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Iversen KK, Ronit A, Ahlström MG, Nordestgaard BG, Afzal S, Benfield T. Lung function trajectories in mild COVID-19 with two-year follow-up. J Infect Dis 2024:jiae037. [PMID: 38271235 DOI: 10.1093/infdis/jiae037] [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: 09/26/2023] [Revised: 01/02/2024] [Accepted: 01/22/2024] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVE To characterize lung function dynamics in individuals with mild COVID-19 from pre-infection to two years post-infection. METHODS We re-invited participants two years after infection from our matched cohort study of the Copenhagen General Population who had initially been examined 5.4 months after infection. We repeated lung tests and questionnaires. Linear mixed models were used to estimate lung volume changes in individuals with COVID-19 patients versus uninfected controls over two intervals: from pre-infection to six months post-infection and six months post-infection to two years post-infection. RESULTS 52 individuals (48.6%) attended the two-year examination at median 1.9 years (IQR 1.8; 2.4) after COVID-19, all with mild infection. Individuals with COVID-19 had an adjusted excess decline in FEV1 of 13.0 mL per year (CI 23.5; 2.5), p=0.02 from prior infection to 6 months after infection compared to uninfected controls. From 6 to 24 months after infection, they had an excess decline of 7.5 mL per year (CI 25.6; 9.6), p=0.40. A similar pattern was observed for FVC. Participants had a mean increase in DLco of 3.33 (SD 7.97) between the 6- and 24-month examination. CONCLUSION Our results indicate that mild COVID-19 infection affects lung function at time of infection with limited recovery two years after infection.
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Affiliation(s)
- Katrine K Iversen
- Department of Infectious Diseases, Copenhagen University Hospital - Amager Hvidovre, Hvidovre, Denmark
| | - Andreas Ronit
- Department of Infectious Diseases, Copenhagen University Hospital - Amager Hvidovre, Hvidovre, Denmark
- Department of Infectious Diseases, Zealand University Hospital, Roskilde, Denmark
| | - Magnus G Ahlström
- Department of Clinical Microbiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Shoaib Afzal
- Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Thomas Benfield
- Department of Infectious Diseases, Copenhagen University Hospital - Amager Hvidovre, Hvidovre, Denmark
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Iversen KK, Ronit A, Kristensen TS, Afzal S, Jankovic J, Kalhauge A, Ahlström MG, Nordestgaard BG, Kofoed KF, Benfield T. Lung abnormalities in SARS-CoV-2 infection: An analysis of paired computed tomography scans before and after infection. Open Forum Infect Dis 2022; 9:ofac596. [DOI: 10.1093/ofid/ofac596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
Abstract
Background
Studies on the pulmonary consequences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are impeded by limited access to pre-SARS-CoV-2 examinations.
Methods
We invited Copenhagen General Population Study participants with a confirmed SARS-CoV-2 PCR test during the first and second COVID-19 wave in Denmark for a repeat chest CT scan. Paired CT scans were independently assessed for interstitial and non-interstitial abnormalities by two trained radiologist. A semiquantitative CT score (ranging from 0-25) was used to quantify the extent of interstitial abnormalities.
Results
Of 111 SARS-CoV-2 infected individuals, 102 (91.2%) experienced symptoms and 12 (11.2%) were hospitalized. Follow-up examination was performed at median of 5.4 (IQR 4.1; 7.8) months after a positive SARS-CoV-2 PCR-test. Of 67 individuals with paired CT scans, ground glass opacities and reticulation were present in 31 (46.3%) individuals post-SARS-CoV-2 compared to 23 (34.1%) pre-SARS-CoV-2 (mean CT score 3.0 vs 1.3, p = 0.011). Results were similar for non-hospitalized individuals. We did not detect development of bronchiectasis, emphysema or nodules.
Conclusions
SARS-CoV-2 infection in predominantly non-hospitalized individuals with mild disease was associated with a small increase in only interstitial lung abnormalities.
