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Povlsen AL, Helgestad OKL, Josiassen J, Christensen S, Højgaard HF, Kjærgaard J, Hassager C, Schmidt H, Jensen LO, Holmvang L, Møller JE, Ravn HB. Invasive mechanical ventilation in cardiogenic shock complicating acute myocardial infarction: A contemporary Danish cohort analysis. Int J Cardiol 2024; 405:131910. [PMID: 38423479 DOI: 10.1016/j.ijcard.2024.131910] [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: 09/21/2023] [Revised: 02/04/2024] [Accepted: 02/26/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE Invasive mechanical ventilation (IMV) is widely used in patients with cardiogenic shock following acute myocardial infarction (AMICS), but evidence to guide practice remains sparse. We sought to evaluate trends in the rate of IMV utilization, applied settings, and short term-outcome of a contemporary cohort of AMICS patients treated with IMV according to out-of-hospital cardiac arrest (OHCA) at admission. METHODS Consecutive AMICS patients receiving IMV in an intensive care unit (ICU) at two tertiary centres between 2010 and 2017. Data were analysed in relation to OHCA. RESULTS A total of 1274 mechanically ventilated AMICS patients were identified, 682 (54%) with OHCA. Frequency of IMV increased during the study period, primarily due to higher occurrence of OHCA admissions. Among 566 patients with complete ventilator data, positive-end-expiratory pressure, inspired oxygen fraction, and minute ventilation during the initial 24 h in ICU were monitored. No differences were observed between 30-day survivors and non-survivors with OHCA. In non-OHCA, these ventilator requirements were significantly higher among 30-day non-survivors (P for all<0.05), accompanied by a lower PaO2/FiO2 ratio (median 143 vs. 230, P < 0.001) and higher arterial lactate levels (median 3.5 vs. 1.5 mmol/L, P < 0.001) than survivors. Physiologically normal PaO2 and pCO2 levels were achieved in all patients irrespective of 30-day survival and OHCA status. CONCLUSION In the present contemporary cohort of AMICS patients, physiologically normal blood gas values were achieved both in OHCA and non-OHCA in the early phase of admission. However, increased demand of ventilatory support was associated with poorer survival only in non-OHCA patients.
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Affiliation(s)
- Amalie Ling Povlsen
- Department of Cardiothoracic Anaesthesia, Odense University Hospital, Odense, Denmark; Department of Cardiothoracic Anaesthesia, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Ole Kristian Lerche Helgestad
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jakob Josiassen
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Henrik Frederiksen Højgaard
- Department of Cardiothoracic Anaesthesia, Odense University Hospital, Odense, Denmark; Department of Clinical Medicine, University of Southern Denmark, Denmark
| | - Jesper Kjærgaard
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henrik Schmidt
- Department of Cardiothoracic Anaesthesia, Odense University Hospital, Odense, Denmark; Department of Clinical Medicine, University of Southern Denmark, Denmark
| | - Lisette Okkels Jensen
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Department of Clinical Medicine, University of Southern Denmark, Denmark
| | - Lene Holmvang
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Southern Denmark, Denmark
| | - Hanne Berg Ravn
- Department of Cardiothoracic Anaesthesia, Odense University Hospital, Odense, Denmark; Department of Cardiothoracic Anaesthesia, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Southern Denmark, Denmark
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Andersen CF, Larsen JH, Jensen J, Omar M, Nouhravesh N, Kistorp C, Tuxen C, Gustafsson F, Knop FK, Forman JL, Davidovski FS, Jensen LT, Højlund K, Køber L, Antonsen L, Poulsen MK, Schou M, Møller JE. Empagliflozin to elderly and obese patients with increased risk of developing heart failure: Study protocol for the Empire Prevent trial program. Am Heart J 2024; 271:84-96. [PMID: 38365073 DOI: 10.1016/j.ahj.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 02/10/2024] [Accepted: 02/11/2024] [Indexed: 02/18/2024]
Abstract
INTRODUCTION Sodium-glucose cotransporter 2 (SGLT2) inhibitors have previously demonstrated cardioprotective properties in patients with type 2 diabetes, suggesting a preventive effect on heart failure (HF). The Empire Prevent trial program investigates the therapeutic potential for HF prevention by evaluating the cardiac, metabolic, and renal effects of the SGLT2 inhibitor empagliflozin in patients with increased risk of developing HF, but without diabetes or established HF. METHODS The Empire Prevent trial program is an investigator-initiated, double-blind, randomized clinical trial program including elderly and obese patients (60-84 years, body mass index >28 kg/m2) with at least one manifestation of hypertension, cardiovascular or chronic kidney disease, but no history of diabetes or HF. The aims are to investigate the effects of empagliflozin on 1) physical capacity and left ventricular and atrial structural changes with peak oxygen consumption and left ventricular mass as primary endpoints (Empire Prevent Cardiac), and 2) cardiac-adipose tissue interaction and volume homeostasis with primary endpoints of changes in epicardial adipose tissue and estimated extracellular volume (Empire Prevent Metabolic). At present, 138 of 204 patients have been randomized in the Empire Prevent trial program. Patients are randomized 1:1 to 180 days treatment with empagliflozin 10 mg daily or placebo, while undergoing a comprehensive examination program at baseline and follow-up. DISCUSSION The Empire Prevent trial program will mark the first step towards elucidating the potential of SGLT2 inhibition for HF prevention in an outpatient setting in elderly and obese patients with increased risk of developing HF, but with no history of diabetes or established HF. Furthermore, the Empire Prevent trial program will supplement the larger event-driven trials by providing mechanistic insights to the beneficial effects of SGLT2 inhibition. TRIAL REGISTRATION Both parts of the trial program have been registered on September 13th 2021 (Clinical Trial Registration numbers: NCT05084235 and NCT05042973) before enrollment of the first patient. All patients will provide oral and written informed consent. The trial is approved by The Regional Committee on Health Research Ethics and the Danish Medicines Agency. Data will be disseminated through scientific meetings and peer-reviewed journals irrespective of outcome.
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Affiliation(s)
- Camilla Fuchs Andersen
- Department of Cardiology, Herlev-Gentofte University Hospital, Denmark; Faculty of Health and Medical Sciences, Copenhagen University, Denmark.
| | - Julie Hempel Larsen
- Department of Cardiology, Odense University Hospital, Denmark; Faculty of Health Sciences, University of Southern Denmark, Denmark
| | - Jesper Jensen
- Department of Cardiology, Herlev-Gentofte University Hospital, Denmark; Faculty of Health and Medical Sciences, Copenhagen University, Denmark
| | - Massar Omar
- Department of Cardiology, Odense University Hospital, Denmark; Faculty of Health Sciences, University of Southern Denmark, Denmark; Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
| | - Nina Nouhravesh
- Department of Cardiology, Herlev-Gentofte University Hospital, Denmark; Faculty of Health and Medical Sciences, Copenhagen University, Denmark
| | - Caroline Kistorp
- Department of Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Christian Tuxen
- Department of Cardiology, Frederiksberg-Bispebjerg University Hospital, Denmark
| | - Finn Gustafsson
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Filip K Knop
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Julie Lyng Forman
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
| | - Filip Soeskov Davidovski
- Department of Cardiology, Herlev-Gentofte University Hospital, Denmark; Faculty of Health and Medical Sciences, Copenhagen University, Denmark
| | - Lars Thorbjørn Jensen
- Faculty of Health and Medical Sciences, Copenhagen University, Denmark; Department of Clinical Physiology and Nuclear Medicine, Herlev Gentofte University Hospital, Copenhagen, Denmark
| | - Kurt Højlund
- Steno Diabetes Center Odense, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark
| | | | | | - Morten Schou
- Department of Cardiology, Herlev-Gentofte University Hospital, Denmark; Faculty of Health and Medical Sciences, Copenhagen University, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Herlev-Gentofte University Hospital, Denmark; Department of Cardiology, Odense University Hospital, Denmark; Faculty of Health Sciences, University of Southern Denmark, Denmark; Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark
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Gregers E, Kragholm K, Linde L, Mørk SR, Andreasen JB, Terkelsen CJ, Lassen JF, Møller JE, Laugesen H, Smerup M, Kjærgaard J, Møller-Sørensen PH, Holmvang L, Torp-Pedersen C, Hassager C, Søholm H. Return to Work After Refractory Out-of-Hospital Cardiac Arrest in Patients Managed With or Without Extracorporeal Cardiopulmonary Resuscitation: A Nationwide Register-Based Study. J Am Heart Assoc 2024; 13:e034024. [PMID: 38533974 DOI: 10.1161/jaha.123.034024] [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: 12/25/2023] [Accepted: 02/19/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly used for refractory out-of-hospital cardiac arrest (OHCA). However, survivors managed with ECPR are at risk of poor functional status. The purpose of this study was to investigate return to work (RTW) after refractory OHCA. METHODS AND RESULTS Of 44 360 patients with OHCA in the period of 2011 to 2020, this nationwide registry-based study included 805 patients with refractory OHCA in the working age (18-65 years) who were employed before OHCA (2% of the total OHCA cohort). Demographics, prehospital characteristics, status at hospital arrival, employment status, and survival were retrieved through the Danish national registries. Sustainable RTW was defined as RTW for ≥6 months without any long sick leave relapses. Median follow-up time was 4.1 years. ECPR and standard advanced cardiovascular life support were applied in 136 and 669 patients, respectively. RTW 1 year after OHCA was similar (39% versus 54%; P=0.2) and sustainable RTW was high in both survivors managed with ECPR and survivors managed with standard advanced cardiovascular life support (83% versus 85%; P>0.9). Younger age and shorter length of hospitalization were associated with RTW in multivariable Cox analysis, whereas ECPR was not. CONCLUSIONS In refractory OHCA-patients employed prior to OHCA, approximately 1 out of 2 patients were employed after 1 year with no difference between patients treated with ECPR or standard advanced cardiovascular life support. Younger age and shorter length of hospitalization were associated with RTW while ECPR was not.
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Affiliation(s)
- Emilie Gregers
- Department of Cardiology Rigshospitalet Copenhagen Denmark
| | - Kristian Kragholm
- Department of Cardiology Aalborg University Hospital Aalborg Denmark
- Department of Clinical Medicine Aalborg University Aalborg Denmark
| | - Louise Linde
- Department of Cardiology Odense University Hospital Odense Denmark
| | | | | | - Christian Juhl Terkelsen
- Department of Cardiology Aarhus University Hospital Aarhus Denmark
- Department of Clinical Medicine Aarhus University Aarhus Denmark
| | - Jens Flensted Lassen
- Department of Cardiology Odense University Hospital Odense Denmark
- Department of Clinical Medicine University of Southern Denmark Copenhagen Denmark
| | - Jacob Eifer Møller
- Department of Cardiology Rigshospitalet Copenhagen Denmark
- Department of Cardiology Odense University Hospital Odense Denmark
- Department of Clinical Medicine University of Southern Denmark Copenhagen Denmark
| | - Helle Laugesen
- Department of Anaesthesiology Aalborg University Hospital Aalborg Denmark
| | - Morten Smerup
- Department of Cardiothoracic Surgery Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine Copenhagen University Copenhagen Denmark
| | | | | | - Lene Holmvang
- Department of Cardiology Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine Copenhagen University Copenhagen Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology North Zealand Hospital Hillerød Denmark
- Department of Public Health Copenhagen University Copenhagen Denmark
| | - Christian Hassager
- Department of Cardiology Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine Copenhagen University Copenhagen Denmark
| | - Helle Søholm
- Department of Cardiology Rigshospitalet Copenhagen Denmark
- Department of Cardiology Zealand University Hospital Roskilde Roskilde Denmark
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Lassen M, Seven E, Søholm H, Hassager C, Møller JE, Køber NV, Lindholm MG. Heart Failure with Preserved vs. Reduced Ejection Fraction: Patient Characteristics, In-hospital Treatment and Mortality-DanAHF, a Nationwide Prospective Study. J Cardiovasc Transl Res 2024; 17:265-274. [PMID: 37052785 DOI: 10.1007/s12265-023-10385-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/30/2023] [Indexed: 04/14/2023]
Abstract
This study aims to describe baseline characteristics and in-hospital management of a patient cohort hospitalized with acute heart failure (AHF). Adult patients in Denmark admitted with a medical diagnosis during a 7-day period were reviewed for symptoms and clinical findings suggestive of AHF. HFpEF was defined as LVEF ≥ 45%. Of 5194 patients, 290 (6%) had AHF. Sixty-two percent (n = 179) was diagnosed with HFpEF. Compared to HFrEF patients, HFpEF patients were more often women (48% vs. 31%, p = 0.004), less likely to have ischemic heart disease (31% vs. 53%, p = 0.002) and a pacemaker/ICD (7% vs. 21%, p < 0.001/1% vs. 8%, p < 0.001). Fewer HFpEF patients received intravenous diuretics (43% vs. 73%, p < 0.001) and inotropes (2% vs. 7%, p = 0.02), while more HFpEF patients received nitro-glycerine (59% vs. 44%, p = 0.02). Intubation/NIV, ICU admission, and revascularization were used similarly. Hospitalization was shorter for HFpEF patients (4 vs. 6 days, p < 0.001), with no significant difference in survival to discharge (96% vs. 91%, p = 0.07). Of AHF admissions, nearly two-thirds was due to HFpEF. Compared to HFrEF, HFpEF patients had a lower cardiac comorbidity and a 2-day shorter hospitalization.
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Affiliation(s)
- Maria Lassen
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark.
- Department of Anaesthesiology and Intensive Care, Bispebjerg Hospital, Copenhagen, Denmark.
| | - Ekim Seven
- Department of Cardiology, Hvidovre Hospital, Copenhagen, Denmark
| | - Helle Søholm
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- University of Copenhagen, Copenhagen, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
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Gregers E, Linde L, Kunkel JB, Wiberg S, Møller-Sørensen PH, Smerup M, Borregaard B, Schmidt H, Lassen JF, Møller JE, Hassager C, Søholm H, Kjærgaard J. Health-related quality of life and cognitive function after out-of-hospital cardiac arrest; a comparison of prehospital return-of-spontaneous circulation and refractory arrest managed with extracorporeal cardiopulmonary resuscitation. Resuscitation 2024; 197:110151. [PMID: 38401709 DOI: 10.1016/j.resuscitation.2024.110151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/10/2024] [Accepted: 02/19/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Extracorporeal cardiopulmonary resuscitation (ECPR) for selected refractory out-of-hospital cardiac arrest (OHCA) is increasingly used. Detailed knowledge of health-related quality of life (HRQoL) and long-term cognitive function is limited. HRQoL and cognitive function were assessed in ECPR-survivors and OHCA-survivors with prehospital return of spontaneous circulation after standard advanced cardiac life support (sACLS). METHODS Fifteen ECPR-survivors and 22 age-matched sACLS-survivors agreed to participate in this follow-up study. Participants were examined with echocardiography, 6-minute walk test, and neuropsychological testing, and answered HRQoL (EQ-5D-5L and Short Form 36 (SF-36)), and mental health questionnaires. RESULTS Most patients were male (73 % and 82 %) and median age at follow-up was similar between groups (55 years and 60 years). Low flow time was significantly longer for ECPR-survivors (86 min vs. 15 min) and lactate levels were significantly higher (14.1 mmol/l vs. 3.9 mmol/l). No between-group difference was found in physical function nor in cognitive function with scores corresponding to the 23rd worst percentile of the general population. SACLS-survivors had HRQoL on level with the Danish general population while ECPR-survivors scored lower in both EQ-5D-5L (index score 0.73 vs. 0.86, p = 0.03, visual analog scale: 70 vs. 84, p = 0.04) and in multiple SF-36 health domains (role physical, bodily pain, general health, and mental health). CONCLUSIONS Despite substantially longer low flow times with thrice as high lactate levels, ECPR-survivors were similar in cognitive and physical function compared to sACLS-survivors. Nonetheless, ECPR-survivors reported lower HRQoL overall and related to mental health, pain management, and the perception of limitations in physical role.
