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Neumann JT, Twerenbold R, Weimann J, Ballantyne CM, Benjamin EJ, Costanzo S, de Lemos JA, deFilippi CR, Di Castelnuovo A, Donfrancesco C, Dörr M, Eggers KM, Engström G, Felix SB, Ferrario MM, Gansevoort RT, Giampaoli S, Giedraitis V, Hedberg P, Iacoviello L, Jørgensen T, Kee F, Koenig W, Kuulasmaa K, Lewis JR, Lorenz T, Lyngbakken MN, Magnussen C, Melander O, Nauck M, Niiranen TJ, Nilsson PM, Olsen MH, Omland T, Oskarsson V, Palmieri L, Peters A, Prince RL, Qaderi V, Vasan RS, Salomaa V, Sans S, Smith JG, Söderberg S, Thorand B, Tonkin AM, Tunstall-Pedoe H, Veronesi G, Watanabe T, Watanabe M, Zeiher AM, Zeller T, Blankenberg S, Ojeda F. Prognostic Value of Cardiovascular Biomarkers in the Population. JAMA 2024:2818624. [PMID: 38739396 DOI: 10.1001/jama.2024.5596] [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: 05/14/2024]
Abstract
Importance Identification of individuals at high risk for atherosclerotic cardiovascular disease within the population is important to inform primary prevention strategies. Objective To evaluate the prognostic value of routinely available cardiovascular biomarkers when added to established risk factors. Design, Setting, and Participants Individual-level analysis including data on cardiovascular biomarkers from 28 general population-based cohorts from 12 countries and 4 continents with assessments by participant age. The median follow-up was 11.8 years. Exposure Measurement of high-sensitivity cardiac troponin I, high-sensitivity cardiac troponin T, N-terminal pro-B-type natriuretic peptide, B-type natriuretic peptide, or high-sensitivity C-reactive protein. Main Outcomes and Measures The primary outcome was incident atherosclerotic cardiovascular disease, which included all fatal and nonfatal events. The secondary outcomes were all-cause mortality, heart failure, ischemic stroke, and myocardial infarction. Subdistribution hazard ratios (HRs) for the association of biomarkers and outcomes were calculated after adjustment for established risk factors. The additional predictive value of the biomarkers was assessed using the C statistic and reclassification analyses. Results The analyses included 164 054 individuals (median age, 53.1 years [IQR, 42.7-62.9 years] and 52.4% were women). There were 17 211 incident atherosclerotic cardiovascular disease events. All biomarkers were significantly associated with incident atherosclerotic cardiovascular disease (subdistribution HR per 1-SD change, 1.13 [95% CI, 1.11-1.16] for high-sensitivity cardiac troponin I; 1.18 [95% CI, 1.12-1.23] for high-sensitivity cardiac troponin T; 1.21 [95% CI, 1.18-1.24] for N-terminal pro-B-type natriuretic peptide; 1.14 [95% CI, 1.08-1.22] for B-type natriuretic peptide; and 1.14 [95% CI, 1.12-1.16] for high-sensitivity C-reactive protein) and all secondary outcomes. The addition of each single biomarker to a model that included established risk factors improved the C statistic. For 10-year incident atherosclerotic cardiovascular disease in younger people (aged <65 years), the combination of high-sensitivity cardiac troponin I, N-terminal pro-B-type natriuretic peptide, and high-sensitivity C-reactive protein resulted in a C statistic improvement from 0.812 (95% CI, 0.8021-0.8208) to 0.8194 (95% CI, 0.8089-0.8277). The combination of these biomarkers also improved reclassification compared with the conventional model. Improvements in risk prediction were most pronounced for the secondary outcomes of heart failure and all-cause mortality. The incremental value of biomarkers was greater in people aged 65 years or older vs younger people. Conclusions and Relevance Cardiovascular biomarkers were strongly associated with fatal and nonfatal cardiovascular events and mortality. The addition of biomarkers to established risk factors led to only a small improvement in risk prediction metrics for atherosclerotic cardiovascular disease, but was more favorable for heart failure and mortality.
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Affiliation(s)
- Johannes Tobias Neumann
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Raphael Twerenbold
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Jessica Weimann
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christie M Ballantyne
- Center for Cardiometabolic Disease Prevention, Department of Medicine, College of Medicine, Baylor University, Houston, Texas
| | - Emelia J Benjamin
- Department of Medicine, Boston Medical Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts
| | - Simona Costanzo
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
| | - James A de Lemos
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | | | | | - Chiara Donfrancesco
- Department of Cardiovascular, Endocrine-Metabolic Diseases, and Aging, National Institute of Health, Rome, Italy
| | - Marcus Dörr
- Department of Internal Medicine B, University Greifswald, Greifswald, Germany
- German Center for Cardiovascular Research, Partner Site Greifswald, University Medicine, Greifswald, Germany
| | - Kai M Eggers
- Departments of Medical Sciences and Cardiology, Uppsala University, Uppsala, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Stephan B Felix
- Department of Internal Medicine B, University Greifswald, Greifswald, Germany
- German Center for Cardiovascular Research, Partner Site Greifswald, University Medicine, Greifswald, Germany
| | - Marco M Ferrario
- Research Centre in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Ron T Gansevoort
- Department of Nephrology, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Vilmantas Giedraitis
- Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, Sweden
| | - Pär Hedberg
- Department of Clinical Physiology and Centre for Clinical Research, Västmanland County Hospital, Uppsala University, Västerås, Sweden
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
- Department of Medicine and Surgery, Libera Università Mediterranea, Casamassima, Italy
| | - Torben Jørgensen
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Centre for Clinical Research and Prevention, BFH Hospital, Copenhagen, Denmark
| | - Frank Kee
- UKCRC Centre of Excellence for Public Health, Queens University of Belfast, Belfast, Northern Ireland
| | - Wolfgang Koenig
- German Heart Center, Technical University of Munich, Munich, Germany
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
- German Center for Cardiovascular Disease Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Kari Kuulasmaa
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Joshua R Lewis
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
- Medical School, University of Western Australia, Perth
- Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Thiess Lorenz
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Magnus N Lyngbakken
- Division of Medicine, Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
- K. G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Christina Magnussen
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Olle Melander
- Departments of Medical Sciences and Cardiology, Uppsala University, Uppsala, Sweden
| | - Matthias Nauck
- German Center for Cardiovascular Research, Partner Site Greifswald, University Medicine, Greifswald, Germany
- Institute for Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Teemu J Niiranen
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Division of Medicine, Turku University Hospital, Turku, Finland
- Department of Internal Medicine, University of Turku, Turku, Finland
| | - Peter M Nilsson
- Departments of Medical Sciences and Cardiology, Uppsala University, Uppsala, Sweden
| | - Michael H Olsen
- Cardiology Section, Department of Internal Medicine, Holbaek Hospital, Holbaek, Denmark
- Department of Regional Health, University of Southern Denmark, Odense
| | - Torbjorn Omland
- Division of Medicine, Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
- K. G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Viktor Oskarsson
- Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden
| | - Luigi Palmieri
- Department of Cardiovascular, Endocrine-Metabolic Diseases, and Aging, National Institute of Health, Rome, Italy
| | - Anette Peters
- German Center for Cardiovascular Disease Research, Partner Site Munich Heart Alliance, Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology, Faculty of Medicine, Ludwig-Maximilians-Universität, Munich, Germany
| | - Richard L Prince
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
- Medical School, University of Western Australia, Perth
| | - Vazhma Qaderi
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ramachandran S Vasan
- Department of Medicine, Boston Medical Center, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
- University of Texas School of Public Health and the University of Texas Health Science Center, San Antonio
| | - Veikko Salomaa
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Susana Sans
- Catalan Department of Health, Barcelona, Spain
| | - J Gustav Smith
- Wallenberg Laboratory and Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden
| | - Barbara Thorand
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology, Faculty of Medicine, Ludwig-Maximilians-Universität, Munich, Germany
| | - Andrew M Tonkin
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Hugh Tunstall-Pedoe
- Cardiovascular Epidemiology Unit, Institute of Cardiovascular Research, University of Dundee, Dundee, Scotland
| | - Giovanni Veronesi
- Research Centre in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, School of Medicine, Yamagata University, Yamagata, Japan
| | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, School of Medicine, Yamagata University, Yamagata, Japan
| | - Andreas M Zeiher
- Institute for Cardiovascular Regeneration, Goethe University, Frankfurt, Germany
- German Center for Cardiovascular Disease Research, Partner Site Rhine-Main, Mainz, Germany
| | - Tanja Zeller
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Francisco Ojeda
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Aakre KM, Lyngbakken MN, Faaren AL, Røsjø H, Dalen H, Omland T. Reference intervals of circulating secretoneurin concentrations determined in a large cohort of community dwellers: the HUNT study. Clin Chem Lab Med 2024; 0:cclm-2024-0154. [PMID: 38564801 DOI: 10.1515/cclm-2024-0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/07/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES Secretoneurin (SN) is a novel cardiac biomarker that associates with the risk of mortality and dysfunctional cardiomyocyte Ca2+ handling in heart failure patients. Reference intervals for SN are unknown. METHODS SN was measured with a CE-marked ELISA in healthy community dwellers from the fourth wave of the Trøndelag Health Study (HUNT4) conducted in 2017-2019. The common, sex and age specific 90th, 95th, 97.5th and 99th percentiles were calculated using the non-parametric method and outlier exclusion according to the Reed test. The applicability of sex and age specific reference intervals were investigated using Harris and Boyd test. We also estimated the percentiles in a subset with normal findings on echocardiographic screening. RESULTS The total cohort included 887 persons (56.4 % women). After echocardiographic screening 122 persons were excluded, leaving a total of 765 persons (57.8 % women). The 97.5th percentile (95 % CI in brackets) of SN was 59.7 (57.5-62.1) pmol/L in the total population and 58.6 (57.1-62.1) pmol/L after echocardiography screening. In general, slightly higher percentiles were found in women and elderly participants, but less than 4 % in these subgroups had concentrations deviating from the common 97.5th percentile. Low BMI or eGFR was also associated with higher concentrations of SN. CONCLUSIONS Upper reference limits for SN were similar amongst healthy adult community dwellers regardless of prescreening including cardiac echocardiography or not. Women and elderly showed higher concentrations of SN, but the differences were not sufficiently large to justify age and sex stratified upper reference limits.