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Affiliation(s)
- Katrine K Iversen
- Department of Infectious Diseases 144, Copenhagen University Hospital – Amager Hvidovre , Hvidovre , Denmark
| | - Andreas Ronit
- Department of Infectious Diseases 144, Copenhagen University Hospital – Amager Hvidovre , Hvidovre , Denmark
| | - Thomas S Kristensen
- Department of Radiology and Cardiology, Copenhagen University Hospital – Rigshospitalet , Copenhagen , Denmark
| | - Shoaib Afzal
- Department of Clinical Biochemistry, Copenhagen University Hospital – Herlev and Gentofte , Hvidovre , Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen , Copenhagen , Denmark
- The Copenhagen General Population Study, Copenhagen University Hospital – Herlev and Gentofte , Hvidovre , Denmark
| | - Jelena Jankovic
- Department of Radiology and Cardiology, Copenhagen University Hospital – Rigshospitalet , Copenhagen , Denmark
| | - Anna Kalhauge
- Department of Radiology and Cardiology, Copenhagen University Hospital – Rigshospitalet , Copenhagen , Denmark
| | - Magnus G Ahlström
- Department of Clinical Microbiology, Copenhagen University Hospital – Rigshospitalet , Copenhagen , Denmark
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry, Copenhagen University Hospital – Herlev and Gentofte , Hvidovre , Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen , Copenhagen , Denmark
- The Copenhagen General Population Study, Copenhagen University Hospital – Herlev and Gentofte , Hvidovre , Denmark
| | - Klaus F Kofoed
- Department of Radiology and Cardiology, Copenhagen University Hospital – Rigshospitalet , Copenhagen , Denmark
| | - Thomas Benfield
- Department of Infectious Diseases 144, Copenhagen University Hospital – Amager Hvidovre , Hvidovre , Denmark
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Noerregaard M, Voegg ROB, Raja AA, Sillesen AS, Joergensen FS, Basit S, Boyd H, Iversen KK, Bundgaard H. Impact of maternal risk factors on the structure and function of the heart in newborns. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Maternal factors such as smoking during pregnancy, advanced age, and obesity are associated with increased risk of complex congenital heart defects in the offspring. It is unknown whether maternal risk factors may also cause subtle abnormalities in cardiac structure and function.
Purpose
To investigate whether the following maternal factors: advanced age, high body mass index (BMI), and smoking during pregnancy are associated with changes in left ventricle (LV) dimensions and systolic function in the newborn child.
Methods
Data was obtained as part of a population-based cohort study with prenatal inclusion and postnatal transthoracic echocardiography (TTE) of newborns within 60 days of birth. The TTE protocol included measurements of: Interventricular septal thickness at end-diastole (IVSd), LV posterior wall thickness at end-diastole (LVPWd), LV internal diameter at end-diastole (LVIDd) and LV internal diameter at end-systole (LVIDs). Fractional shortening (FS) was calculated by use of Teicholz's formula.
Children of mothers with data available on age, BMI, and smoking status, respectively, were divided into the following groups depending on whether their mothers were: of young age <25 years, 25–29 years, 30–34 years (reference group), 35–39 years, and advanced age ≥40 years; underweight BMI <18.5, normal range BMI 18.5–24.9 (reference group), preobese BMI 25–29.9, and obese BMI ≥30; smoking or nonsmoking (reference group).
Associations between different groups with each maternal risk factor and newborn LV parameters were analysed using a multiple linear regression model.
Results
Children of mothers with advanced age at the time of childbirth (n=1,411) had significantly smaller LVIDd and LVIDs (Table 1) compared to children of mothers in their early thirties (n=10,045). Children of preobese (n=4,707) and obese mothers (n=2,138) had significantly smaller LVIDd and LVIDs than children of mothers in the normal BMI range (n=17,654). Children of mothers who smoked during pregnancy (n=808) had significantly larger LVPWd than children of non-smoking mothers (n=24,072). A significant difference in FS was only seen in children of obese mothers.
Subanalyses of the quantity of maternal smoking (available data in n=548 [67.8%] of mothers who smoked during pregnancy) showed that children of heavy smoking mothers (≥15 cigarettes/day, n=101), had significantly thicker IVSd and LVPWd compared with children of nonsmoking mothers, whereas no significant effect was identified in newborns of mothers smoking less than 15 cigarettes per day (Table 2).
Conclusions
Systematic population-based echocardiography of newborns showed that an increased maternal BMI and maternal age above 40 years were associated with smaller LV cavity dimensions in the offspring and that heavy smoking during pregnancy was associated with increased LV myocardial thickness. FS was only affected in children of obese mothers. The long-term effects of these novel findings are unknown.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Herlev-Gentofte Hospital Internal Funding for Cardiological Research andThe Novo Nordisk Foundation
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Affiliation(s)
- M Noerregaard
- Herlev Hospital, Department of Cardiology , Herlev , Denmark
| | - R O B Voegg
- Herlev Hospital, Department of Cardiology , Herlev , Denmark
| | - A A Raja
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Center , Copenhagen , Denmark
| | - A S Sillesen
- Herlev Hospital, Department of Cardiology , Herlev , Denmark
| | - F S Joergensen
- Hvidovre Hospital, Department of Obstetrics and Gynaecology , Copenhagen , Denmark
| | - S Basit
- Statens Serum Institut, Epidemiological Research , Copenhagen , Denmark
| | - H Boyd
- Statens Serum Institut, Epidemiological Research , Copenhagen , Denmark
| | - K K Iversen
- Herlev Hospital, Department of Cardiology , Herlev , Denmark
| | - H Bundgaard
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Center , Copenhagen , Denmark
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Paerregaard M, Haartmann J, Pihl C, Pietersen A, Iversen KK, Bundgaard H, Christensen AH. Prevalence of Wolff-Parkinson-White syndrome, association with congenital heart disease, and natural history in newborns. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Wolff-Parkinson-White (WPW) syndrome is characterized by an accessory electrical pathway between the atria and ventricles. Clinically, the condition can lead to supraventricular tachycardia, and is associated with sudden cardiac death and congenital heart disease. Studies investigating the prevalence, associated structural cardiac abnormalities, and natural history in newborns are few.