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Affiliation(s)
- Emilie Gregers
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark; Department of Cardiothoracic Surgery, Copenhagen University Hospital Rigshospitalet, Denmark; Department of Clinical Medicine, Copenhagen University, Denmark.
| | - Louise Linde
- Department of Cardiology, Odense University Hospital, Denmark; Department of Clinical Medicine, University of Southern Denmark, Denmark
| | - Joakim Bo Kunkel
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark; Department of Clinical Medicine, Copenhagen University, Denmark
| | - Sebastian Wiberg
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark; Department of Cardiothoracic Anaesthestiology, Copenhagen University Hospital Rigshospitalet, Denmark; Department of Clinical Medicine, University of Southern Denmark, Denmark
| | | | - Morten Smerup
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark; Department of Clinical Medicine, Copenhagen University, Denmark
| | - Britt Borregaard
- Department of Cardiology, Odense University Hospital, Denmark; Department of Clinical Medicine, University of Southern Denmark, Denmark
| | - Henrik Schmidt
- Department of Cardiothoracic Anaesthesiology, Odense University Hospital, Denmark
| | - Jens Flensted Lassen
- Department of Cardiology, Odense University Hospital, Denmark; Department of Clinical Medicine, University of Southern Denmark, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark; Department of Clinical Medicine, Copenhagen University, Denmark; Department of Clinical Medicine, University of Southern Denmark, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark; Department of Clinical Medicine, Copenhagen University, Denmark
| | - Helle Søholm
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark; Department of Cardiology, Zealand University Hospital Roskilde, Denmark
| | - Jesper Kjærgaard
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark; Department of Clinical Medicine, Copenhagen University, Denmark
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Zohori Bahrami HS, Hasselbalch RB, Søholm H, Thomsen JH, Sørgaard M, Kofoed KF, Valeur N, Boesgaard S, Sarah Fry NA, Møller JE, Raja AA, Køber L, Iversen K, Rasmussen H, Bundgaard H. First-in-man trial of β3-adrenoceptor agonist treatment in chronic heart failure - impact on diastolic function. J Cardiovasc Pharmacol 2024:00005344-990000000-00294. [PMID: 38452283 DOI: 10.1097/fjc.0000000000001545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/10/2024] [Indexed: 03/09/2024]
Abstract
Diastolic dysfunction (DD) in heart failure (HF) is associated with increased myocardial cytosolic calcium, and calcium-efflux via the sodium-calcium-exchanger depends on the sodium gradient. Beta-3-adrenoceptor (β3-AR) agonists lower cytosolic sodium and have reversed organ congestion. Accordingly, β3-AR agonists might improve diastolic function, which we aimed to assess. In a first-in-man, randomized, double-blinded trial, we assigned 70 patients with HF with reduced ejection fraction (HFrEF), NYHA II-III, and LVEF<40% to receive the β3-AR agonist mirabegron (300 mg/day) or placebo for six months, in addition to recommended HF therapy. We performed echocardiography and cardiac computed tomography (CCT) and measured N-terminal pro-brain natriuretic peptide (NT-proBNP) at baseline and follow-up. DD was graded per multiple renowned algorithms. Baseline and follow-up data were available in 57 patients (59±11 years, 88% male, 49% ischemic heart disease). No clinically significant changes in diastolic measurements were found within or between groups by echocardiography (E/e' placebo: 13±7 to 13±5, p=0.21 vs mirabegron: 12±6 to 13±8, p=0.74, between group follow-up difference 0.2 [95% CI -3 to 4], p=0.89), or CCT (left atrial volume index: between group follow-up difference 9 ml/m2 [95% CI -3 to 19], p=0.15). DD gradings did not change within or between groups following two algorithms (p=0.72, p=0.75). NT-proBNP remained unchanged in both groups (p=0.74, p=0.64). In patients with HFrEF, no changes were identified in diastolic measurements, gradings or biomarker after β3-AR stimulation compared to placebo. The findings add to previous literature questioning the role of impaired Na+-Ca2+ mediated calcium-export as a major culprit in DD. NCT01876433.
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Affiliation(s)
- Hashmat Sayed Zohori Bahrami
- Department of Cardiology, Copenhagen University Hospital Hvidovre, Denmark. Kettegård Alle 30, 2650 Hvidovre
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Blegdamsvej 9, 2100 Copenhagen
| | - Rasmus Bo Hasselbalch
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Blegdamsvej 9, 2100 Copenhagen
| | - Helle Søholm
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Blegdamsvej 9, 2100 Copenhagen
- Department of Cardiology, Zealand University Hospital, Denmark. Sygehusvej 10, 4000 Roskilde
| | - Jakob Hartvig Thomsen
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Blegdamsvej 9, 2100 Copenhagen
| | - Mathias Sørgaard
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Blegdamsvej 9, 2100 Copenhagen
| | - Klaus Fuglsang Kofoed
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Blegdamsvej 9, 2100 Copenhagen
| | - Nana Valeur
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg-Frederiksberg, Denmark. Bispebjerg Bakke 23, 2400 Copenhagen
| | - Søren Boesgaard
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Blegdamsvej 9, 2100 Copenhagen
| | - Natasha Alexandria Sarah Fry
- Department of Cardiology, Royal North Shore Hospital and University of Sydney, Australia. Reserve Rd, St Leonards NSW 2065
| | - Jacob Eifer Møller
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Blegdamsvej 9, 2100 Copenhagen
| | - Anna Axelsson Raja
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Blegdamsvej 9, 2100 Copenhagen
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Blegdamsvej 9, 2100 Copenhagen
| | - Kasper Iversen
- Department of Emergency Medicine, Copenhagen University Hospital Herlev-Gentofte, Denmark. Borgmester Ib Juuls Vej 1, 2730 Herlev
| | - Helge Rasmussen
- Department of Cardiology, Royal North Shore Hospital and University of Sydney, Australia. Reserve Rd, St Leonards NSW 2065
| | - Henning Bundgaard
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Blegdamsvej 9, 2100 Copenhagen
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7
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Thevathasan T, Gregers E, Rasalingam Mørk S, Degbeon S, Linde L, Bønding Andreasen J, Smerup M, Eifer Møller J, Hassager C, Laugesen H, Dreger H, Brand A, Balzer F, Landmesser U, Juhl Terkelsen C, Flensted Lassen J, Skurk C, Søholm H. Lactate and Lactate Clearance as Predictors of One-Year Survival in Extracorporeal Cardiopulmonary Resuscitation - An International, Multicentre Cohort Study. Resuscitation 2024:110149. [PMID: 38403182 DOI: 10.1016/j.resuscitation.2024.110149] [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: 12/14/2023] [Revised: 02/09/2024] [Accepted: 02/18/2024] [Indexed: 02/27/2024]
Abstract
AIM Extracorporeal cardiopulmonary resuscitation (ECPR) can be considered in selected patients with refractory cardiac arrest. Given the risk of patient futility and high resource utilisation, identifying ECPR candidates, who would benefit from this therapy, is crucial. Previous ECPR studies investigating lactate as a potential prognostic marker have been small and inconclusive. It was hypothesised that the lactate level (immediately prior to initiation of ECPR) and lactate clearance (within 24 hours after ECPR initiation) are predictors of one-year survival in a large, multicentre study cohort of ECPR patients. METHODS Adult patients with refractory cardiac arrest at three German and four Danish tertiary cardiac care centres between 2011 and 2021 were included. Pre-ECPR lactate and 24-hour lactate clearance were divided into three equally sized tertiles. Multivariable logistic regression analyses and Kaplan-Meier analyses were used to analyse survival outcomes. RESULTS 297 adult patients with refractory cardiac arrest were included in this study, of which 65 (22%) survived within one year. The pre-ECPR lactate level and 24-hour lactate clearance were level-dependently associated with one-year survival: OR 5.40 [95% CI 2.30-13.60] for lowest versus highest pre-ECPR lactate level and OR 0.25 [95% CI 0.09-0.68] for lowest versus highest 24-hour lactate clearance. Results were confirmed in Kaplan-Meier analyses (each p log rank <0.001) and subgroup analyses. CONCLUSION Pre-ECPR lactate levels and 24 hour-lactate clearance after ECPR initiation in patients with refractory cardiac arrest were level-dependently associated with one-year survival. Lactate is an easily accessible and quickly available point-of-care measurement which might be considered as an early prognostic marker when considering initiation or continuation of ECPR treatment.
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Affiliation(s)
- Tharusan Thevathasan
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany; Berlin Institute of Health, Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Potsdamer Str. 58, 10785 Berlin, Germany; Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Emilie Gregers
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Sivagowry Rasalingam Mørk
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus, Denmark
| | - Sêhnou Degbeon
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Louise Linde
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark; Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 17, 5000 Odense, Denmark
| | - Jo Bønding Andreasen
- Department of Anesthesiology and Intensive Medicine, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Morten Smerup
- Department of Cardiothoracic Surgery, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark; Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 17, 5000 Odense, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Helle Laugesen
- Department of Anesthesiology and Intensive Medicine, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Henryk Dreger
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Anna Brand
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Felix Balzer
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Ulf Landmesser
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany; Berlin Institute of Health, Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Potsdamer Str. 58, 10785 Berlin, Germany
| | - Christian Juhl Terkelsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; The Danish Heart Foundation, Vognmagergade 7, 3rd floor, 1120 Copenhagen, Denmark
| | - Jens Flensted Lassen
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark; Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 17, 5000 Odense, Denmark
| | - Carsten Skurk
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Potsdamer Str. 58, 10785 Berlin, Germany.
| | - Helle Søholm
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Cardiology, Zealand University Hospital Roskilde, Sygehusvej 10, 4000 Roskilde, Denmark
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8
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Graversen PL, Hadji-Turdeghal K, Møller JE, Bruun NE, Laghmoch H, Jensen AD, Petersen JK, Bundgaard H, Iversen K, Povlsen JA, Moser C, Smerup M, Jensen HS, Søgaard P, Helweg-Larsen J, Faurholt-Jepsen D, Østergaard L, Køber L, Fosbøl EL. NatIonal Danish endocarditis stUdieS - Design and objectives of the NIDUS registry. Am Heart J 2024; 268:80-93. [PMID: 38056547 DOI: 10.1016/j.ahj.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/24/2023] [Accepted: 11/24/2023] [Indexed: 12/08/2023]
Abstract
AIMS The NatIonal Danish endocarditis stUdieS (NIDUS) registry aims to investigate the mechanisms contributing to the increasing incidence of infective endocarditis (IE) and to discover risk factors associated to the course, treatment and clinical outcomes of the disease. METHODS The NIDUS registry was created to investigate a nationwide unselected group of patients hospitalized for IE. The National Danish healthcare registries have been queried for validated IE diagnosis codes (International Classification of Disease, 10th edition [ICD-10]: DI33, DI38, and DI398). Subsequently, a team of 28 healthcare professionals, including experts in endocarditis, will systematically review and evaluate all identified patient records using the modified Duke Criteria and the 2015 European Society of Cardiology modified diagnostic criteria. The registry will contain all cases with definite or possible IE found in primary data sources in Denmark between January 1, 2016, and December 31, 2021. We will gather individual patient data, such as clinical, microbiological, and echocardiographic characteristics, treatment regimens, and clinical outcomes. A digital data collection form will be used to the gathering of data. A sample of approximately 4,300 individual patients will be evaluated using primary data sources. CONCLUSIONS AND PERSPECTIVES The NIDUS registry will be the first comprehensive nationwide IE registry, contributing critical knowledge about the course, treatment, and clinical outcomes of the disease. Additionally, it will significantly aid in identifying areas in which future research is needed.
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Affiliation(s)
- Peter L Graversen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
| | - Katra Hadji-Turdeghal
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Research Unit of Cardiology, Department of Cardiology, Odense University Hospital, Odense, Denmark; Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Niels Eske Bruun
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Hicham Laghmoch
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | | | - Jeppe K Petersen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kasper Iversen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Emergency Medicine, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Jonas A Povlsen
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Claus Moser
- Department of Clinical Microbiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Morten Smerup
- Department of Cardiothoracic Surgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | | | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jannik Helweg-Larsen
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Daniel Faurholt-Jepsen
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lauge Østergaard
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Emil L Fosbøl
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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9
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Mieritz HB, Povlsen AL, Linde L, Beske RP, Helgestad OKL, Josiassen J, Hassager C, Schmidt H, Jensen LO, Holmvang L, Møller JE, Ravn HB. DIFFERENCES IN MANAGEMENT AND PROGNOSTICATION OF CARDIOGENIC SHOCK PATIENTS IN THE PRESENCE AND ABSENCE OF OUT-OF-HOSPITAL CARDIAC ARREST. Shock 2024; 61:209-214. [PMID: 38010103 DOI: 10.1097/shk.0000000000002272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
ABSTRACT Background: The clinical spectrum of acute myocardial infarction complicated by cardiogenic shock (AMICS) varies. Out-of-hospital cardiac arrest (OHCA) can be the first sign of cardiac failure, whereas others present with various degrees of hemodynamic instability (non-OHCA). The aim of the present study was to explore differences in prehospital management and characteristics of survivors and nonsurvivors in AMICS patients with OHCA or non-OHCA. Methods: Data analysis was based on patient data from the RETROSHOCK cohort comprising consecutive AMICS patients admitted to two tertiary cardiac centers between 2010 and 2017. Results: 1,716 AMICS patients were included and 42% presented with OHCA. Mortality in OHCA patients was 47% versus 57% in the non-OHCA group. Almost all OHCA patients were intubated before admission (96%). In the non-OHCA group, prehospital intubation (25%) was associated with a better survival ( P < 0.001). Lactate level on admission demonstrated a linear relationship with mortality in OHCA patients. In non-OHCA, probability of death was higher for any given lactate level <12 mmol/L compared with OHCA. However, a lactate level >7 mmol/L in non-OHCA did not increase mortality odds any further. Conclusion: Mortality was almost doubled for any admission lactate level up to 7 mmol/L in non-OHCA patients. Above this level, mortality remained unchanged in non-OHCA patients but continued to increase in OHCA patients. Prehospital intubation was performed in almost all OHCA patients but only in one of four patients without OHCA. Early intubation in non-OHCA patients was associated with a better outcome.
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Affiliation(s)
- Hanne Beck Mieritz
- Department of Cardiothoracic Anesthesia, Odense University Hospital, Odense, Denmark
| | - Amalie Ling Povlsen
- Department of Cardiothoracic Anesthesia, Odense University Hospital, Odense, Denmark
| | - Louise Linde
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Rasmus Paulin Beske
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Jakob Josiassen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Henrik Schmidt
- Department of Cardiothoracic Anesthesia, Odense University Hospital, Odense, Denmark
| | | | - Lene Holmvang
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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10
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Sarkisian L, Isse YA, Gerke O, Obling LER, Paulin Beske R, Grand J, Schmidt H, Højgaard HF, Meyer MAS, Borregaard B, Hassager C, Kjaergaard J, Møller JE. Survival and neurological outcome after bystander versus lay responder defibrillation in out-of-hospital cardiac arrest: A sub-study of the BOX trial. Resuscitation 2024; 195:110059. [PMID: 38013147 DOI: 10.1016/j.resuscitation.2023.110059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/15/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND AND AIM Bystander defibrillation is associated with increased survival with good neurological outcome after out-of-hospital cardiac arrest (OHCA). Dispatch of lay responders could increase defibrillation rates, however, survival with good neurological outcome in these remain unknown. The aim was to compare long-term survival with good neurological outcome in bystander versus lay responder defibrillated OHCAs. METHODS This is a sub-study of the BOX trial, which included OHCA patients from two Danish tertiary cardiac intensive care units from March 2017 to December 2021. The main outcome was defined as 3-month survival with good neurological performance (Cerebral Performance Category of 1or 2, on a scale from 1 (good cerebral performance) to 5 (death or brain death)). For this study EMS witnessed OHCAs were excluded. RESULTS Of the 715 patients, a lay responder arrived before EMS in 125 cases (16%). In total, 81 patients were defibrillated by a lay responder (11%), 69 patients by a bystander (10%) and 565 patients by the EMS staff (79%). The 3-month survival with good neurological outcome was 65% and 81% in the lay responder and bystander defibrillated groups, respectively (P = 0.03). CONCLUSION In patients with OHCA, 3-month survival with good neurological outcome was higher in bystander defibrillated patients compared with lay responder defibrillated patients.
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Affiliation(s)
- Laura Sarkisian
- Research Unit of Cardiology, Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark; OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.
| | - Yusuf Abdi Isse
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19, 5000 Odense C, Denmark.
| | - Laust Emil Roelsgaard Obling
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Ramus Paulin Beske
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Johannes Grand
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Henrik Schmidt
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Odense University Hospital, Department of Anesthesiology, J.B. Winsløws Vej 4, 5000 Odense C, Denmark.
| | | | - Martin Abild Stengaard Meyer
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Britt Borregaard
- Research Unit of Cardiology, Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19, 5000 Odense C, Denmark.
| | - Christian Hassager
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Jesper Kjaergaard
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Jacob Eifer Møller
- Research Unit of Cardiology, Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark; Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19, 5000 Odense C, Denmark.