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Affiliation(s)
- Kristin M Aakre
- Department of Medical Biochemistry and Pharmacology, 60498 Haukeland University Hospital , Bergen, Norway
- Department of Heart Disease, 60498 Haukeland University Hospital , Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Magnus N Lyngbakken
- Department of Cardiology, Division of Medicine, 60483 Akershus University Hospital , Lørenskog, Norway
- K.G. Jebsen Centre for Cardiac Biomarkers, 60504 Institute of Clinical Medicine, University of Oslo , Oslo, Norway
| | | | - Helge Røsjø
- K.G. Jebsen Centre for Cardiac Biomarkers, 60504 Institute of Clinical Medicine, University of Oslo , Oslo, Norway
- Akershus Clinical Research Center (ACR), Division of Research and Innovation, 60483 Akershus University Hospital , Lørenskog, Norway
| | - Håvard Dalen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Cardiology, St Olav's University Hospital, Trondheim, Norway
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Torbjørn Omland
- Department of Cardiology, Division of Medicine, 60483 Akershus University Hospital , Lørenskog, Norway
- K.G. Jebsen Centre for Cardiac Biomarkers, 60504 Institute of Clinical Medicine, University of Oslo , Oslo, Norway
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3
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Kimenai DM, Anand A, de Bakker M, Shipley M, Fujisawa T, Lyngbakken MN, Hveem K, Omland T, Valencia-Hernández CA, Lindbohm JV, Kivimaki M, Singh-Manoux A, Strachan FE, Shah ASV, Kardys I, Boersma E, Brunner EJ, Mills NL. Trajectories of cardiac troponin in the decades before cardiovascular death: a longitudinal cohort study. BMC Med 2023; 21:216. [PMID: 37337233 PMCID: PMC10280894 DOI: 10.1186/s12916-023-02921-8] [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: 01/29/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND High-sensitivity cardiac troponin testing is a promising tool for cardiovascular risk prediction, but whether serial testing can dynamically predict risk is uncertain. We evaluated the trajectory of cardiac troponin I in the years prior to a cardiovascular event in the general population, and determine whether serial measurements could track risk within individuals. METHODS In the Whitehall II cohort, high-sensitivity cardiac troponin I concentrations were measured on three occasions over a 15-year period. Time trajectories of troponin were constructed in those who died from cardiovascular disease compared to those who survived or died from other causes during follow up and these were externally validated in the HUNT Study. A joint model that adjusts for cardiovascular risk factors was used to estimate risk of cardiovascular death using serial troponin measurements. RESULTS In 7,293 individuals (mean 58 ± 7 years, 29.4% women) cardiovascular and non-cardiovascular death occurred in 281 (3.9%) and 914 (12.5%) individuals (median follow-up 21.4 years), respectively. Troponin concentrations increased in those dying from cardiovascular disease with a steeper trajectory compared to those surviving or dying from other causes in Whitehall and HUNT (Pinteraction < 0.05 for both). The joint model demonstrated an independent association between temporal evolution of troponin and risk of cardiovascular death (HR per doubling, 1.45, 95% CI,1.33-1.75). CONCLUSIONS Cardiac troponin I concentrations increased in those dying from cardiovascular disease compared to those surviving or dying from other causes over the preceding decades. Serial cardiac troponin testing in the general population has potential to track future cardiovascular risk.
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Affiliation(s)
- Dorien M Kimenai
- British Heart Foundation/University Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, EH16 4SA, UK
| | - Atul Anand
- British Heart Foundation/University Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, EH16 4SA, UK
| | - Marie de Bakker
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Martin Shipley
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Takeshi Fujisawa
- British Heart Foundation/University Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, EH16 4SA, UK
| | - Magnus N Lyngbakken
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
- K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kristian Hveem
- Department of Public Health and General Practice, HUNT Research Centre, Norwegian University of Science and Technology, Levanger, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Torbjørn Omland
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
- K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Joni V Lindbohm
- Department of Epidemiology and Public Health, University College London, London, UK
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Mika Kivimaki
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Archana Singh-Manoux
- Department of Epidemiology and Public Health, University College London, London, UK
- Epidemiology of Ageing and Neurodegenerative Diseases, Inserm U1153, Université de Paris, Paris, France
| | | | - Anoop S V Shah
- Department of Non-Communicable Disease, London School of Hygiene and Tropical Medicine, London, UK
| | - Isabella Kardys
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Eric J Brunner
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Nicholas L Mills
- British Heart Foundation/University Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, EH16 4SA, UK.
- Usher Institute, University of Edinburgh, Edinburgh, UK.
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4
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Lång M, Jakob SM, Takala R, Lyngbakken MN, Turpeinen A, Omland T, Merz TM, Wiegand J, Grönlund J, Rahi M, Valtonen M, Koivisto T, Røsjø H, Bendel S. The prevalence of cardiac complications and their impact on outcomes in patients with non-traumatic subarachnoid hemorrhage. Sci Rep 2022; 12:20109. [PMID: 36418906 PMCID: PMC9684538 DOI: 10.1038/s41598-022-24675-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022] Open
Abstract
Subarachnoid hemorrhage (SAH) is a serious condition, and a myocardial injury or dysfunction could contribute to the outcome. We assessed the prevalence and prognostic impact of cardiac involvement in a cohort with SAH. This is a prospective observational multicenter study. We included 192 patients treated for non-traumatic subarachnoid hemorrhage. We performed ECG recordings, echocardiographic examinations, and blood sampling within 24 h of admission and on days 3 and 7 and at 90 days. The primary endpoint was the evidence of cardiac involvement at 90 days, and the secondary endpoint was to examine the prevalence of a myocardial injury or dysfunction. The median age was 54.5 (interquartile range [IQR] 48.0-64.0) years, 44.3% were male and the median World Federation of Neurological Surgeons (WFNS) score was 2 (IQR 1-4). At day 90, 22/125 patients (17.6%) had left ventricular ejection fractions ≤ 50%, and 2/121 patients (1.7%) had evidence of a diastolic dysfunction as defined by mitral peak E-wave velocity by peak e' velocity (E/e') > 14. There was no prognostic impact from echocardiographic evidence of cardiac complications on neurological outcomes. The overall prevalence of cardiac dysfunction was modest. We found no demographic or SAH-related factors associated with 90 days cardiac dysfunction.
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Affiliation(s)
- Maarit Lång
- grid.9668.10000 0001 0726 2490Department of Intensive Care Medicine, Kuopio University Hospital, University of Eastern Finland, PO BOX 100, 70029 KYS Kuopio, Finland
| | - Stephan M. Jakob
- grid.5734.50000 0001 0726 5157Department of Intensive Care Medicine, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Riikka Takala
- grid.1374.10000 0001 2097 1371Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital, Anaesthesiology, Intensive Care, Emergency Care and Pain Medicine, University of Turku, Turku, Finland
| | - Magnus N. Lyngbakken
- grid.5510.10000 0004 1936 8921Division of Medicine, Department of Cardiology, Akershus University Hospital, Lørenskog, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anu Turpeinen
- grid.410705.70000 0004 0628 207XDepartment of Cardiology, Kuopio University Hospital, University of Eastern Finad, Kuopio, Finland
| | - Torbjørn Omland
- grid.5510.10000 0004 1936 8921Division of Medicine, Department of Cardiology, Akershus University Hospital, Lørenskog, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Tobias M. Merz
- grid.5734.50000 0001 0726 5157Department of Intensive Care Medicine, University Hospital of Bern, University of Bern, Bern, Switzerland ,grid.414055.10000 0000 9027 2851Present Address: Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
| | - Jan Wiegand
- grid.5734.50000 0001 0726 5157Department of Intensive Care Medicine, University Hospital of Bern, University of Bern, Bern, Switzerland ,grid.415941.c0000 0004 0509 4333Present Address: Intensive Care Unit, Lindenhofspital, Bern, Switzerland
| | - Juha Grönlund
- grid.1374.10000 0001 2097 1371Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital, Anaesthesiology, Intensive Care, Emergency Care and Pain Medicine, University of Turku, Turku, Finland
| | - Melissa Rahi
- grid.1374.10000 0001 2097 1371Neurocenter, Department of Neurosurgery, Turku University Hospital, University of Turku, Turku, Finland
| | - Mika Valtonen
- grid.1374.10000 0001 2097 1371Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital, Anaesthesiology, Intensive Care, Emergency Care and Pain Medicine, University of Turku, Turku, Finland
| | - Timo Koivisto
- grid.9668.10000 0001 0726 2490Department of Neurosurgery, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Helge Røsjø
- grid.5510.10000 0004 1936 8921Division for Research and Innovation, Akershus University Hospital, Lørenskog, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Stepani Bendel
- grid.9668.10000 0001 0726 2490Department of Intensive Care Medicine, Kuopio University Hospital, University of Eastern Finland, PO BOX 100, 70029 KYS Kuopio, Finland
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5
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Roenningen PS, Lyngbakken MN, Solberg MG, Berge T, Brynildsen J, Aagaard EN, Kvisvik B, Rosjo H, Steine K, Tveit A, Omland T. Prediction of incident atrial fibrillation with GDF-15 and echocardiographic left atrial volumes: data from the Akershus cardiac examination 1950 study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.522] [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
Left atrial structural remodeling is associated with the risk of incident atrial fibrillation, but there is uncertainty as to what echocardiographic left atrial indices that best predict incident atrial fibrillation. GDF-15 is a marker of oxidative stress and inflammation that is closely associated with the risk of stroke, bleeding and mortality in patients with atrial fibrillation. There is, however, limited data regarding its relation with left atrial remodeling and incident atrial fibrillation in the general population.
Purpose
To investigate the association between GDF-15 and left atrial volumes, and their prognostic properties for incident atrial fibrillation in a general population cohort.
Methods
The Akershus Cardiac Examination 1950 Study is a population-based cohort of individuals born in 1950. Comprehensive baseline examinations were performed for 3706 study participants in 2012–2015. Left atrial maximum and minimum volumes were measured, indexed to body surface area yielding LAVimax and LAVimin. Left atrial emptying fraction (LAEF) was calculated as ((LAVimax - LAVimin)/LAVimax)x100%. Individuals with known atrial fibrillation at baseline (n=166) were excluded, leaving 3540 included in this analysis. National health registries provided clinical outcome data regarding atrial fibrillation and death from any cause. Incident atrial fibrillation cases were validated by health records. Atrial flutter was included in the outcome definition. The CHARGE-AF risk score for atrial fibrillation was quantified. Prediction of incident atrial fibrillation was assessed by Cox proportional hazards regression models and visualised by Kaplan-Meier plots.
Results
Mean age at baseline was 63.9±0.7 years and 1763 (49.8%) were female. GDF-15 correlated weakly with LAVimax (r=−0.07, p<0.001) and LAVimin (r=−0.05 p=0.007), but not with LAEF (r=−0.01, p=0.61). During a median follow-up of 6.4 years, incident atrial fibrillation occurred in 135 (3.8%) individuals. Subjects who developed atrial fibrillation had larger LAVimax (30.1±8.3 vs. 26.2±6.9 mL/m2; p<0.001), larger LAVimin (17.1±7.1 vs. 14.1±4.7 mL/m2; p<0.001), and lower LAEF (44.3±10.7 vs. 46.3±9.0%; p=0.019). Concentrations of GDF-15 were not significantly different in those who experienced atrial fibrillation (median 850 [670–1107] vs. 790 [630–1020] ng/L; p=0.06). Left atrial volumes and LAEF, but not GDF-15, were associated with incident atrial fibrillation (Table 1 and Figure 1).
