and diastolic dysfunction, were also associated with increasing mechanical dispersion.
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Affiliation(s)
- Erika N Aagaard
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Postbox 1000, 1478 Lørenskog, Norway.,Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Postbox 1078 Blindern, 0316 Oslo, Norway
| | - Brede Kvisvik
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Postbox 1000, 1478 Lørenskog, Norway.,Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Postbox 1078 Blindern, 0316 Oslo, Norway
| | - Mohammad O Pervez
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Postbox 1000, 1478 Lørenskog, Norway.,Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Postbox 1078 Blindern, 0316 Oslo, Norway
| | - Magnus N Lyngbakken
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Postbox 1000, 1478 Lørenskog, Norway.,Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Postbox 1078 Blindern, 0316 Oslo, Norway
| | - Trygve Berge
- Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Postbox 1078 Blindern, 0316 Oslo, Norway.,Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Postbox 800, 3004 Drammen, Norway
| | - Steve Enger
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Postbox 800, 3004 Drammen, Norway
| | - Eivind B Orstad
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Postbox 1000, 1478 Lørenskog, Norway
| | - Pål Smith
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Postbox 1000, 1478 Lørenskog, Norway.,Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Postbox 1078 Blindern, 0316 Oslo, Norway
| | - Torbjørn Omland
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Postbox 1000, 1478 Lørenskog, Norway.,Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Postbox 1078 Blindern, 0316 Oslo, Norway
| | - Arnljot Tveit
- Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Postbox 1078 Blindern, 0316 Oslo, Norway.,Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Postbox 800, 3004 Drammen, Norway
| | - Helge Røsjø
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Postbox 1000, 1478 Lørenskog, Norway.,Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Postbox 1078 Blindern, 0316 Oslo, Norway
| | - Kjetil Steine
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Postbox 1000, 1478 Lørenskog, Norway.,Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Postbox 1078 Blindern, 0316 Oslo, Norway
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31
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Heck SL, Mecinaj A, Ree AH, Hoffmann P, Schulz-Menger J, Fagerland MW, Gravdehaug B, Røsjø H, Steine K, Geisler J, Gulati G, Omland T. Prevention of Cardiac Dysfunction During Adjuvant Breast Cancer Therapy (PRADA): Extended Follow-Up of a 2×2 Factorial, Randomized, Placebo-Controlled, Double-Blind Clinical Trial of Candesartan and Metoprolol. Circulation 2021; 143:2431-2440. [PMID: 33993702 PMCID: PMC8212877 DOI: 10.1161/circulationaha.121.054698] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 04/13/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Adjuvant breast cancer therapy containing anthracyclines with or without anti-human epidermal growth factor receptor-2 antibodies and radiotherapy is associated with cancer treatment-related cardiac dysfunction. In the PRADA trial (Prevention of Cardiac Dysfunction During Adjuvant Breast Cancer Therapy), concomitant treatment with the angiotensin receptor blocker candesartan attenuated the reduction in left ventricular ejection fraction (LVEF) in women receiving treatment for breast cancer, whereas the β-blocker metoprolol attenuated the increase in cardiac troponins. This study aimed to assess the long-term effects of candesartan and metoprolol or their combination to prevent a reduction in cardiac function and myocardial injury. METHODS In this 2×2 factorial, randomized, placebo-controlled, double-blind, single-center trial, patients with early breast cancer were assigned to concomitant treatment with candesartan cilexetil, metoprolol succinate, or matching placebos. Target doses were 32 and 100 mg, respectively. Study drugs were discontinued after adjuvant therapy. All 120 validly randomized patients were included in the intention-to-treat analysis. The primary outcome measure was change in LVEF assessed by cardiovascular magnetic resonance imaging from baseline to extended follow-up. Secondary outcome measures included changes in left ventricular volumes, echocardiographic peak global longitudinal strain, and circulating cardiac troponin concentrations. RESULTS A small decline in LVEF but no significant between-group differences were observed from baseline to extended follow-up, at a median of 23 months (interquartile range, 21 to 28 months) after randomization (candesartan, 1.7% [95% CI, 0.5 to 2.8]; no candesartan, 1.8% [95% CI, 0.6 to 3.0]; metoprolol, 1.6% [95% CI, 0.4 to 2.7]; no metoprolol, 1.9% [95% CI, 0.7 to 3.0]). Candesartan treatment during adjuvant therapy was associated with a significant reduction in left ventricular end-diastolic volume compared with the noncandesartan group (P=0.021) and attenuated decline in global longitudinal strain (P=0.046) at 2 years. No between-group differences in change in cardiac troponin I and T concentrations were observed. CONCLUSIONS Anthracycline-containing adjuvant therapy for early breast cancer was associated with a decline in LVEF during extended follow-up. Candesartan during adjuvant therapy did not prevent reduction in LVEF at 2 years, but was associated with modest reduction in left ventricular end-diastolic volume and preserved global longitudinal strain. These results suggest that a broadly administered cardioprotective approach may not be required in most patients with early breast cancer without preexisting cardiovascular disease. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01434134.
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Affiliation(s)
- Siri Lagethon Heck
- Department of Diagnostic Imaging (S.L.H.), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (S.L.H., A.M., A.H.R., H.R., K.S., J.G., G.G., T.O.)
| | - Albulena Mecinaj
- Department of Cardiology (A.M., K.S., G.G., T.O.), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (S.L.H., A.M., A.H.R., H.R., K.S., J.G., G.G., T.O.)
| | - Anne Hansen Ree
- Department of Oncology (A.H.R., J.G.), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (S.L.H., A.M., A.H.R., H.R., K.S., J.G., G.G., T.O.)
| | - Pavel Hoffmann
- Section for Interventional Cardiology, Department of Cardiology, Division of Cardiovascular and Pulmonary Diseases (P.H.), Oslo University Hospital, Ullevål, Norway
| | - Jeanette Schulz-Menger
- Department of Cardiology, Charité Campus Buch, Universitätsmedizin Berlin, Germany (J.S.-M.)
- HELIOS Clinics, Berlin, Germany (J.S.-M.)
| | - Morten Wang Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Norway (M.W.F.)
| | - Berit Gravdehaug
- Department of Breast and Endocrine Surgery, (B.G.), Akershus University Hospital, Lørenskog, Norway
| | - Helge Røsjø
- Division of Research and Innovation (H.R.), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (S.L.H., A.M., A.H.R., H.R., K.S., J.G., G.G., T.O.)
| | - Kjetil Steine
- Department of Cardiology (A.M., K.S., G.G., T.O.), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (S.L.H., A.M., A.H.R., H.R., K.S., J.G., G.G., T.O.)
| | - Jürgen Geisler
- Department of Oncology (A.H.R., J.G.), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (S.L.H., A.M., A.H.R., H.R., K.S., J.G., G.G., T.O.)
| | - Geeta Gulati
- Department of Cardiology (A.M., K.S., G.G., T.O.), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (S.L.H., A.M., A.H.R., H.R., K.S., J.G., G.G., T.O.)
- Department of Cardiology, Division of Medicine (G.G.), Oslo University Hospital, Ullevål, Norway
| | - Torbjørn Omland
- Department of Cardiology (A.M., K.S., G.G., T.O.), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (S.L.H., A.M., A.H.R., H.R., K.S., J.G., G.G., T.O.)
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Myhre PL, Lyngbakken MN, Berge T, Røysland R, Aagaard EN, Pervez O, Kvisvik B, Brynildsen J, Norseth J, Tveit A, Steine K, Omland T, Røsjø H. Diagnostic Thresholds for Pre-Diabetes Mellitus and Diabetes Mellitus and Subclinical Cardiac Disease in the General Population: Data From the ACE 1950 Study. J Am Heart Assoc 2021; 10:e020447. [PMID: 33998259 PMCID: PMC8483542 DOI: 10.1161/jaha.120.020447] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Diabetes mellitus (DM) is associated with left ventricular remodeling and incident heart failure, but the association between glycated hemoglobin A1c (HbA1c) and subclinical cardiac disease is not established. We aimed to determine the associations between HbA1c and (1) echocardiographic measures of left ventricular structure and function, and (2) cardiovascular biomarkers: cardiac troponin T, NT-proBNP (N-terminal pro-B-type natriuretic peptide), and CRP (C-reactive protein). Methods and Results Participants (n=3688) born in 1950 from the population-based ACE (Akershus Cardiac Examination) 1950 Study were classified as DM (HbA1c≥6.5% or self-reported DM), pre-DM (HbA1c 5.7%-6.5%), and no-DM (HbA1c<5.7%). DM, pre-DM, and no-DM were classified in 380 (10%), 1630 (44%), and 1678 (46%) participants, respectively. Mean age was 63.9±0.7 years, mean body mass index was 27.2±4.4 kg/m2, and 49% were women. Higher HbA1c was associated with worse left ventricular systolic (ejection fraction and global longitudinal strain) and diastolic (E/e'-ratio) function, myocardial injury (cardiac troponin T), inflammation (CRP), and impaired neurohormonal homeostasis (NT-proBNP) (P<0.001 in unadjusted and P<0.01 in adjusted analysis for all). The associations between HbA1c and cardiovascular biomarkers were independent of the echocardiographic variables, and vice versa. Associations were nonlinear (P<0.05 for nonlinearity) and appeared stronger in the pre-DM range of HbA1c than the no-DM and DM range. Conclusions HbA1c was associated with indexes of subclinical cardiovascular disease, and this was more pronounced in pre-DM. Our results suggest that cardiovascular preventive measures should be considered also in subjects with hyperglycemia and HbA1c below the established DM cutoff. Registration clinicaltrials.gov. Identifier: NCT01555411.