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11
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Beske RP, Søndergaard FT, Møller JE, Schmidt H, Kjaergaard J, Obling L, Meyer MAS, Mølstrøm S, Winther-Jensen M, Højgaard HF, Jeppesen KK, Sarkisian L, Grand J, Hassager C. Treatment effects of blood pressure targets and hemodynamics according to initial blood lactate levels in comatose out-of-hospital cardiac arrest patients - A sub study of the BOX trial. Resuscitation 2024; 194:110007. [PMID: 37863419 DOI: 10.1016/j.resuscitation.2023.110007] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) survivors remaining comatose are often circulatory unstable with high mortality in the first days following resuscitation. Elevated lactate will reflect the severity and duration of hypoperfusion in cardiac arrest. Further, the severity of hypoperfusion could modify the effect on survival of different mean arterial blood pressure (MAP) targets. METHODS In this sub-study of the BOX trial, adult successfully resuscitated comatose OHCA patients (n = 789) with a presumed cardiac cause were randomized to a MAP target of 63 mmHg vs. 77 mmHg. Patients were arbitrarily grouped in low-lactate: <25% of sample, medium-lactate: 25%-75%, and high >75 percentile according to blood lactate levels at hospital arrival as a surrogate of the severity of hypoperfusion. Invasive hemodynamic evaluations were performed using an arterial catheter and pulmonary artery catheter (PAC), and data from admission to 48 hours (h) were recorded. Logistic regression analysis evaluated whether lactate levels (as continuous and categorical) modify the effect of MAP targets on mortality at 365 days. RESULTS The three lactate groups had initial lactate levels of low-lactate: <2.9 mmol/L, medium-lactate: 2.9-7.9 mmol/L, and high-lactate > 7.9 mmol/L. All patients were randomized to a 63 mmHg or 77 mmHg MAP target. The proportion of patients in the high-MAP target group was 100/201 (50%), 178/388 (46%), and 114/197 (58%) for low, medium, and high-lactate groups respectively. At admission, the high-lactate groups had a lower MAP compared to the medium-lactate (2.6 mmHg (95% CI: 0.1-5.0 mmHg, p = 0.02), and the low-lactate group, (3.6 mmHg (95% CI: 0.8-6.5 mmHg, p < 0.01). Accordingly, the vasoactive inotropic score was 79% (95%CI: 42%-124%%) higher with increasing initial lactate level (High-lactate vs. low-lactate) with the largest difference at 6 hours (110.6% (95%CI: 54.4%-187.2%) higher in high-lactate patients). No difference in the cardiac index or systemic vascular resistance was observed between lactate groups. The initial lactate level (continuous) modified the effect of the two MAP targets (p = 0.04). In the highest lactate group, the mortality was 100/197 (51%), and with an odds ratio (OR): 1.7 (95%CI: 0.9-3.0) if randomized to MAP 77 mmHg compared to MAP 63 mmHg. In the lowest lactate group, the mortality was 35/201(17%) and similar if randomized to a MAP target of 77 mmHg (OR: 1.1 (95% CI: 0.5-2.3)). CONCLUSION Comatose OHCA patients with high initial lactate levels required more vasoactive drugs on the first two days of ICU admission to meet the blood pressure target and had a poorer prognosis. No indication that aiming for a higher MAP target is beneficial in patients with an initial high lactate level was found, however, given the post-hoc nature of this study, these results should be considered hypothesis-generating.
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Affiliation(s)
- Rasmus P Beske
- Department of Cardiology, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Denmark.
| | - Frederik T Søndergaard
- Department of Cardiology, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Denmark; Department of Clinical Research, University of Southern, Denmark
| | - Henrik Schmidt
- Odense University Hospital, Department of Cardiology - B, Odense, Denmark; Department of Clinical Research, University of Southern, Denmark; Odense University Hospital, Cardiothoracic Intensive Care Unit, Odense, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Laust Obling
- Department of Cardiology, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Martin A S Meyer
- Department of Cardiology, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Simon Mølstrøm
- Odense University Hospital, Cardiothoracic Intensive Care Unit, Odense, Denmark
| | - Matilde Winther-Jensen
- Department of Cardiology, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Denmark
| | | | | | - Laura Sarkisian
- Odense University Hospital, Department of Cardiology - B, Odense, Denmark
| | - Johannes Grand
- Department of Cardiology, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Denmark; Department of Clinical Research, University of Southern, Denmark
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12
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Borregaard B, Bruvik SM, Dahl J, Ekholm O, Bekker-Jensen D, Sibilitz KL, Zwisler AD, Lauck SB, Pedersen SS, Norekvål T, Riber LPS, Møller JE. Psychometric Properties of the Kansas City Cardiomyopathy Questionnaire in a Surgical Population of Patients With Aortic Valve Stenosis. Am J Cardiol 2023; 209:165-172. [PMID: 37898098 DOI: 10.1016/j.amjcard.2023.09.068] [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: 07/19/2023] [Revised: 09/08/2023] [Accepted: 09/18/2023] [Indexed: 10/30/2023]
Abstract
The 12-item version of the Kansas City Cardiomyopathy Questionnaire (KCCQ-12) was originally developed for patients with heart failure but has been used and tested among patients with severe aortic stenosis (AS) who underwent transcatheter aortic valve implantation. Whether the instrument is suitable for patients with AS who underwent surgical aortic valve replacement (SAVR) is currently unknown. Thus, we aimed to investigate the psychometric properties of the KCCQ-12 before and after SAVR among patients with severe AS. We conducted a prospective cohort of 184 patients with AS who completed the KCCQ-12 and the EuroQol 5 Dimension 5 Levels before and 4 weeks after surgery. Construct validity was investigated with hypothesis testing and an analysis of Spearman's correlation between the two instruments. Structural validity was investigated with explorative and confirmatory factor analyses and reliability with Cronbach's α. All analyses were conducted on data from the two time points (preoperatively and four weeks after surgery). The hypothesis testing revealed how the New York Heart Association class was significantly correlated with the preoperative KCCQ-12 total score (higher New York Heart Association class, worse score). A longer length of hospital stay and living alone were significantly associated with poorer postoperative KCCQ-12 total score. KCCQ-12 and EuroQol 5 Dimension 5 Levels were moderately correlated in most domains/the total score/Visual Analogue Scale score. Principal component analyses revealed two 3-factor structures. The confirmatory factor analyses did not support the original model at any time point. Cronbach's α ranged from 0.22 to 0.84 in three preoperative factors and from 0.39 to 0.76 in the postoperative factors. The total Cronbach's α was 0.83 for the suggested preoperative 3-factor model and 0.83 for the postoperative model. In conclusion, the Danish version of the KCCQ-12 tested in a population of patients with AS who underwent SAVR appears to have acceptable construct validity, whereas structural validity cannot be confirmed for the original four-factor model. Overall reliability is good.
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Affiliation(s)
- Britt Borregaard
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark; Faculty of Health Science, University of Southern Denmark, Odense, Denmark; OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark.
| | | | - Jordi Dahl
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | | | - Ann Dorthe Zwisler
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Faculty of Health Science, University of Southern Denmark, Odense, Denmark; Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark, Nyborg, Denmark
| | - Sandra B Lauck
- Centre for Heart Valve Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, British Columbia, Canada
| | - Susanne S Pedersen
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Tone Norekvål
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Lars P Schødt Riber
- Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark; Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Faculty of Health Science, University of Southern Denmark, Odense, Denmark; The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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13
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Rasmussen SB, Jeppesen KK, Kjaergaard J, Hassager C, Schmidt H, Mølstrøm S, Beske RP, Grand J, Ravn HB, Winther-Jensen M, Meyer MAS, Møller JE. Blood Pressure and Oxygen Targets on Kidney Injury After Cardiac Arrest. Circulation 2023; 148:1860-1869. [PMID: 37791480 DOI: 10.1161/circulationaha.123.066012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 09/06/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) represents a common and serious complication to out-of-hospital cardiac arrest. The importance of post-resuscitation care targets for blood pressure and oxygenation for the development of AKI is unknown. METHODS This is a substudy of a randomized 2-by-2 factorial trial, in which 789 comatose adult patients who had out-of-hospital cardiac arrest with presumed cardiac cause and sustained return of spontaneous circulation were randomly assigned to a target mean arterial blood pressure of either 63 or 77 mm Hg. Patients were simultaneously randomly assigned to either a restrictive oxygen target of a partial pressure of arterial oxygen (Pao2) of 9 to 10 kPa or a liberal oxygenation target of a Pao2 of 13 to 14 kPa. The primary outcome for this study was AKI according to KDIGO (Kidney Disease: Improving Global Outcomes) classification in patients surviving at least 48 hours (N=759). Adjusted logistic regression was performed for patients allocated to high blood pressure and liberal oxygen target as reference. RESULTS The main population characteristics at admission were: age, 64 (54-73) years; 80% male; 90% shockable rhythm; and time to return of spontaneous circulation, 18 (12-26) minutes. Patients allocated to a low blood pressure and liberal oxygen target had an increased risk of developing AKI compared with patients with high blood pressure and liberal oxygen target (84/193 [44%] versus 56/187 [30%]; adjusted odds ratio, 1.87 [95% CI, 1.21-2.89]). Multinomial logistic regression revealed that the increased risk of AKI was only related to mild-stage AKI (KDIGO stage 1). There was no difference in risk of AKI in the other groups. Plasma creatinine remained high during hospitalization in the low blood pressure and liberal oxygen target group but did not differ between groups at 6- and 12-month follow-up. CONCLUSIONS In comatose patients who had been resuscitated after out-of-hospital cardiac arrest, patients allocated to a combination of a low mean arterial blood pressure and a liberal oxygen target had a significantly increased risk of mild-stage AKI. No difference was found in terms of more severe AKI stages or other kidney-related adverse outcomes, and creatinine had normalized at 1 year after discharge. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03141099.
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Affiliation(s)
- Sebastian Buhl Rasmussen
- Department of Anesthesiology and Intensive Care (S.B.R., H.S., S.M., H.B.R., M.A.S.M.), Odense University Hospital, Denmark
| | | | - Jesper Kjaergaard
- Department of Cardiology, the Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark (J.K., C.H., R.P.B., J.G., M.W.-J., J.E.M.)
- Department of Clinical Medicine, University of Copenhagen, Denmark (J.K., C.H.)
| | - Christian Hassager
- Department of Cardiology, the Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark (J.K., C.H., R.P.B., J.G., M.W.-J., J.E.M.)
- Department of Clinical Medicine, University of Copenhagen, Denmark (J.K., C.H.)
| | - Henrik Schmidt
- Department of Anesthesiology and Intensive Care (S.B.R., H.S., S.M., H.B.R., M.A.S.M.), Odense University Hospital, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense (H.S., H.B.R., J.E.M.)
| | - Simon Mølstrøm
- Department of Anesthesiology and Intensive Care (S.B.R., H.S., S.M., H.B.R., M.A.S.M.), Odense University Hospital, Denmark
| | - Rasmus Paulin Beske
- Department of Cardiology, the Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark (J.K., C.H., R.P.B., J.G., M.W.-J., J.E.M.)
| | - Johannes Grand
- Department of Cardiology, the Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark (J.K., C.H., R.P.B., J.G., M.W.-J., J.E.M.)
| | - Hanne Berg Ravn
- Department of Anesthesiology and Intensive Care (S.B.R., H.S., S.M., H.B.R., M.A.S.M.), Odense University Hospital, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense (H.S., H.B.R., J.E.M.)
| | - Matilde Winther-Jensen
- Department of Cardiology, the Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark (J.K., C.H., R.P.B., J.G., M.W.-J., J.E.M.)
| | - Martin Abild Stengaard Meyer
- Department of Anesthesiology and Intensive Care (S.B.R., H.S., S.M., H.B.R., M.A.S.M.), Odense University Hospital, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology (K.K.J., J.E.M.), Odense University Hospital, Denmark
- Department of Cardiology, the Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark (J.K., C.H., R.P.B., J.G., M.W.-J., J.E.M.)
- Department of Clinical Research, University of Southern Denmark, Odense (H.S., H.B.R., J.E.M.)
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14
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Vandenbriele C, Baldetti L, Beneduce A, Belohlavek J, Hassager C, Pieri M, Polzin A, Scandroglio AM, Møller JE. Monitoring MCS patients on the intensive care unit: integrating haemodynamic assessment, laboratory data, and imaging techniques for timely detection of deterioration and recovery. Eur Heart J Suppl 2023; 25:I24-I31. [PMID: 38093766 PMCID: PMC10715942 DOI: 10.1093/eurheartjsupp/suad130] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Monitoring of the patient supported with a temporary mechanical circulatory support (tMCS) is crucial in achieving the best possible outcome. Monitoring is a continuous and labour-intensive process, as cardiogenic shock (CS) patients can rapidly deteriorate and may require new interventions within a short time period. Echocardiography and invasive haemodynamic monitoring form the cornerstone of successful tMCS support. During monitoring, it is particularly important to ensure that adequate end-organ perfusion is achieved and maintained. Here, we provide a comprehensive overview of best practices for monitoring the CS patient supported by a micro-axial flow pump, veno-arterial extracorporeal membrane oxygenation, and both devices simultaneously (ECMELLA approach). It is a complex process that encompasses device control, haemodynamic control and stabilization, monitoring of interventions, and assessment of end-organ function. The combined, continuous, and preferably protocol-based approach of echocardiography, evaluation of biomarkers, end-organ assessment, and haemodynamic parameters is crucial in assessing this critically ill CS patient population.
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Affiliation(s)
- Christophe Vandenbriele
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
- Adult Intensive Care, Royal Brompton and Harefield Guy’s & St.Thomas’ NHS Foundation Trust, Sydney St, London SW3 6NP, UK
| | - Luca Baldetti
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Beneduce
- Groupe Cardio-Vasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Jan Belohlavek
- 2nd Department of Internal Medicine, Cardiovascular Medicine General Teaching Hospital and 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Marina Pieri
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Amin Polzin
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Pulmonology, and Vascular Medicine, Cardiovascular Research Institute Düsseldorf (CARID), Düsseldorf, Germany
| | - Anna Mara Scandroglio
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Jacob Eifer Møller
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
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15
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Nyholm B, Grand J, Obling LER, Hassager C, Møller JE, Schmidt H, Othman MH, Kondziella D, Kjaergaard J. Quantitative pupillometry for neuroprognostication in comatose post-cardiac arrest patients: A protocol for a predefined sub-study of the Blood pressure and Oxygenations Targets after Out-of-Hospital Cardiac Arrest (BOX)-trial. Resusc Plus 2023; 16:100475. [PMID: 37779885 PMCID: PMC10540039 DOI: 10.1016/j.resplu.2023.100475] [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] [Indexed: 10/03/2023] Open
Abstract
Background Resuscitation guidelines propose a multimodal prognostication strategy algorithm at ≥72 hours after the return of spontaneous circulation to evaluate neurological outcome for unconscious cardiac arrest survivors. Even though guidelines suggest quantitative pupillometry for assessing pupillary light reflex, threshold values are not yet validated.This study aims to validate pre-specified thresholds of quantitative pupillometry by quantitatively assessing the percentage reduction of pupillary size (qPLR) <4% and Neurological Pupil index (NPi) ≤2 and in predicting unfavorable neurological outcome. Both as an isolated predictor and combined with guideline-suggested neuron-specific enolase (NSE) threshold >60 μg L-1 in the current prognostication strategy algorithm. Methods We conduct this pre-planned diagnostic sub-study in the randomized, controlled, multicenter clinical trial "Blood Pressure and Oxygenation Targets after Out-of-Hospital Cardiac Arrest-trial". Blinded to treating physicians and outcome assessors, measurements of qPLR and NPi are obtained from cardiac arrest survivors at time points (±6 hours) of admission, after 24, 48, and 72 hours, or until the time of awakening or death. Discussion This study will be the largest prospective study investigating the predictive performance of automated quantitative pupillometry in unconscious patients resuscitated from cardiac arrest. We will test specific threshold values of NPi ≤2 and qPLR <4% to predict unfavorable outcome following cardiac arrest. The validation of pupillometry alone and combined with NSE with the criteria of the current prognostication strategy algorithm will hopefully increase the level of evidence and support clinical neuroprognostication with automated quantitative pupillometry in unconscious post-cardiac arrest patients. Trial registration Registered March 30, 2017, at ClinicalTrials.gov (Identifier: NCT03141099).