Conclusions
In this population-based cohort study, LAVimax, LAVimin, and LAEF predicted incident atrial fibrillation independently of the CHARGE-AF risk score. GDF-15 was not significantly associated with left atrial structural remodeling or with increased risk of incident atrial fibrillation.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Vestre Viken HF, Hospital TrustAkershus University Hospital
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Affiliation(s)
| | | | | | - T Berge
- Baerum Hospital , Baerum , Norway
| | - J Brynildsen
- Akershus University Hospital , Akershus , Norway
| | - E N Aagaard
- Akershus University Hospital , Akershus , Norway
| | - B Kvisvik
- Akershus University Hospital , Akershus , Norway
| | - H Rosjo
- Akershus University Hospital , Akershus , Norway
| | - K Steine
- Akershus University Hospital , Akershus , Norway
| | - A Tveit
- Baerum Hospital , Baerum , Norway
| | - T Omland
- Akershus University Hospital , Akershus , Norway
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6
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Aagaard EN, Lyngbakken MN, Kvisvik B, Berge T, Pervez MO, Ariansen I, Tveit A, Steine K, Røsjø H, Omland T. Associations between cardiovascular risk factors, biomarkers, and left ventricular mechanical dispersion: insights from the ACE 1950 Study. European Heart Journal Open 2022; 2:oeac006. [PMID: 35919126 PMCID: PMC9242045 DOI: 10.1093/ehjopen/oeac006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/22/2022] [Indexed: 11/14/2022]
Abstract
Aims Mechanical dispersion measures left ventricular contraction heterogeneity and is associated with the risk of sudden cardiac death. However, the associations between mechanical dispersion and cardiovascular risk factors in early mid-life, and established biomarkers of sub-clinical myocardial injury and dysfunction are not known. We aimed to examine this in the general population. Methods and results During 2012–15, we included 2527 Norwegian individuals from the general population born in 1950, with measurements of mechanical dispersion by 2D speckle tracking echocardiography and concentrations of high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) available. Mechanical dispersion was calculated as the standard deviation of the contraction duration of 17 strain segments. We assessed the associations between mechanical dispersion, concentrations of hs-cTnT and NT-proBNP, and cardiovascular risk factors collected at a national health screening survey two decades earlier. At echocardiography baseline, median age was 64 (interquartile range 63.5–64.5) years, 49.8% were women, 59.1% had hypertension, and 5.9% reported established coronary artery disease. Median mechanical dispersion was 38.0 (29.5–47.0) ms, median hs-cTnT concentration 6 (4–8) ng/L, and the median NT-proBNP concentration 54 (34–93) ng/L. Mechanical dispersion was associated with both hs-cTnT and NT-proBNP concentrations in multivariable models adjusted for clinical and echocardiographic variables. High body mass index, serum triglyceride concentrations, and low resting heart rate at Age 40 were independently associated with increased mechanical dispersion two decades later. Conclusion Established risk factors at Age 40 are associated with mechanical dispersion two decades later, and mechanical dispersion is cross-sectionally associated with biomarkers of subclinical myocardial injury and dysfunction.
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Affiliation(s)
- Erika N Aagaard
- Division of Medicine, Department of Cardiology, Akershus University Hospital , Lørenskog, Norway
- Faculty of Medicine, Institute for Clinical Medicine, University of Oslo , Oslo, Norway
| | - Magnus N Lyngbakken
- Division of Medicine, Department of Cardiology, Akershus University Hospital , Lørenskog, Norway
- Faculty of Medicine, Institute for Clinical Medicine, University of Oslo , Oslo, Norway
| | - Brede Kvisvik
- Division of Medicine, Department of Cardiology, Akershus University Hospital , Lørenskog, Norway
- Faculty of Medicine, Institute for Clinical Medicine, University of Oslo , Oslo, Norway
| | - Trygve Berge
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust , Norway
| | - Mohammad O Pervez
- Division of Medicine, Department of Cardiology, Akershus University Hospital , Lørenskog, Norway
| | - Inger Ariansen
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health , Oslo, Norway
| | - Arnljot Tveit
- Faculty of Medicine, Institute for Clinical Medicine, University of Oslo , Oslo, Norway
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust , Norway
| | - Kjetil Steine
- Division of Medicine, Department of Cardiology, Akershus University Hospital , Lørenskog, Norway
- Faculty of Medicine, Institute for Clinical Medicine, University of Oslo , Oslo, Norway
| | - Helge Røsjø
- Faculty of Medicine, Institute for Clinical Medicine, University of Oslo , Oslo, Norway
- Division of Research and Innovation, Akershus University Hospital , Sykehusveien 25, 1478 Lørenskog, Norway
| | - Torbjørn Omland
- Division of Medicine, Department of Cardiology, Akershus University Hospital , Lørenskog, Norway
- Faculty of Medicine, Institute for Clinical Medicine, University of Oslo , Oslo, Norway
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7
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Moksnes MR, Røsjø H, Richmond A, Lyngbakken MN, Graham SE, Hansen AF, Wolford BN, Gagliano Taliun SA, LeFaive J, Rasheed H, Thomas LF, Zhou W, Aung N, Surakka I, Douville NJ, Campbell A, Porteous DJ, Petersen SE, Munroe PB, Welsh P, Sattar N, Smith GD, Fritsche LG, Nielsen JB, Åsvold BO, Hveem K, Hayward C, Willer CJ, Brumpton BM, Omland T. Genome-wide association study of cardiac troponin I in the general population. Hum Mol Genet 2021; 30:2027-2039. [PMID: 33961016 PMCID: PMC8522636 DOI: 10.1093/hmg/ddab124] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 04/23/2021] [Accepted: 04/27/2021] [Indexed: 11/16/2022] Open
Abstract
Circulating cardiac troponin proteins are associated with structural heart disease and predict incident cardiovascular disease in the general population. However, the genetic contribution to cardiac troponin I (cTnI) concentrations and its causal effect on cardiovascular phenotypes are unclear. We combine data from two large population-based studies, the Trøndelag Health Study and the Generation Scotland Scottish Family Health Study, and perform a genome-wide association study of high-sensitivity cTnI concentrations with 48 115 individuals. We further use two-sample Mendelian randomization to investigate the causal effects of circulating cTnI on acute myocardial infarction (AMI) and heart failure (HF). We identified 12 genetic loci (8 novel) associated with cTnI concentrations. Associated protein-altering variants highlighted putative functional genes: CAND2, HABP2, ANO5, APOH, FHOD3, TNFAIP2, KLKB1 and LMAN1. Phenome-wide association tests in 1688 phecodes and 83 continuous traits in UK Biobank showed associations between a genetic risk score for cTnI and cardiac arrhythmias, metabolic and anthropometric measures. Using two-sample Mendelian randomization, we confirmed the non-causal role of cTnI in AMI (5948 cases, 355 246 controls). We found indications for a causal role of cTnI in HF (47 309 cases and 930 014 controls), but this was not supported by secondary analyses using left ventricular mass as outcome (18 257 individuals). Our findings clarify the biology underlying the heritable contribution to circulating cTnI and support cTnI as a non-causal biomarker for AMI in the general population. Using genetically informed methods for causal inference helps inform the role and value of measuring cTnI in the general population.
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Affiliation(s)
- Marta R Moksnes
- Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology, NTNU - Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Helge Røsjø
- Division of Research and Innovation, Akershus University Hospital, 1478 Lørenskog, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, 0316 Oslo, Norway
| | - Anne Richmond
- MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Magnus N Lyngbakken
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, 0316 Oslo, Norway
- Division of Medicine, Department of Cardiology, Akershus University Hospital, 1478 Lørenskog, Norway
| | - Sarah E Graham
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Ailin Falkmo Hansen
- Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology, NTNU - Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Brooke N Wolford
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Sarah A Gagliano Taliun
- Faculty of Medicine, Université de Montréal, Montréal, QC H3T 1J4, Canada
- Montréal Heart Institute, Montréal, QC H1T 1C8, Canada
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
- Center for Statistical Genetics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Jonathon LeFaive
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
- Center for Statistical Genetics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Humaira Rasheed
- Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology, NTNU - Norwegian University of Science and Technology, 7491 Trondheim, Norway
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol BS8 2BN, UK
| | - Laurent F Thomas
- Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology, NTNU - Norwegian University of Science and Technology, 7491 Trondheim, Norway
- Department of Clinical and Molecular Medicine, NTNU - Norwegian University of Science and Technology, 7491 Trondheim, Norway
- BioCore - Bioinformatics Core Facility, NTNU - Norwegian University of Science and Technology, 7491 Trondheim. Norway
- Clinic of Laboratory Medicine, St. Olavs Hospital, Trondheim University Hospital, 7491 Trondheim, Norway
| | - Wei Zhou
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI 48109, USA
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
| | - Nay Aung
- William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- National Institute for Health Research Barts Cardiovascular Biomedical Research Centre, Queen Mary University of London, London E1 4NS, UK
- Barts Heart Centre, St. Bartholomew’s Hospital, Barts Health NHS Trust, London EC1A 7BE, UK
| | - Ida Surakka
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Nicholas J Douville
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Archie Campbell
- Medical Genetics Section, CGEM, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - David J Porteous
- Medical Genetics Section, CGEM, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Steffen E Petersen
- William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- National Institute for Health Research Barts Cardiovascular Biomedical Research Centre, Queen Mary University of London, London E1 4NS, UK
- Barts Heart Centre, St. Bartholomew’s Hospital, Barts Health NHS Trust, London EC1A 7BE, UK
| | - Patricia B Munroe
- William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- National Institute for Health Research Barts Cardiovascular Biomedical Research Centre, Queen Mary University of London, London E1 4NS, UK
| | - Paul Welsh
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8TA, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8TA, UK
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol BS8 2BN, UK
| | - Lars G Fritsche
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
- Center for Statistical Genetics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Jonas B Nielsen
- Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology, NTNU - Norwegian University of Science and Technology, 7491 Trondheim, Norway
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Epidemiology Research, Statens Serum Institute, 2300 Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Bjørn Olav Åsvold
- Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology, NTNU - Norwegian University of Science and Technology, 7491 Trondheim, Norway
- Department of Public Health and Nursing, HUNT Research Centre, NTNU - Norwegian University of Science and Technology, 7600 Levanger, Norway
- Department of Endocrinology, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Kristian Hveem
- Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology, NTNU - Norwegian University of Science and Technology, 7491 Trondheim, Norway
- Department of Public Health and Nursing, HUNT Research Centre, NTNU - Norwegian University of Science and Technology, 7600 Levanger, Norway
| | - Caroline Hayward
- MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Cristen J Willer
- Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology, NTNU - Norwegian University of Science and Technology, 7491 Trondheim, Norway
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Human Genetics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Ben M Brumpton
- Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology, NTNU - Norwegian University of Science and Technology, 7491 Trondheim, Norway
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol BS8 2BN, UK
- Clinic of Thoracic and Occupational Medicine, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Torbjørn Omland
- Division of Research and Innovation, Akershus University Hospital, 1478 Lørenskog, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, 0316 Oslo, Norway
- Division of Medicine, Department of Cardiology, Akershus University Hospital, 1478 Lørenskog, Norway
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8
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Sigurdardottir FD, Lyngbakken MN, Hveem K, Strøm HH, Røsjø H, Redline S, Omland T. Insomnia symptoms and subclinical myocardial injury: Data from the Nord-Trøndelag Health (HUNT) study. J Sleep Res 2021; 30:e13299. [PMID: 33629480 PMCID: PMC8382789 DOI: 10.1111/jsr.13299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/10/2021] [Accepted: 01/15/2021] [Indexed: 11/29/2022]
Abstract
Insomnia symptoms are associated with increased risk of heart failure (HF) and cardiovascular (CV) mortality. We hypothesised that insomnia symptoms are cross-sectionally associated with increased cardiac troponin I (cTnI), a biomarker of subclinical myocardial injury, and that phenotyping by insomnia symptoms and cTnI enhances longitudinal risk stratification in the general population. In a population-based study, cTnI was measured in 8,398 participants (median age 49 years, 55% women), who had answered questionnaires regarding insomnia symptoms. Association between cTnI and insomnia symptoms was assessed by linear regression analysis for each response category of a sleep questionnaire. Insomnia symptoms were defined as having difficulty falling asleep almost every night, difficulty maintaining sleep almost every night, and/or non-restorative sleep once a week or more. The primary outcome measure was a composite endpoint of CV mortality or first admission for HF. In all, 844 participants reported insomnia symptoms, 585 (69%) were women. Those with insomnia symptoms had marginally, but significantly higher median cTnI than those without insomnia symptoms, (median [interquartile range] 3.4 [2.4-5.2] ng/L versus 3.2 [2.2-4.9] ng/L; p = .014), but there was no association between any insomnia symptom and cTnI in unadjusted linear regression models (β 0.06, 95% confidence interval [CI] -0.01 to 0.12). In adjusted analyses, participants with insomnia symptoms and increased cTnI were at increased risk of the composite endpoint (hazard ratio 1.71, 95% CI 1.04-2.79) compared to participants with insomnia symptoms and low cTnI. In the general population, insomnia symptoms are not associated with biochemical evidence of subclinical myocardial injury.