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Affiliation(s)
- Peder L Myhre
- Department of CardiologyAkershus University Hospital Lørenskog Norway.,Department of Multidisciplinary Laboratory Medicine and Medical BiochemistryAkershus University Hospital Lørenskog Norway
| | - Magnus N Lyngbakken
- Department of CardiologyAkershus University Hospital Lørenskog Norway.,Department of Multidisciplinary Laboratory Medicine and Medical BiochemistryAkershus University Hospital Lørenskog Norway
| | - Trygve Berge
- Department of Multidisciplinary Laboratory Medicine and Medical BiochemistryAkershus University Hospital Lørenskog Norway.,Division for Research and InnovationAkershus University Hospital Lørenskog Norway
| | - Ragnhild Røysland
- Department of Multidisciplinary Laboratory Medicine and Medical BiochemistryAkershus University Hospital Lørenskog Norway.,Institute for Clinical MedicineUniversity of Oslo Norway
| | - Erika N Aagaard
- Department of CardiologyAkershus University Hospital Lørenskog Norway.,Department of Multidisciplinary Laboratory Medicine and Medical BiochemistryAkershus University Hospital Lørenskog Norway
| | - Osman Pervez
- Department of CardiologyAkershus University Hospital Lørenskog Norway.,Department of Multidisciplinary Laboratory Medicine and Medical BiochemistryAkershus University Hospital Lørenskog Norway
| | - Brede Kvisvik
- Department of CardiologyAkershus University Hospital Lørenskog Norway.,Department of Multidisciplinary Laboratory Medicine and Medical BiochemistryAkershus University Hospital Lørenskog Norway
| | - Jon Brynildsen
- Department of CardiologyAkershus University Hospital Lørenskog Norway.,Department of Multidisciplinary Laboratory Medicine and Medical BiochemistryAkershus University Hospital Lørenskog Norway
| | - Jon Norseth
- Department of Multidisciplinary Laboratory Medicine and Medical BiochemistryAkershus University Hospital Lørenskog Norway.,Department of Medical ResearchVestre Viken Hospital Trust Bærum Norway
| | - Arnljot Tveit
- Department of Multidisciplinary Laboratory Medicine and Medical BiochemistryAkershus University Hospital Lørenskog Norway.,Division for Research and InnovationAkershus University Hospital Lørenskog Norway
| | - Kjetil Steine
- Department of CardiologyAkershus University Hospital Lørenskog Norway.,Department of Multidisciplinary Laboratory Medicine and Medical BiochemistryAkershus University Hospital Lørenskog Norway
| | - Torbjørn Omland
- Department of CardiologyAkershus University Hospital Lørenskog Norway.,Department of Multidisciplinary Laboratory Medicine and Medical BiochemistryAkershus University Hospital Lørenskog Norway
| | - Helge Røsjø
- Department of Multidisciplinary Laboratory Medicine and Medical BiochemistryAkershus University Hospital Lørenskog Norway.,Department of Laboratory MedicineVestre Viken Hospital Trust Bærum Norway
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33
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Axfors C, Schmitt AM, Janiaud P, van’t Hooft J, Abd-Elsalam S, Abdo EF, Abella BS, Akram J, Amaravadi RK, Angus DC, Arabi YM, Azhar S, Baden LR, Baker AW, Belkhir L, Benfield T, Berrevoets MAH, Chen CP, Chen TC, Cheng SH, Cheng CY, Chung WS, Cohen YZ, Cowan LN, Dalgard O, de Almeida e Val FF, de Lacerda MVG, de Melo GC, Derde L, Dubee V, Elfakir A, Gordon AC, Hernandez-Cardenas CM, Hills T, Hoepelman AIM, Huang YW, Igau B, Jin R, Jurado-Camacho F, Khan KS, Kremsner PG, Kreuels B, Kuo CY, Le T, Lin YC, Lin WP, Lin TH, Lyngbakken MN, McArthur C, McVerry BJ, Meza-Meneses P, Monteiro WM, Morpeth SC, Mourad A, Mulligan MJ, Murthy S, Naggie S, Narayanasamy S, Nichol A, Novack LA, O’Brien SM, Okeke NL, Perez L, Perez-Padilla R, Perrin L, Remigio-Luna A, Rivera-Martinez NE, Rockhold FW, Rodriguez-Llamazares S, Rolfe R, Rosa R, Røsjø H, Sampaio VS, Seto TB, Shahzad M, Soliman S, Stout JE, Thirion-Romero I, Troxel AB, Tseng TY, Turner NA, Ulrich RJ, Walsh SR, Webb SA, Weehuizen JM, Velinova M, Wong HL, Wrenn R, Zampieri FG, Zhong W, Moher D, Goodman SN, Ioannidis JPA, Hemkens LG. Author Correction: Mortality outcomes with hydroxychloroquine and chloroquine in COVID-19 from an international collaborative meta-analysis of randomized trials. Nat Commun 2021; 12:3001. [PMID: 33990619 PMCID: PMC8121133 DOI: 10.1038/s41467-021-23559-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Cathrine Axfors
- grid.168010.e0000000419368956Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA USA ,grid.8993.b0000 0004 1936 9457Department for Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Andreas M. Schmitt
- grid.6612.30000 0004 1937 0642Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland ,grid.6612.30000 0004 1937 0642Department of Medical Oncology, University of Basel, Basel, Switzerland
| | - Perrine Janiaud
- grid.6612.30000 0004 1937 0642Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Janneke van’t Hooft
- grid.168010.e0000000419368956Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA USA ,grid.7177.60000000084992262Amsterdam University Medical Center, Amsterdam University, Amsterdam, the Netherlands
| | - Sherief Abd-Elsalam
- grid.412258.80000 0000 9477 7793Tropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ehab F. Abdo
- grid.252487.e0000 0000 8632 679XTropical Medicine and Gastroenterology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Benjamin S. Abella
- grid.25879.310000 0004 1936 8972Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Javed Akram
- grid.412956.dDepartment of Internal Medicine, Vice Chancellor, University of Health Sciences, Lahore, Punjab Pakistan
| | - Ravi K. Amaravadi
- grid.25879.310000 0004 1936 8972Abramson Cancer Center and Department of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Derek C. Angus
- grid.21925.3d0000 0004 1936 9000Department of Critical Care Medicine, The Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, University of Pittsburgh, Pittsburgh, PA USA ,grid.21925.3d0000 0004 1936 9000the UPMC Health System Office of Healthcare Innovation, University of Pittsburgh Medical Centre, Pittsburgh, PA USA
| | - Yaseen M. Arabi
- grid.412149.b0000 0004 0608 0662Intensive Care Department, King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Shehnoor Azhar
- grid.412956.dDepartment of Public Health, University of Health Sciences, Lahore, Punjab Pakistan
| | - Lindsey R. Baden
- grid.62560.370000 0004 0378 8294Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, MA USA
| | - Arthur W. Baker
- grid.189509.c0000000100241216Department of Medicine, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC USA
| | - Leila Belkhir
- grid.7942.80000 0001 2294 713XInfectious Diseases Department, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Thomas Benfield
- grid.4973.90000 0004 0646 7373Center of Research & Disruption of Infectious Diseases, Department of Infectious Diseases, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | - Marvin A. H. Berrevoets
- grid.416373.4Department of Internal Medicine, Elisabeth-Tweesteden hospital, Tilburg, Netherlands
| | - Cheng-Pin Chen
- grid.454740.6Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Tsung-Chia Chen
- grid.454740.6Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Shu-Hsing Cheng
- grid.454740.6Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Chien-Yu Cheng
- grid.454740.6Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Wei-Sheng Chung
- grid.454740.6Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | | | - Lisa N. Cowan
- grid.417555.70000 0000 8814 392XSanofi, Bridgewater, NJ USA
| | - Olav Dalgard
- grid.411279.80000 0000 9637 455XDepartment of Infectious Diseases, Division of Medicine, Akershus University Hospital, Lørenskog, Norway ,grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Marcus V. G. de Lacerda
- grid.418153.a0000 0004 0486 0972Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM Brazil ,Instituto Leonidas e Maria Deane – ILMD, FIOCRUZ-AM, Manaus, AM Brazil
| | - Gisely C. de Melo
- grid.418153.a0000 0004 0486 0972Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM Brazil ,grid.412290.c0000 0000 8024 0602Universidade do Estado do Amazonas, Manaus, AM Brazil
| | - Lennie Derde
- grid.7692.a0000000090126352Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands ,grid.7692.a0000000090126352Intensive Care Centre, University Medical Center Utrecht, Utrecht, Netherlands
| | - Vincent Dubee
- grid.411147.60000 0004 0472 0283Infectious and Tropical Diseases Department, Angers University Hospital, Angers, France
| | | | - Anthony C. Gordon
- grid.417895.60000 0001 0693 2181Department of Surgery and Cancer, Anaesthetics, Pain Medicine, and Intensive Care Medicine, Imperial College London and Imperial College Healthcare NHS Trust, London, UK
| | - Carmen M. Hernandez-Cardenas
- grid.419179.30000 0000 8515 3604Critical Care Department, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Ciudad de México, Mexico
| | - Thomas Hills
- grid.415117.70000 0004 0445 6830Medical Research Institute of New Zealand, Wellington, New Zealand ,grid.414055.10000 0000 9027 2851Auckland City Hospital, Auckland, New Zealand
| | - Andy I. M. Hoepelman
- grid.7692.a0000000090126352Department of Infectious Diseases, University Medical Center Utrecht, Utrecht, Netherlands
| | - Yi-Wen Huang
- grid.454740.6Department of Internal Medicine, Chang Hua Hospital, Ministry of Health and Welfare, Changhua, Taiwan
| | - Bruno Igau
- grid.417555.70000 0000 8814 392XSanofi, Bridgewater, NJ USA
| | - Ronghua Jin
- grid.24696.3f0000 0004 0369 153XBeijing Youan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Felipe Jurado-Camacho
- grid.419179.30000 0000 8515 3604Critical Care Department, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Ciudad de México, Mexico
| | - Khalid S. Khan
- grid.4489.10000000121678994Department of Preventive Medicine & Public Health, University of Granada, Hospital Real, Avenida del Hospicio, Granada, Granada, Spain
| | - Peter G. Kremsner
- grid.10392.390000 0001 2190 1447Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany ,grid.452268.fCentre de Recherches Médicales de Lambaréné, Lambaréné, Gabon ,grid.452463.2German Center for Infection Research, Partner Site Tübingen, Tübingen, Germany
| | - Benno Kreuels
- grid.13648.380000 0001 2180 3484Department of Medicine, Division of Tropical Medicine and Division of Infectious Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany ,grid.424065.10000 0001 0701 3136Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Cheng-Yu Kuo
- grid.454740.6Department of Internal Medicine, Pingtung Hospital, Ministry of Health and Welfare, Pingtung, Taiwan
| | - Thuy Le
- grid.189509.c0000000100241216Department of Medicine, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC USA
| | - Yi-Chun Lin
- grid.454740.6Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Wu-Pu Lin
- grid.454740.6Department of Internal Medicine, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Tse-Hung Lin
- grid.454740.6Department of Internal Medicine, Chang Hua Hospital, Ministry of Health and Welfare, Changhua, Taiwan
| | - Magnus Nakrem Lyngbakken
- grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway ,grid.411279.80000 0000 9637 455XDivision of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Colin McArthur
- grid.415117.70000 0004 0445 6830Medical Research Institute of New Zealand, Wellington, New Zealand ,grid.414055.10000 0000 9027 2851Auckland City Hospital, Auckland, New Zealand ,grid.1002.30000 0004 1936 7857School of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC Australia
| | - Bryan J. McVerry
- grid.21925.3d0000 0004 1936 9000Department of Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | | | - Wuelton M. Monteiro
- grid.418153.a0000 0004 0486 0972Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM Brazil ,grid.412290.c0000 0000 8024 0602Universidade do Estado do Amazonas, Manaus, AM Brazil
| | - Susan C. Morpeth
- grid.415534.20000 0004 0372 0644Middlemore Hospital, Auckland, New Zealand
| | - Ahmad Mourad
- grid.189509.c0000000100241216Department of Medicine, Duke University Medical Center, Durham, NC 27710 USA
| | - Mark J. Mulligan
- grid.137628.90000 0004 1936 8753Department of Microbiology, NYU Grossman School of Medicine, New York, NY USA ,grid.137628.90000 0004 1936 8753Department of Internal Medicine, Division of Infectious Diseases and Immunology, NYU Grossman School of Medicine, New York, NY USA
| | - Srinivas Murthy
- grid.17091.3e0000 0001 2288 9830University of British Columbia School of Medicine, Vancouver, BC Canada
| | - Susanna Naggie
- grid.189509.c0000000100241216Department of Medicine, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC USA