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Affiliation(s)
- Benjamin Nyholm
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Johannes Grand
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Cardiology, Odense University Hospital, 5000 C Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Henrik Schmidt
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Marwan H. Othman
- Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Daniel Kondziella
- Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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16
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Drag MH, Debes KP, Franck CS, Flethøj M, Lyhne MK, Møller JE, Ludvigsen TP, Jespersen T, Olsen LH, Kilpeläinen TO. Nanopore sequencing reveals methylation changes associated with obesity in circulating cell-free DNA from Göttingen Minipigs. Epigenetics 2023; 18:2199374. [PMID: 37032646 PMCID: PMC10088973 DOI: 10.1080/15592294.2023.2199374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/29/2023] [Accepted: 03/08/2023] [Indexed: 04/11/2023] Open
Abstract
Profiling of circulating cell-free DNA (cfDNA) by tissue-specific base modifications, such as 5-methylcytosines (5mC), may enable the monitoring of ongoing pathophysiological processes. Nanopore sequencing allows genome-wide 5mC detection in cfDNA without bisulphite conversion. The aims of this study were: i) to find differentially methylated regions (DMRs) of cfDNA associated with obesity in Göttingen minipigs using Nanopore sequencing, ii) to validate a subset of the DMRs using methylation-specific PCR (MSP-PCR), and iii) to compare the cfDNA DMRs with those from whole blood genomic DNA (gDNA). Serum cfDNA and gDNA were obtained from 10 lean and 7 obese Göttingen Minipigs both with experimentally induced myocardial infarction and sequenced using Oxford Nanopore MinION. A total of 1,236 cfDNA DMRs (FDR<0.01) were associated with obesity. In silico analysis showed enrichment of the adipocytokine signalling, glucagon signalling, and cellular glucose homoeostasis pathways. A strong cfDNA DMR was discovered in PPARGC1B, a gene linked to obesity and type 2 diabetes. The DMR was validated using MSP-PCR and correlated significantly with body weight (P < 0.05). No DMRs intersected between cfDNA and gDNA, suggesting that cfDNA originates from body-wide shedding of DNA. In conclusion, nanopore sequencing detected differential methylation in minute quantities (0.1-1 ng/µl) of cfDNA. Future work should focus on translation into human and comparing 5mC from somatic tissues to pinpoint the exact location of pathology.
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Affiliation(s)
- Markus Hodal Drag
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Conservation, Copenhagen Zoo, Frederiksberg, Denmark
| | | | - Clara Sandkamm Franck
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mette Flethøj
- Research & Early Development, Novo Nordisk A/S, Måløv, Denmark
| | - Mille Kronborg Lyhne
- Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Copenhagen University Hospital and Odense University Hospital, Odense, Denmark
| | | | - Thomas Jespersen
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lisbeth Høier Olsen
- Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tuomas O. Kilpeläinen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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17
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Grand J, Fuglsbjerg C, Borregaard B, Wagner MK, Kragh AR, Bekker-Jensen D, Mikkelsen AD, Møller JE, Glud H, Hassager C, Kikkenborg S, Kjaergaard J. Sex differences in symptoms of anxiety, depression, post-traumatic stress disorder, and cognitive function among survivors of out-of-hospital cardiac arrest. Eur Heart J Acute Cardiovasc Care 2023; 12:765-773. [PMID: 37551457 DOI: 10.1093/ehjacc/zuad093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/25/2023] [Accepted: 08/04/2023] [Indexed: 08/09/2023]
Abstract
AIMS Anxiety, depression, and post-traumatic stress disorder (PTSD) among out-of-hospital cardiac arrest (OHCA) survivors may impact long-term recovery. Coping and perception of symptoms may vary between sexes. The aim was to explore sex differences in psychological consequences following OHCA. METHODS AND RESULTS This was a prospective observational study of OHCA survivors who attended a structured 3-month follow-up. Symptoms of anxiety/depression were measured using the Hospital Anxiety and Depression Scale, range 0-21, with a cut-off score of ≥8 for significant symptoms; PTSD was measured with the PTSD Checklist for DSM-5 (PCL-5), range 0-80. A score of ≥33 indicated PTSD symptoms. Cognitive function was assessed by the Montreal Cognitive Assessment. From 2016 to 2021, 381 consecutive comatose OHCA survivors were invited. Of these, 288 patients (76%) participated in the follow-up visit [53 (18%) females out of 80 survivors and 235 (82%) males out of 300 alive at follow-up (78%)]. Significant symptoms of anxiety were present in 47 (20%) males and 19 (36%) females (P = 0.01). Significant symptoms of PTSD were present in 30% of males and 55% of females (P = 0.01). Adjusting for pre-specified covariates using multivariable logistic regression, female sex was significantly associated with anxiety [odds ratio (OR): 2.18, confidence interval (CI): 1.09-4.38, P = 0.03]. This difference was especially pronounced among young females (below median age, ORadjusted: 3.31, CI: 1.32-8.29, P = 0.01) compared with young males. No significant sex difference was observed for depression or cognitive function. CONCLUSION Symptoms of anxiety and PTSD are frequent in OHCA survivors, and female survivors report significantly more symptoms of anxiety and PTSD compared with males. In particular, young females were significantly more symptomatic than young males.
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Affiliation(s)
- Johannes Grand
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital Amager-Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
| | - Cecilie Fuglsbjerg
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Britt Borregaard
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark
- Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
| | - Mette Kirstine Wagner
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Astrid Rolin Kragh
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Ditte Bekker-Jensen
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark
| | - Astrid Duus Mikkelsen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark
| | - Heidi Glud
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 København, Denmark
| | - Selina Kikkenborg
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 København, Denmark
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18
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Banke A, Andersson C, D'Souza M, Fosbøl E, Nielsen D, Pedersen CT, Gislason GH, Møller JE, Køber L, Rasmussen CM, Schou M. Importance of familial predisposition to heart failure to the risk of anthracycline-related cardiotoxicity: A nationwide study. Am Heart J 2023; 265:59-65. [PMID: 37453730 DOI: 10.1016/j.ahj.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/03/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Anthracycline-based chemotherapy has improved the prognosis of various malignancies, but increases the long-term risk of heart failure (HF). Identification of patients at risk prior to treatment initiation is warranted. Therefore, the aim of this study was to evaluate if a familial predisposition to HF increases the risk of anthracycline related HF. METHODS Using nationwide Danish registries, all patients treated with anthracycline from 2004 to 16 were identified. The primary outcome was long-term HF risk. First-degree relatives were identified in the Danish Family Registry and exposure was defined as a first-degree biological relative with prior HF. Risk of HF was evaluated in a cumulative incidence function and the association in a multivariable Cox regression model. RESULTS A total of 11,651 patients (median age 49.1 years (IQR: 43.6-53.7), 12.2% male) were included after exclusion of 46 with preanthracycline HF. Median follow-up was 3.8 years (IQR 1.9-6.4). In the group with a first-degree relative with HF (n = 1,608) 35 patients (2.2%) were diagnosed with HF vs 133 (1.3%) in the group without a first-degree relative with HF (n = 10,043), corresponding to incidence rates per 1,000 patient-years of 5.2 (CI:3.8-7.3) vs 3.0 (CI:2.5-3.5). The cumulative incidence of HF after 10 years was higher in the first-degree relative group (3.2% vs 2.0%, P = .004); adjusted hazard ratio 1.53 (CI:1.05-2.23, P = .03). CONCLUSION In this nationwide register-based study having a first-degree relative with HF was associated with increased risk of anthracycline related HF, suggesting that attention towards family predisposition may be warranted when estimating the risk of anthracycline related cardiotoxicity.
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Affiliation(s)
- Ann Banke
- Department of Cardiology, Odense University Hospital, Odense, Denmark.
| | - Charlotte Andersson
- Department of Medicine, Section of Cardiovascular Medicine, Boston Medical Center, Boston, MA
| | - Maria D'Souza
- Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark
| | - Emil Fosbøl
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Dorte Nielsen
- Department of Oncology, Herlev and Gentofte University Hospital, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Torp Pedersen
- Department of Clinical Investigation and Cardiology, Nordsjaellands Hospital, Hillerod, Denmark
| | - Gunnar H Gislason
- Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; The Danish Heart Foundation, Copenhagen, Denmark; The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Department of Cardiology, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lars Køber
- Department of Oncology, Herlev and Gentofte University Hospital, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Morten Schou
- Department of Cardiology, Herlev and Gentofte University Hospital, Herlev, Denmark
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19
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Møller JE, Kjaergaard J, Hassager C. Contemporary use of temporary mechanical circulatory support in infarct-related cardiogenic shock: Time to stop and reflect? Eur J Heart Fail 2023; 25:2032-2033. [PMID: 37828765 DOI: 10.1002/ejhf.3060] [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: 09/30/2023] [Accepted: 10/06/2023] [Indexed: 10/14/2023] Open
Affiliation(s)
- Jacob Eifer Møller
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- Department of Clinical Medicine, University of Southern Denmark, Odense, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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20
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Kjaergaard J, Møller JE. Haemodynamic, oxygenation, and ventilation targets after cardiac arrest: the current ABC of post-cardiac arrest intensive care. Eur Heart J Acute Cardiovasc Care 2023; 12:513-517. [PMID: 37459572 DOI: 10.1093/ehjacc/zuad077] [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] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 07/06/2023] [Indexed: 08/26/2023]
Affiliation(s)
- Jesper Kjaergaard
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark
- Department of Cardiology, Odense University Hospital, JB Winsløvvej 4, Odense 5000, Denmark
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21
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Møller JE, Sionis A, Aissaoui N, Ariza A, Belohlavek J, De Backer D, Färber G, Gollmann-Tepeköylu C, Mebazaa A, Price S, Swol J, Thiele H, Hassager C. Step by step daily management of short-term mechanical circulatory support for cardiogenic shock in adults in the intensive cardiac care unit. A clinical consensus statement of the Association for Acute Cardio Vascular Care (ACVC) of the ESC, the European Society of Intensive Care Medicine (ESICM), the European branch of the Extracorporeal Life Support Organization (EuroELSO) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J Acute Cardiovasc Care 2023:zuad064. [PMID: 37315190 DOI: 10.1093/ehjacc/zuad064] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/12/2023] [Indexed: 06/16/2023]
Abstract
The use of mechanical circulatory support using percutaneous ventricular assist devices (pVAD) has increased rapidly during the last decade without substantial new evidence for their effect on outcome. In addition, many gaps in knowledge still exist such as timing and duration of support, hemodynamic monitoring, management of complications, concomitant medical therapy, and weaning protocols. This clinical consensus statement summarizes the consensus of an expert panel of the Association for Acute CardioVascular Care (ACVC), European Society of Intensive Care Medicine (ESCIM), European Extracorporeal Life Support Organization (EuroELSO) and European Association for Cardio-Thoracic Surgery (EACTS). It provides practical advice regarding the management of patients managed with pVAD in the intensive care unit based on existing evidence and consensus on best current practice.
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Affiliation(s)
- Jacob Eifer Møller
- Cardiac Intensive Care Unit, Heart Center, Copenhagen University Hospital, Rigshospitalet and Department of Cardiology Odense University Hospital, Odense and Copenhagen, Denmark
| | - Alessandro Sionis
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain, and Centro de Investigaciones Biomédicas en Red Enfermedades Cardiovasculares, CIBER-CV, Madrid, Spain
| | - Nadia Aissaoui
- Department Critical Care, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Albert Ariza
- Servicio de Cardiología, Hospital Universitario de Bellvitge -IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jan Belohlavek
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Daniel De Backer
- Department of Intensive Care, CHIREC Hospitals, Université Libre de Bruxelles, Boulevard du Triomphe 201, 1160, Brussels, Belgium
| | - Gloria Färber
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | | | - Alexandre Mebazaa
- Department of Anesthesiology and Critical Care Medicine, AP-HP, St. Louis and Lariboisière University Hospitals and INSERM UMR-S 942, MASCOT, Université de Paris, Paris, France
| | - Susanna Price
- Royal Brompton & Harefield Hospitals, National Heart & Lung Institute, Imperial College, London, United Kingdom
| | - Justyna Swol
- Department of Respiratory Medicine, Paracelsus Medical University Nuremberg, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, Leipzig, Germany
| | - Christian Hassager
- Cardiac Intensive Care Unit, Heart Center, Copenhagen University Hospital, Rigshospitalet and Clinical Institute Copenhagen University, Copenhagen, Denmark
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22
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Nyholm B, Obling LER, Hassager C, Grand J, Møller JE, Othman MH, Kondziella D, Kjaergaard J. Specific thresholds of quantitative pupillometry parameters predict unfavorable outcome in comatose survivors early after cardiac arrest. Resusc Plus 2023; 14:100399. [PMID: 37252025 PMCID: PMC10220278 DOI: 10.1016/j.resplu.2023.100399] [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: 02/21/2023] [Revised: 04/30/2023] [Accepted: 05/05/2023] [Indexed: 05/31/2023] Open
Abstract
Aim Quantitative pupillometry is the guideline-recommended method for assessing pupillary light reflex for multimodal prognostication in comatose patients resuscitated from out-of-hospital cardiac arrest (OHCA). However, threshold values predicting an unfavorable outcome have been inconsistent across studies; therefore, we aimed to identify specific thresholds for all quantitative pupillometry parameters. Methods Comatose post-OHCA patients were consecutively admitted to the cardiac arrest center at Copenhagen University Hospital Rigshospitalet from April 2015 to June 2017. The parameters of quantitatively assessed pupillary light reflex (qPLR), Neurological Pupil index (NPi), average/max constriction velocity (CV/MCV), dilation velocity (DV), and latency of constriction (Lat) were recorded on the first three days after admission. We evaluated the prognostic performance and identified thresholds achieving zero percent false positive rate (0% PFR) for an unfavorable outcome of 90-day Cerebral Performance Category (CPC) 3-5. Treating physicians were blinded for pupillometry results. Results Of the 135 post-OHCA patients, the primary outcome occurred for 53 (39%) patients.On any day during hospitalization, a qPLR < 4%, NPi < 2.45, CV < 0.1 mm/s, and an MCV < 0.335 mm/s predicted 90-day unfavorable neurological outcome with 0% FPR (95%CI: 0-0%), with sensitivities of 28% (17-40%), 9% (2-19%), 13% (6-23%), and 17% (8-26%), respectively on day 1. Conclusion We found that specific thresholds of all quantitative pupillometry parameters, measured at any time following hospital admission until day 3, predicted a 90-day unfavorable outcome with 0% FPR in comatose patients resuscitated from OHCA. However, at 0% FPR, thresholds resulted in low sensitivity. These findings should be further validated in larger multicenter clinical trials.
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Affiliation(s)
- Benjamin Nyholm
- Department of Cardiology, the Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | - Christian Hassager
- Department of Cardiology, the Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Johannes Grand
- Department of Cardiology, the Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, the Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Marwan H. Othman
- Department of Neurology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Daniel Kondziella
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Neurology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, the Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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23
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Sondergaard L, Møller JE, De Backer O, Møller-Sørensen PH, Cheng Y, Rossing K, Smerup M, Quadri A. First-in-Human Implantation of a New Transcatheter Tricuspid Valve Replacement System. JACC Case Rep 2023; 14:101841. [PMID: 37152699 PMCID: PMC10157149 DOI: 10.1016/j.jaccas.2023.101841] [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: 12/05/2022] [Revised: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 05/09/2023]
Abstract
Therapeutic options for patients with isolated severe to torrential tricuspid regurgitation have been limited. Because a surgical option is often not attractive, new catheter-based therapies are emerging. We report the first-in-human percutaneous transcatheter tricuspid valve replacement with the MonarQ system in a 75-year-old female patient with severely symptomatic torrential tricuspid regurgitation. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Lars Sondergaard
- The Heart Center, Rigshospitalet, Copenhagen, Denmark
- Address for correspondence: Dr Lars Sondergaard, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Inge Lehmannsvej 7, 2100 Copenhagen, Denmark.
| | | | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen, Denmark
| | | | - Yanping Cheng
- InQB8 Medical Technologies, Inc, Winchester, Massachusetts, USA
| | | | - Morten Smerup
- The Heart Center, Rigshospitalet, Copenhagen, Denmark
| | - Arshad Quadri
- InQB8 Medical Technologies, Inc, Winchester, Massachusetts, USA
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24
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Kunkel JB, Josiassen J, Helgestad OKL, Schmidt H, Holmvang L, Jensen LO, Thøgersen M, Fosbøl E, Ravn HB, Møller JE, Hassager C. Inflammatory response by 48 hours after admission and mortality in patients with acute myocardial infarction complicated by cardiogenic shock. Eur Heart J Acute Cardiovasc Care 2023; 12:306-314. [PMID: 36857166 DOI: 10.1093/ehjacc/zuad018] [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] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 02/21/2023] [Accepted: 02/24/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Cardiogenic shock is known to induce an inflammatory response. The prognostic utility of this remains unclear. PURPOSE To investigate the association between C-reactive protein (CRP) levels and leucocyte count and mortality in patients with acute myocardial infarction complicated by cardiogenic shock (AMICS). METHODS Consecutive patients (N=1716) admitted between 2010 and 2017 with an individually validated diagnosis of AMICS were included. The analysis was restricted to patients alive at 48 hours (h) after 1'st medical contact and a valid CRP and leucocyte measurement at 48 h +/- 12 h from the first medical contact. A combined inflammatory score for each patient was computed by summing the CRP and leucocyte count z-scores to normalise the response on a standard deviation scale. Associations with mortality were analysed using a multivariable Cox proportional hazards model stratified by inflammatory response quartiles. RESULTS Of the 1716 patients in the cohort, 1111 (64.7%) fulfilled inclusion criteria. The median CRP level at 48 h was 145 mg/dL (IQR 96-211). The median leucocyte count was 12.6 x 10-9/L (IQR 10.1-16.4). Patients with the highest inflammatory response (Q4) had lower median left ventricular ejection fractions and higher lactate levels at the time of diagnosis. The 30-day all-cause mortality rates were 46% in Q4 and 21% in Q1 (p < 0.001). In multivariable models, the inflammatory response remained associated with mortality (HRQ4 2.32, 95%CI 1.59-3.39, p < 0.001). The finding was also significant in AMICS patients presenting with out-of-hospital cardiac arrest following multivariable adjustment (HRQ4 3.37, 95%CI 2.02-4-64, p < 0.001). CONCLUSIONS Cardiogenic shock induces an acute inflammatory response, the severity of which is associated with mortality.