Purpose
To determine the prevalence of WPW syndrome in newborns, describe electrocardiographic and echocardiographic characteristics, and the natural history in childhood.
Methods
Electrocardiograms (ECGs) and echocardiograms of newborns (aged 0–30 days) from a large, prospective, general population study were included. WPW cases were identified through manual evaluation of outliers in PR-interval, QRS-duration, and QRS axis. Newborns with suspected or confirmed pre-excitation on their initial ECG were offered a cardiac follow-up. Localization of the accessory pathway was assessed utilizing a QRS polarity algorithm. Cases were matched 1:4 to controls by age, sex, weight and gestational age.
Results
Among the 17,489 ECGs we identified 17 (76% boys) newborns with definite WPW syndrome consistent with a prevalence of 0.1%. At follow-up (available in 12/17 children) at a mean age of three years, the WPW pattern remained in three children while the ECG had normalized in the nine remaining children. The median values for the newborns' heart rate, PR-interval, QRS-duration, QTc(Bazett), the maximum amplitude in R-V1 and S-V6 in cases and controls were 131 vs. 142 beats per minute, 80 vs. 96 ms, 74 vs. 56 ms, 449 vs. 420 ms, 1,562 vs. 1,028 μV and 546 vs. 693 μV, respectively (all p<0.05, Figure 1). The newborns' QRS axis, max amplitude in S-V1 and R-V6 did not differ among cases and controls (all p>0.05). Echocardiographic measurements of the newborns' left ventricular diameter and function, wall thicknesses, and doppler measurements of trans-mitral- and main pulmonary artery blood flow did not differ significantly between cases and controls (all p>0.05). The accessory electrical pathway was left-sided in 14 (82%) of the newborns. One newborn had significant mitral regurgitation while all other newborns had structurally normal hearts; there were no cases of Ebstein's anomaly.
Conclusion
The prevalence of WPW syndrome in our cohort of asymptomatic newborns was 0.1%. The syndrome was more frequent in boys, the accessory pathway was mostly left-sided, and was associated with changes in several ECG parameters, but generally not associated with structural heart disease. A striking observation was, that the WPW pattern in the majority of children could not be reproduced on follow-up ECGs at a mean age of three years, suggesting either that the ECG pattern is intermittent, or normalization occurs.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation
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Affiliation(s)
- M Paerregaard
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
| | - J Haartmann
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
| | - C Pihl
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
| | - A Pietersen
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
| | - K K Iversen
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
| | - H Bundgaard
- Rigshospitalet - Copenhagen University Hospital, The Heart Centre, Rigshospitalet , Copenhagen , Denmark
| | - A H Christensen
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
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5
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Boye Thygesen C, Paerregaard MM, Molin J, Sillesen AS, Voegg ROB, Axelsson Raja A, Iversen KK, Bundgaard H, Christensen AH. The impact of perinatal factors on the neonatal electrocardiogram. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Myocardial development is still incomplete by the time of birth making the cardiomyocyte vulnerable in the perinatal period. However, little is known on whether perinatal factors affect the neonatal electrocardiogram, and if so, to what degree these effects persist in the neonatal period.
Purpose
To investigate the impact of maternal and perinatal factors on the neonatal electrocardiogram in a large unselected cohort of neonates.
Methods
In a multicentre, prospective, population-based cohort study, neonates underwent cardiac evaluation during the first month of life. Electrocardiograms and echocardiograms were obtained and systematically analysed. Medical and demographic information on the parents, pregnancy, and birth-related factors were registered, and the following perinatal risk factors were evaluated: maternal comorbidities, maternal BMI ≥25, use of assisted reproduction technology, parity, (preterm) premature rupture of membranes, placental disorders, abnormal foetus presentation, induction of labour with synthetic hormone, instrumental induction, administration of nitrous oxide, epidural/spinal administration, labour ≥24h, pushing stage ≥1h, Caesarean section, and instrumental delivery.