| | - Shanti Narayanasamy
- grid.189509.c0000000100241216Department of Medicine, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC USA
| | - Alistair Nichol
- grid.1002.30000 0004 1936 7857School of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC Australia ,grid.267362.40000 0004 0432 5259Department of Intensive Care, Alfred Health, Melbourne, VIC Australia ,grid.412751.40000 0001 0315 8143Department of Anesthesia and Intensive Care, St Vincent’s University Hospital, Dublin, Ireland ,grid.7886.10000 0001 0768 2743School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - Lewis A. Novack
- grid.38142.3c000000041936754XDivision of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Sean M. O’Brien
- grid.189509.c0000000100241216Department of Biostatistics and Bioinformatics, Duke University Medical Center and Duke Clinical Research Institute, Durham, NC USA
| | - Nwora Lance Okeke
- grid.189509.c0000000100241216Department of Medicine, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC USA
| | | | - Rogelio Perez-Padilla
- grid.419179.30000 0000 8515 3604Department of Smoking and COPD, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Ciudad de México, Mexico
| | | | - Arantxa Remigio-Luna
- grid.419179.30000 0000 8515 3604Department of Smoking and COPD, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Ciudad de México, Mexico
| | | | - Frank W. Rockhold
- grid.189509.c0000000100241216Department of Biostatistics and Bioinformatics, Duke University Medical Center and Duke Clinical Research Institute, Durham, NC USA
| | - Sebastian Rodriguez-Llamazares
- grid.419179.30000 0000 8515 3604Department of Smoking and COPD, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Ciudad de México, Mexico
| | - Robert Rolfe
- grid.189509.c0000000100241216Department of Medicine, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC USA
| | - Rossana Rosa
- grid.430652.60000 0004 0396 2096UnityPoint Health, Des Moines, IA USA
| | - Helge Røsjø
- grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway ,grid.411279.80000 0000 9637 455XDivision of Research and Innovation, Akershus University Hospital, Lørenskog, Norway
| | - Vanderson S. Sampaio
- grid.418153.a0000 0004 0486 0972Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM Brazil ,Fundação de Vigilância em Saúde do Amazonas, Manaus, AM Brazil
| | - Todd B. Seto
- grid.410445.00000 0001 2188 0957University of Hawaii John A. Burns School of Medicine, Honolulu, HI USA ,grid.415594.8The Queen’s Medical Center, Honolulu, HI USA
| | - Muhammad Shahzad
- grid.412956.dDepartment of Pharmacology, University of Health Sciences, Lahore, Punjab Pakistan
| | - Shaimaa Soliman
- grid.411775.10000 0004 0621 4712Public Health and Community Medicine, Menoufia University, Menoufia, Egypt
| | - Jason E. Stout
- grid.189509.c0000000100241216Department of Medicine, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC USA
| | - Ireri Thirion-Romero
- grid.419179.30000 0000 8515 3604Department of Smoking and COPD, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Ciudad de México, Mexico
| | - Andrea B. Troxel
- grid.137628.90000 0004 1936 8753Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, New York, NY USA
| | - Ting-Yu Tseng
- grid.454740.6Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Nicholas A. Turner
- grid.189509.c0000000100241216Department of Medicine, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC USA
| | - Robert J. Ulrich
- grid.137628.90000 0004 1936 8753Department of Medicine, Division of Infectious Diseases and Immunology, NYU Grossman School of Medicine, New York, NY USA
| | - Stephen R. Walsh
- grid.62560.370000 0004 0378 8294Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, MA USA
| | - Steve A. Webb
- grid.1002.30000 0004 1936 7857School of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC Australia ,grid.460013.0St. John of God Hospital, Subiaco, WA Australia
| | - Jesper M. Weehuizen
- grid.7692.a0000000090126352Department of Infectious Diseases, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Hon-Lai Wong
- grid.454740.6Department of Internal Medicine, Keelung Hospital, Ministry of Health and Welfare, Keelung, Taiwan
| | - Rebekah Wrenn
- grid.189509.c0000000100241216Department of Medicine, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC USA
| | - Fernando G. Zampieri
- grid.477370.00000 0004 0454 243XResearch Institute, HCor-Hospital do Coração, São Paulo, Brazil ,Research Institute, BRICNet - Brazilian Research in Intensive Care Network, São Paulo, Brazil ,IDor Research Institute, São Paulo, Brazil
| | - Wu Zhong
- grid.410740.60000 0004 1803 4911National Engineering Research Center for the Emergency Drug, Beijing Institute of Pharmacology and Toxicology, Beijing, People’s Republic of China
| | - David Moher
- grid.412687.e0000 0000 9606 5108Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Steven N. Goodman
- grid.168010.e0000000419368956Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA USA ,grid.168010.e0000000419368956Stanford University School of Medicine, Stanford, CA USA ,grid.168010.e0000000419368956Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA USA
| | - John P. A. Ioannidis
- grid.168010.e0000000419368956Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA USA ,grid.168010.e0000000419368956Stanford University School of Medicine, Stanford, CA USA ,grid.168010.e0000000419368956Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA USA ,grid.168010.e0000000419368956Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA USA ,grid.484013.aMeta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany
| | - Lars G. Hemkens
- grid.168010.e0000000419368956Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA USA ,grid.6612.30000 0004 1937 0642Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland ,grid.484013.aMeta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany
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34
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Lyngbakken MN, Vigen T, Ihle-Hansen H, Brynildsen J, Berge T, Rønning OM, Tveit A, Røsjø H, Omland T. Cardiac troponin I measured with a very high sensitivity assay predicts subclinical carotid atherosclerosis: The Akershus Cardiac Examination 1950 Study. Clin Biochem 2021; 93:59-65. [PMID: 33861986 DOI: 10.1016/j.clinbiochem.2021.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/16/2021] [Accepted: 04/08/2021] [Indexed: 11/25/2022]
Abstract
AIMS Concentrations of cardiac troponin I (cTnI) are associated with incident ischemic stroke and predict the presence and severity of coronary atherosclerosis. Accordingly, we hypothesized that concentrations of cTnI measured with a very high sensitivity (hs-) assay would be associated with subclinical stages of carotid atherosclerosis in the general population. METHODS We measured hs-cTnI on the Singulex Clarity System in 1745 women and 1666 men participating in the prospective observational Akershus Cardiac Examination 1950 Study. All study participants were free from known coronary heart disease and underwent extensive cardiovascular phenotyping at baseline, including carotid ultrasound. We quantified carotid atherosclerosis by the carotid plaque score, carotid intima-media thickness (cIMT) and the presence of hypoechoic plaques. RESULTS Concentrations of hs-cTnI were measurable in 99.8% of study participants and were significantly associated with increased carotid plaque score (odds ratio for quartile 4 of hs-cTnI 1.59, 95% CI 1.22 to 2.07, p for trend < 0.001) and cIMT (odds ratio for quartile 4 of hs-cTnI 1.57, 95% CI 1.02 to 2.42, p for trend = 0.036), but not with the presence of hypoechoic plaques. hs-cTnI concentrations significantly improved reclassification and discrimination models in predicting carotid plaques when added to cardiovascular risk factors, no improvements were evident in predicting cIMT or hypoechoic plaques. CONCLUSION Concentrations of cTnI measured with a very high sensitivity assay are predictive of carotid atherosclerotic burden, a phenomenon likely attributable to common risk factors of subclinical myocardial injury, coronary and carotid atherosclerosis.
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Affiliation(s)
- Magnus Nakrem Lyngbakken
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Thea Vigen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Neurology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Håkon Ihle-Hansen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Norway
| | - Jon Brynildsen
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Trygve Berge
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Norway
| | - Ole Morten Rønning
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Neurology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Arnljot Tveit
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Norway
| | - Helge Røsjø
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway
| | - Torbjørn Omland
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
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35
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Axfors C, Schmitt AM, Janiaud P, Van't Hooft J, Abd-Elsalam S, Abdo EF, Abella BS, Akram J, Amaravadi RK, Angus DC, Arabi YM, Azhar S, Baden LR, Baker AW, Belkhir L, Benfield T, Berrevoets MAH, Chen CP, Chen TC, Cheng SH, Cheng CY, Chung WS, Cohen YZ, Cowan LN, Dalgard O, de Almeida E Val FF, de Lacerda MVG, de Melo GC, Derde L, Dubee V, Elfakir A, Gordon AC, Hernandez-Cardenas CM, Hills T, Hoepelman AIM, Huang YW, Igau B, Jin R, Jurado-Camacho F, Khan KS, Kremsner PG, Kreuels B, Kuo CY, Le T, Lin YC, Lin WP, Lin TH, Lyngbakken MN, McArthur C, McVerry BJ, Meza-Meneses P, Monteiro WM, Morpeth SC, Mourad A, Mulligan MJ, Murthy S, Naggie S, Narayanasamy S, Nichol A, Novack LA, O'Brien SM, Okeke NL, Perez L, Perez-Padilla R, Perrin L, Remigio-Luna A, Rivera-Martinez NE, Rockhold FW, Rodriguez-Llamazares S, Rolfe R, Rosa R, Røsjø H, Sampaio VS, Seto TB, Shahzad M, Soliman S, Stout JE, Thirion-Romero I, Troxel AB, Tseng TY, Turner NA, Ulrich RJ, Walsh SR, Webb SA, Weehuizen JM, Velinova M, Wong HL, Wrenn R, Zampieri FG, Zhong W, Moher D, Goodman SN, Ioannidis JPA, Hemkens LG. Mortality outcomes with hydroxychloroquine and chloroquine in COVID-19 from an international collaborative meta-analysis of randomized trials. Nat Commun 2021; 12:2349. [PMID: 33859192 PMCID: PMC8050319 DOI: 10.1038/s41467-021-22446-z] [Citation(s) in RCA: 149] [Impact Index Per Article: 49.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 03/15/2021] [Indexed: 02/06/2023] Open
Abstract
Substantial COVID-19 research investment has been allocated to randomized clinical trials (RCTs) on hydroxychloroquine/chloroquine, which currently face recruitment challenges or early discontinuation. We aim to estimate the effects of hydroxychloroquine and chloroquine on survival in COVID-19 from all currently available RCT evidence, published and unpublished. We present a rapid meta-analysis of ongoing, completed, or discontinued RCTs on hydroxychloroquine or chloroquine treatment for any COVID-19 patients (protocol: https://osf.io/QESV4/ ). We systematically identified unpublished RCTs (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, Cochrane COVID-registry up to June 11, 2020), and published RCTs (PubMed, medRxiv and bioRxiv up to October 16, 2020). All-cause mortality has been extracted (publications/preprints) or requested from investigators and combined in random-effects meta-analyses, calculating odds ratios (ORs) with 95% confidence intervals (CIs), separately for hydroxychloroquine and chloroquine. Prespecified subgroup analyses include patient setting, diagnostic confirmation, control type, and publication status. Sixty-three trials were potentially eligible. We included 14 unpublished trials (1308 patients) and 14 publications/preprints (9011 patients). Results for hydroxychloroquine are dominated by RECOVERY and WHO SOLIDARITY, two highly pragmatic trials, which employed relatively high doses and included 4716 and 1853 patients, respectively (67% of the total sample size). The combined OR on all-cause mortality for hydroxychloroquine is 1.11 (95% CI: 1.02, 1.20; I² = 0%; 26 trials; 10,012 patients) and for chloroquine 1.77 (95%CI: 0.15, 21.13, I² = 0%; 4 trials; 307 patients). We identified no subgroup effects. We found that treatment with hydroxychloroquine is associated with increased mortality in COVID-19 patients, and there is no benefit of chloroquine. Findings have unclear generalizability to outpatients, children, pregnant women, and people with comorbidities.