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Affiliation(s)
- Joakim Bo Kunkel
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Jakob Josiassen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | | | - Henrik Schmidt
- Department of Cardiothoracic Anesthesia Odense University Hospital Odense Denmark
| | - Lene Holmvang
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | | | - Michael Thøgersen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Emil Fosbøl
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Hanne Berg Ravn
- Department of Cardiothoracic Anesthesia Odense University Hospital Odense Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark.,Department of Cardiology, Odense University Hospital, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
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25
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Larsen JH, Omar M, Jensen J, Andersen CF, Kistrup CM, Poulsen MK, Videbæk L, Gustafsson F, Køber L, Schou M, Møller JE. Influence of angiotensin receptor-neprilysin inhibition on the efficacy of Empagliflozin on cardiac structure and function in patients with chronic heart failure and a reduced ejection fraction: The Empire HF trial. Am Heart J Plus 2023; 26:100264. [PMID: 38510180 PMCID: PMC10946004 DOI: 10.1016/j.ahjo.2023.100264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/17/2023] [Accepted: 02/01/2023] [Indexed: 03/22/2024]
Abstract
Study objective The objective was to assess the effect of ongoing angiotensin receptor-neprilysin inhibitor(ARNI) on the effect of the sodium glucose cotransporter 2 (SGLT2) inhibitor empagliflozin on left ventricular (LV) size and function in patients with heart failure and reduced ejection fraction(HFrEF). Design Post hoc analysis of the Empire HF trial, an investigator-initiated, double-blind, randomized controlled trial. Participants 190 patients with HFrEF with New York Heart association class I-III symptoms with an ejection fraction of 40 % or below. Patients were stratified according to ongoing ARNI treatment at baseline. Intervention Empagliflozin 10 mg daily or placebo for 12 weeks. Echocardiography at baseline and follow-up. Main outcome measures Left ventricular end-systolic volume index (LVESVI), end-diastolic volume index (LVEDVI), left atrial volume index (LAVI), left ventricular ejection fraction (LVEF). Results A total of 58 patients (31 %) received ARNI at baseline. Compared to with placebo, empagliflozin reduced the LVESVI ([-6.2 (-14.1 to 1.6); p = 0.12] and [-3.3 (-8.2 to 1.6); p = 0.19], interaction P = 0.49), LVEDVI ([-11.2 (-21.2 to -1.2); p = 0.03] and [-2.9 (-8.7 to 2.9); p = 0.32], interaction P = 0.13), and LAVI ([-3.9 (-9.1 to 1.2); p = 0.14] and. [-1.8 (-4.4 to 0.7); p = 0.16], respectively, interaction P = 0.9) in patients treated with and without ARNI at baseline, respectively. No treatment-by-ARNI subgroup interaction were found. Unaffected by baseline ARNI treatment, empagliflozin did not improve LVEF. Conclusion The effect of empagliflozin on cardiac structure and function compared to placebo was not affected by background treatment with ARNI.
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Affiliation(s)
- Julie Hempel Larsen
- Department of Cardiology, Odense University Hospital, J.B. Winsløw Vej 4, 5000 Odense C, Denmark
| | - Massar Omar
- Department of Cardiology, Odense University Hospital, J.B. Winsløw Vej 4, 5000 Odense C, Denmark
| | - Jesper Jensen
- Department of Cardiology, Herlev-Gentofte University Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark
| | - Camilla Fuchs Andersen
- Department of Cardiology, Herlev-Gentofte University Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark
| | - Caroline Michaela Kistrup
- Department of Endocrinology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Mikael Kjær Poulsen
- Department of Cardiology, Odense University Hospital, J.B. Winsløw Vej 4, 5000 Odense C, Denmark
| | - Lars Videbæk
- Department of Cardiology, Odense University Hospital, J.B. Winsløw Vej 4, 5000 Odense C, Denmark
| | - Finn Gustafsson
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev-Gentofte University Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Odense University Hospital, J.B. Winsløw Vej 4, 5000 Odense C, Denmark
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
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26
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Søndergaard FT, Beske RP, Frydland M, Møller JE, Helgestad OKL, Jensen LO, Holmvang L, Goetze JP, Engstrøm T, Hassager C. Soluble ST2 in plasma is associated with post-procedural no-or-slow reflow after primary percutaneous coronary intervention in ST-elevation myocardial infarction. Eur Heart J Acute Cardiovasc Care 2023; 12:48-52. [PMID: 36355574 DOI: 10.1093/ehjacc/zuac146] [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] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/19/2022] [Accepted: 11/08/2022] [Indexed: 11/12/2022]
Abstract
AIM The no-or-slow-reflow phenomenon after primary percutaneous coronary intervention is associated with more extensive myocardial injury in patients with ST-elevation myocardial infarction (STEMI). Soluble suppression of tumourigenicity 2 (sST2) is released in acute myocardial response to injury, and an increase in plasma level in the initial phase of STEMI is associated with increased mortality and risk of heart failure. We have therefore explored the association of pre-intervention plasma sST2 with the post-procedural no-or-slow-reflow phenomenon in patients with STEMI. METHODS AND RESULTS We included consecutive patients with verified STEMI from two tertiary heart centres. Blood samples were collected at admission before angiography. Post-procedural coronary flow was assessed according to thrombolysis in myocardial infarction (TIMI) classification for STEMI. Patients were divided into two groups: post-procedural TIMI 0-2 as no-or-slow reflow and TIMI 3 as normal reflow. The association between sST2 and TIMI flow was explored using multiple logistic regression. A total of 1607 patients with available TIMI flow classification were included in the analysis. Normal reflow was seen in 1520 (94.6%), while 87 (5.4%) had no-or-slow reflow. No-or-slow-reflow patients had higher all-cause 30-day mortality [10 (11%) vs. 65 (4.3%), P = 0.006]. Pre-procedural sST2 was higher in the no-or-slow-flow group [47 ng/mL, interquartile range (IQR, 33-83) vs. 39 ng/mL (IQR 29-55), P < 0.001] and was independently associated with post-procedural no-or-slow flow [two-fold sST2 increase: odds ratio 1.44 (1.15-1.78), P = 0.0012]. CONCLUSION In patients with STEMI, the sST2 level at admission before coronary angiography is independently associated with the post-procedural no-or-slow-reflow phenomenon.
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Affiliation(s)
- Frederik T Søndergaard
- Department of Cardiology, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej, Copenhagen 9 DK-2100, Denmark
| | - Rasmus P Beske
- Department of Cardiology, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej, Copenhagen 9 DK-2100, Denmark
| | - Martin Frydland
- Department of Cardiology, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej, Copenhagen 9 DK-2100, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej, Copenhagen 9 DK-2100, Denmark.,Department of Cardiology-B, Odense University Hospital, Odense, Denmark
| | - Ole K L Helgestad
- Department of Cardiology-B, Odense University Hospital, Odense, Denmark
| | - Lisette Okkels Jensen
- Department of Cardiology-B, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Odense University Hospital, Odense, Denmark
| | - Lene Holmvang
- Department of Cardiology, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej, Copenhagen 9 DK-2100, Denmark
| | - Jens P Goetze
- Department of Clinical Biochemistry, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej, Copenhagen 9 DK-2100, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej, Copenhagen 9 DK-2100, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej, Copenhagen 9 DK-2100, Denmark
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27
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Falster C, Egholm G, Wiig R, Poulsen MK, Møller JE, Posth S, Brabrand M, Laursen CB. Diagnostic Accuracy of a Bespoke Multiorgan Ultrasound Approach in Suspected Pulmonary Embolism. Ultrasound Int Open 2023; 8:E59-E67. [PMID: 36726389 PMCID: PMC9886498 DOI: 10.1055/a-1971-7454] [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: 03/21/2022] [Accepted: 10/23/2022] [Indexed: 01/18/2023] Open
Abstract
Purpose The aims of this study were to prospectively assess the diagnostic accuracy of a bespoke multiorgan point-of-care ultrasound approach for suspected pulmonary embolism and evaluate if this model allows reduced referral to further radiation diagnostics while maintaining safety standards. Materials and Methods Patients with suspected pulmonary embolism referred for CT pulmonary angiography or ventilation/perfusion scintigraphy were included as a convenience sample. All patients were subject to blinded ultrasound investigation with cardiac, lung, and deep venous ultrasound. The sensitivity and specificity of applied ultrasound signs and the hypothetical reduction in the need for further diagnostic workup were calculated. Results 75 patients were prospectively enrolled. The Wells score was below 2 in 48 patients, between 2 and 6 in 24 patients, and above 6 in 3 patients. The prevalence of pulmonary embolism was 28%. The most notable ultrasound signs were presence of a deep venous thrombus, at least two hypoechoic pleural-based lesions, the D-sign, the 60/60-sign, and a visible right ventricular thrombus which all had a specificity of 100%. Additionally, a multiorgan ultrasound investigation with no findings compatible with pulmonary embolism yielded a sensitivity of 95.2% (95%CI: 76.2-99.9). CT or scintigraphy could be safely avoided in 70% of cases (95%CI: 63.0-83.1%). Conclusion The findings of our study suggest that implementation of a multiorgan ultrasound assessment in patients with suspected pulmonary embolism may safely reduce the need for CT or scintigraphy by confirming or dismissing the suspicion.
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Affiliation(s)
- Casper Falster
- Department of Respiratory Medicine, Odense University Hospital, Odense,
Denmark,Odense Respiratory Research Unit (ODIN), Department of Clinical
Research, University of Southern Denmark, Odense, Denmark,OPEN, Open Patient data Explorative Network, Odense University
Hospital, Odense, Denmark,Correspondence Dr. Casper Falster Odense
University HospitalDepartment of respiratory
medicineKløvervænget
25000
OdenseDenmark+4560139562
| | - Gro Egholm
- Department of Cardiology, Odense University Hospital, Odense,
Denmark
| | - Rune Wiig
- Odense Respiratory Research Unit (ODIN), Department of Clinical
Research, University of Southern Denmark, Odense, Denmark
| | | | | | - Stefan Posth
- Department of Emergency Medicine, Odense University Hospital, Odense,
Denmark
| | - Mikkel Brabrand
- Department of Emergency Medicine, Odense University Hospital, Odense,
Denmark
| | - Christian Borbjerg Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense,
Denmark,Odense Respiratory Research Unit (ODIN), Department of Clinical
Research, University of Southern Denmark, Odense, Denmark
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Abstract
BACKGROUND The main objective of the Danish German Cardiogenic Shock trial (DanGer Shock ClinicalTrials.gov Identifier: NCT01633502) is to assess the efficacy of the trans valvular axial flow device Impella CP in treating patients with AMICS shock due to STEMI undergoing emergency percutaneous coronary intervention. METHODS This statistical analysis plan represents an overview of the statistical methods which will be used for analyzing the DanGer Shock trial. RESULTS The primary study endpoint is death from all causes through 180 days in the intention to treat population (all randomized consented patients). The secondary endpoints comprise; composite event of the need for additional mechanical support, need for cardiac transplantation, and death of all causes whichever comes first; and days alive and out of hospital. As exploratory analyses an as treated analysis of primary endpoint will be performed. Composite safety endpoint will comprise of major bleeding, vascular complications, device malfunction, damage to the aortic valve, and significant hemolysis. The primary endpoint death rate at 180 days will be analyzed using Cox proportional hazards analysis. The result will be reported as hazard ratio and corresponding 95% confidence interval (95% CI). No imputation of missing values will be performed. Additional statistical analyses for predefined hemodynamic, metabolic, renal, hematological, and health economics substudies will be specified in separate protocols. CONCLUSION Main analyses of the primary and secondary outcomes of the DanGer Shock trial will be conducted according to this publication.
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Affiliation(s)
- Jacob Eifer Møller
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Cardiology, the Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
| | - Oke Gerke
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
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Gregers E, Mørk SR, Linde L, Andreasen JB, Smerup M, Kjærgaard J, Møller-Sørensen PH, Holmvang L, Christensen S, Terkelsen CJ, Tang M, Møller JE, Lassen JF, Schmidt H, Riber LP, Winther-Jensen M, Thomassen S, Laugesen H, Hassager C, Søholm H. Extracorporeal cardiopulmonary resuscitation: a national study on the association between favourable neurological status and biomarkers of hypoperfusion, inflammation, and organ injury. European Heart Journal. Acute Cardiovascular Care 2022; 11:808-817. [DOI: 10.1093/ehjacc/zuac135] [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] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/06/2022] [Accepted: 10/12/2022] [Indexed: 11/09/2022]
Abstract
Abstract
Aims
In refractory out-of-hospital cardiac arrest (OHCA) with prolonged whole-body ischaemia, global tissue injury proceeds even after establishment of circulation with extracorporeal cardiopulmonary resuscitation (ECPR). We aimed to investigate the role of biomarkers reflecting hypoperfusion, inflammation, and organ injury in prognostication of patients with refractory OHCA managed with ECPR.
Methods and results
This nationwide retrospective study included 226 adults with refractory OHCA managed with ECPR in Denmark (2011–2020). Biomarkers the first days after ECPR-initiation were assessed. Odds ratio of favourable neurological status (Cerebral Performance Category 1–2) at hospital discharge was estimated by logistic regression analyses. Cut-off values were calculated using the Youden’s index. Fifty-six patients (25%) survived to hospital discharge, 51 (91%) with a favourable neurological status. Factors independently associated with favourable neurological status were low flow time <81 min, admission leukocytes ≥12.8 × 109/L, admission lactate <13.2 mmol/L, alkaline phosphatase (ALP) < 56 (day1) or <55 U/L (day2), and day 1 creatine kinase MB (CK-MB) < 500 ng/mL. Selected biomarkers (leukocytes, C-reactive protein, and lactate) were significantly better predictors of favourable neurological status than classic OHCA-variables (sex, age, low-flow time, witnessed arrest, shockable rhythm) alone (P = 0.001) after hospital admission.
Conclusion
Biomarkers of hypoperfusion (lactate), inflammation (leucocytes), and organ injury (ALP and CK-MB) were independently associated with neurological status at hospital discharge. Biomarkers of hypoperfusion and inflammation (at hospital admission) and organ injury (days 1 and 2 after ECPR) may aid in the clinical decision of when to prolong or terminate ECPR in cases of refractory OHCA.