Results
A total of 15,928 singletons with normal echocardiograms were included (52% boys; median age at examination 11 days). The neonates were divided into groups by accumulated number of perinatal risk factors: 0 (n=1,587), 1 (n=3,718), 2 (n=4,026), 3–4 (n=4,998), and ≥5 (n=1,197), and differences in ECG parameters between the groups were analysed. Heart rate, QRS axis, uncorrected QT interval, QTcBazett, QTcFridericia, and maximum amplitudes in R-V1 and R-V6 differed across the five subgroups (all p<0.05). We observed a cumulative effect of perinatal risk factors on ECG parameters with increasing left-shift in the QRS axis, prolongation of the QT interval, and increasing amplitudes in R-V1 and R-V6. The subgroup with ≥5 perinatal risk factors differed the most, and absolute differences between this subgroup and neonates without any perinatal risk factors were 7.6% in maximum amplitudes in R-V6 (940 vs. 874 μV, p<0.01), 4.3% in R-V1 (1,201 vs. 1,152 μV, p<0.05), 5.1% in the QRS axis (111 vs 117°, p<0.0001) and 0.8% in QTcFridericia (366 vs. 363 ms, p<0.01).
Conclusion
We observed a cumulative effect of perinatal risk factors including a significantly more left-shifted QRS axis, increased values of the QT interval, and higher amplitudes in R-V1 and R-V6 in the subgroup with ≥5 perinatal risk factors. These findings suggest a relatively lower right ventricular dominance pattern, discrete prolongation of the QT interval and increased myocardial mass of the right ventricle in neonates exposed to multiple perinatal risk factors. However, the absolute differences in ECG parameters were relatively small. These findings may be useful for identification of neonates with increased cardiovascular risk.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Department of Cardiology, Herlev-Gentofte Hospital, Internal Funding
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Affiliation(s)
- C Boye Thygesen
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
| | - M M Paerregaard
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
| | - J Molin
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
| | - A S Sillesen
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
| | - R O B Voegg
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
| | - A Axelsson Raja
- Rigshospitalet - Copenhagen University Hospital, The Capital Regions Unit for Inherited Cardiac Diseases, Department of Cardiology, The Heart Center , Copenhagen , Denmark
| | - K K Iversen
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
| | - H Bundgaard
- Rigshospitalet - Copenhagen University Hospital, The Capital Regions Unit for Inherited Cardiac Diseases, Department of Cardiology, The Heart Center , Copenhagen , Denmark
| | - A H Christensen
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
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6
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Myhr KA, Zinglersen AH, Hermansen MLF, Jepsen MM, Iversen KK, Ngo AT, Pecini R, Jacobsen S. Left ventricular size and function in patients with systemic lupus erythematosus associate with lupus anticoagulant: An echocardiographic follow-up study. J Autoimmun 2022; 132:102884. [PMID: 36029716 DOI: 10.1016/j.jaut.2022.102884] [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: 06/14/2022] [Revised: 07/20/2022] [Accepted: 07/20/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with increased risk of cardiac dysfunction. The pathophysiological mechanisms are poorly understood, and prognostic markers are warranted. PURPOSE We aimed to identify SLE-characteristics associated with measures of cardiac size and function during a five-year follow-up. METHODS We included 108 patients with SLE: 90% females, mean age 46 ± 13 years, median disease duration 14 (range 7-21) years. We performed blood sampling for potential biomarkers as well as a standard echocardiography at baseline and at a 5-year follow-up. To investigate associations with baseline and prospective 5-year changes in echocardiographic parameters, we performed multivariate regression analyses of SLE-related baseline variables (clinical disease activity, lupus nephritis, chronic kidney disease, anti-cardiolipin and/or anti-beta-2 glycoprotein I antibodies, and lupus anticoagulant (LAC)) and adjusted for traditional risk factors. RESULTS During follow-up, diastolic function regressed in two out of five echocardiographic measures (E/A ratio 1.4 ± 0.5 vs. 1.3 ± 0.5, p = 0.002; tricuspid regurgitation peak velocity 2.0 ± 0.6 vs. 2.2 ± 0.4 mmHg, p < 0.001). Left ventricular (LV) end-diastolic volume index increased (43.7 ± 13.9 vs. 52.5 ± 15.7 mL/m2, p < 0.001). Left and right ventricular systolic function remained stationary. LAC was associated with inferior diastolic function: lower E/A ratio (p = 0.04) and higher E/e' ratio at baseline (p = 0.04) and increased left ventricular atrial volume index during follow-up (p = 0.01). LAC was further associated with LV dilatation during follow-up (p = 0.01). CONCLUSION Presence of LAC was associated with measures of diastolic function as well as progressive LV dilatation during the 5-year follow-up. Thus, LAC might be a predictor of cardiac dysfunction in SLE patients. LAC is known to have implications for the microvascular circulation, but the clinical significance of the present findings is yet to be elucidated.