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Affiliation(s)
- Fjola D. Sigurdardottir
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
- Cardiovascular Research Group, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Magnus N. Lyngbakken
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
- Cardiovascular Research Group, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kristian Hveem
- HUNT Research Centre, Department of Public Health and General Practice, Norwegian University of Science and Technology, Levanger, Norway
| | - Harald Hrubos Strøm
- Division of Surgery, department of Ear, Nose and Throat, Akershus University Hospital, Lørenskog, Norway
- University of Oslo, Medical faculty, Institute of basic medical sciences, department of behavioural sciences
| | - Helge Røsjø
- Cardiovascular Research Group, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Torbjørn Omland
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
- Cardiovascular Research Group, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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9
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Aagaard EN, Kvisvik B, Pervez MO, Lyngbakken MN, Berge T, Enger S, Orstad EB, Smith P, Omland T, Tveit A, Røsjø H, Steine K. Left ventricular mechanical dispersion in a general population: Data from the Akershus Cardiac Examination 1950 study. Eur Heart J Cardiovasc Imaging 2021; 21:183-190. [PMID: 31504360 DOI: 10.1093/ehjci/jez210] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/22/2019] [Indexed: 12/24/2022] Open
Abstract
AIMS Increased left ventricular mechanical dispersion by 2D speckle tracking echocardiography predicts ventricular arrhythmias in ischaemic heart disease and heart failure. However, little is known about mechanical dispersion in the general population. We aimed to study mechanical dispersion in the general population and in diseases associated with increased risk of cardiovascular disease. METHODS AND RESULTS The present cross-sectional study consists of 2529 subjects born in 1950 included in the Akershus Cardiac Examination (ACE) 1950 study. Global longitudinal strain (GLS) was assessed from 17 strain segments, and mechanical dispersion calculated as the standard deviation of contraction duration of all segments. The cohort was divided according to the median value of mechanical dispersion, and multivariable linear regression models were performed with mechanical dispersion as the dependent variable. The prevalence of coronary artery disease (CAD), hypertension, obesity, and diabetes (P < 0.01 for all) was significantly higher in subjects with supra-median mechanical dispersion. In a multivariable clinical model, CAD (B = 7.05), hypertension (B = 4.15; both P < 0.001), diabetes (B = 3.39), and obesity (B = 1.89; both P < 0.05) were independently associated with increasing mechanical dispersion. When echocardiographic indices were added to the multivariable model, CAD (B = 4.38; P < 0.01) and hypertension (B = 2.86; P < 0.001) remained significant in addition to peak early diastolic tissue velocity e' (B = -2.00), GLS (B = 1.68), and ejection fraction (B = 0.22; P < 0.001 for all). CONCLUSION In a general middle-aged population, prevalent CAD and hypertension were associated with increasing mechanical dispersion, possibly indicating elevated risk of fatal arrhythmias and sudden cardiac death. Albeit weaker, systolic and diastolic dysfunction, were also associated with increasing mechanical dispersion.
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Affiliation(s)
- Erika N Aagaard
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Postbox 1000, 1478 Lørenskog, Norway.,Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Postbox 1078 Blindern, 0316 Oslo, Norway
| | - Brede Kvisvik
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Postbox 1000, 1478 Lørenskog, Norway.,Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Postbox 1078 Blindern, 0316 Oslo, Norway
| | - Mohammad O Pervez
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Postbox 1000, 1478 Lørenskog, Norway.,Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Postbox 1078 Blindern, 0316 Oslo, Norway
| | - Magnus N Lyngbakken
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Postbox 1000, 1478 Lørenskog, Norway.,Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Postbox 1078 Blindern, 0316 Oslo, Norway
| | - Trygve Berge
- Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Postbox 1078 Blindern, 0316 Oslo, Norway.,Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Postbox 800, 3004 Drammen, Norway
| | - Steve Enger
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Postbox 800, 3004 Drammen, Norway
| | - Eivind B Orstad
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Postbox 1000, 1478 Lørenskog, Norway
| | - Pål Smith
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Postbox 1000, 1478 Lørenskog, Norway.,Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Postbox 1078 Blindern, 0316 Oslo, Norway
| | - Torbjørn Omland
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Postbox 1000, 1478 Lørenskog, Norway.,Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Postbox 1078 Blindern, 0316 Oslo, Norway
| | - Arnljot Tveit
- Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Postbox 1078 Blindern, 0316 Oslo, Norway.,Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Postbox 800, 3004 Drammen, Norway
| | - Helge Røsjø
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Postbox 1000, 1478 Lørenskog, Norway.,Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Postbox 1078 Blindern, 0316 Oslo, Norway
| | - Kjetil Steine
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Postbox 1000, 1478 Lørenskog, Norway.,Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Postbox 1078 Blindern, 0316 Oslo, Norway
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10
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Myhre PL, Lyngbakken MN, Berge T, Røysland R, Aagaard EN, Pervez O, Kvisvik B, Brynildsen J, Norseth J, Tveit A, Steine K, Omland T, Røsjø H. Diagnostic Thresholds for Pre-Diabetes Mellitus and Diabetes Mellitus and Subclinical Cardiac Disease in the General Population: Data From the ACE 1950 Study. J Am Heart Assoc 2021; 10:e020447. [PMID: 33998259 PMCID: PMC8483542 DOI: 10.1161/jaha.120.020447] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Diabetes mellitus (DM) is associated with left ventricular remodeling and incident heart failure, but the association between glycated hemoglobin A1c (HbA1c) and subclinical cardiac disease is not established. We aimed to determine the associations between HbA1c and (1) echocardiographic measures of left ventricular structure and function, and (2) cardiovascular biomarkers: cardiac troponin T, NT-proBNP (N-terminal pro-B-type natriuretic peptide), and CRP (C-reactive protein). Methods and Results Participants (n=3688) born in 1950 from the population-based ACE (Akershus Cardiac Examination) 1950 Study were classified as DM (HbA1c≥6.5% or self-reported DM), pre-DM (HbA1c 5.7%-6.5%), and no-DM (HbA1c<5.7%). DM, pre-DM, and no-DM were classified in 380 (10%), 1630 (44%), and 1678 (46%) participants, respectively. Mean age was 63.9±0.7 years, mean body mass index was 27.2±4.4 kg/m2, and 49% were women. Higher HbA1c was associated with worse left ventricular systolic (ejection fraction and global longitudinal strain) and diastolic (E/e'-ratio) function, myocardial injury (cardiac troponin T), inflammation (CRP), and impaired neurohormonal homeostasis (NT-proBNP) (P<0.001 in unadjusted and P<0.01 in adjusted analysis for all). The associations between HbA1c and cardiovascular biomarkers were independent of the echocardiographic variables, and vice versa. Associations were nonlinear (P<0.05 for nonlinearity) and appeared stronger in the pre-DM range of HbA1c than the no-DM and DM range. Conclusions HbA1c was associated with indexes of subclinical cardiovascular disease, and this was more pronounced in pre-DM. Our results suggest that cardiovascular preventive measures should be considered also in subjects with hyperglycemia and HbA1c below the established DM cutoff. Registration clinicaltrials.gov. Identifier: NCT01555411.