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Affiliation(s)
- Cathrine Axfors
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
- Department for Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Andreas M Schmitt
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Medical Oncology, University of Basel, Basel, Switzerland
| | - Perrine Janiaud
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Janneke Van't Hooft
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
- Amsterdam University Medical Center, Amsterdam University, Amsterdam, the Netherlands
| | - Sherief Abd-Elsalam
- Tropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ehab F Abdo
- Tropical Medicine and Gastroenterology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Benjamin S Abella
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Javed Akram
- Department of Internal Medicine, Vice Chancellor, University of Health Sciences, Lahore, Punjab, Pakistan
| | - Ravi K Amaravadi
- Abramson Cancer Center and Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Derek C Angus
- Department of Critical Care Medicine, The Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, University of Pittsburgh, Pittsburgh, PA, USA
- the UPMC Health System Office of Healthcare Innovation, University of Pittsburgh Medical Centre, Pittsburgh, PA, USA
| | - Yaseen M Arabi
- Intensive Care Department, King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Shehnoor Azhar
- Department of Public Health, University of Health Sciences, Lahore, Punjab, Pakistan
| | - Lindsey R Baden
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA
| | - Arthur W Baker
- Department of Medicine, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA
| | - Leila Belkhir
- Infectious Diseases Department, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Thomas Benfield
- Center of Research & Disruption of Infectious Diseases, Department of Infectious Diseases, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | - Marvin A H Berrevoets
- Department of Internal Medicine, Elisabeth-Tweesteden hospital, Tilburg, Netherlands
| | - Cheng-Pin Chen
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Tsung-Chia Chen
- Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Shu-Hsing Cheng
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Chien-Yu Cheng
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Wei-Sheng Chung
- Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | | | | | - Olav Dalgard
- Department of Infectious Diseases, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Marcus V G de Lacerda
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil
- Instituto Leonidas e Maria Deane - ILMD, FIOCRUZ-AM, Manaus, AM, Brazil
| | - Gisely C de Melo
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil
- Universidade do Estado do Amazonas, Manaus, AM, Brazil
| | - Lennie Derde
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
- Intensive Care Centre, University Medical Center Utrecht, Utrecht, Netherlands
| | - Vincent Dubee
- Infectious and Tropical Diseases Department, Angers University Hospital, Angers, France
| | | | - Anthony C Gordon
- Department of Surgery and Cancer, Anaesthetics, Pain Medicine, and Intensive Care Medicine, Imperial College London and Imperial College Healthcare NHS Trust, London, UK
| | - Carmen M Hernandez-Cardenas
- Critical Care Department, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Ciudad de México, Mexico
| | - Thomas Hills
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Auckland City Hospital, Auckland, New Zealand
| | - Andy I M Hoepelman
- Department of Infectious Diseases, University Medical Center Utrecht, Utrecht, Netherlands
| | - Yi-Wen Huang
- Department of Internal Medicine, Chang Hua Hospital, Ministry of Health and Welfare, Changhua, Taiwan
| | | | - Ronghua Jin
- Beijing Youan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Felipe Jurado-Camacho
- Critical Care Department, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Ciudad de México, Mexico
| | - Khalid S Khan
- Department of Preventive Medicine & Public Health, University of Granada, Hospital Real, Avenida del Hospicio, Granada, Granada, Spain
| | - Peter G Kremsner
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- German Center for Infection Research, Partner Site Tübingen, Tübingen, Germany
| | - Benno Kreuels
- Department of Medicine, Division of Tropical Medicine and Division of Infectious Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Cheng-Yu Kuo
- Department of Internal Medicine, Pingtung Hospital, Ministry of Health and Welfare, Pingtung, Taiwan
| | - Thuy Le
- Department of Medicine, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA
| | - Yi-Chun Lin
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Wu-Pu Lin
- Department of Internal Medicine, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Tse-Hung Lin
- Department of Internal Medicine, Chang Hua Hospital, Ministry of Health and Welfare, Changhua, Taiwan
| | - Magnus Nakrem Lyngbakken
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Colin McArthur
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Auckland City Hospital, Auckland, New Zealand
- School of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Bryan J McVerry
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Wuelton M Monteiro
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil
- Universidade do Estado do Amazonas, Manaus, AM, Brazil
| | | | - Ahmad Mourad
- Department of Medicine, Duke University Medical Center, Durham, NC, 27710, USA
| | - Mark J Mulligan
- Department of Microbiology, NYU Grossman School of Medicine, New York, NY, USA
- Department of Internal Medicine, Division of Infectious Diseases and Immunology, NYU Grossman School of Medicine, New York, NY, USA
| | - Srinivas Murthy
- University of British Columbia School of Medicine, Vancouver, BC, Canada
| | - Susanna Naggie
- Department of Medicine, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA
| | - Shanti Narayanasamy
- Department of Medicine, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA
| | - Alistair Nichol
- School of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
- Department of Intensive Care, Alfred Health, Melbourne, VIC, Australia
- Department of Anesthesia and Intensive Care, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - Lewis A Novack
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sean M O'Brien
- Department of Biostatistics and Bioinformatics, Duke University Medical Center and Duke Clinical Research Institute, Durham, NC, USA
| | - Nwora Lance Okeke
- Department of Medicine, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA
| | | | - Rogelio Perez-Padilla
- Department of Smoking and COPD, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Ciudad de México, Mexico
| | | | - Arantxa Remigio-Luna
- Department of Smoking and COPD, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Ciudad de México, Mexico
| | | | - Frank W Rockhold
- Department of Biostatistics and Bioinformatics, Duke University Medical Center and Duke Clinical Research Institute, Durham, NC, USA
| | - Sebastian Rodriguez-Llamazares
- Department of Smoking and COPD, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Ciudad de México, Mexico
| | - Robert Rolfe
- Department of Medicine, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA
| | | | - Helge Røsjø
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway
| | - Vanderson S Sampaio
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil
- Fundação de Vigilância em Saúde do Amazonas, Manaus, AM, Brazil
| | - Todd B Seto
- University of Hawaii John A. Burns School of Medicine, Honolulu, HI, USA
- The Queen's Medical Center, Honolulu, HI, USA
| | - Muhammad Shahzad
- Department of Pharmacology, University of Health Sciences, Lahore, Punjab, Pakistan
| | - Shaimaa Soliman
- Public Health and Community Medicine, Menoufia University, Menoufia, Egypt
| | - Jason E Stout
- Department of Medicine, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA
| | - Ireri Thirion-Romero
- Department of Smoking and COPD, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Ciudad de México, Mexico
| | - Andrea B Troxel
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Ting-Yu Tseng
- Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Nicholas A Turner
- Department of Medicine, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA
| | - Robert J Ulrich
- Department of Medicine, Division of Infectious Diseases and Immunology, NYU Grossman School of Medicine, New York, NY, USA
| | - Stephen R Walsh
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA
| | - Steve A Webb
- School of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
- St. John of God Hospital, Subiaco, WA, Australia
| | - Jesper M Weehuizen
- Department of Infectious Diseases, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Hon-Lai Wong
- Department of Internal Medicine, Keelung Hospital, Ministry of Health and Welfare, Keelung, Taiwan
| | - Rebekah Wrenn
- Department of Medicine, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA
| | - Fernando G Zampieri
- Research Institute, HCor-Hospital do Coração, São Paulo, Brazil
- Research Institute, BRICNet - Brazilian Research in Intensive Care Network, São Paulo, Brazil
- IDor Research Institute, São Paulo, Brazil
| | - Wu Zhong
- National Engineering Research Center for the Emergency Drug, Beijing Institute of Pharmacology and Toxicology, Beijing, People's Republic of China
| | - David Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Steven N Goodman
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
- Stanford University School of Medicine, Stanford, CA, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - John P A Ioannidis
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
- Stanford University School of Medicine, Stanford, CA, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA, USA
- Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany
| | - Lars G Hemkens
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA.
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.
- Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany.
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Rutkovskiy A, Lyngbakken MN, Dahl MB, Bye A, Pedersen MH, Wisløff U, Christensen G, Høiseth AD, Omland T, Røsjø H. Circulating MicroRNA-210 Concentrations in Patients with Acute Heart Failure: Data from the Akershus Cardiac Examination 2 Study. Clin Chem 2021; 67:889-898. [PMID: 33783502 DOI: 10.1093/clinchem/hvab030] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/26/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND MicroRNA (miR)-210 expression is induced by acute and chronic hypoxia and provides prognostic information in patients with aortic stenosis and acute coronary syndrome. We hypothesized that circulating miR-210 concentrations could provide diagnostic and prognostic information in patients with acute heart failure (HF). METHODS We measured miR-210 concentrations in serum samples on admission from 314 patients hospitalized for acute dyspnea and 9 healthy control subjects. The diagnostic and prognostic properties of miR-210 were tested in patients after adjudication of all diagnoses and with median follow-up of 464 days. RESULTS All patients and control subjects had miR-210 concentrations within the range of detection, and the analytical variation was low as the coefficient of variation of synthetic spike-in RNA was 4%. Circulating miR-210 concentrations were increased in patients with HF compared to healthy control subjects, but miR-210 concentrations did not separate patients with acute HF (n = 143) from patients with non-HF-related dyspnea (n = 171): the area under the curve was 0.50 (95% CI 0.43-0.57). Circulating miR-210 concentrations were associated with mortality (n = 114) after adjustment for clinical risk factors (hazard ratio 1.65 [95% CI 1.03-2.62] per unit miR-210 increase), but this association was attenuated and not significant after adjustment for established cardiac protein biomarkers. CONCLUSIONS Circulating miR-210 concentrations are associated with mortality, but do not add to established protein biomarkers for diagnosis or prognosis in patients with acute dyspnea.