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Affiliation(s)
- Emilie Gregers
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet , Blegdamsvej 9, 2100 Copenhagen OE , Denmark
- Department of Cardiothoracic Surgery, Copenhagen University Hospital Rigshospitalet , Blegdamsvej 9, 2100 Copenhagen OE , Denmark
| | - Sivagowry Rasalingam Mørk
- Department of Cardiology, Aarhus University Hospital , Palle Juul-Jensens Boulevard 99, 8200 Aarhus N , Denmark
| | - Louise Linde
- Department of Cardiology, Odense University Hospital , J. B. Winsløws Vej 4, 5000 Odense C , Denmark
| | - Jo Bønding Andreasen
- Department of Anesthesiology and Intensive Care, Aalborg University Hospital , Hobrovej 18-22, 9000 Aalborg , Denmark
| | - Morten Smerup
- Department of Cardiothoracic Surgery, Copenhagen University Hospital Rigshospitalet , Blegdamsvej 9, 2100 Copenhagen OE , Denmark
- Department of Clinical Medicine, University of Copenhagen , Blegdamsvej 3, 2200 Copenhagen N , Denmark
| | - Jesper Kjærgaard
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet , Blegdamsvej 9, 2100 Copenhagen OE , Denmark
| | - Peter Hasse Møller-Sørensen
- Department of Cardiothoracic Anesthesiology, Copenhagen University Hospital Rigshospitalet , Blegdamsvej 9, 2100 Copenhagen OE , Denmark
| | - Lene Holmvang
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet , Blegdamsvej 9, 2100 Copenhagen OE , Denmark
- Department of Clinical Medicine, University of Copenhagen , Blegdamsvej 3, 2200 Copenhagen N , Denmark
| | - Steffen Christensen
- Department of Cardiology, Aarhus University Hospital , Palle Juul-Jensens Boulevard 99, 8200 Aarhus N , Denmark
- Department of Clinical Medicine, Aarhus University , Palle Juul-Jensens Boulevard 11, 8200 Aarhus N , Denmark
| | - Christian Juhl Terkelsen
- Department of Cardiology, Aarhus University Hospital , Palle Juul-Jensens Boulevard 99, 8200 Aarhus N , Denmark
- Department of Clinical Medicine, Aarhus University , Palle Juul-Jensens Boulevard 11, 8200 Aarhus N , Denmark
- The Danish Heart Foundation , Vognmagergade 7, 3. sal, 1120 Copenhagen K , Denmark
| | - Mariann Tang
- Department of Clinical Medicine, Aarhus University , Palle Juul-Jensens Boulevard 11, 8200 Aarhus N , Denmark
- Department of Cardiothoracic Surgery, Aarhus University Hospital , Palle Juul-Jensens Boulevard 99, 8200 Aarhus N , Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet , Blegdamsvej 9, 2100 Copenhagen OE , Denmark
- Department of Cardiology, Odense University Hospital , J. B. Winsløws Vej 4, 5000 Odense C , Denmark
- Department of Clinical Research, University of Southern Denmark , J. B. Winsløws Vej 19, 3, 5000 Odense C , Denmark
| | - Jens Flensted Lassen
- Department of Cardiology, Odense University Hospital , J. B. Winsløws Vej 4, 5000 Odense C , Denmark
- Department of Clinical Research, University of Southern Denmark , J. B. Winsløws Vej 19, 3, 5000 Odense C , Denmark
| | - Henrik Schmidt
- Department of Anesthesiology and Intensive Care, Odense University Hospital , J. B. Winsløws Vej 4, 5000 Odense C , Denmark
| | - Lars Peter Riber
- Department of Cardiothoracic Surgery, Odense University Hospital , J. B. Winsløws Vej 4, 5000 Odense C , Denmark
| | - Matilde Winther-Jensen
- Section for Data, Biostatistics and Pharmacoepidemiology, Center for Clinical Research and Prevention, Frederiksberg Hospital , Nordre Fasanvej 57, Indgang 5 (bygning 41), 2000 Frederiksberg , Denmark
| | - Sisse Thomassen
- Department of Anesthesiology and Intensive Care, Aalborg University Hospital , Hobrovej 18-22, 9000 Aalborg , Denmark
| | - Helle Laugesen
- Department of Anesthesiology and Intensive Care, Aalborg University Hospital , Hobrovej 18-22, 9000 Aalborg , Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet , Blegdamsvej 9, 2100 Copenhagen OE , Denmark
- Department of Clinical Medicine, University of Copenhagen , Blegdamsvej 3, 2200 Copenhagen N , Denmark
| | - Helle Søholm
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet , Blegdamsvej 9, 2100 Copenhagen OE , Denmark
- Department of Cardiology, Zealand University Hospital Roskilde , Sygehusvej 10, 4000 Roskilde , Denmark
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Grand J, Nielsen OW, Møller JE, Hassager C, Jakobsen JC. Vasodilators for acute heart failure – a protocol for a systematic review of randomized clinical trials with meta‐analysis and Trial Sequential Analysis. Acta Anaesthesiol Scand 2022; 66:1156-1164. [PMID: 36054782 PMCID: PMC9542024 DOI: 10.1111/aas.14130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 07/30/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Johannes Grand
- Department of Cardiology Copenhagen University Hospital Hvidovre and Amager‐Hospital, Kettegård Alle 30 Copenhagen Denmark
| | - Olav W. Nielsen
- Department of Cardiology Bispebjerg Hospital Copenhagen University Hospital, Rigshospitalet Bispebjerg Bakke 23 Copenhagen
- University of Copenhagen, Department of Clinical Medicine Copenhagen Denmark
| | - Jacob Eifer Møller
- The Heart Center, Copenhagen University Hospital Rigshospitalet, Department of Cardiology Copenhagen Denmark
- Odense University Hospital, Department of Cardiology, University of Southern Denmark, Department of Clinical Medicine Odense Denmark
| | - Christian Hassager
- The Heart Center, Copenhagen University Hospital Rigshospitalet, Department of Cardiology Copenhagen Denmark
- University of Copenhagen, Department of Clinical Medicine Copenhagen Denmark
| | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research Copenhagen University Hospital – Rigshospitalet Copenhagen Denmark
- Department of Regional Health Research, Faculty of Health Sciences University of Southern Denmark Odense Denmark
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Udesen NLJ, Helgestad OKL, Josiassen J, Hassager C, Højgaard HF, Linde L, Kjaergaard J, Holmvang L, Jensen LO, Schmidt H, Ravn HB, Møller JE. Vasoactive pharmacological management according to SCAI class in patients with acute myocardial infarction and cardiogenic shock. PLoS One 2022; 17:e0272279. [PMID: 35925990 PMCID: PMC9352108 DOI: 10.1371/journal.pone.0272279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 07/15/2022] [Indexed: 11/18/2022] Open
Abstract
Background Vasoactive treatment is a cornerstone in treating hypoperfusion in cardiogenic shock following acute myocardial infarction (AMICS). The purpose was to compare the achievement of treatment targets and outcome in relation to vasoactive strategy in AMICS patients stratified according to the Society of Cardiovascular Angiography and Interventions (SCAI) shock classification. Methods Retrospective analysis of patients with AMICS admitted to cardiac intensive care unit at two tertiary cardiac centers during 2010–2017 with retrieval of real-time hemodynamic data and dosages of vasoactive drugs from intensive care unit databases. Results Out of 1,249 AMICS patients classified into SCAI class C, D, and E, mortality increased for each shock stage from 34% to 60%, and 82% (p<0.001). Treatment targets of mean arterial blood pressure > 65mmHg and venous oxygen saturation > 55% were reached in the majority of patients; however, more patients in SCAI class D and E had values below treatment targets within 24 hours (p<0.001) despite higher vasoactive load and increased use of epinephrine for each severity stage (p<0.001). In univariate analysis no significant difference in mortality within SCAI class D and E regarding vasoactive strategy was observed, however in SCAI class C, epinephrine was associated with higher mortality and a significantly higher vasoactive load to reach treatment targets. In multivariate analysis there was no statistically association between individually vasoactive choice within each SCAI class and 30-day mortality. Conclusion Hemodynamic treatment targets were achieved in most patients at the expense of increased vasoactive load and more frequent use of epinephrine for each shock severity stage. Mortality was high regardless of vasoactive strategy; only in SCAI class C, epinephrine was associated with a significantly higher mortality, but the signal was not significant in adjusted analysis.
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Affiliation(s)
| | | | - Jakob Josiassen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Louise Linde
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lene Holmvang
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Henrik Schmidt
- Department of Cardiothoracic Anesthesia, Odense University Hospital, Odense, Denmark
| | - Hanne Berg Ravn
- Department of Cardiothoracic Anesthesia, Odense University Hospital, Odense, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Jensen J, Omar M, Kistorp C, Tuxen C, Poulsen MK, Faber J, Køber L, Gustafsson F, Møller JE, Schou M. Effect of Empagliflozin on Multiple Biomarkers in Heart Failure: Insights From the Empire Heart Failure Trial. Circ Heart Fail 2022; 15:e009333. [PMID: 35973031 DOI: 10.1161/circheartfailure.121.009333] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jesper Jensen
- Department of Cardiology (J.J., M.S.), Herlev and Gentofte University Hospital, Denmark
| | - Massar Omar
- Department of Cardiology, Odense University Hospital, Denmark (M.O., M.K.P., J.E.M.).,Steno Diabetes Center Odense, Denmark (M.O.).,Faculty of Health Sciences, University of Southern Denmark, Odense (M.O., J.E.M.)
| | - Caroline Kistorp
- Department of Endocrinology (C.K.), Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark (C.K., J.F., L.K., F.G., M.S.)
| | - Christian Tuxen
- Department of Cardiology, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark (C.T.)
| | - Mikael Kjær Poulsen
- Department of Cardiology, Odense University Hospital, Denmark (M.O., M.K.P., J.E.M.)
| | - Jens Faber
- Department of Internal Medicine, Center of Endocrinology and Metabolism (J.F.), Herlev and Gentofte University Hospital, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark (C.K., J.F., L.K., F.G., M.S.)
| | - Lars Køber
- Department of Cardiology (L.K., F.G., J.E.M.), Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark (C.K., J.F., L.K., F.G., M.S.)
| | - Finn Gustafsson
- Department of Cardiology (L.K., F.G., J.E.M.), Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark (C.K., J.F., L.K., F.G., M.S.)
| | - Jacob Eifer Møller
- Department of Cardiology, Odense University Hospital, Denmark (M.O., M.K.P., J.E.M.).,Department of Cardiology (L.K., F.G., J.E.M.), Rigshospitalet, Copenhagen, Denmark.,Faculty of Health Sciences, University of Southern Denmark, Odense (M.O., J.E.M.)
| | - Morten Schou
- Department of Cardiology (J.J., M.S.), Herlev and Gentofte University Hospital, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark (C.K., J.F., L.K., F.G., M.S.)
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Jensen J, Omar M, Ali M, Frederiksen PH, Kistorp C, Tuxen C, Andersen CF, Larsen JH, Ersbøll MK, Køber L, Gustafsson F, Faber J, Forman JL, Møller JE, Schou M. The effect of empagliflozin on contractile reserve in heart failure: Prespecified sub-study of a randomized, double-blind, and placebo-controlled trial. Am Heart J 2022; 250:57-65. [PMID: 35513022 DOI: 10.1016/j.ahj.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 03/30/2022] [Accepted: 04/23/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 inhibitors improve cardiac structure but most studies suggest no change in left ventricular (LV) systolic function at rest. Whether sodium-glucose co-transporter-2 inhibitors improve LV contractile reserve is unknown. We investigated the effect of empagliflozin on LV contractile reserve in patients with heart failure (HF) and reduced ejection fraction. METHODS Prespecified sub-study of the Empire HF trial, a double-blind, placebo-controlled, and randomized trial. Patients with LV ejection fraction (LVEF) ≤ 40% on guideline-directed HF therapy were randomized (1:1) to empagliflozin 10 mg or placebo for 12 weeks. The treatment effect on contractile reserve was assessed by low dose dobutamine stress echocardiography. RESULTS In total, 120 patients were included. The mean age was 68 (SD 10) years, 83% were male, and the mean LVEF was 38 (SD 10) %. Respectively 60 (100%) and 59 (98%) patients in the empagliflozin and placebo groups completed stress echocardiography. No statistically significant effect of empagliflozin was observed for the contractile reserve assessed by LV-GLS (adjusted mean absolute change, empagliflozin vs placebo, 0.7% [95% confidence interval {CI} -0.5 to 2.0, P = .25]) or LVEF (adjusted mean absolute change, empagliflozin vs placebo, 2.2% [95% CI -1.4 to 5.8, P = .22]) from baseline to 12 weeks. LV-GLS contractile reserve was associated with accelerometer-measured daily activity level (coefficient -24 accelerometer counts [95% CI -46 to -1.8, P = .03]). CONCLUSIONS Empagliflozin for 12 weeks added to guideline-directed HF therapy did not improve LV contractile reserve in patients with HF and reduced ejection fraction.
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Affiliation(s)
- Jesper Jensen
- Department of Cardiology, Herlev and Gentofte University Hospital, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Massar Omar
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Steno Diabetes Center Odense, Odense, Denmark; Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Mulham Ali
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Peter H Frederiksen
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Caroline Kistorp
- Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Tuxen
- Department of Cardiology, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | - Camilla F Andersen
- Department of Cardiology, Herlev and Gentofte University Hospital, Herlev, Denmark
| | - Julie H Larsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jens Faber
- Department of Internal Medicine, Center of Endocrinology and Metabolism, Herlev and Gentofte University Hospital, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Julie Lyng Forman
- Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; Department of Cardiology, Rigshospitalet, Copenhagen, Denmark; Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev and Gentofte University Hospital, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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Jensen J, Omar M, Kistorp C, Gustafsson F, Køber L, Møller JE, Schou M. Sodium-glucose co-transporter-2 inhibitors in heart failure with reduced ejection fraction: Current evidence and future perspectives. Basic Clin Pharmacol Toxicol 2022; 131:5-17. [PMID: 35510595 DOI: 10.1111/bcpt.13739] [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: 11/26/2021] [Revised: 04/22/2022] [Accepted: 04/29/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The sodium-glucose co-transporter-2 (SGLT2) inhibitors were developed as glucose-lowering drugs to treat type 2 diabetes (T2D). However, significant reductions in clinical outcomes have now been demonstrated in patients with heart failure with reduced ejection fraction (HFrEF), irrespective of the presence of T2D. Multiple hypotheses have been proposed for the underlying mechanisms, and the data to support these proposals are emerging. OBJECTIVES To review the clinical outcome data with SGLT2 inhibitors in HFrEF and the data to support the mechanisms for these clinical effects. METHODS Literature review was supported by a PubMed search for relevant articles up to 19 April 2022. FINDINGS Current data support increased diuresis and reverse cardiac remodelling as important mechanisms for the reductions in heart failure hospitalizations and mortality observed with SGLT2 inhibitors (empagliflozin or dapagliflozin) in patients with HFrEF. Alteration in intrarenal haemodynamic is likely contributing to the observed renoprotective effect of SGLT2 inhibitors. CONCLUSIONS Solid clinical data support the current recommendations to use empagliflozin or dapagliflozin in HFrEF. The underlying mechanisms likely include changes in cardiac and intrarenal haemodynamic. Yet, these mechanisms do not seem to solely explain the observed magnitude of clinical effect with SGLT2 inhibitors in HFrEF, and other mechanisms may contribute.
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Affiliation(s)
- Jesper Jensen
- Department of Cardiology, Herlev and Gentofte University Hospital, Herlev, Denmark
| | - Massar Omar
- Department of Cardiology, Odense University Hospital, Odense, Denmark.,Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Caroline Kistorp
- Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Odense University Hospital, Odense, Denmark.,Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.,Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev and Gentofte University Hospital, Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Møller JE, Sørensen PHM, Kjaergaard J. Refractory in-hospital cardiac arrest - No time to waste. Int J Cardiol 2022; 364:62-63. [PMID: 35716945 DOI: 10.1016/j.ijcard.2022.06.034] [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: 01/27/2022] [Accepted: 06/10/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Jacob Eifer Møller
- Department of Cardiology, Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej, 2100 Copenhagen East, Denmark; Department of Cardiology, Odense University Hospital, Winsløvvej, 5000 Odense C, Denmark.
| | - Peter Hasse Møller Sørensen
- Department of Cardiothoracic Anaesthesiology, Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej, 2100 Copenhagen East, Denmark.
| | - Jesper Kjaergaard
- Department of Cardiology, Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej, 2100 Copenhagen East, Denmark.
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Toftgaard Pedersen A, Kjaergaard J, Hassager C, Frydland M, Hartvig Thomsen J, Klein A, Schmidt H, Møller JE, Wiberg S. Association between inflammatory markers and survival in comatose, resuscitated out-of-hospital cardiac arrest patients. SCAND CARDIOVASC J 2022; 56:85-90. [PMID: 35546563 DOI: 10.1080/14017431.2022.2074093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Prognostication after out-of-hospital cardiac arrest (OHCA) remains challenging. The inflammatory response after OHCA has been associated with increased mortality. This study investigates the associations and predictive value between inflammatory markers and outcome in resuscitated OHCA patients. DESIGN The study is based on post hoc analyses of a double-blind controlled trial, where resuscitated OHCA patients were randomized to receive either exenatide or placebo. Blood was analyzed for levels of inflammatory markers the day following admission. Primary endpoint was time to death for up to 180 days. Secondary endpoints included 180-day mortality and poor neurological outcome after 180 days, defined as a cerebral performance category (CPC) of 3 to 5. RESULTS Among 110 included patients we found significant associations between higher leucocyte quartile and increasing mortality in univariable analysis (OR 2.6 (95%CI 1.6-4.2), p < .001), as well as in multivariable analysis (OR 2.1 (95%CI 1.1-4.0), p = .02). A significant association was found between higher neutrophil quartile and increasing mortality in univariable analysis (OR 3.0 (95%CI 1.8-5.0), p < .001) as well as multivariable analysis (OR 2.4 (95%CI 1.2-4.6), p = .01). Leucocyte and neutrophil levels were predictive of poor outcome after 180 days with area under the receiver operating characteristics curves of 0.79 and 0.81, respectively. We found no associations between CRP and lymphocyte levels versus outcome. CONCLUSIONS Total leucocyte count and neutrophil levels measured the first day following OHCA were significantly associated with 180-day all-cause mortality and may potentially act as early predictors of outcome. CLINICAL TRIAL REGISTRATION www.clinicaltrials.gov, unique identifier: NCT02442791.