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Affiliation(s)
- Katrine A Myhr
- Department of Cardiology, Rigshospitalet, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark.
| | - Amanda H Zinglersen
- Copenhagen Research Center for Autoimmune Connective Tissue Diseases, Center for Rheumatology and Spine Diseases, Rigshospitalet, Juliane Maries Vej 10, 2100, Copenhagen, Denmark.
| | - Marie-Louise F Hermansen
- Copenhagen Research Center for Autoimmune Connective Tissue Diseases, Center for Rheumatology and Spine Diseases, Rigshospitalet, Juliane Maries Vej 10, 2100, Copenhagen, Denmark.
| | - Mathies M Jepsen
- Department of Cardiology, Rigshospitalet, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark.
| | - Katrine K Iversen
- Copenhagen Research Center for Autoimmune Connective Tissue Diseases, Center for Rheumatology and Spine Diseases, Rigshospitalet, Juliane Maries Vej 10, 2100, Copenhagen, Denmark.
| | - Anh T Ngo
- Department of Cardiology, Rigshospitalet, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark.
| | - Redi Pecini
- Department of Cardiology, Rigshospitalet, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark.
| | - Søren Jacobsen
- Copenhagen Research Center for Autoimmune Connective Tissue Diseases, Center for Rheumatology and Spine Diseases, Rigshospitalet, Juliane Maries Vej 10, 2100, Copenhagen, Denmark.
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Myhr KA, Jepsen MM, Zinglersen AH, Iversen KK, Hermansen MF, Ngo AT, Pecini R, Jacobsen S. Lupus anticoagulant in patients with systemic lupus erythematosus is associated with lower E/A ratio and progressive left ventricular dilatation: a five-year follow-up study. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Copenhagen University Hospital
Background
Systemic lupus erythematosus (SLE) is an autoimmune disease with increased risk of cardiovascular complications such as coronary artery disease, myocarditis, pericarditis and valvular dysfunction. The pathophysiological mechanisms are poorly understood and clinical, biochemical and/or imaging markers to identify high risk patients are warranted.
Purpose
We aimed to identify SLE-characteristics that are associated with progressive cardiac dysfunction during a five-year follow-up period in patients with SLE.
Methods
A total of 147 patients with SLE were included from 2013 to 2014. All patients underwent standard echocardiography at baseline as well as a collection of blood samples, including a selection of biomarkers. Patients were invited to a five-year follow-up with a total of 108 patients (90 % female, mean age 46 ± 13 years, median disease duration of 14 (7-21) years) completing a full echocardiographic, laboratory, and clinical examination. Multivariate regression analyses with eight independent baseline variables of interest (age, sex, disease activity (SLEDAI-2K), lupus nephritis, ischemic heart disease (IHD), antiphospholipid antibodies (IgM and IgG), and lupus anticoagulant(LAC)) were performed as for the association with baseline echocardiographic parameters as well as for changes during follow-up. Only echocardiographic measurements that changed significantly (p < 0.01) during follow-up were selected for the regression analyses. Left ventricular end-diastolic volume index (LVEDVI) and E/A ratio were log-transformed at baseline in the regression analyses due to non-normality.
Results
During a five-year follow-up period, LVEDVI increased from 43.5 ± 13.9 to 52.5 ± 15.7 ml/m2 (p <0.001), and left ventricular diastolic measures declined (E/A ratio 1.4 ± 0.5 vs. 1.3 ± 0.5, p = 0.002; e’ velocity 12.8 ± 3.8 vs. 12.0 ± 3.7 ms, p = 0.02; mitral valve deceleration time 227.9 vs. 200.8 ms, p < 0.001), except for E/e’ (7.5 ± 3.8 vs. 6.8 ± 3.4, p = 0.02). Left ventricular ejection fraction remained stationary (59.5 ± 6.8 vs. 59.6 ± 6.4 %, p = 0.81). In multivariate regression analyses, presence of LAC was significantly associated with progressive left ventricular dilation during the follow-up period (p = 0.003) but not with higher baseline levels (p = 0.64) (Fig. A1 & A2). LAC was associated with lower E/A ratio at baseline (p = 0.005) but did not predict a decrease of E/A ratio during follow-up (p = 0.24) (Fig. B1 & B2). IHD was associated with higher LVEDVI at baseline (p = 0.004), but not with further progression of dilation (p = 0.07).