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Affiliation(s)
- Peder L Myhre
- Department of CardiologyAkershus University Hospital Lørenskog Norway.,Department of Multidisciplinary Laboratory Medicine and Medical BiochemistryAkershus University Hospital Lørenskog Norway
| | - Magnus N Lyngbakken
- Department of CardiologyAkershus University Hospital Lørenskog Norway.,Department of Multidisciplinary Laboratory Medicine and Medical BiochemistryAkershus University Hospital Lørenskog Norway
| | - Trygve Berge
- Department of Multidisciplinary Laboratory Medicine and Medical BiochemistryAkershus University Hospital Lørenskog Norway.,Division for Research and InnovationAkershus University Hospital Lørenskog Norway
| | - Ragnhild Røysland
- Department of Multidisciplinary Laboratory Medicine and Medical BiochemistryAkershus University Hospital Lørenskog Norway.,Institute for Clinical MedicineUniversity of Oslo Norway
| | - Erika N Aagaard
- Department of CardiologyAkershus University Hospital Lørenskog Norway.,Department of Multidisciplinary Laboratory Medicine and Medical BiochemistryAkershus University Hospital Lørenskog Norway
| | - Osman Pervez
- Department of CardiologyAkershus University Hospital Lørenskog Norway.,Department of Multidisciplinary Laboratory Medicine and Medical BiochemistryAkershus University Hospital Lørenskog Norway
| | - Brede Kvisvik
- Department of CardiologyAkershus University Hospital Lørenskog Norway.,Department of Multidisciplinary Laboratory Medicine and Medical BiochemistryAkershus University Hospital Lørenskog Norway
| | - Jon Brynildsen
- Department of CardiologyAkershus University Hospital Lørenskog Norway.,Department of Multidisciplinary Laboratory Medicine and Medical BiochemistryAkershus University Hospital Lørenskog Norway
| | - Jon Norseth
- Department of Multidisciplinary Laboratory Medicine and Medical BiochemistryAkershus University Hospital Lørenskog Norway.,Department of Medical ResearchVestre Viken Hospital Trust Bærum Norway
| | - Arnljot Tveit
- Department of Multidisciplinary Laboratory Medicine and Medical BiochemistryAkershus University Hospital Lørenskog Norway.,Division for Research and InnovationAkershus University Hospital Lørenskog Norway
| | - Kjetil Steine
- Department of CardiologyAkershus University Hospital Lørenskog Norway.,Department of Multidisciplinary Laboratory Medicine and Medical BiochemistryAkershus University Hospital Lørenskog Norway
| | - Torbjørn Omland
- Department of CardiologyAkershus University Hospital Lørenskog Norway.,Department of Multidisciplinary Laboratory Medicine and Medical BiochemistryAkershus University Hospital Lørenskog Norway
| | - Helge Røsjø
- Department of Multidisciplinary Laboratory Medicine and Medical BiochemistryAkershus University Hospital Lørenskog Norway.,Department of Laboratory MedicineVestre Viken Hospital Trust Bærum Norway
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11
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Berge K, Lyngbakken MN, Omland T, Juliebø V, Schirmer H, Røsjø H. Further learning points from a cardiological perspective. Tidsskr Nor Laegeforen 2021; 141:20-1025. [PMID: 33433094 DOI: 10.4045/tidsskr.20.1025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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12
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Ihle-Hansen H, Vigen T, Berge T, Hagberg G, Engedal K, Rønning OM, Thommessen B, Lyngbakken MN, Nygård S, Røsjø H, Tveit A, Ihle-Hansen H. Carotid Atherosclerosis and Cognitive Function in a General Population Aged 63-65 Years: Data from the Akershus Cardiac Examination (ACE) 1950 Study. J Alzheimers Dis 2020; 70:1041-1049. [PMID: 31306128 DOI: 10.3233/jad-190327] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Studies on the relationship between carotid atherosclerosis and cognitive function in subjects from the general population are few and results have been inconsistent. OBJECTIVE We aimed to investigate the association between carotid atherosclerotic burden and cognitive function in a cross-sectional analysis of a population-based cohort aged 63-65 years. METHODS All habitants born in 1950 from Akershus County, Norway were invited to participate. A linear regression model was used to assess the association between carotid atherosclerosis and cognitive function. We used carotid plaque score as a measure of carotid atherosclerotic burden and the Montreal Cognitive Assessment (MoCA) for global cognitive function. RESULTS We analyzed 3,413 individuals aged 63-65 with mean MoCA score 25.3±2.9 and 87% visible carotid plaques. We found a negative correlation between carotid plaque score and MoCA score (r = -0.14, p < 0.001), but this association was lost in multivariable analysis. In contrast, diameter or area of the thickest plaque was independently associated with MoCA score. Lower educational level, male sex, current smoking, and diabetes were also associated with lower MoCA score in multivariable analysis. CONCLUSION Carotid atherosclerotic burden was, unlike other measures of advanced carotid atherosclerosis, not independently associated with global cognitive function.
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Affiliation(s)
- Håkon Ihle-Hansen
- Department of Medical Research, B-rum Hospital, Vestre Viken Hospital Trust, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Thea Vigen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Medicine, Akershus University Hospital, L-renskog, Norway
| | - Trygve Berge
- Department of Medical Research, B-rum Hospital, Vestre Viken Hospital Trust, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Guri Hagberg
- Department of Medical Research, B-rum Hospital, Vestre Viken Hospital Trust, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Knut Engedal
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Ullevaal, Oslo, Norway
| | - Ole Morten Rønning
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Medicine, Akershus University Hospital, L-renskog, Norway
| | - Bente Thommessen
- Division of Medicine, Akershus University Hospital, L-renskog, Norway
| | - Magnus N Lyngbakken
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Medicine, Akershus University Hospital, L-renskog, Norway
| | - Ståle Nygård
- Bioinformatics Core facility, Oslo University Hospital and the University of Oslo, Norway
| | - Helge Røsjø
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Medicine, Akershus University Hospital, L-renskog, Norway
| | - Arnljot Tveit
- Department of Medical Research, B-rum Hospital, Vestre Viken Hospital Trust, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hege Ihle-Hansen
- Department of Medical Research, B-rum Hospital, Vestre Viken Hospital Trust, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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13
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Myhre PL, Lyngbakken MN, Røsjø H, Omland T. Removing stable and adding precision to chronic coronary artery disease. Int J Cardiol 2020; 316:54-56. [PMID: 32360648 DOI: 10.1016/j.ijcard.2020.04.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/22/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Peder L Myhre
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Magnus N Lyngbakken
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Helge Røsjø
- Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Division for Research and Innovation, Akershus University Hospital, Lørenskog, Norway
| | - Torbjørn Omland
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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14
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Aakre KM, Omland T, Nordstrand N, Gjevestad ES, Holven KB, Lyngbakken MN, Hjelmesæth J. Gastric bypass surgery is associated with reduced subclinical myocardial injury and greater activation of the cardiac natriuretic peptide system than lifestyle intervention. Clin Biochem 2020; 86:36-44. [PMID: 32986994 DOI: 10.1016/j.clinbiochem.2020.09.006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/09/2020] [Accepted: 09/19/2020] [Indexed: 12/18/2022]
Abstract
AIMS Morbid obesity is a risk factor for cardiovascular disease. The relative effects of Roux-en-Y gastric bypass surgery (GBS) and intensive lifestyle intervention (ILI) on subclinical myocardial injury, the activity of the cardiac natriuretic system, and systemic inflammation remain unclear. METHODS In a 59-week non-randomized clinical trial that included 131 patients with morbid obesity, we compared the effects ofGBS and ILI on concentrations of cardiac troponin T (cTnT) and I (cTnI), N-terminal pro-B-type natriuretic peptide (NT-proBNP) and C-reactive protein (CRP). RESULTS In the GBS and ILI group, median body mass index (BMI) was reduced by 14.4 kg/m2 versus 3.9 kg/m2, respectively (p value < 0.001). Cardiac troponins decreased after GBS, p = 0.014 (cTnT) and p = 0.065 (cTnI) and increased significantly in those treated with ILI (p values ≤ 0.021) (between-group differences for deltas: p ≤ 0.003). NT-proBNP increased in both groups, but significantly more in the GBS than in the ILI group (between-group differences for deltas: p = 0.008). CRP decreased significantly within the GBS and the ILI group, with this change significantly greater in the GBS group (between-group differences for deltas p < 0.001). The dominating mediator of the biomarker changes was weight loss. Prior coronary artery disease and diabetes were predictive of the magnitude of the changes in cTnI and NT-proBNP, respectively. CONCLUSION Compared to ILI, GBS was associated with reduced subclinical myocardial injury and systemic inflammation, and enhancement of the cardiac natriuretic peptide system. The biomarker changes were predominantly mediated by weight loss.
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Affiliation(s)
- Kristin M Aakre
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Torbjørn Omland
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Cardiovascular Research Group, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Njord Nordstrand
- Morbid Obesity Center, Vestfold Hospital Trust, Tønsberg, Norway
| | | | - Kirsten B Holven
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway; Norwegian National Advisory Unit on Familial Hypercholesterolemia, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Magnus N Lyngbakken
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Cardiovascular Research Group, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jøran Hjelmesæth
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, Norway
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15
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Røsjø H, Hijazi Z, Omland T, Westerbergh J, Lyngbakken MN, Alexander JH, Gersh BJ, Granger CB, Hylek EM, Lopes RD, Siegbahn A, Wallentin L. Cardiac troponin is associated with cardiac outcomes in men and women with atrial fibrillation, insights from the ARISTOTLE trial. J Intern Med 2020; 288:248-259. [PMID: 32350915 DOI: 10.1111/joim.13072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/11/2020] [Accepted: 03/30/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Cardiac troponin T (cTnT) and I (cTnI) concentrations provide strong prognostic information in anticoagulated patients with atrial fibrillation (AF). Whether the associations between cardiac troponin concentrations and mortality and morbidity differ by sex is not known. OBJECTIVES To assess whether men and women have different concentrations and prognostic value of cTnT and cTnI measurements in anticoagulated patients with AF. METHODS cTnT and cTnI concentrations were measured with high-sensitivity (hs) assays in EDTA plasma samples obtained from the multicentre ARISTOTLE trial, which randomized patients with AF and at least one risk factor for stroke or systemic embolic event to warfarin or apixaban. Patients were stratified according to sex and the associations between hs-troponin concentrations, and all-cause death, cardiac death, myocardial infarction, stroke or systemic embolic event and major bleeding were assessed in multivariable regression models. RESULTS We found higher cardiac troponin concentrations in men (n = 9649) compared to women (n = 5331), both for hs-cTnT (median 11.8 [Q1-3 8.1-18.0] vs. 9.6 [6.7-14.3] ng L-1 , P < 0.001) and hs-cTnI (5.8 [3.4-10.8] vs. 4.9 [3.1-8.8] ng L-1 , P < 0.001). Adjusting for baseline demographics, comorbidities and medications, men still had significantly higher hs-troponin concentrations than women. C-reactive protein and N-terminal pro-B-type natriuretic peptide concentrations were higher in female patients. Both hs-cTnT and hs-cTnI concentrations were associated with all clinical outcomes similarly in men and women (p-value for interaction >0.05 for all end-points). CONCLUSION Men have higher hs-troponin concentrations than women in AF. Regardless of sex, hs-troponin concentrations remain similarly associated with adverse clinical outcomes in anticoagulated patients with AF.
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Affiliation(s)
- H Røsjø
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.,Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Z Hijazi
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.,Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - T Omland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - J Westerbergh
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - M N Lyngbakken
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - J H Alexander
- Duke Clinical Research Institute, Duke Health, Durham, NC, USA
| | - B J Gersh
- Mayo Clinic College of Medicine, Rochester, MN, USA
| | - C B Granger
- Duke Clinical Research Institute, Duke Health, Durham, NC, USA
| | - E M Hylek
- Boston University Medical Center, Boston, MA, USA
| | - R D Lopes
- Duke Clinical Research Institute, Duke Health, Durham, NC, USA
| | - A Siegbahn
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.,Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - L Wallentin
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.,Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
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16
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Selmer Roenningen P, Berge T, Solberg MG, Enger S, Nygaard S, Pervez O, Orstad EB, Kvisvik BA, Aagaard EN, Lyngbakken MN, Ariansen I, Rosjo H, Steine K, Tveit A. P1270 Systolic blood pressure at age 40 is associated with left atrial volumes at age 64. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.720] [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
Funding Acknowledgements
Vestre Viken Hospital Trust
Background
Left atrial (LA) enlargement is associated with elevated blood pressure (BP) and with cardiovascular morbidity and mortality. In the assessment of LA size, echocardiographic guidelines recommend the use of LA end-systolic volume (LAVmax). LA end-diastolic volume (LAVmin) and LA emptying fraction (LAEF) may add valuable information in risk assessment. The knowledge of early adulthood BP and its association to LA volumes and LAEF later in life is limited.