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Affiliation(s)
- Anne Toftgaard Pedersen
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Martin Frydland
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jakob Hartvig Thomsen
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Anika Klein
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Henrik Schmidt
- Department of Intensive Care, Odense University Hospital, Odense, Denmark
| | | | - Sebastian Wiberg
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Møller JE, Kjaergaard J, Terkelsen CJ, Hassager C. Impella to Treat Acute Myocardial Infarct-Related Cardiogenic Shock. J Clin Med 2022; 11:2427. [PMID: 35566553 PMCID: PMC9101440 DOI: 10.3390/jcm11092427] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/08/2022] [Accepted: 04/21/2022] [Indexed: 12/15/2022] Open
Abstract
Acute myocardial infarction complicated by cardiogenic shock (AMICS), is characterized by critically low cardiac output and decreased myocardial contractility. In this situation, a treatment that unloads the myocardium and restores CO without increasing the myocardial oxygen demand is theoretically appealing. Axial flow pumps offer hemodynamic support without increasing myocardial oxygen consumption. Consequently, the use of axial flow pumps, especially the Impella devices, is increasing. It is likely that the SCAI C patient with predominantly left ventricular failure and without prolonged cardiac arrest is the best candidate for these devices. Registry data suggest that pre-PCI Impella may be advantageous to post-PCI placement. However, several gaps in knowledge exist regarding optimal patient selection, futility criteria, timing, weaning and escalation strategy, and until data from adequately sized randomized trials are available, immediate individual evaluation for mechanical circulatory support by a shock team is warranted when a patient is diagnosed with AMICS.
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Affiliation(s)
- Jacob Eifer Møller
- Department of Cardiology, Odense University Hospital, 5000 Odense, Denmark
- Heart Center, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark; (J.K.); (C.H.)
| | - Jesper Kjaergaard
- Heart Center, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark; (J.K.); (C.H.)
| | | | - Christian Hassager
- Heart Center, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark; (J.K.); (C.H.)
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Frederiksen P, Josiassen J, Helgestad O, Udesen NLJ, Banke ABS, Schmidt H, Jensen LO, Ravn HB, Møller JE. IMPACT OF IMPELLA RP VERSUS VASOACTIVE TREATMENT ON LEFT VENTRICULAR STRAIN IN A PORCINE MODEL OF ACUTE CARDIOGENIC SHOCK DUE TO RIGHT CORONARY ARTERY EMBOLIZATION. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01487-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Omar M, Jensen J, Kistorp C, Højlund K, Videbæk L, Tuxen C, Larsen JH, Andersen CF, Gustafsson F, Køber L, Schou M, Møller JE. The effect of empagliflozin on growth differentiation factor 15 in patients with heart failure: a randomized controlled trial (Empire HF Biomarker). Cardiovasc Diabetol 2022; 21:34. [PMID: 35219331 PMCID: PMC8882292 DOI: 10.1186/s12933-022-01463-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/09/2022] [Indexed: 02/07/2023] Open
Abstract
Background Plasma growth differentiation factor-15 (GDF-15) biomarker levels increase in response to inflammation and tissue injury, and increased levels of GDF-15 are associated with increased risk of mortality in patients with heart failure with reduced ejection fraction (HFrEF). Sodium-glucose cotransporter-2 (SGLT2) inhibitors, which improve outcome in HFrEF, have been shown to increase plasma GDF-15 in diabetic patients. We aimed to investigate the effect of empagliflozin on GDF-15 in HFrEF patients. Methods This Empire HF Biomarker substudy was from the multicentre, randomized, double-blind, placebo-controlled Empire HF trial that included 190 patients from June 29, 2017, to September 10, 2019. Stable ambulatory HFrEF patients with ejection fraction of ≤ 40% were randomly assigned (1:1) to empagliflozin 10 mg once daily, or matching placebo for 12 weeks. Changes from baseline to 12 weeks in plasma levels of GDF-15, high-sensitive C-reactive protein (hsCRP), and high-sensitive troponin T (hsTNT) were assessed. Results A total of 187 patients who were included in this study, mean age was 64 ± 11 years; 85% male, 12% with type 2 diabetes, mean ejection fraction 29 ± 8, with no differences between the groups. Baseline median plasma GDF-15 was 1189 (918–1720) pg/mL with empagliflozin, and 1299 (952–1823) pg/mL for placebo. Empagliflozin increased plasma GDF-15 compared to placebo (adjusted between-groups treatment effect; ratio of change (1·09 [95% confidence interval (CI), 1.03–1.15]: p = 0.0040). The increase in plasma GDF15 was inversely associated with a decrease in left ventricular end-systolic (R = – 0.23, p = 0.031), and end-diastolic volume (R = – 0.29, p = 0.0066). There was no change in plasma hsCRP (1.09 [95%CI, 0.86–1.38]: p = 0.48) or plasma hsTNT (1.07 [95%CI, 0.97–1.19]: p = 0.18) compared to placebo. Patients with diabetes and treated with metformin demonstrated no increase in plasma GDF-15 with empagliflozin, p for interaction = 0·01. Conclusion Empagliflozin increased plasma levels of GDF-15 in patients with HFrEF, with no concomitant increase in hsTNT nor hsCRP. Trial registration: The Empire HF trial is registered with ClinicalTrials.gov, NCT03198585. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01463-2.
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Diederichsen A, Lindholt JS, Møller JE, Gerke O, Rasmussen LM, Dahl JS. Sex Differences in Factors Associated With Progression of Aortic Valve Calcification in the General Population. Circ Cardiovasc Imaging 2022; 15:e013165. [PMID: 34983195 DOI: 10.1161/circimaging.121.013165] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Guidelines recommend measurement of the aortic valve calcification (AVC) score to help differentiate between severe and nonsevere aortic stenosis, but a paucity exists in data about AVC in the general population. The aim of this study was to describe the natural history of AVC progression in the general population and to identify potential sex differences in factors associated with this progression rate. METHODS Noncontrast cardiac computed tomography was performed in 1298 randomly selected women and men aged 65 to 74 years who participated in the DANCAVAS trial (Danish Cardiovascular Screening). Participants were invited to attend a reexamination after 4 years. The AVC score was measured at the computed tomography, and AVC progression (ΔAVC) was defined as the difference between AVC scores at baseline and follow-up. Multivariable regression analyses were performed to identify factors associated with ΔAVC. RESULTS Among the 1298 invited citizens, 823 accepted to participate in the follow-up examination. The mean age at follow-up was 73 years. Men had significantly higher AVC scores at baseline (median AVC score 13 Agatston Units [AU; interquartile range, 0-94 AU] versus 1 AU [interquartile range, 0-22 AU], P<0.001) and a higher ΔAVC (median 26 AU [interquartile range, 0-101 AU] versus 4 AU [interquartile range, 0-37 AU], P<0.001) than women. In the fully adjusted model, the most important factor associated with ΔAVC was the baseline AVC score. However, hypertension was associated with ΔAVC in women (incidence rate ratios, 1.58 [95% CI, 1.06-2.34], P=0.024) but not in men, whereas dyslipidemia was associated with ΔAVC in men (incidence rate ratio: 1.66 [95% CI, 1.18-2.34], P=0.004) but not in women. CONCLUSIONS The magnitude of the AVC score was the most important marker of AVC progression. However, sex differences were significant; hence, dyslipidemia was associated with AVC progression only among men; hypertension with AVC progression only among women. Registration: URL: https://www.isrctn.com; Unique identifier: ISRCTN12157806.
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Affiliation(s)
- Axel Diederichsen
- Department of Cardiology (A.D., J.E.M., J.S.D.), and Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Denmark
| | - Jes Sanddal Lindholt
- Department of Thoracic and Vascular Surgery (J.S.L.), and Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology (A.D., J.E.M., J.S.D.), and Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Denmark.,Department of Cardiology, Rigshospitalet - Copenhagen, Denmark (J.E.M.)
| | - Oke Gerke
- Department of Nuclear Medicine (O.G., L.M.R.), and Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Denmark
| | - Lars Melholt Rasmussen
- Department of Nuclear Medicine (O.G., L.M.R.), and Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Denmark
| | - Jordi S Dahl
- Department of Cardiology (A.D., J.E.M., J.S.D.), and Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Denmark
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Omar M, Jensen J, Schou M, Møller JE. Reply: Accelerometers: A Useful Technology in HF Research? JACC Heart Fail 2022; 10:70-71. [PMID: 34969502 DOI: 10.1016/j.jchf.2021.11.002] [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] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 06/14/2023]
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Mohamed AA, Basaran T, Poulsen MK, Antonsen L, Møller JE. [Rational dosing of diuretics in the treatment of chronic heart failure with acute deterioration]. Ugeskr Laeger 2021; 183:V05210405. [PMID: 34895438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
For decades, diuretics have been the cornerstone in the treatment of patients with chronic heart failure with reduced ejection fraction (HFrEF) presenting with congestion. However, evidence guiding the use of diuretics is generally lacking. Adequate dosing and evaluation of diuretic effect are important for treatment success. Measuring the concentration of sodium in urine in addition to urinary output has been suggested as a good marker to guide the use of diuretics. This review summaries the current knowledge on the use of diuretics in patients with HFrEF presenting with congestion.
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Omar M, Jensen J, Burkhoff D, Frederiksen PH, Kistorp C, Videbæk L, Poulsen MK, Gustafsson F, Køber L, Borlaug BA, Schou M, Møller JE. Effect of Empagliflozin on Blood Volume Redistribution in Patients With Chronic Heart Failure and Reduced Ejection Fraction: An Analysis from the Empire HF Randomized Clinical Trial. Circ Heart Fail 2021; 15:e009156. [PMID: 34743533 DOI: 10.1161/circheartfailure.121.009156] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 01/03/2023]
Abstract
Background: Stressed blood volume (SBV) is a major determinant of systemic and pulmonary venous pressures which, in turn, determine left and right ventricular fillings and regulates cardiac output via the Frank-Starling mechanism. It is not known whether inhibition of the sodium-glucose cotransporter-2 (SGLT2) favorably affects SBV. We investigated the effect of empagliflozin on estimated stressed blood volume (eSBV) in patients with heart failure andreduced ejection fraction (HFrEF) compared to placebo. Methods: This was a post-hoc analysis of an investigator-initiated, double-blinded, placebo controlled, randomized trial. Seventy patients were assigned to empagliflozin 10 mg or matching placebo once-daily for 12 weeks. Patients underwent right heart catheterization at rest and during exercise at baseline and follow-up. The outcome was change in eSBV after 12 weeks of empagliflozin treatment over the full range of exercise, determined using a recently introduced analytical approach based on invasive hemodynamic assessment. Results: Patients with HFrEF, mean age, 57 years and mean ejection fraction 27 %, with 47 patients (71%) receiving diuretics were randomized. The effect of empagliflozin on eSBV over the full range of exercise loads showed a statistically significant reduction compared with placebo (-198.4 mL, 95%CI: -317.4; -79.3, p=0.001), a 9% decrease. The decrease in eSBV by empagliflozin was significantly correlated with the decrease in PCWP ((R= ̶ 0.33, p<0.0001). The effect of empagliflozin was consistent across subgroup analysis. Conclusions: Empagliflozin treatment significantly reduced stressed blood volume compared with placebo after 12 weeks of treatment in patients with stable chronic HFrEF during sub maximal exercise. Registration: URL: https://www.clinicaltrials.gov, Unique identifier: NCT03198585.
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Affiliation(s)
- Massar Omar
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark; Steno Diabetes Center Odense, 5000 Odense C, Denmark; Faculty of Health Sciences, University of Southern Denmark, J.B. Winsløws Vej 19, 3, 5000 Odense C, Denmark
| | - Jesper Jensen
- Department of Cardiology, Herlev and Gentofte University Hospital, Borgmester Ib Juuls Vej 1, 2730 Herlev Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | | | - Peter H Frederiksen
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark; Faculty of Health Sciences, University of Southern Denmark, J.B. Winsløws Vej 19, 3, 5000 Odense C, Denmark
| | - Caroline Kistorp
- Department of Endocrinology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 København Ã, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Lars Videbæk
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark
| | - Mikael Kjær Poulsen
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark
| | - Finn Gustafsson
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Barry A Borlaug
- Division of Cardiovascular Diseases, Department of Cardiovascular Medicine, Mayo Clinic Hospital, Rochester, MN
| | - Morten Schou
- Department of Cardiology, Herlev and Gentofte University Hospital, Borgmester Ib Juuls Vej 1, 2730 Herlev Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark; Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Faculty of Health Sciences, University of Southern Denmark, J.B. Winsløws Vej 19, 3, 5000 Odense C, Denmark
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Mark PD, Frydland M, Helgestad OKL, Holmvang L, Møller JE, Johansson PI, Ostrowski SR, Prickett T, Hassager C, Goetze JP. Sex-specific mortality prediction by pro-C-type natriuretic peptide measurement in a prospective cohort of patients with ST-elevation myocardial infarction. BMJ Open 2021; 11:e048312. [PMID: 34588247 PMCID: PMC8480007 DOI: 10.1136/bmjopen-2020-048312] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To determine the predictive value of pro-C-type natriuretic peptide (pro-CNP) measurement in plasma sampled on admission from patients presenting with ST-elevation myocardial infarction (STEMI). DESIGN Prospective cohort study. SETTING Two University Hospitals in Denmark. PARTICIPANTS 1760 consecutive patients (470 females and 1290 males) with confirmed STEMI. MAIN OUTCOMES AND MEASURES The main outcome was all-cause mortality at 1 year after presentation and the primary measure was pro-CNP concentration in plasma at admission in all patients and longitudinal measurements in a consecutive subgroup of 287 patients. A reference population (n=688) defined cut-off values of increased pro-CNP concentrations. RESULTS In all patients, an increased pro-CNP concentration was associated with a higher all-cause mortality after 1 year (HR 1.6, 95% CI 1.1 to 2.4, Plogrank=0.009) including an interaction of sex (p=0.03). In separate sex-stratified analyses, female patients showed increased all-cause mortality (HR1 year 2.6, 95% CI 1.5 to 4.6), Plogrank <0.001), whereas no differences were found in male patients (HR1 year 1.1, 95% CI 0.7 to 1.9, Plogrank=0.66). After adjusting for potential risk factors, we found increased pro-CNP concentrations≥the median value to be independently associated with increased risk of mortality in female patients within 1 year (HR per 1 pmol/L increase: 1.04, 95% CI 1.01 to 1.06, p=0.007). Moreover, we found indications of sex differences in pro-CNP concentrations over time (higher pro-CNP in males (4.4, 95% CI -0.28 to 9.1 pmol/L, p=0.07) and interaction of sex and time (p=0.13)), and that hypertension was independently associated with higher pro-CNP (4.5, 95% CI 0.6 to 8.4 pmol/L, p=0.03). CONCLUSIONS In female but not male patients presenting with STEMI, high concentrations of pro-CNP (≥median) at admission independently indicate a higher risk of all-cause mortality. The findings are remarkably specific for female patients, suggesting a different vascular phenotype beyond traditional measures of coronary artery flow compared with male patients.