Conclusion
Presence of LAC was associated with lower E/A ratio at baseline as well as progressive left ventricular dilation during a five-year follow-up period. Hence, LAC might be a predictor of progressive cardiac dysfunction in patients with SLE. LAC is known to have implications for the microvascular circulation, but the clinical significance of the present findings is yet to be elucidated. Abstract Figure A Abstract Figure B
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Affiliation(s)
- KA Myhr
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - MM Jepsen
- Bispebjerg University Hospital, Department of Clinical Pharmacology, Copenhagen, Denmark
| | - AH Zinglersen
- Rigshospitalet - Copenhagen University Hospital, Department of Rheumatology, Copenhagen, Denmark
| | - KK Iversen
- Rigshospitalet - Copenhagen University Hospital, Department of Rheumatology, Copenhagen, Denmark
| | - MF Hermansen
- Aarhus University Hospital, Department of Rheumatology, Aarhus, Denmark
| | - AT Ngo
- Zealand University Hospital, Department of Cardiology, Roskilde, Denmark
| | - R Pecini
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - S Jacobsen
- Rigshospitalet - Copenhagen University Hospital, Department of Rheumatology, Copenhagen, Denmark
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8
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Iversen KK, Afzal S, Ahlström MG, Nordestgaard BG, Schneider UV, Nielsen L, Kofoed K, Benfield T, Ronit A. Lung function decline in relation to COVID-19 in the general population: a matched cohort study with pre-pandemic assessment of lung function. J Infect Dis 2022; 225:1308-1316. [PMID: 34979029 PMCID: PMC8755346 DOI: 10.1093/infdis/jiab636] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/02/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To quantify the potential decline in dynamic lung volumes following coronavirus disease 2019 (COVID-19) in the general population. METHODS A prospective matched cohort study of adult Copenhagen General Population Study (CGPS) participants with a pre-pandemic spirometry available. CGPS individuals with a positive SARS-CoV-2 polymerase chain reaction (PCR) test performed a repeat spirometry, a questionnaire regarding respiratory symptoms and a diffusing capacity test for carbon monoxide. A matched uninfected CGPS control sample was used, and simple regression and linear mixed effect models were computed to study lung function decline. RESULTS A total of 606 were included. 92/107 (85.9%) of individuals with a positive SARS-CoV-2 PCR test experienced COVID-19 symptoms and 12 (11.2%) were hospitalized. Spirometry was performed at a median (interquartile range) of 5.6 (3.9-12.8) months after positive SARS-CoV-2 PCR test. COVID-19 was associated with an adjusted 7.3 mL (95%CI: 0.3-14.3) and 22.6 mL (95%CI: 13.1-32.0) steeper decline in annual FEV1 and FVC or a total of 113.8 and 301.3 ml lower FEV1 and FVC from baseline to follow up. Results were robust in analyses restricted to individuals not requiring hospitalization. CONCLUSION COVID-19 related decline of dynamic lung volumes in the general population not requiring hospitalization were small but measurable.
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Affiliation(s)
- Katrine K Iversen
- Department of Infectious Diseases 144, Copenhagen University Hospital - Amager Hvidovre; Hvidovre, Denmark
| | - Shoaib Afzal
- Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark.,The Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Magnus G Ahlström
- Department of Clinical Microbiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark.,The Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Uffe V Schneider
- Department of Clinical Microbiology, Copenhagen University Hospital - Amager Hvidovre, Hvidovre, Denmark
| | - Lene Nielsen
- Department of Clinical Microbiology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Klaus Kofoed
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Thomas Benfield
- Department of Infectious Diseases 144, Copenhagen University Hospital - Amager Hvidovre; Hvidovre, Denmark
| | - Andreas Ronit
- Department of Infectious Diseases 144, Copenhagen University Hospital - Amager Hvidovre; Hvidovre, Denmark
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9
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Voegg ROB, Ghouse J, Sillesen AS, Pihl CA, Axelsson Raja A, Vejlstrup N, Iversen KK, Bundgaard H, Boyd HA. P3441Impact of maternal preeclampsia on left ventricular structure and function in the newborn heart. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Maternal preeclampsia (PE) has been associated with an increased risk of a variety of congenital heart defects in the infant. Whether PE also confers an increased risk of subtle structural and functional cardiac deficits is unknown.