Purpose
To explore the association between systolic BP at age 40 and LA volumes and LAEF at age 64.
Methods
We linked data from subjects who had participated in both a nationwide cardiovascular screening survey (1990-1991) at the age of 40, and the Akershus Cardiac Examination (ACE) 1950 Study (2012-2015) at the age of 64 (n = 2,597). In the ACE 1950 Study, LAVmax and LAVmin were measured with echocardiography according to the summation of discs method. LAEF was calculated as (LAVmax-LAVmin/LAVmax)x100%. The association between systolic BP at age 40 and LA volumes and LAEF at age 64 was assessed in univariate and multivariate linear regression analyses.
Results
Systolic BP at age 40 was associated with LAVmax and LAVmin but not with LAEF at age 64. In our multivariate model, a 10 mm Hg higher systolic BP at age 40 was associated with a 0.9 ml greater LA end-systolic volume and a 0.5 ml greater LA end-diastolic volume at age 64.
Conclusion
Early adulthood systolic BP is associated with LA volumes 24 years later in life.
Table. Association of systolic blood pressure at age 40 to left atrial (LA) volumes and LAEF at age 64 Univariate Multivariate* Dependent variable B (95% CI) p-value B (95% CI) p-value LAVmax (ml) 2.4 (2.0, 2.9) <0.001 0.9 (0.4, 1.4) 0.001 LAVmin (ml) 1.5 (1.1, 1.8) <0.001 0.5 (0.1, 0.9) 0.015 LAEF (%) -0.01 (-0.3, 0.3) 0.938 0.2 (-0.2, 0.5) 0.294 *Adjusted for gender, body mass index, smoking, resting heart rate and antihypertensive treatment, all assessed at age 40. B (95% CI), regression coefficient for systolic blood pressure (per 10 mm Hg) with 95% confidence interval; LAVmax, LA end-systolic volume; LAVmin LA end-diastolic volume; LAEF, LA emptying fraction
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Affiliation(s)
| | - T Berge
- Baerum Hospital, Department of Medical Research, Baerum, Norway
| | - M G Solberg
- Baerum Hospital, Department of Medical Research, Baerum, Norway
| | - S Enger
- Baerum Hospital, Department of Medical Research, Baerum, Norway
| | - S Nygaard
- University of Oslo, Department of Informatics, Oslo, Norway
| | - O Pervez
- Akershus University Hospital, Division of Medicine, Akershus, Norway
| | - E B Orstad
- Akershus University Hospital, Division of Medicine, Akershus, Norway
| | - B A Kvisvik
- Akershus University Hospital, Division of Medicine, Akershus, Norway
| | - E N Aagaard
- Akershus University Hospital, Division of Medicine, Akershus, Norway
| | - M N Lyngbakken
- Akershus University Hospital, Division of Medicine, Akershus, Norway
| | - I Ariansen
- Norwegian Institute of Public Health, Oslo, Norway
| | - H Rosjo
- Akershus University Hospital, Division of Medicine, Akershus, Norway
| | - K Steine
- Akershus University Hospital, Division of Medicine, Akershus, Norway
| | - A Tveit
- Baerum Hospital, Department of Medical Research, Baerum, Norway
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17
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Selmer Roenningen P, Berge T, Solberg MG, Enger S, Nygaard S, Pervez O, Orstad EB, Kvisvik BA, Aagaard EN, Lyngbakken MN, Rosjo H, Tveit A, Steine K. 103 Normal values and gender differences of left atrial volumes. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Vestre Viken Hospital Trust
Background
Left atrial (LA) enlargement is associated with cardiovascular morbidity and mortality. Echocardiographic guidelines recommend body surface area (BSA) indexed LA end-systolic volume (LAVimax) in the assessment of LA size with an upper normal limit of 34 ml/m² for both genders and all age groups. LA end-diastolic volume (LAVimin) and LA emptying fraction (LAEF) may add valuable information in risk assessment, but there are limited data on normal values.
Purpose
To add knowledge and explore gender differences of LA volumetric measures.
Methods
In The Akershus Cardiac Examination 1950 Study, all inhabitants of Akershus County, Norway, born in 1950 were invited. In 3,489 individuals LAVmax and LAVmin were measured with echocardiography according to the summation of discs method and indexed to BSA. LAEF was calculated. A healthy group was defined by excluding those with heart failure, atrial fibrillation, coronary artery disease, stroke, hypertension, diabetes, chronic obstructive pulmonary disease, body mass index > 30kg/m², eGFR < 60 ml/min/1.73 m², left ventricular ejection fraction < 50%, E/e’>14 and E/A > 2.0. Data are presented as mean ± standard deviation (SD) and a normal range of mean ± 2SD. T-tests were used for comparisons.
Results
In 840 healthy individuals, aged 63.8 ± 0.6 years, mean LAVimax was 25.6 ± 6.3 ml/m² and the normal range was 13.0-38.2 ml/m². Men had significantly larger volumes than women.
Conclusion
We present LA volumes and LAEF in a large cohort from the general population at age 64. The upper normal limit of LAVimax in 840 healthy individuals was 38 ml/m². Men had larger LA volumes than women, contrary to most previous studies. Thus, 13% of the healthy men in our cohort would be defined with an enlarged atrium with the current cut-off value at 34 ml/m².
Table. Left atrial (LA) volumes and LAEF Total (mean ± SD) Total (2SD range) Male (mean ± SD) Female (mean ± SD) P-value (male vs. female) All participants (n = 3489) LAVimax (ml/m²) 26.8 ± 7.6 11.6-42.0 27.9 ± 8.1 25.6 ± 6.8 <0.001 LAVimin (ml/m²) 14.7 ± 5.8 3.1-26.3 15.5 ± 6.5 13.9 ± 4.9 <0.001 LAEF (%) 45.6 ± 9.7 26.2-65.0 45.3 ± 10.2 45.9 ± 9.2 0.07 Healthy group (n = 840) LAVimax (ml/m²) 25.6 ± 6.3 13.0-38.2 26.6 ± 6.7 24.9 ± 5.8 <0.001 LAVimin (ml/m²) 13.7 ± 4.3 5.1-22.3 14.1 ± 4.6 13.3 ± 3.9 0.008 LAEF (%) 46.8 ± 8.8 29.2-64.4 47.0 ± 9.1 46.5 ± 8.4 0.37 LAVimax, LA end-systolic volume, body surface area (BSA)-indexed; LAVimin, LA end-diastolic volume, BSA-indexed; LAEF, LA emptying fraction; SD, standard deviation
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Affiliation(s)
| | - T Berge
- Baerum Hospital, Department of Medical Research, Baerum, Norway
| | - M G Solberg
- Baerum Hospital, Department of Medical Research, Baerum, Norway
| | - S Enger
- Baerum Hospital, Department of Medical Research, Baerum, Norway
| | - S Nygaard
- University of Oslo, Department of Informatics, Oslo, Norway
| | - O Pervez
- Akershus University Hospital, Division of Medicine, Akershus, Norway
| | - E B Orstad
- Akershus University Hospital, Division of Medicine, Akershus, Norway
| | - B A Kvisvik
- Akershus University Hospital, Division of Medicine, Akershus, Norway
| | - E N Aagaard
- Akershus University Hospital, Division of Medicine, Akershus, Norway
| | - M N Lyngbakken
- Akershus University Hospital, Division of Medicine, Akershus, Norway
| | - H Rosjo
- Akershus University Hospital, Division of Medicine, Akershus, Norway
| | - A Tveit
- Baerum Hospital, Department of Medical Research, Baerum, Norway
| | - K Steine
- Akershus University Hospital, Division of Medicine, Akershus, Norway
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18
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Vigen T, Ihle‐Hansen H, Lyngbakken MN, Berge T, Thommessen B, Ihle‐Hansen H, Orstad EB, Enger S, Røsjø H, Tveit A, Rønning OM. Carotid Atherosclerosis is Associated with Middle Cerebral Artery Pulsatility Index. J Neuroimaging 2019; 30:233-239. [DOI: 10.1111/jon.12684] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/13/2019] [Accepted: 11/13/2019] [Indexed: 01/01/2023] Open
Affiliation(s)
- Thea Vigen
- Division of Medicine Akershus University Hospital Lørenskog Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Department of Neurology Akershus University Hospital Lørenskog Norway
| | - Håkon Ihle‐Hansen
- Department of Medical Research Bærum Hospital, Vestre Viken Hospital Trust Drammen Norway
| | - Magnus N Lyngbakken
- Division of Medicine Akershus University Hospital Lørenskog Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Department of Cardiology Akershus University Hospital Lørenskog Norway
| | - Trygve Berge
- Department of Medical Research Bærum Hospital, Vestre Viken Hospital Trust Drammen Norway
| | - Bente Thommessen
- Division of Medicine Akershus University Hospital Lørenskog Norway
- Department of Neurology Akershus University Hospital Lørenskog Norway
| | - Hege Ihle‐Hansen
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Department of Medical Research Bærum Hospital, Vestre Viken Hospital Trust Drammen Norway
| | - Eivind B Orstad
- Division of Medicine Akershus University Hospital Lørenskog Norway
- Department of Cardiology Akershus University Hospital Lørenskog Norway
| | - Steve Enger
- Department of Medical Research Bærum Hospital, Vestre Viken Hospital Trust Drammen Norway
| | - Helge Røsjø
- Division of Medicine Akershus University Hospital Lørenskog Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Department of Cardiology Akershus University Hospital Lørenskog Norway
| | - Arnljot Tveit
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Department of Medical Research Bærum Hospital, Vestre Viken Hospital Trust Drammen Norway
| | - Ole Morten Rønning
- Division of Medicine Akershus University Hospital Lørenskog Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Department of Neurology Akershus University Hospital Lørenskog Norway
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19
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Skranes JB, Claggett BL, Myhre PL, Lyngbakken MN, Solomon SD, Sabatine MS, Pfeffer MA, Omland T. Current Smoking Is Associated With Lower Concentrations of High-Sensitivity Cardiac Troponin T in Patients With Stable Coronary Artery Disease: The PEACE Trial. Circulation 2019; 140:2044-2046. [PMID: 31815543 DOI: 10.1161/circulationaha.119.041991] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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)
- Julia B Skranes
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway (J.B.S., P.L.M., M.N.L., T.O.).,Center for Heart Failure Research, Institute of Clinical Medicine, University of Oslo, Norway (J.B.S., P.L.M., M.N.L., T.O.)
| | - Brian L Claggett
- Division of Cardiovascular Medicine (B.L.C., S.D.S., M.A.P.), Brigham and Women's Hospital, and Harvard Medical School, Boston, MA
| | - Peder L Myhre
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway (J.B.S., P.L.M., M.N.L., T.O.).,Center for Heart Failure Research, Institute of Clinical Medicine, University of Oslo, Norway (J.B.S., P.L.M., M.N.L., T.O.)
| | - Magnus N Lyngbakken
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway (J.B.S., P.L.M., M.N.L., T.O.).,Center for Heart Failure Research, Institute of Clinical Medicine, University of Oslo, Norway (J.B.S., P.L.M., M.N.L., T.O.)
| | - Scott D Solomon
- Division of Cardiovascular Medicine (B.L.C., S.D.S., M.A.P.), Brigham and Women's Hospital, and Harvard Medical School, Boston, MA
| | - Marc S Sabatine
- The Thrombolysis in Myocardial Infarction (TIMI) Study Group, Division of Cardiovascular Medicine (M.S.S.), Brigham and Women's Hospital, and Harvard Medical School, Boston, MA
| | - Marc A Pfeffer
- Division of Cardiovascular Medicine (B.L.C., S.D.S., M.A.P.), Brigham and Women's Hospital, and Harvard Medical School, Boston, MA
| | - Torbjørn Omland
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway (J.B.S., P.L.M., M.N.L., T.O.).,Center for Heart Failure Research, Institute of Clinical Medicine, University of Oslo, Norway (J.B.S., P.L.M., M.N.L., T.O.)