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Affiliation(s)
- Arkady Rutkovskiy
- Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Magnus Nakrem Lyngbakken
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Mai Britt Dahl
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Clinical Molecular Biology, Akershus University Hospital, Lørenskog, Norway
| | - Anja Bye
- The Cardiac Exercise Research Group, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian Institute of Science and Technology, Trondheim, Norway.,Department of Cardiology, St. Olavs Hospital, Trondheim, Norway
| | - Marit Holmefjord Pedersen
- Department of Clinical Molecular Biology, Akershus University Hospital, Lørenskog, Norway.,Department of Multidisciplinary Laboratory Medicine and Medical Biochemistry, Akershus University Hospital, Lørenskog, Norway
| | - Ulrik Wisløff
- The Cardiac Exercise Research Group, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian Institute of Science and Technology, Trondheim, Norway
| | - Geir Christensen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Institute for Experimental Medical Research, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Arne Didrik Høiseth
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Torbjørn Omland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Helge Røsjø
- Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Berge K, Lyngbakken MN, Omland T, Juliebø V, Schirmer H, Røsjø H. Further learning points from a cardiological perspective. Tidsskr Nor Laegeforen 2021; 141:20-1025. [PMID: 33433094 DOI: 10.4045/tidsskr.20.1025] [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: 11/02/2022] Open
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38
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Myhre PL, Prebensen C, Strand H, Røysland R, Jonassen CM, Rangberg A, Sørensen V, Søvik S, Røsjø H, Svensson M, Berdal JE, Omland T. Growth Differentiation Factor 15 Provides Prognostic Information Superior to Established Cardiovascular and Inflammatory Biomarkers in Unselected Patients Hospitalized With COVID-19. Circulation 2020; 142:2128-2137. [PMID: 33058695 PMCID: PMC7688084 DOI: 10.1161/circulationaha.120.050360] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Supplemental Digital Content is available in the text. Background: Growth differentiation factor 15 (GDF-15) is a strong prognostic marker in sepsis and cardiovascular disease (CVD). The prognostic value of GDF-15 in coronavirus disease 2019 (COVID-19) is unknown. Methods: Consecutive, hospitalized patients with laboratory-confirmed infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and symptoms of COVID-19 were enrolled in the prospective, observational COVID Mechanisms Study. Biobank samples were collected at baseline, day 3 and day 9. The primary end point was admission to the intensive care unit or death during hospitalization, and the prognostic performance of baseline and serial GDF-15 concentrations were compared with that of established infectious disease and cardiovascular biomarkers. Results: Of the 123 patients enrolled, 35 (28%) reached the primary end point; these patients were older, more often had diabetes, and had lower oxygen saturations and higher National Early Warning Scores on baseline. Baseline GDF-15 concentrations were elevated (>95th percentile in age-stratified healthy individuals) in 97 (79%), and higher concentrations were associated with detectable SARS-CoV-2 viremia and hypoxemia (both P<0.001). Patients reaching the primary end point had higher concentrations of GDF-15 (median, 4225 [IQR, 3197–5972] pg/mL versus median, 2187 [IQR, 1344–3620] pg/mL, P<0.001). The area under the receiver operating curve was 0.78 (95% CI, 0.70–0.86). The association between GDF-15 and the primary end point persisted after adjusting for age, sex, race, body mass index, estimated glomerular filtration rate, previous myocardial infarction, heart failure, and atrial fibrillation (P<0.001) and was superior and incremental to interleukin-6, C-reactive protein, procalcitonin, ferritin, D-dimer, cardiac troponin T, and N-terminal pro-B-type natriuretic peptide. Increase in GDF-15 from baseline to day 3 was also greater in patients reaching the primary end point (median, 1208 [IQR, 0–4305] pg/mL versus median, –86 [IQR, –322 to 491] pg/mL, P<0.001). Conclusions: GDF-15 is elevated in the majority of patients hospitalized with COVID-19, and higher concentrations are associated with SARS-CoV-2 viremia, hypoxemia, and worse outcome. The prognostic value of GDF-15 was additional and superior to established cardiovascular and inflammatory biomarkers. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04314232.
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Affiliation(s)
- Peder L Myhre
- Department of Cardiology (P.L.M., T.O.), Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (P.L.M., C.P., R.R., S.S., H.R., M.S., J.E.B., T.O.)
| | - Christian Prebensen
- Department of Infectious Diseases (C.P., J.E.B.), Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (P.L.M., C.P., R.R., S.S., H.R., M.S., J.E.B., T.O.)
| | - Heidi Strand
- Multidisciplinary Laboratory Medicine and Medical Biochemistry, Division of Diagnostics and Technology (H.S., R.R.), Akershus University Hospital, Lørenskog, Norway
| | - Ragnhild Røysland
- Multidisciplinary Laboratory Medicine and Medical Biochemistry, Division of Diagnostics and Technology (H.S., R.R.), Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (P.L.M., C.P., R.R., S.S., H.R., M.S., J.E.B., T.O.)
| | - Christine M Jonassen
- Center for Laboratory Medicine, Østfold Hospital Trust, Grålum, Norway (C.M.J., A.R.)
| | - Anbjørg Rangberg
- Center for Laboratory Medicine, Østfold Hospital Trust, Grålum, Norway (C.M.J., A.R.)
| | - Vibecke Sørensen
- Department of Anaesthesia and Intensive Care, Division of Surgery (V.S., S.S.), Akershus University Hospital, Lørenskog, Norway
| | - Signe Søvik
- Department of Anaesthesia and Intensive Care, Division of Surgery (V.S., S.S.), Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (P.L.M., C.P., R.R., S.S., H.R., M.S., J.E.B., T.O.)
| | - Helge Røsjø
- Division of Research and Innovation (H.R.), Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (P.L.M., C.P., R.R., S.S., H.R., M.S., J.E.B., T.O.)
| | - My Svensson
- Department of Research (M.S.), Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (P.L.M., C.P., R.R., S.S., H.R., M.S., J.E.B., T.O.)
| | - Jan Erik Berdal
- Department of Infectious Diseases (C.P., J.E.B.), Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (P.L.M., C.P., R.R., S.S., H.R., M.S., J.E.B., T.O.)
| | - Torbjørn Omland
- Department of Cardiology (P.L.M., T.O.), Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (P.L.M., C.P., R.R., S.S., H.R., M.S., J.E.B., T.O.)
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Ihle-Hansen H, Vigen T, Berge T, Hagberg G, Engedal K, Rønning OM, Thommessen B, Lyngbakken MN, Nygård S, Røsjø H, Tveit A, Ihle-Hansen H. Carotid Atherosclerosis and Cognitive Function in a General Population Aged 63-65 Years: Data from the Akershus Cardiac Examination (ACE) 1950 Study. J Alzheimers Dis 2020; 70:1041-1049. [PMID: 31306128 DOI: 10.3233/jad-190327] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Studies on the relationship between carotid atherosclerosis and cognitive function in subjects from the general population are few and results have been inconsistent. OBJECTIVE We aimed to investigate the association between carotid atherosclerotic burden and cognitive function in a cross-sectional analysis of a population-based cohort aged 63-65 years. METHODS All habitants born in 1950 from Akershus County, Norway were invited to participate. A linear regression model was used to assess the association between carotid atherosclerosis and cognitive function. We used carotid plaque score as a measure of carotid atherosclerotic burden and the Montreal Cognitive Assessment (MoCA) for global cognitive function. RESULTS We analyzed 3,413 individuals aged 63-65 with mean MoCA score 25.3±2.9 and 87% visible carotid plaques. We found a negative correlation between carotid plaque score and MoCA score (r = -0.14, p < 0.001), but this association was lost in multivariable analysis. In contrast, diameter or area of the thickest plaque was independently associated with MoCA score. Lower educational level, male sex, current smoking, and diabetes were also associated with lower MoCA score in multivariable analysis. CONCLUSION Carotid atherosclerotic burden was, unlike other measures of advanced carotid atherosclerosis, not independently associated with global cognitive function.