Purpose
We investigated whether left ventricular dimensions and systolic function differed among infants of mothers with PE, compared to infants born after uncomplicated pregnancies.
Method
Systematic transthoracic echocardiography (TTE) was performed in neonates included in a population-based study in the period 2016–2018 (n=25,000). TTE was preferably performed within 14 days of birth. Left ventricular (LV) posterior wall end-diastolic thickness (LVPWd), interventricular septum end-diastole thickness (IVSd), LV internal diameter in end-diastole and end-systole (LVIDd and LVIDs), LV ejection fraction (LVEF) and fractional shortening (FS) were assessed. Information on maternal PE (ICD-10 codes DO140–142 and DO159) was retrieved from an obstetric database. Using linear regression in a sample of echocardiograms, we compared the LV structure and function adjusted for maternal age; gestational age; sex; weight and length.
Results
In total, 447 infants were exposed to PE, and 7,178 were born to uncomplicated pregnancies (Table). In infants of PE mothers, we found significantly larger LVPWd and IVSd (0.18 mm, 95% CI [0.14; 0.22], p<0.001 and 0.06 mm, 95% CI [0.02; 0.10], p=0.001, resp.) and LVIDd as LVIDs were significantly smaller (−0.15 mm, 95% CI [−0.29; −0.01], p=0.032 and −0.16 mm 95% CI [−0.28; −0.04], p=0.009, resp.) compared to infants of non-PE mothers. We found no differences in systolic function.
LV measures in PE and non-PE infants Parameter Infants of PE mothers, Infants of non-PE mothers, p-value Estimate* [95% CI] p-value mean [± SD] (n=447) mean [± SD] (n=7,178) Left Ventricular Posterior Wall in end-Diastole, LVPWd (mm) 2.20 [±0.58] 2.07 [±0.40] <0.001 0.18 [0.14; 0.22] <0.001 Interventricular Septum in end-Diastole, IVSd (mm) 2.53 [±0.52] 2.55 [±0.41] 0.562 0.06 [0.02; 0.10] 0.001 Left Ventricular Internal Diameter in end-Diastole, LVIDd (mm) 19.35 [±2.00] 20.10 [±1.41] <0.001 −0.15 [−0.29; −0.01] 0.032 Left Ventricular Internal Diameter in end-Diastole, LVIDs (mm) 13.13 [±1.43] 13.65 [±1.79] <0.001 −0.16 [−0.28; −0.04] 0.009 Fractional Shortening, FS (%) 32.10 [±4.07] 32.11 [±3.86] 0.937 0.26 [−0.11; 0.63] 0.168 Left Ventricular Ejection Fraction, LVEF (%) 63.19 [±5.61] 63.09 [±5.30] 0.690 0.34 [−0.17; 0.85] 0.192 *Adjusted for maternal age; gestational age; sex; weight and length.
Conclusion
In the largest population-based group of neonates to date, we showed that infants born to PE mothers compared to infants of non-PE mothers had significantly thicker left ventricular myocardium, and reduced left ventricular volumes. However, PE was not associated with altered systolic function. Our results might reflect an adaption of the fetal heart to the increased resistance in the placental arteries in PE mothers, and a secondary increased left ventricular afterload.
Acknowledgement/Funding
Danish Heart Association, Danish Children's Heart Foundation, Candy's Found., Toyota Found., Herlev-Gentofte Hospital Research Found., Lundbeck Found.