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Affiliation(s)
- Peter D Mark
- Department of Clinical Biochemistry, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Martin Frydland
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | | | - Lene Holmvang
- Department of Cardiology, Odense University hospital, Odense, Denmark
| | | | - Pär I Johansson
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Sisse R Ostrowski
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Timothy Prickett
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Jens Peter Goetze
- Department of Clinical Biochemistry, Copenhagen University Hospital, Rigshospitalet, Denmark
- Department of Biomedical Sciences, Faculty of Health Sciences, Copenhagen University, Copenhagen, Denmark
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Omar M, Jensen J, Frederiksen PH, Videbæk L, Poulsen MK, Brønd JC, Gustafsson F, Borlaug BA, Schou M, Møller JE. Hemodynamic Determinants of Activity Measured by Accelerometer in Patients With Stable Heart Failure. JACC Heart Fail 2021; 9:824-835. [PMID: 34509409 DOI: 10.1016/j.jchf.2021.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study examined the link between accelerometer recordings and cardiac pathophysiology measured with right heart cauterization at rest and with exercise in patients with HFrEF. BACKGROUND Patient-worn accelerometers are increasingly being used in patients with heart failure with reduced ejection fraction (HFrEF) to assess activity and serve as surrogate endpoints in heart failure trials. METHODS Physical average daily activity (PADA) and total average daily activity according to accelerometer units were assessed in 63 patients (mean age 58 ± 10 years; mean ejection fraction 26% ± 4%). Patients underwent hemodynamic exercise testing and accelerometry. Patients were divided according to PADA in PADALow and PADAHigh activity level groups based on median counts per minute of physical activity. RESULTS Patients in the PADALow group were older and more frequently treated with diuretics. At rest, the PADALow group was characterized by a lower cardiac index (2.2 ± 0.4 L/min/m2 vs 2.4 ± 0.4 L/min/m2; P = 0.01) and stroke volume (70 ± 19 mL vs 81 ± 17 mL; P = 0.02) but not pulmonary capillary wedge pressure (12 ± 5 mm Hg vs 11 ± 5 mm Hg; P = 0.3). The PADALow group reached a lower cardiac index (4.8 ± 1.7 L/min/m2 vs 6.6 ± 1.7 L/min/m2; P < 0.001) but not in pulmonary capillary wedge pressure (31 ± 12 mm Hg vs 27 ± 8 mm Hg; P = 0.2) at peak exercise. The attenuated increase was associated with an attenuated increase in stroke volume (94 ± 32 mL vs 121 ± 29 mL; P < 0.001) rather than a reduced increase in heart rate (42 ± 23 beats/min vs 52 ± 21 beats/min; P = 0.07). PADA and total average daily accelerometer units were associated with patient-reported functional impairment according to the Kansas City Cardiomyopathy Questionnaire but not with New York Heart Association functional class. CONCLUSIONS Among stable ambulatory patients with HFrEF, lower daily activity is associated with poorer cardiac index reserve and reduced cardiac index during exercise. (Empagliflozin in Heart Failure Patients With Reduced Ejection Fraction; NCT03198585).
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Affiliation(s)
- Massar Omar
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Steno Diabetes Center Odense, Odense, Denmark; Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
| | - Jesper Jensen
- Department of Cardiology, Herlev and Gentofte University Hospital, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Peter H Frederiksen
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Lars Videbæk
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Jan Christian Brønd
- Center for Research in Childhood Health/Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Finn Gustafsson
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Barry A Borlaug
- Division of Cardiovascular Diseases, Department of Cardiovascular Medicine, Mayo Clinic Hospital, Rochester, Minnesota, USA
| | - Morten Schou
- Department of Cardiology, Herlev and Gentofte University Hospital, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Falster C, Jacobsen N, Coman KE, Højlund M, Gaist TA, Posth S, Møller JE, Brabrand M, Laursen CB. Diagnostic accuracy of focused deep venous, lung, cardiac and multiorgan ultrasound in suspected pulmonary embolism: a systematic review and meta-analysis. Thorax 2021; 77:679-689. [PMID: 34497138 DOI: 10.1136/thoraxjnl-2021-216838] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 08/12/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the diagnostic accuracy of point-of-care ultrasound in suspected pulmonary embolism. DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE, Embase, CINAHL and Cochrane library were searched on 2 July 2020 with no restrictions on the date of publication. Subject headings or subheadings combined with text words for the concepts of pulmonary embolism, ultrasound and diagnosis were used. ELIGIBILITY CRITERIA AND DATA ANALYSIS Eligible studies reported sensitivity and specificity of deep venous, lung, cardiac or multiorgan ultrasound in patients with suspected pulmonary embolism, using an adequate reference-test. Prospective, cross-sectional and retrospective studies were considered for eligibility. No restrictions were made on language. Studies were excluded if a control group consisted of healthy volunteers or if transesophageal or endobronchial ultrasound was used. Risk of bias was assessed using quality assessment of diagnostic accuracy studies-2. Meta-analysis of sensitivity and specificity was performed by construction of hierarchical summary receiver operator curves. I2 was used to assess the study heterogeneity. MAIN OUTCOME MEASURES The primary outcome was overall sensitivity and specificity of reported ultrasound signs, stratified by organ approach (deep venous, lung, cardiac and multiorgan). Secondary outcomes were stratum-specific sensitivity and specificity within subgroups defined by pretest probability of pulmonary embolism. RESULTS 6378 references were identified, and 70 studies included. The study population comprised 9664 patients with a prevalence of pulmonary embolism of 39.9% (3852/9664). Risk of bias in at least one domain was found in 98.6% (69/70) of included studies. Most frequently, 72.8% (51/70) of studies reported >24 hours between ultrasound examination and reference test or did not disclose time interval at all. Level of heterogeneity ranged from 0% to 100%. Most notable ultrasound signs were bilateral compression of femoral and popliteal veins (22 studies; 4708 patients; sensitivity 43.7% (36.3% to 51.4%); specificity 96.7% (95.4% to 97.6%)), presence of at least one hypoechoic pleural-based lesion (19 studies; 2134 patients; sensitivity 81.4% (73.2% to 87.5%); specificity 87.4% (80.9% to 91.9%)), D-sign (13 studies; 1579 patients; sensitivity 29.7% (24.6% to 35.4%); specificity 96.2% (93.1% to 98.0%)), visible right ventricular thrombus (5 studies; 995 patients; sensitivity 4.7% (2.7% to 8.1%); specificity 100% (99.0% to 100%)) and McConnell's sign (11 studies; 1480 patients; sensitivity 29.1% (20.0% to 40.1%); specificity 98.6% (96.7% to 99.4%)). CONCLUSION Several ultrasound signs exhibit a high specificity for pulmonary embolism, suggesting that implementation of ultrasound in the initial assessment of patients with suspected pulmonary embolism may improve the selection of patients for radiation imaging. PROSPERO REGISTRATION NUMBER CRD42020184313.
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Affiliation(s)
- Casper Falster
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark .,Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Niels Jacobsen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Mikkel Højlund
- Department of Public Health, Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | | | - Stefan Posth
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
| | | | - Mikkel Brabrand
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark.,Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Khurrami L, Møller JE, Lindholt JS, Dahl JS, Fredgart MH, Obel LM, Steffensen FH, Urbonaviciene G, Lambrechtsen J, Diederichsen ACP. Aortic valve calcification among elderly males from the general population, associated echocardiographic findings, and clinical implications. Eur Heart J Cardiovasc Imaging 2021; 23:177-184. [PMID: 34491310 DOI: 10.1093/ehjci/jeab182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/24/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Aortic valve calcification (AVC) detected by non-contrast computed tomography (NCCT) associates with morbidity and mortality in patients with aortic valve stenosis. However, the importance of AVC in the general population is sparsely evaluated. We intend to describe the associations between AVC score on NCCT and echocardiographic findings as left atrial (LA) dilatation, left ventricular (LV) hypertrophy, aortic valve area (AVA), peak velocity, mean gradient, and aortic valve replacement (AVR) in a population with AVC scores ≥300 AU. METHODS AND RESULTS Of 10 471 males aged 65-74 years from the Danish Cardiovascular Screening trial (DANCAVAS), participants with AVC score ≥300 AU were invited for transthoracic echocardiography and 828 (77%) of 1075 accepted the invitation. AVC scores were categorized (300-599, 600-799, 800-1199, and ≥1200 AU). AVR was obtained from registries. AVC was significantly associated with a steady increase in LA dilation (10.5%, 16.3%, 15.8%, 19.6%, P = 0.031), LV hypertrophy (3.9%, 6.6%, 8.9%, 10.1%, P = 0.021), peak velocity (1.7, 1.9, 2.1, 2.8 m/s, P = 0001), mean gradient (6, 8, 11, 19 mmHg, P = 0.0001), and a decrease in AVA (2.0, 1.9, 1.7, 1.3 cm2, P = 0.0001). The area under the curve was 0.79, 0.93, and 0.92 for AVA ≤1.5 cm2, peak velocity ≥3.0 m/s, and mean gradient ≥20 mmHg, respectively, and the associated optimal AVC score thresholds were 734, 1081, and 1019 AU. AVC > 1200 AU was associated with AVR (P < 0.0001). CONCLUSION Among males from the background population, increasing AVC scores were associated with LA dilatation, LV hypertrophy, AVA, peak aortic velocity, mean aortic gradient, and AVR.
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Affiliation(s)
- Lida Khurrami
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, Odense 5000, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, Odense 5000, Denmark.,Department of Cardiology, Copenhagen University Hospital, Blegdamsvej 9, 2100 København, Denmark
| | - Jes Sanddal Lindholt
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, J. B. Winsløws Vej 4, Odense 5000, Denmark
| | - Jordi Sancez Dahl
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, Odense 5000, Denmark
| | - Maise Hoeigaard Fredgart
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, Odense 5000, Denmark
| | - Lasse M Obel
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, J. B. Winsløws Vej 4, Odense 5000, Denmark
| | | | - Grazina Urbonaviciene
- Department of Cardiology, Regional Hospital Central Jutland, Falkevej 1A, 8600 Silkeborg, Denmark
| | - Jess Lambrechtsen
- Department of Cardiology, Odense University Hospital, Baagøes Alle 31, 5700 Svendborg, Denmark
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Grand J, Kjaergaard J, Hassager C, Møller JE, Bro-Jeppesen J. Comparing Doppler Echocardiography and Thermodilution for Cardiac Output Measurements in a Contemporary Cohort of Comatose Cardiac Arrest Patients Undergoing Targeted Temperature Management. Ther Hypothermia Temp Manag 2021; 12:159-167. [PMID: 34415801 DOI: 10.1089/ther.2021.0008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 11/12/2022] Open
Abstract
Measuring cardiac output is used to guide treatment during postresuscitation care. The aim of this study was to compare Doppler echocardiography (Doppler-CO) with thermodilution using pulmonary artery catheters (PAC-CO) for cardiac output estimation in a large cohort of comatose out-of-hospital cardiac arrest (OHCA) patients undergoing targeted temperature management (TTM). Single-center substudy of 141 patients included in the TTM trial randomly assigned to 33 or 36°C for 24 hours after OHCA. Per protocol, PAC-CO and Doppler-CO were measured simultaneously shortly after admission and again at 24 and 48 hours. Linear correlation was assessed between methods and positive predictive value (PPV) and negative predictive value (NPV) of Doppler to estimate low cardiac output (<3.5 L/min) was calculated. A total of 301 paired cardiac output measurements were available. Average cardiac output was 5.28 ± 1.94 L/min measured by thermodilution and 4.06 ± 1.49 L/min measured by Doppler with a mean bias of 1.22 L/min (limits of agreements -1.92 to 4.36 L/min). Correlation between methods was moderate (R2 = 0.36). Using PAC-CO as the gold standard, PPV of a low cardiac output measurement (<3.5 L/min) by Doppler was 33%. However, the NPV was 92%. Hypothermia at 33°C did not negatively affect the correlations of CO methods. In the lowest quartile of Doppler, 13% had elevated lactate (>2 mmol/L). In the lowest quartile of thermodilution, 36% had elevated lactate (>2 mmol/L). In ventilated OHCA patients, the two methods for estimating cardiac output correlated moderately and there was a consistent underestimation of Doppler-CO. Absolute cardiac output values from Doppler-CO should be interpreted with caution. However, Doppler can be used to exclude low cardiac output with high accuracy. TTM at 33°C did not negatively affect the correlation or bias of cardiac output measurements. ClinicalTrials.gov ID: NCT01020916.
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Affiliation(s)
- Johannes Grand
- Department of Cardiology B, Section 2142, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology B, Section 2142, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology B, Section 2142, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology B, Section 2142, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - John Bro-Jeppesen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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Thøgersen M, Frydland M, Lerche Helgestad OK, Okkels Jensen L, Josiassen J, Goetze JP, Møller JE, Hassager C. Admission biomarkers among patients with acute myocardial-infarction related cardiogenic shock with or without out-of-hospital cardiac arrest an exploratory study. Biomarkers 2021; 26:632-638. [PMID: 34259098 DOI: 10.1080/1354750x.2021.1955975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Acute myocardial infarction complicated by cardiogenic shock (AMICS) with or without out-of-hospital cardiac arrest (OHCA) have some pathophysiological differences and could potentially be considered as two individual clinical entities. Thus, there may also be differences in terms of blood borne biomarkers. PURPOSE To explore potential differences in concentrations of the biomarkers lactate, mid-regional proadrenomedullin (MRproADM), Copeptin, pro-atrial natriuretic peptide (proANP), Syndecan-1, soluble thrombomodulin (sTM), soluble suppression of tumorigenicity 2 (sST2) and neutrophil gelatinase-associated lipocalin (NGAL), in patients with AMICS with or without OHCA. METHOD Patients admitted for acute coronary angiography due to suspected ST-elevation myocardial infarction were enrolled during a 1-year period. In the present study 86 patients with confirmed AMICS at admission were included. RESULTS In the adjusted analysis OHCA patients had higher levels of lactate (p = 0.008), NGAL (p = 0.03) and sTM (p = 0.011) while the level of sST2 was lower (p = 0.029). There was little difference in 30-day mortality between the OHCA and non-OHCA groups (OHCA 37% vs. non-OHCA 38%). CONCLUSION AMICS patients with or without OHCA had similar 30-day mortality but differed in terms of Lactate, NGAL, sTM and sST2 levels. These findings support that non-OHCA and OHCA patients with CS could be considered as two individual clinical entities.
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Affiliation(s)
- Michael Thøgersen
- Department of Cardiology, Copenhagen University Hospital Denmark, Copenhagen, Denmark
| | - Martin Frydland
- Department of Cardiology, Copenhagen University Hospital Denmark, Copenhagen, Denmark
| | | | | | - Jakob Josiassen
- Department of Cardiology, Copenhagen University Hospital Denmark, Copenhagen, Denmark
| | - Jens Peter Goetze
- Department of Clinical Biochemistry, Copenhagen University Hospital Denmark, Copenhagen, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Copenhagen University Hospital Denmark, Copenhagen, Denmark.,Department of Cardiology, Odense University Hospital Denmark, Odense, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital Denmark, Copenhagen, Denmark
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Khurrami L, Møller JE, Lindholt JS, Urbonaviciene G, Steffensen FH, Lambrechtsen J, Karon M, Frost L, Busk M, Egstrup K, Fredgart MH, Diederichsen ACP. Cross-sectional study of aortic valve calcification and cardiovascular risk factors in older Danish men. Heart 2021; 107:1536-1543. [PMID: 34376488 DOI: 10.1136/heartjnl-2021-319023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 06/27/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Aortic valve calcification (AVC) and coronary artery calcification (CAC) are predictors of cardiovascular disease (CVD), presumably sharing risk factors. Our objectives were to determine the prevalence and extent of AVC in a large population of men aged 60-74 years and to assess the association between AVC and cardiovascular risk factors including CAC and biomarkers. METHODS Participants from the DANish CArdioVAscular Screening and intervention trial (DANCAVAS) with AVC and CAC scores and without previous valve replacement were included in the study. Calcification scores were calculated on non-contrast CT scans. Cardiovascular risk factors were self-reported, measured or both, and further explored using descriptive and regression analysis for AVC association. RESULTS 14 073 men aged 60-74 years were included. The AVC scores ranged from 0 to 9067 AU, with a median AVC of 6 AU (IQR 0-82). In 8156 individuals (58.0%), the AVC score was >0 and 215 (1.5%) had an AVC score ≥1200. In the regression analysis, all cardiovascular risk factors were associated with AVC; however, after inclusion of CAC ≥400, only age (ratio of expected counts (REC) 1.07 (95% CI 1.06 to 1.09)), hypertension (REC 1.24 (95% CI 1.09 to 1.41)), obesity (REC 1.34 (95% CI 1.20 to 1.50)), known CVD (REC 1.16 (95% CI 1.03 to 1.31)) and serum phosphate (REC 2.25 (95% CI 1.66 to 3.10) remained significantly associated, while smoking, diabetes, hyperlipidaemia, estimated glomerular filtration rate and serum calcium were not. CONCLUSIONS AVC was prevalent in the general population of men aged 60-74 years and was significantly associated with all modifiable cardiovascular risk factors, but only selectively after adjustment for CAC ≥400 AU. TRIAL REGISTRATION NUMBER NCT03946410 and ISRCTN12157806.
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Affiliation(s)
- Lida Khurrami
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Odense University Hospital, Odense, Denmark.,Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jes Sanddal Lindholt
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark.,Cardiovascular Centre of Excellence (CAVAC), Odense, Denmark.,University of Southern Denmark, Odense, Denmark
| | | | | | - Jess Lambrechtsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Marek Karon
- Department of Medicine, Nykøbing Falster Hospital, Region Zealand, Denmark
| | - Lars Frost
- Department of Cardiology, Regional Hospital of Central Jutland, Silkeborg, Denmark
| | - Martin Busk
- Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark
| | - Kenneth Egstrup
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Axel Cosmus Pyndt Diederichsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark.,Cardiovascular Centre of Excellence (CAVAC), Odense, Denmark.,University of Southern Denmark, Odense, Denmark
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