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20
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Rutkovskiy A, Lyngbakken MN, Dahl MB, Bye A, Pedersen MH, Wisloff U, Christensen G, Hoiseth AD, Omland T, Rosjo H. P3528Circulating microRNA-210 concentrations are increased in patients with acute heart failure and provide prognostic information. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0392] [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
MicroRNA (miR)-210 is induced by cellular hypoxia and circulating miR-210 concentrations are associated with clinical outcome in patients with myocardial infarction and aortic stenosis. Whether circulating miR-210 concentrations provide diagnostic and prognostic information in unselected patients with dyspnea is not known.
Purpose
To assess the diagnostic and prognostic value of circulating miR-210 concentrations in patients hospitalised due to acute dyspnea.
Methods
We extracted microRNA from plasma samples obtained on admission from 314 patients hospitalised for acute dyspnea and 10 healthy control subjects. miR-210 concentrations were measured by quantitative polymerase chain reaction and we used miR-425 for normalisation. The merit of circulating miR-210 concentrations to diagnose and provide prognostic information in patients with acute heart failure (HF) was compared to the merit of N-terminal pro-B-type natriuretic peptide (NT-proBNP).
Results
In total, 143 patients (46%) were adjudicated as hospitalised due to acute heart failure (HF) and 84 patients (27%) due to acute exacerbation of chronic obstructive lung disease (AECOPD). All patients and control subjects had miR-210 concentrations within the range of detection (Cq 26–32) and analytical variation was low. miR-210 concentrations correlated with age, NT-proBNP and cardiac troponin T concentrations in the total cohort. Circulating miR-210 concentrations were increased in patients with HF (4.7±3.3 fold increase, p<0.0001) and AECOPD (3.4±1.7 fold increase, p<0.0001) compared to control subjects. Circulating miR-210 concentrations were not different between patient groups and receiver operating characteristics area under the curve (AUC) for miR-210 to diagnose acute HF was 0.50 (95% CI 0.43–0.57) compared to AUC 0.85 (0.81–0.89) for NT-proBNP. During a median 817 days of follow-up, 66 patients (46%) with acute HF died and 35 patients (42%) with AECOPD died. Circulating miR-210 concentrations separated acute HF patients with a poor and favourable outcome (Figure 1; p by the log rank test =0.017). Circulating miR-210 concentrations were also associated with mortality during follow-up in Cox regression model: hazard ratio (HR) for lnRQ of miR-210 was 2.11 (95% CI 1.27–2.50), p=0.004. The association between circulating miR-210 concentrations and outcome was attenuated and no longer significant after adjusting for NT-proBNP concentrations. Circulating miR-210 concentrations did not predict outcome in patients with AECOPD: HR 1.38 (0.65–2.93); p=0.4.
Figure 1
Conclusions
Circulating miR-210 concentrations are increased in patients with acute HF, and provide prognostic information during follow-up. Still, circulating miR-210 concentrations did not diagnose acute HF among unselected patients with dyspnea and the association with outcome was attenuated by NT-proBNP.
Acknowledgement/Funding
Nasjonalforeningen for Folkehelsen
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Affiliation(s)
- A Rutkovskiy
- Akershus University Hospital, Division of Medicine, Lørenskog, Norway
| | - M N Lyngbakken
- Akershus University Hospital, Division of Medicine, Lørenskog, Norway
| | - M B Dahl
- Akershus University Hospital, Division of Medicine, Lørenskog, Norway
| | - A Bye
- Norwegian University of Science and Technology, K.G. Jebsen Center for Cardiovascular Health, Trondheim, Norway
| | - M H Pedersen
- Akershus University Hospital, Division of Medicine, Lørenskog, Norway
| | - U Wisloff
- Norwegian University of Science and Technology, K.G. Jebsen Center for Cardiovascular Health, Trondheim, Norway
| | - G Christensen
- Institute for Experimental Medical Research, Oslo University Hospital, Ullevaal, Oslo, Norway
| | - A D Hoiseth
- Akershus University Hospital, Division of Medicine, Lørenskog, Norway
| | - T Omland
- Akershus University Hospital, Division of Medicine, Lørenskog, Norway
| | - H Rosjo
- Akershus University Hospital, Division of Medicine, Lørenskog, Norway
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21
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Brynildsen J, Myhre PL, Lyngbakken MN, Klaeboe LG, Stridsberg M, Christensen G, Edvardsen T, Omland T, Rosjo H. P1544Circulating secretoneurin concentrations provide incremental prognostic information to established risk indices in patients with moderate to severe aortic stenosis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0306] [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
Secretoneurin (SN) concentrations provide important prognostic information in patients with myocardial dysfunction. Whether preoperative SN concentrations improve risk assessment in patients with moderate to severe aortic stenosis (AS) is unknown.
Methods
We included 57 patients with moderate to severe AS referred for presurgical evaluation and recorded all-cause mortality during follow-up. All patients were examined with comprehensive echocardiography, electrocardiogram (ECG), and high-sensitivity cardiac troponin T (hs-TnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurements.
Results
Median (quartile 1–3) SN concentration in the AS patients was 141 (121–163) pmol/L. Lower estimated creatinine clearance and use of diuretics, but not standard ECG or echocardiographic indices and cardiac biomarkers, were associated with increasing SN concentrations. In total, 15 patients (26%) died during 3.5 years median follow-up. SN concentrations were higher in non-survivors than survivors: 156 (133–209) vs. 140 (116–155) pmol/L, p=0.007. The optimal cut-off concentration for SN in discriminating long-term mortality was 147 pmol/L (sensitivity 67% [95% CI 38–88%], specificity 74% [58–86%]) and patients with SN concentrations above the optimal cut-off had worse prognosis than patients below the cut-off (Figure; p=0.005 with the log-rank test). Higher SN concentrations were associated with increased risk of mortality after adjustment for clinical risk factors, echocardiographic and ECG variables, hs-TnT and NT-proBNP concentrations, and whether patients were subjected to aortic valvular surgery (n=34): hazard ratio per lnSN 15.13 (95% CI 1.05–219.00); p=0.046. Receiver operating characteristics area under the curve for SN to predict mortality was 0.74 (95% CI 0.60–0.88) compared to 0.73 (0.59–0.87) for hs-TnT and 0.67 (0.51–0.82) for NT-proBNP.
Conclusions
SN concentrations seem to reflect additional pathophysiology to established risk indices and improve risk assessment in patients with moderate to severe AS.
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Affiliation(s)
- J Brynildsen
- University of Oslo, Akershus University Hospital, Department of Medicine, Lorenskog, Norway
| | - P L Myhre
- University of Oslo, Akershus University Hospital, Department of Medicine, Lorenskog, Norway
| | - M N Lyngbakken
- University of Oslo, Akershus University Hospital, Department of Medicine, Lorenskog, Norway
| | - L G Klaeboe
- University of Oslo, Oslo University Hospital, Department of Cardiology, Rikshospitalet, Oslo, Norway
| | - M Stridsberg
- Uppsala University, Department of Medical Sciences, Uppsala, Sweden
| | - G Christensen
- University of Oslo, Institute for Experimental Medical Research, Ulleval University Hospital, Oslo, Norway
| | - T Edvardsen
- University of Oslo, Oslo University Hospital, Department of Cardiology, Rikshospitalet, Oslo, Norway
| | - T Omland
- University of Oslo, Akershus University Hospital, Department of Medicine, Lorenskog, Norway
| | - H Rosjo
- University of Oslo, Akershus University Hospital, Department of Medicine, Lorenskog, Norway
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22
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Lyngbakken MN, Sithiravel C, Kvisvik BA, Aagaard EN, Berge T, Pervez MO, Brynildsen J, Tveit A, Steine K, Rosjo H, Omland T. P3433Growth differentiation factor 15 predicts subclinical left ventricular dysfunction: Data from the Akershus Cardiac Examination 1950 Study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0307] [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
Growth differentiation factor 15 (GDF-15) is upregulated in response to both acute and chronic cardiac injury, and concentrations of GDF-15 are increased in acute myocardial infarction and acute heart failure. Associations between GDF-15, left ventricular structure and preclinical stages of left ventricular dysfunction in the general population remain unclear.
Methods
We measured GDF-15 in 1237 women and 1158 men participating in the prospective observational Akershus Cardiac Examination (ACE) 1950 Study, which included community dwellers aged 63–65 residing in Akershus county, Norway. All study participants were free from known coronary heart disease and underwent extensive cardiovascular phenotyping at baseline, including detailed echocardiography. Regression models were constructed on global longitudinal strain (GLS), left ventricular mass index (LVMI), and left ventricular ejection fraction (LVEF), and adjusted for demographics, established cardiovascular risk factors, hs-cTnT and NT-proBNP.
Results
Concentrations of GDF-15 were measurable in 98.1% of study participants, and were positively associated with male sex, age, BMI, current smoking, diabetes mellitus, as well as concentrations C-reactive protein, hs-cTnT and NT-proBNP. Higher education, alcohol consumption, eGFR and concentrations of total cholesterol were all associated with lower concentrations of GDF-15. Concentrations of lnGDF-15 were significantly associated with GLS (B −0.44 [95% CI −0.70 to −0.18]; Figure) and LVEF (B 0.72 [95% CI 0.14–1.29]), but not LVMI (Table).
Table 1. Associations between GDF-15 and indices of left ventricular structure and function. Model 1 Model 2 Model 3 B (95% CI) GLS (n=2395) 0.17 (−0.07 to 0.42) −0.04 (−0.28 to 0.20) −0.44 (−0.70 to −0.18) LVEF (n=2383) 0.01 (−0.52 to 0.54) 0.21 (−0.31 to 0.73) 0.72 (0.14 to 1.29) LVMI (n=2371) 2.00 (0.32 to 3.68) −0.37 (−1.98 to 1.24) −0.42 (−2.16 to 1.33) OR (95% CI) GLS (n=2395) 1.35 (0.98 to 1.87) 1.28 (0.92 to 1.78) 0.81 (0.56 to 1.17) LVEF (n=2383) 1.04 (0.75 to 1.44) 0.88 (0.62 to 1.24) 0.73 (0.50 to 1.07) LVMI (n=2371) 1.27 (0.91 to 1.76) 1.12 (0.79 to 1.57) 1.11 (0.75 to 1.64) Linear regression models constructed on continuous levels of GLS, LVMI and LVEF. Logistic regression models constructed on the upper sex specific deciles of GLS and LVMI, and on the lower sex specific decile of LVEF. GDF-15, hs-cTnT and NT-proBNP were all transformed by the natural logarithm. Model 1, unadjusted. Model 2, adjusted for sex, age and study site. Model 3, adjusted for sex, age, study site, BMI, eGFR, total and HDL cholesterol, CRP, higher education, hypertension, diabetes mellitus, statin use, current smoking, alcohol consumption, hs-cTnT and NT-proBNP.