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Affiliation(s)
- Håkon Ihle-Hansen
- Department of Medical Research, B-rum Hospital, Vestre Viken Hospital Trust, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Thea Vigen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Medicine, Akershus University Hospital, L-renskog, Norway
| | - Trygve Berge
- Department of Medical Research, B-rum Hospital, Vestre Viken Hospital Trust, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Guri Hagberg
- Department of Medical Research, B-rum Hospital, Vestre Viken Hospital Trust, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Knut Engedal
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Ullevaal, Oslo, Norway
| | - Ole Morten Rønning
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Medicine, Akershus University Hospital, L-renskog, Norway
| | - Bente Thommessen
- Division of Medicine, Akershus University Hospital, L-renskog, Norway
| | - Magnus N Lyngbakken
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Medicine, Akershus University Hospital, L-renskog, Norway
| | - Ståle Nygård
- Bioinformatics Core facility, Oslo University Hospital and the University of Oslo, Norway
| | - Helge Røsjø
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Medicine, Akershus University Hospital, L-renskog, Norway
| | - Arnljot Tveit
- Department of Medical Research, B-rum Hospital, Vestre Viken Hospital Trust, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hege Ihle-Hansen
- Department of Medical Research, B-rum Hospital, Vestre Viken Hospital Trust, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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40
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Myhre PL, Lyngbakken MN, Røsjø H, Omland T. Removing stable and adding precision to chronic coronary artery disease. Int J Cardiol 2020; 316:54-56. [PMID: 32360648 DOI: 10.1016/j.ijcard.2020.04.063] [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] [Received: 02/27/2020] [Accepted: 04/22/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Peder L Myhre
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Magnus N Lyngbakken
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Helge Røsjø
- Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Division for Research and Innovation, Akershus University Hospital, Lørenskog, Norway
| | - Torbjørn Omland
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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41
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Axfors C, Schmitt AM, Janiaud P, van ’t Hooft J, Abd-elsalam S, Abdo EF, Abella BS, Akram J, Amaravadi RK, Angus DC, Arabi YM, Azhar S, Baden LR, Baker AW, Belkhir L, Benfield T, Berrevoets MA, Chen C, Chen T, Cheng S, Cheng C, Chung W, Cohen YZ, Cowan LN, Dalgard O, de Almeida e Val FF, de Lacerda MV, de Melo GC, Derde L, Dubee V, Elfakir A, Gordon AC, Hernandez-cardenas CM, Hills T, Hoepelman AI, Huang Y, Igau B, Jin R, Jurado-camacho F, Khan KS, Kremsner PG, Kreuels B, Kuo C, Le T, Lin Y, Lin W, Lin T, Lyngbakken MN, Mcarthur C, Mcverry BJ, Meza-meneses P, Monteiro WM, Morpeth SC, Mourad A, Mulligan MJ, Murthy S, Naggie S, Narayanasamy S, Nichol A, Novack LA, O’brien SM, Okeke NL, Perez L, Perez-padilla R, Perrin L, Remigio-luna A, Rivera-martinez NE, Rockhold FW, Rodriguez-llamazares S, Rolfe R, Rosa R, Røsjø H, Sampaio VS, Seto TB, Shehzad M, Soliman S, Stout JE, Thirion-romero I, Troxel AB, Tseng T, Turner NA, Ulrich RJ, Walsh SR, Webb SA, Weehuizen JM, Velinova M, Wong H, Wrenn R, Zampieri FG, Zhong W, Moher D, Goodman SN, Ioannidis JP, Hemkens LG. Mortality outcomes with hydroxychloroquine and chloroquine in COVID-19: an international collaborative meta-analysis of randomized trials.. [DOI: 10.1101/2020.09.16.20194571] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
AbstractBackgroundSubstantial COVID-19 research investment has been allocated to randomized clinical trials (RCTs) on hydroxychloroquine/chloroquine, which currently face recruitment challenges or early discontinuation. We aimed to estimate the effects of hydroxychloroquine and chloroquine on survival in COVID-19 from all currently available RCT evidence, published and unpublished. Methods: Rapid meta-analysis of ongoing, completed, or discontinued RCTs on hydroxychloroquine or chloroquine treatment for any COVID-19 patients (protocol: https://osf.io/QESV4/). We systematically identified published and unpublished RCTs by September 14, 2020 (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, PubMed, Cochrane COVID-19 registry). All-cause mortality was extracted (publications/preprints) or requested from investigators and combined in random-effects meta-analyses, calculating odds ratios (ORs) with 95% confidence intervals (CIs), separately for hydroxychloroquine/chloroquine. Prespecified subgroup analyses included patient setting, diagnostic confirmation, control type, and publication status.ResultsSixty-two trials were potentially eligible. We included 16 unpublished trials (1596 patients) and 10 publications/preprints (6317 patients). The combined summary OR on all-cause mortality for hydroxychloroquine was 1.08 (95%CI: 0.99, 1.18; I2=0%; 24 trials; 7659 patients) and for chloroquine 1.77 (95%CI: 0.15, 21.13, I2=0%; 4 trials; 307 patients). We identified no subgroup effects.ConclusionsWe found no benefit of hydroxychloroquine or chloroquine on the survival of COVID-19 patients. For hydroxychloroquine, the confidence interval is compatible with increased mortality (OR 1.18) or negligibly reduced mortality (OR 0.99). Findings have unclear generalizability to outpatients, children, pregnant women, and people with comorbidities.
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Omland T, Prebensen C, Røysland R, Søvik S, Sørensen V, Røsjø H, Svensson M, Berdal JE, Myhre PL. Established Cardiovascular Biomarkers Provide Limited Prognostic Information in Unselected Patients Hospitalized With COVID-19. Circulation 2020; 142:1878-1880. [PMID: 32910681 PMCID: PMC7643784 DOI: 10.1161/circulationaha.120.050089] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Torbjørn Omland
- Department of Cardiology (T.O., P.L.M.), Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (T.O., C.P., R.R., S.S., H.R., M.S., J.E.B., P.L.M.)
| | - Christian Prebensen
- Department of Infectious Diseases (C.P., J.E.B.), Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (T.O., C.P., R.R., S.S., H.R., M.S., J.E.B., P.L.M.)
| | - Ragnhild Røysland
- Department of Division of Medicine, Multidisciplinary Laboratory Medicine and Medical Biochemistry, Division of Diagnostics and Technology (R.R.), Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (T.O., C.P., R.R., S.S., H.R., M.S., J.E.B., P.L.M.)
| | - Signe Søvik
- Department of Anaesthesia and Intensive Care, Division of Surgery (S.S., V.S.), Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (T.O., C.P., R.R., S.S., H.R., M.S., J.E.B., P.L.M.)
| | - Vibecke Sørensen
- Department of Anaesthesia and Intensive Care, Division of Surgery (S.S., V.S.), Akershus University Hospital, Lørenskog, Norway
| | - Helge Røsjø
- Division of Research and Innovation (H.R.), Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (T.O., C.P., R.R., S.S., H.R., M.S., J.E.B., P.L.M.)
| | - My Svensson
- Department of Cardiology (T.O., P.L.M.), Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (T.O., C.P., R.R., S.S., H.R., M.S., J.E.B., P.L.M.)
| | - Jan Erik Berdal
- Department of Infectious Diseases (C.P., J.E.B.), Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (T.O., C.P., R.R., S.S., H.R., M.S., J.E.B., P.L.M.)
| | - Peder L Myhre
- Department of Cardiology (T.O., P.L.M.), Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (T.O., C.P., R.R., S.S., H.R., M.S., J.E.B., P.L.M.)
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Aarsetøy R, Omland T, Røsjø H, Strand H, Lindner T, Aarsetøy H, Staines H, Nilsen DWT. N-terminal pro-B-type natriuretic peptide as a prognostic indicator for 30-day mortality following out-of-hospital cardiac arrest: a prospective observational study. BMC Cardiovasc Disord 2020; 20:382. [PMID: 32838754 PMCID: PMC7445901 DOI: 10.1186/s12872-020-01630-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/20/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Early risk stratification applying cardiac biomarkers may prove useful in sudden cardiac arrest patients. We investigated the prognostic utility of early-on levels of high sensitivity cardiac troponin-T (hs-cTnT), copeptin and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with out-of-hospital cardiac arrest (OHCA). METHODS We conducted a prospective observational unicenter study, including patients with OHCA of assumed cardiac origin from the southwestern part of Norway from 2007 until 2010. Blood samples for later measurements were drawn during cardiopulmonary resuscitation or at hospital admission. RESULTS A total of 114 patients were included, 37 patients with asystole and 77 patients with VF as first recorded heart rhythm. Forty-four patients (38.6%) survived 30-day follow-up. Neither hs-cTnT (p = 0.49), nor copeptin (p = 0.39) differed between non-survivors and survivors, whereas NT-proBNP was higher in non-survivors (p < 0.001) and significantly associated with 30-days all-cause mortality in univariate analysis, with a hazard ratio (HR) for patients in the highest compared to the lowest quartile of 4.6 (95% confidence interval (CI), 2.1-10.1), p < 0.001. This association was no longer significant in multivariable analysis applying continuous values, [HR 0.96, (95% CI, 0.64-1.43), p = 0.84]. Similar results were obtained by dividing the population by survival at hospital admission, excluding non-return of spontaneous circulation (ROSC) patients on scene [HR 0.93 (95% CI, 0.50-1.73), P = 0.83]. We also noted that NT-proBNP was significantly higher in asystole- as compared to VF-patients, p < 0.001. CONCLUSIONS Early-on levels of hs-cTnT, copeptin and NT-proBNP did not provide independent prognostic information following OHCA. Prediction was unaffected by excluding on-scene non-ROSC patients in the multivariable analysis. TRIAL REGISTRATION ClinicalTrials. gov, NCT02886273 .
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Affiliation(s)
- Reidun Aarsetøy
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway.
- Department of Cardiology, Division of Medicine, Stavanger University Hospital, Mailbox 8100, 4068, Stavanger, Norway.
| | - Torbjørn Omland
- Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Division of Medicine, Akershus University Hospital , Lørenskog, Norway
| | - Helge Røsjø
- Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway
| | - Heidi Strand
- Multidisciplinary Laboratory Medicine and Medical Biochemistry, Akershus University Hospital, Lørenskog, Norway
| | - Thomas Lindner
- The Regional Centre for Emergency Medical Research and Development (RAKOS), Stavanger University Hospital , Stavanger, Norway
| | - Hildegunn Aarsetøy
- Department of Endocrinology, Division of Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Harry Staines
- Sigma Statistical Services, Sigma Statistical Services, Balmullo, UK
| | - Dennis W T Nilsen
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
- Department of Cardiology, Division of Medicine, Stavanger University Hospital, Mailbox 8100, 4068, Stavanger, Norway
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Røsjø H, Hijazi Z, Omland T, Westerbergh J, Lyngbakken MN, Alexander JH, Gersh BJ, Granger CB, Hylek EM, Lopes RD, Siegbahn A, Wallentin L. Cardiac troponin is associated with cardiac outcomes in men and women with atrial fibrillation, insights from the ARISTOTLE trial. J Intern Med 2020; 288:248-259. [PMID: 32350915 DOI: 10.1111/joim.13072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/11/2020] [Accepted: 03/30/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Cardiac troponin T (cTnT) and I (cTnI) concentrations provide strong prognostic information in anticoagulated patients with atrial fibrillation (AF). Whether the associations between cardiac troponin concentrations and mortality and morbidity differ by sex is not known. OBJECTIVES To assess whether men and women have different concentrations and prognostic value of cTnT and cTnI measurements in anticoagulated patients with AF. METHODS cTnT and cTnI concentrations were measured with high-sensitivity (hs) assays in EDTA plasma samples obtained from the multicentre ARISTOTLE trial, which randomized patients with AF and at least one risk factor for stroke or systemic embolic event to warfarin or apixaban. Patients were stratified according to sex and the associations between hs-troponin concentrations, and all-cause death, cardiac death, myocardial infarction, stroke or systemic embolic event and major bleeding were assessed in multivariable regression models. RESULTS We found higher cardiac troponin concentrations in men (n = 9649) compared to women (n = 5331), both for hs-cTnT (median 11.8 [Q1-3 8.1-18.0] vs. 9.6 [6.7-14.3] ng L-1 , P < 0.001) and hs-cTnI (5.8 [3.4-10.8] vs. 4.9 [3.1-8.8] ng L-1 , P < 0.001). Adjusting for baseline demographics, comorbidities and medications, men still had significantly higher hs-troponin concentrations than women. C-reactive protein and N-terminal pro-B-type natriuretic peptide concentrations were higher in female patients. Both hs-cTnT and hs-cTnI concentrations were associated with all clinical outcomes similarly in men and women (p-value for interaction >0.05 for all end-points). CONCLUSION Men have higher hs-troponin concentrations than women in AF. Regardless of sex, hs-troponin concentrations remain similarly associated with adverse clinical outcomes in anticoagulated patients with AF.