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Affiliation(s)
- R O B Voegg
- Herlev Hospital - Copenhagen University Hospital, Copenhagen, Denmark
| | - J Ghouse
- Rigshospitalet - Copenhagen University Hospital, Laboratory for Molecular Cardiology, The Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - A S Sillesen
- Herlev Hospital - Copenhagen University Hospital, Copenhagen, Denmark
| | - C A Pihl
- Herlev Hospital - Copenhagen University Hospital, Copenhagen, Denmark
| | - A Axelsson Raja
- Herlev Hospital - Copenhagen University Hospital, Copenhagen, Denmark
| | - N Vejlstrup
- Rigshospitalet - Copenhagen University Hospital, The Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - K K Iversen
- Herlev Hospital - Copenhagen University Hospital, Copenhagen, Denmark
| | - H Bundgaard
- Rigshospitalet - Copenhagen University Hospital, The Unit for Inherited Cardiac Diseases, The Heart Centre, Copenhagen, Denmark
| | - H A Boyd
- Statens Serum Institut, Department of Epidemiology, Copenhagen, Denmark
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10
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Hasselbalch RB, Schultz M, Hartmann Rasmussen LJ, Hoei-Hansen T, Kjoeller E, Nybo Jensen B, Lind MN, Ravn L, Kallemose T, Lange T, Koeber L, Eugen-Olsen J, Iversen KK. P1745Routine blood tests are strong predictors of mortality among patients with suspected heart disease in the emergency department. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- R B Hasselbalch
- Herlev Hospital - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - M Schultz
- Herlev Hospital - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - L J Hartmann Rasmussen
- Hvidovre Hospital - Copenhagen University Hospital, Clinical Research Centre, Hvidovre, Denmark
| | - T Hoei-Hansen
- Herlev Hospital - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - E Kjoeller
- Herlev Hospital - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - B Nybo Jensen
- Bispebjerg University Hospital, Department of Emergency Medicine, Bispebjerg, Denmark
| | - M N Lind
- Herlev Hospital, Department of Emergency Medicine, Herlev, Denmark
| | - L Ravn
- Herlev Hospital, Department of Emergency Medicine, Herlev, Denmark
| | - T Kallemose
- Hvidovre Hospital - Copenhagen University Hospital, Clinical Research Centre, Hvidovre, Denmark
| | - T Lange
- University of Copenhagen, Department of Public Health, Copenhagen, Denmark
| | - L Koeber
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J Eugen-Olsen
- Hvidovre Hospital - Copenhagen University Hospital, Clinical Research Centre, Hvidovre, Denmark
| | - K K Iversen
- Herlev Hospital - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
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11
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Arnadottir A, Haarh-Pedersen SAHP, Jensen JSJ, Goetze JPG, Iversen KK. 1091Induced myocardial ischemia: serial troponin T, troponin I and copeptin measurements (ICE-land). Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Arnadottir
- Herlev Hospital - Copenhagen University Hospital, Copenhagen, Denmark
| | | | - J S J Jensen
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - J P G Goetze
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - K K Iversen
- Herlev Hospital - Copenhagen University Hospital, Copenhagen, Denmark
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12
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Paerregaard MMP, Pietersen AH, Pihl CA, Hvidemose SO, Iversen KK, Bundgaard H, Christensen AH. P3464Defining the normal QTc interval in newborns; data from a large prospective general population study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M M P Paerregaard
- Herlev Hospital - Copenhagen University Hospital, Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - A H Pietersen
- Hillerod Hospital, Department of Cardiology, Hillerod, Denmark
| | - C A Pihl
- Herlev Hospital - Copenhagen University Hospital, Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - S O Hvidemose
- Herlev Hospital - Copenhagen University Hospital, Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - K K Iversen
- Herlev Hospital - Copenhagen University Hospital, Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - H Bundgaard
- Rigshospitalet - Copenhagen University Hospital, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
| | - A H Christensen
- Herlev Hospital - Copenhagen University Hospital, Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
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13
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Iversen KK, Kjaergaard J, Akkan D, Kober L, Torp-Pedersen C, Hassager C, Vestbo J, Kjoller E. Chronic obstructive pulmonary disease in patients admitted with heart failure. J Intern Med 2008; 264:361-9. [PMID: 18537871 DOI: 10.1111/j.1365-2796.2008.01975.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Chronic obstructive pulmonary disease (COPD) is an important differential diagnosis in patients with heart failure (HF). The primary aims were to determine the prevalence of COPD and to test the accuracy of self-reported COPD in patients admitted with HF. Secondary aims were to study a possible relationship between right and left ventricular function and pulmonary function. DESIGN Prospective substudy. SETTING Systematic screening at 11 centres. SUBJECTS Consecutive patients (n = 532) admitted with HF requiring medical treatment with diuretics and an episode with symptoms corresponding to New York Heart Association class III-IV within a month prior to admission. INTERVENTIONS Forced expiratory volume in 1 s (FEV(1)) and forced vital capacity (FVC) were measured by spirometry and ventricular function by echocardiography. The diagnosis of COPD and HF were made according to established criteria. RESULTS The prevalence of COPD was 35%. Only 43% of the patients with COPD had self-reported COPD and one-third of patients with self-reported COPD did not have COPD based on spirometry. The prevalence of COPD in patients with preserved left ventricular ejection fraction (i.e. LVEF >or=45%) was significantly higher than in patients with impaired LVEF (41% vs. 31%, P = 0.03). FEV(1) and FVC were negatively correlated with right ventricular end-diastolic diameter and tricuspid annular plane systolic excursion and FVC positively correlated with systolic gradient across the tricuspid valve. CONCLUSION Chronic obstructive pulmonary disease is frequent in patients admitted with HF and self-reported COPD only identifies a minority. The prevalence of COPD was high in both patients with systolic and nonsystolic HF.
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Affiliation(s)
- K K Iversen
- Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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