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Affiliation(s)
- H Røsjø
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.,Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Z Hijazi
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.,Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - T Omland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - J Westerbergh
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - M N Lyngbakken
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - J H Alexander
- Duke Clinical Research Institute, Duke Health, Durham, NC, USA
| | - B J Gersh
- Mayo Clinic College of Medicine, Rochester, MN, USA
| | - C B Granger
- Duke Clinical Research Institute, Duke Health, Durham, NC, USA
| | - E M Hylek
- Boston University Medical Center, Boston, MA, USA
| | - R D Lopes
- Duke Clinical Research Institute, Duke Health, Durham, NC, USA
| | - A Siegbahn
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.,Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - L Wallentin
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.,Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
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45
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Lyngbakken MN, Berdal JE, Eskesen A, Kvale D, Olsen IC, Rangberg A, Jonassen CM, Omland T, Røsjø H, Dalgard O. Norwegian Coronavirus Disease 2019 (NO COVID-19) Pragmatic Open label Study to assess early use of hydroxychloroquine sulphate in moderately severe hospitalised patients with coronavirus disease 2019: A structured summary of a study protocol for a randomised controlled trial. Trials 2020; 21:485. [PMID: 32503662 PMCID: PMC7273378 DOI: 10.1186/s13063-020-04420-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 05/14/2020] [Indexed: 11/25/2022] Open
Abstract
Objectives The hypothesis of the study is that treatment with hydroxychloroquine sulphate in hospitalised patients with coronavirus disease 2019 (Covid-19) is safe and will accelerate the virological clearance rate for patients with moderately severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) when compared to standard care. Furthermore, we hypothesize that early treatment with hydroxychloroquine sulphate is associated with more rapid resolve of clinical symptoms as assessed by the National Early Warning Score 2 (NEWS2), decreased admission rate to intensive care units and mortality, and improvement in protein biomarker profiles (C-reactive protein, markers of renal and hepatic injury, and established cardiac biomarkers like cardiac troponin and B-type natriuretic peptide). Trial design The study is a two-arm, open label, pragmatic randomised controlled group sequential adaptive trial designed to assess the effect on viral loads and clinical outcome of hydroxychloroquine sulphate therapy in addition to standard care compared to standard care alone in patients with established Covid-19. By utilizing resources already paid for by the hospitals (physicians and nurses in daily clinical practice), this pragmatic trial can include a larger number of patients over a short period of time and at a lower cost than studies utilizing traditional randomized controlled trial designs with an external study organization. The pragmatic approach will enable swift initiation of randomisation and allocation to treatment. Participants Patients will be recruited from all inpatients at Akershus University Hospital, Lørenskog, Norway. Electronic real-time surveillance of laboratory reports from the Department of Microbiology will be examined regularly for SARS-CoV-2 positive subjects. All of the following conditions must apply to the prospective patient at screening prior to inclusion: (1) Hospitalisation; (2) Adults 18 years or older; (3) Moderately severe Covid-19 disease (NEWS2 of 6 or less); (4) SARS-CoV-2 positive nasopharyngeal swab; (5) Expected time of hospitalisation > 48 hours; and (6) Signed informed consent must be obtained and documented according to Good Clinical Practice guidelines of the International Conference on Harmonization, and national/local regulations. Patients will be excluded from participation in the study if they meet any of the following criteria: (1) Requiring intensive care unit admission at screening; (2) History of psoriasis; (3) Known adverse reaction to hydroxychloroquine sulphate; (4) Pregnancy; or (5) Prolonged corrected QT interval (>450 ms). Clinical data, including standard hospital biochemistry, medical therapy, vital signs, NEWS2, and microbiology results (including blood culture results and reverse transcriptase polymerase chain reaction [RT-PCR] for other upper airway viruses), will be automatically extracted from the hospital electronic records and merged with the study specific database. Intervention and comparator Included patients will be randomised in a 1:1 ratio to (1) standard care with the addition of 400 mg hydroxychloroquine sulphate (PlaquenilTM) twice daily for seven days or (2) standard care alone. Main outcomes The primary endpoint of the study is the rate of decline in SARS-CoV-2 viral load in oropharyngeal samples as assessed by RT-PCR in samples collected at baseline, 48 and 96 hours after randomization and administration of drug for the intervention arm. Secondary endpoints include change in NEWS2 at 96 hours after randomisation, admission to intensive care unit, mortality (in-hospital, and at 30 and 90 days), duration of hospital admission, clinical status on a 7-point ordinal scale 14 days after randomization ([1] Death [2] Hospitalised, on invasive mechanical ventilation or extracorporeal membrane oxygenation [3] Hospitalised, on non-invasive ventilation or high flow oxygen devices [4] Hospitalized, requiring supplemental oxygen [5] Hospitalised, not requiring supplemental oxygen [6] Not hospitalized, but unable to resume normal activities [7] Not hospitalised, with resumption of normal activities), and improvement in protein biomarker profiles (C-reactive protein, markers of renal and hepatic injury, and established cardiac biomarkers like cardiac troponin and B-type natriuretic peptide) at 96 hours after randomization. Randomisation Eligible patients will be allocated in a 1:1 ratio, using a computer randomisation procedure. The allocation sequence has been prepared by an independent statistician. Blinding (masking) Open label randomised controlled pragmatic trial without blinding, no active or placebo control. The virologist assessing viral load in the oropharyngeal samples and the statistician responsible for analysis of the data will be blinded to the treatment allocation for the statistical analyses. Numbers to be randomized (sample size) This is a group sequential adaptive trial where analyses are planned after 51, 101, 151 and 202 completed patients, with a maximum sample size of 202 patients (101 patients allocated to intervention and standard care and 101 patients allocated to standard care alone). Trial Status Protocol version 1.3 (March 26, 2020). Recruitment of first patient on March 26, 2020, and 51 patients were included as per April 28, 2020. Study recruitment is anticipated to be completed by July 2020. Trial registration ClinicalTrials.gov number, NCT04316377. Trial registered March 20, 2020. Full protocol The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.
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Affiliation(s)
- Magnus Nakrem Lyngbakken
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jan-Erik Berdal
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Infectious Diseases, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Arne Eskesen
- Department of Infectious Diseases, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Dag Kvale
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Inge Christoffer Olsen
- Department of Research Support for Clinical Trials, Oslo University Hospital, Oslo, Norway
| | - Anbjørg Rangberg
- Center for Laboratory Medicine, Østfold Hospital Trust, Grålum, Norway
| | | | - Torbjørn Omland
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Helge Røsjø
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway. .,Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway.
| | - Olav Dalgard
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Infectious Diseases, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
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Chandra A, Røsjø H, Svensson M, Vigen T, Ihle-Hansen H, Orstad EB, Rønning OM, Lyngbakken MN, Nygård S, Berge T, Schmidt EB, Omland T, Tveit A, Eide IA. Plasma linoleic acid levels and cardiovascular risk factors: results from the Norwegian ACE 1950 Study. Eur J Clin Nutr 2020; 74:1707-1717. [PMID: 32341488 DOI: 10.1038/s41430-020-0641-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 04/08/2020] [Accepted: 04/08/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND A high intake of linoleic acid (LA), the major dietary polyunsaturated fatty acid (PUFA), has previously been associated with reduced cardiovascular (CV) morbidity and mortality in observational studies. However, recent secondary analyses from clinical trials of LA-rich diet suggest harmful effects of LA on CV health. METHODS A total of 3706 participants, all born in 1950, were included in this cross-sectional study. We investigated associations between plasma phospholipid levels of LA and CV risk factors in a Norwegian general population, characterized by a relative low LA and high marine n-3 PUFA intake. The main statistical approach was multivariable linear regression. RESULTS Plasma phospholipid LA levels ranged from 11.4 to 32.0 wt%, with a median level of 20.8 wt% (interquartile range 16.8-24.8 wt%). High plasma LA levels were associated with lower serum low-density lipoprotein cholesterol levels (standardized regression coefficient [Std. β-coeff.] -0.04, p = 0.02), serum triglycerides (Std. β-coeff. -0.10, p < 0.001), fasting plasma glucose (Std. β-coeff. -0.10, p < 0.001), body mass index (Std. β-coeff. -0.13, p < 0.001), systolic and diastolic blood pressure (Std. β-coeff. -0.04, p = 0.03 and Std. β-coeff. -0.02, p = 0.02, respectively) and estimated glomerular filtration rate (Std. β-coeff. -0.09, p < 0.001). We found no association between plasma LA levels and high-density lipoprotein cholesterol levels, glycated hemoglobin, carotid intima-media thickness, or C-reactive protein. CONCLUSION High plasma LA levels were favorably associated with several CV risk factors in this study of a Norwegian general population.
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Affiliation(s)
- Anupam Chandra
- Department of Renal Medicine, Division of Medicine, Akershus University Hospital, Lørenskog, Norway. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Helge Røsjø
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway
| | - My Svensson
- Department of Renal Medicine, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Thea Vigen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Håkon Ihle-Hansen
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | | | - Ole Morten Rønning
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Magnus Nakrem Lyngbakken
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Ståle Nygård
- Centre for Bioinformatics, Department of Informatics, University of Oslo, Oslo, Norway.,Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Trygve Berge
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Erik Berg Schmidt
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Torbjørn Omland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Arnljot Tveit
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Ivar Anders Eide
- Department of Renal Medicine, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
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Gilmour BC, Gudmundsrud R, Frank J, Hov A, Lautrup S, Aman Y, Røsjø H, Brenner C, Ziegler M, Tysnes OB, Tzoulis C, Omland T, Søraas A, Holmøy T, Bergersen LH, Storm-Mathisen J, Nilsen H, Fang EF. Targeting NAD + in translational research to relieve diseases and conditions of metabolic stress and ageing. Mech Ageing Dev 2020; 186:111208. [PMID: 31953124 DOI: 10.1016/j.mad.2020.111208] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 12/04/2019] [Revised: 01/10/2020] [Accepted: 01/13/2020] [Indexed: 02/07/2023]
Abstract
Nicotinamide adenine dinucleotide (NAD+) plays a fundamental role in life and health through the regulation of energy biogenesis, redox homeostasis, cell metabolism, and the arbitration of cell survival via linkages to apoptosis and autophagic pathways. The importance of NAD+ in ageing and healthy longevity has been revealed from laboratory animal studies and early-stage clinical testing. While basic researchers and clinicians have investigated the molecular mechanisms and translation potential of NAD+, there are still major gaps in applying laboratory science to design the most effective trials. This mini-review was based on the programme and discussions of the 3rd NO-Age Symposium held at the Akershus University Hospital, Norway on the 28th October 2019. This symposium brought together leading basic researchers on NAD+ and clinicians who are leading or are going to perform NAD+ augmentation-related clinical studies. This meeting covered talks about NAD+ synthetic pathways, subcellular homeostasis of NAD+, the benefits of NAD+ augmentation from maternal milk to offspring, current clinical trials of the NAD+ precursor nicotinamide riboside (NR) on Ataxia-Telangiectasia (A-T), Parkinson's disease (PD), post-sepsis fatigue, as well as other potential NR-based clinical trials. Importantly, a consensus is emerging with respect to the design of clinical trials in order to measure meaningful parameters and ensure safety.
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Affiliation(s)
- Brian C Gilmour
- The Norwegian Centre on Healthy Ageing (NO-Age), Oslo, Norway
| | | | - Johannes Frank
- Department of Clinical Molecular Biology, University of Oslo and Akershus University Hospital, 1478 Lørenskog, Norway
| | - Amund Hov
- The Norwegian Centre on Healthy Ageing (NO-Age), Oslo, Norway
| | - Sofie Lautrup
- Department of Clinical Molecular Biology, University of Oslo and Akershus University Hospital, 1478 Lørenskog, Norway
| | - Yahyah Aman
- Department of Clinical Molecular Biology, University of Oslo and Akershus University Hospital, 1478 Lørenskog, Norway
| | - Helge Røsjø
- Division of Research and Innovation, Akershus University Hospital, 1478 Lørenskog, Norway; Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Charles Brenner
- Department of Biochemistry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Mathias Ziegler
- Department of Biomedicine, University of Bergen, 5009 Bergen, Norway
| | - Ole-Bjørn Tysnes
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, 5021 Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Charalampos Tzoulis
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, 5021 Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Torbjørn Omland
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway; Department of Cardiology, Division of Medicine, Akershus University Hospital, 1478 Lørenskog, Norway
| | - Arne Søraas
- Department of Microbiology, Oslo University Hospital, Oslo, Norway
| | - Trygve Holmøy
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway; Department of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Linda H Bergersen
- The Norwegian Centre on Healthy Ageing (NO-Age), Oslo, Norway; The Brain and Muscle Energy Group, Electron Microscopy Laboratory, Department of Oral Biology, University of Oslo, NO-0316 Oslo, Norway; Synaptic Neurochemistry and Amino Acid Transporters Labs, Division of Anatomy, Department of Molecular Medicine, Institute of Basic Medical Sciences (IMB) and Healthy Brain Ageing Centre (SERTA), University of Oslo, NO-0317 Oslo, Norway; Center for Healthy Ageing, Department of Neuroscience and Pharmacology, Faculty of Health Sciences, University of Copenhagen, DK-2200 Copenhagen N, Denmark
| | - Jon Storm-Mathisen
- The Norwegian Centre on Healthy Ageing (NO-Age), Oslo, Norway; Synaptic Neurochemistry and Amino Acid Transporters Labs, Division of Anatomy, Department of Molecular Medicine, Institute of Basic Medical Sciences (IMB) and Healthy Brain Ageing Centre (SERTA), University of Oslo, NO-0317 Oslo, Norway
| | - Hilde Nilsen
- Department of Clinical Molecular Biology, University of Oslo and Akershus University Hospital, 1478 Lørenskog, Norway; The Norwegian Centre on Healthy Ageing (NO-Age), Oslo, Norway
| | - Evandro F Fang
- Department of Clinical Molecular Biology, University of Oslo and Akershus University Hospital, 1478 Lørenskog, Norway; The Norwegian Centre on Healthy Ageing (NO-Age), Oslo, Norway.
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Tveit SH, Myhre PL, Røsjø H, Omland T. Reply: The complementary role of cardiac troponin I and cardiac troponin T. Clin Biochem 2020; 78:42. [PMID: 32088145 DOI: 10.1016/j.clinbiochem.2020.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 02/15/2020] [Accepted: 02/18/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Sjur H Tveit
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Peder L Myhre
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Helge Røsjø
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Division for Research and Innovation, Akershus University Hospital, Lørenskog, Norway
| | - Torbjørn Omland
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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49
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Lyngbakken MN, Aagaard EN, Kvisvik B, Berge T, Pervez MO, Brynildsen J, Tveit A, Steine K, Røsjø H, Omland T. Cardiac Troponin I and T Are Associated with Left Ventricular Function and Structure: Data from the Akershus Cardiac Examination 1950 Study. Clin Chem 2020; 66:567-578. [DOI: 10.1093/clinchem/hvaa023] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/06/2020] [Indexed: 12/27/2022]
Abstract
Abstract
Background
Concentrations of cardiac troponin I (cTnI) and T (cTnT) are associated with clinical cardiac outcomes, but do not correlate closely in subjects recruited from the general population. Accordingly, we hypothesized that cTnI and cTnT concentrations would be influenced by different cardiovascular (CV) and non-CV risk factors and reflect different CV phenotypes.
Methods
We measured cTnI and cTnT with last generation assays in 1236 women and 1157 men with no known CV disease participating in the prospective observational Akershus Cardiac Examination 1950 Study. All study participants underwent extensive CV phenotyping at baseline, including detailed echocardiography.
Results
Concentrations of cTnI were measurable in 60.3% and cTnT in 72.5% of study participants (P < 0.001), and correlated moderately (r = 0.53; P < 0.001). cTnI was more strongly associated with male sex (P = 0.018), higher education (P < 0.001), history of hypertension (P < 0.001), and age (P < 0.001), whereas cTnT was more strongly associated with eGFR (P = 0.015). Both cTnI and cTnT were inversely associated with global longitudinal strain and positively associated with LV mass index (LVMI) in analyses adjusted for CV risk factors. The association between cTnI and LVMI was stronger than the association between cTnT and LVMI (P = 0.035). Concentrations of cTnI improved diagnostic accuracy for LV hypertrophy when added to established CV risk factors, but concentrations of cTnT did not improve these models further.
Conclusions
In a large community-based cohort examined with extensive echocardiography, concentrations of cTnI and cTnT are associated with subclinical LV hypertrophy and dysfunction. Concentrations of cTnI appear superior to cTnT in predicting subclinical LV hypertrophy.
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Affiliation(s)
- Magnus Nakrem Lyngbakken
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Erika Nerdrum Aagaard
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Brede Kvisvik
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Trygve Berge
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Norway
| | - Mohammad Osman Pervez
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jon Brynildsen
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Arnljot Tveit
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Norway
| | - Kjetil Steine
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Helge Røsjø
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway
| | - Torbjørn Omland
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Rønningen PS, Berge T, Solberg MG, Enger S, Nygård S, Pervez MO, Orstad EB, Kvisvik B, Aagaard EN, Røsjø H, Tveit A, Steine K. Sex differences and higher upper normal limits for left atrial end-systolic volume in individuals in their mid-60s: data from the ACE 1950 Study. Eur Heart J Cardiovasc Imaging 2020; 21:501-507. [DOI: 10.1093/ehjci/jeaa004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/24/2019] [Accepted: 01/10/2020] [Indexed: 01/20/2023] Open
Abstract
Abstract
Aims
The current study aimed to describe normal values of left atrial (LA) volumes and LA emptying fraction (LAEF) in a large sample in their mid-60s from the general population and to explore sex differences.
Methods and results
In the Akershus Cardiac Examination (ACE) 1950 Study, body surface area-indexed LA maximum (LAVimax) and minimum (LAVimin) volumes and LAEF were measured in 3489 individuals aged 63.9 ± 0.6 years from the general population. A healthy group of 832 individuals was defined. Data are presented as mean ± standard deviation (SD) and a normal range of mean ± 2 SD. T-tests were used for comparisons. In the healthy group, mean LAVimax was 25.5 ± 6.2 mL/m2 and the normal range was 13.1–37.9 mL/m2. Men had significantly larger body surface area-indexed volumes than women, but there was no difference in LAEF. The mean LAVimax for healthy men was 26.4 ± 6.5 mL/m2, for healthy women 24.9 ± 5.8 mL/m2 (P < 0.001) and the upper normal limits were 39.4 and 36.5 mL/m2, respectively. In the healthy group, 13.0% of all men and 5.4% of all women had LAVimax above the current upper normal limit of 34 mL/m2.
Conclusion
A large proportion of healthy individuals, in particular men, had LAVimax >34 mL/m2. Our findings suggest that the recommended cut-off may be too low at the age of 65 years and above and that sex-specific cut-offs should be considered.
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Affiliation(s)
- Peter Selmer Rønningen
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Postbox 800, 3004 Drammen, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Postbox 1171, Blindern, 0318 Oslo, Norway
| | - Trygve Berge
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Postbox 800, 3004 Drammen, Norway
| | - Magnar Gangås Solberg
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Postbox 800, 3004 Drammen, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Postbox 1171, Blindern, 0318 Oslo, Norway
| | - Steve Enger
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Postbox 800, 3004 Drammen, Norway
| | - Ståle Nygård
- Department of Informatics, Faculty of Mathematics and Natural Sciences, University of Oslo, Postbox 1080, Blindern, 0316 Oslo, Norway
| | - Mohammad Osman Pervez
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Postbox 1171, Blindern, 0318 Oslo, Norway
- Department of Cardiology, Division of Medicine Akershus University Hospital, Postbox 1000, 1478 Lørenskog, Norway
| | - Eivind Bjørkan Orstad
- Department of Cardiology, Division of Medicine Akershus University Hospital, Postbox 1000, 1478 Lørenskog, Norway
| | - Brede Kvisvik
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Postbox 1171, Blindern, 0318 Oslo, Norway
- Department of Cardiology, Division of Medicine Akershus University Hospital, Postbox 1000, 1478 Lørenskog, Norway
| | - Erika Nerdrum Aagaard
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Postbox 1171, Blindern, 0318 Oslo, Norway
- Department of Cardiology, Division of Medicine Akershus University Hospital, Postbox 1000, 1478 Lørenskog, Norway
| | - Helge Røsjø
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Postbox 1171, Blindern, 0318 Oslo, Norway
- Division for Research and Innovation, Akershus University Hospital, Postbox 1000, 1478 Lørenskog, Norway
| | - Arnljot Tveit
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Postbox 800, 3004 Drammen, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Postbox 1171, Blindern, 0318 Oslo, Norway
| | - Kjetil Steine
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Postbox 1171, Blindern, 0318 Oslo, Norway
- Department of Cardiology, Division of Medicine Akershus University Hospital, Postbox 1000, 1478 Lørenskog, Norway
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