Figure 1
Conclusion
Concentrations of GDF-15 are inversely associated with GLS, a highly sensitive index of subclinical myocardial dysfunction. In healthy subjects free from known cardiovascular disease, GDF-15 appears protective and promotes beneficial cardiac function.
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Affiliation(s)
| | | | - B A Kvisvik
- Akershus University Hospital, Lorenskog, Norway
| | - E N Aagaard
- Akershus University Hospital, Lorenskog, Norway
| | - T Berge
- Bærum Hospital, Vestre Viken Hospital Trust, Department of Medical Research, Drammen, Norway
| | - M O Pervez
- Akershus University Hospital, Lorenskog, Norway
| | | | - A Tveit
- Bærum Hospital, Vestre Viken Hospital Trust, Department of Medical Research, Drammen, Norway
| | - K Steine
- Akershus University Hospital, Lorenskog, Norway
| | - H Rosjo
- Akershus University Hospital, Lorenskog, Norway
| | - T Omland
- Akershus University Hospital, Lorenskog, Norway
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Brynildsen J, Myhre PL, Lyngbakken MN, Klaeboe LG, Stridsberg M, Christensen G, Edvardsen T, Omland T, Røsjø H. Circulating secretoneurin concentrations in patients with moderate to severe aortic stenosis. Clin Biochem 2019; 71:17-23. [PMID: 31228433 DOI: 10.1016/j.clinbiochem.2019.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/31/2019] [Accepted: 06/18/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Secretoneurin (SN) concentrations provide important prognostic information in patients with myocardial dysfunction. Whether preoperative SN concentrations improve risk assessment in patients with moderate to severe aortic stenosis (AS) is unknown. METHODS We included 57 patients with moderate to severe AS referred for presurgical evaluation. All patients were examined with comprehensive echocardiography, electrocardiogram (ECG), and biochemical measurements and compared to 10 age- and sex-matched healthy subjects. RESULTS Median (quartile 1-3) SN concentrations were 141 (121-163) pmol/L in AS patients and 132 (106-148) pmol/L in control subjects (p = .17). Lower estimated creatinine clearance and use of diuretics, but not standard ECG or echocardiographic indices and cardiac biomarkers, were associated with increasing SN concentrations. Fifteen patients (26%) died during 3.5 years median follow-up. SN concentrations were higher in non-survivors than survivors: 156 (133-209) vs. 140 (116-155) pmol/L, p = .007. Higher SN concentrations were associated with increased risk of mortality also after adjustment for established risk indices, biomarkers, and status regarding valvular surgery: hazard ratio per lnSN 15.13 (95% CI 1.05-219.00); p = .046. Receiver operating characteristics area under the curve for SN to predict mortality was 0.74 (95% CI 0.60-0.88) compared to 0.73 (0.59-0.87) for high-sensitivity cardiac troponin T and 0.67 (0.51-0.82) for N-terminal pro-B-type natriuretic peptide. The previously identified cut-off of SN >204 pmol/L in cardiac surgical patients predicted mortality also in this cohort. CONCLUSIONS SN concentrations improve risk assessment in patients with moderate to severe AS by providing additional prognostic information to established risk indices such as echocardiography, ECG, and established cardiac biomarkers.
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Affiliation(s)
- Jon Brynildsen
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Center for Heart Failure Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Peder L Myhre
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Center for Heart Failure Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Magnus N Lyngbakken
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Center for Heart Failure Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lars Gunnar Klaeboe
- Center for Heart Failure Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Mats Stridsberg
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Geir Christensen
- Center for Heart Failure Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Institute for Experimental Medical Research, Oslo University Hospital, Ullevål, Norway
| | - Thor Edvardsen
- Center for Heart Failure Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Torbjørn Omland
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Center for Heart Failure Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Helge Røsjø
- Center for Heart Failure Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway.
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Lyngbakken MN, Røsjø H, Holmen OL, Dalen H, Hveem K, Omland T. Temporal Changes in Cardiac Troponin I Are Associated with Risk of Cardiovascular Events in the General Population: The Nord-Trøndelag Health Study. Clin Chem 2019; 65:871-881. [PMID: 30996050 DOI: 10.1373/clinchem.2018.301069] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/11/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cardiac troponins are associated with cardiovascular risk in the general population, but whether temporal changes in cardiac troponin I provide independent prognostic information remains uncertain. Using a large community-based cohort with follow-up close to the present day, we aimed to investigate the associations between temporal changes in cardiac troponin and cardiovascular events. METHODS We measured cardiac troponin I with a high-sensitivity assay (hs-cTnI) in 4805 participants attending both the second (HUNT 2, 1995-97) and third wave (HUNT 3, 2006-2008) of the prospective observational Nord-Trøndelag Health (HUNT) Study. We constructed statistical models with both relative and absolute changes of hs-cTnI from HUNT 2 to HUNT 3. A composite end point of cardiovascular death or first admission for myocardial infarction or heart failure was generated. RESULTS Participants with relative decrease in hs-cTnI were more frequently younger and female and had lower blood pressure and body mass index. Participants with relative increase in hs-cTnI more frequently were older and male, with higher systolic blood pressure. The adjusted hazard ratio (HR) for relative increase in hs-cTnI was 1.68 (95% CI, 1.16-2.42) and the adjusted HR for relative decrease was 1.19 (95% CI, 0.84-1.68). Absolute increases in hs-cTnI exhibited similar prognostic properties as relative increases in hs-cTnI. The most recent measurement of hs-cTnI outperformed the change variables in discrimination and reclassification models. CONCLUSIONS Both relative and absolute increases in hs-cTnI are independently associated with cardiovascular risk. For refinement of risk prediction models, the most recent measurement of hs-cTnI should be preferred in clinical practice.
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Affiliation(s)
- Magnus N Lyngbakken
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway and Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Helge Røsjø
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway and Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Oddgeir L Holmen
- Department of Public Health and General Practice, HUNT Research Centre, Norwegian University of Science and Technology, Levanger, Norway
| | - Håvard Dalen
- Department of Circulation and Medical Imaging, K. G. Jebsen Center for Exercise in Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kristian Hveem
- Department of Public Health and General Practice, HUNT Research Centre, Norwegian University of Science and Technology, Levanger, Norway
| | - Torbjørn Omland
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway and Center for Heart Failure Research, University of Oslo, Oslo, Norway;
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25
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Lyngbakken MN, Kvisvik BA, Aagaard EN, Berge T, Pervez MO, Brynildsen J, Tveit A, Steine K, Rosjo HR, Omland T. P4452Prediction of subclinical myocardial injury and left ventricular dysfunction: data from the Akershus Cardiac Examination (ACE) 1950 Study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4452] [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: 11/15/2022] Open
Affiliation(s)
| | - B A Kvisvik
- Akershus University Hospital, Lorenskog, Norway
| | - E N Aagaard
- Akershus University Hospital, Lorenskog, Norway
| | - T Berge
- Bærum Hospital, Vestre Viken Hospital Trust, Department of Medical Research, Drammen, Norway
| | - M O Pervez
- Akershus University Hospital, Lorenskog, Norway
| | | | - A Tveit
- Bærum Hospital, Vestre Viken Hospital Trust, Department of Medical Research, Drammen, Norway
| | - K Steine
- Akershus University Hospital, Lorenskog, Norway
| | - H R Rosjo
- Akershus University Hospital, Lorenskog, Norway
| | - T Omland
- Akershus University Hospital, Lorenskog, Norway
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26
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Brynildsen J, Petaja L, Myhre PL, Lyngbakken MN, Nygard S, Stridsberg M, Christensen G, Ottesen AH, Pettila V, Omland T, Rosjo H. P6248Low concentrations of circulating secretoneurin predict a favorable prognosis after cardiac surgery. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6248] [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)
- J Brynildsen
- University of Oslo, Akershus University Hospital, Department of Medicine, Lorenskog, Norway
| | - L Petaja
- University of Helsinki, Intensive Care Medicine, Dep. of Perioperative, Intensive and Pain Medicine, Helsinki Univ. Hospital, Helsinki, Finland
| | - P L Myhre
- University of Oslo, Akershus University Hospital, Department of Medicine, Lorenskog, Norway
| | - M N Lyngbakken
- University of Oslo, Akershus University Hospital, Department of Medicine, Lorenskog, Norway
| | - S Nygard
- University of Oslo, Bioinformatics Core Facility, Institute for Medical Informatics, Oslo, Norway
| | - M Stridsberg
- Uppsala University, Department of Medical Sciences, Uppsala, Sweden
| | - G Christensen
- University of Oslo, Institute for Experimental Medical Research, Ulleval University Hospital, Oslo, Norway
| | - A H Ottesen
- University of Oslo, Institute for Experimental Medical Research, Ulleval University Hospital, Oslo, Norway
| | - V Pettila
- University of Helsinki, Intensive Care Medicine, Dep. of Perioperative, Intensive and Pain Medicine, Helsinki Univ. Hospital, Helsinki, Finland
| | - T Omland
- University of Oslo, Akershus University Hospital, Department of Medicine, Lorenskog, Norway
| | - H Rosjo
- University of Oslo, Akershus University Hospital, Department of Medicine, Lorenskog, Norway
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27
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Lyngbakken MN, Vigen T, Ihle-Hansen H, Brynildsen J, Berge T, Ronning OM, Tveit A, Rosjo HR, Omland T. P618Prediction of subclinical atherosclerosis using an ultra-sensitive cardiac troponin I assay: data from the Akershus Cardiac Examination (ACE) 1950 Study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p618] [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)
| | - T Vigen
- Akershus University Hospital, Lorenskog, Norway
| | - H Ihle-Hansen
- Bærum Hospital, Vestre Viken Hospital Trust, Department of Medical Research, Drammen, Norway
| | | | - T Berge
- Bærum Hospital, Vestre Viken Hospital Trust, Department of Medical Research, Drammen, Norway
| | - O M Ronning
- Akershus University Hospital, Lorenskog, Norway
| | - A Tveit
- Bærum Hospital, Vestre Viken Hospital Trust, Department of Medical Research, Drammen, Norway
| | - H R Rosjo
- Akershus University Hospital, Lorenskog, Norway
| | - T Omland
- Akershus University Hospital, Lorenskog, Norway
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28
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Berge T, Ariansen I, Ihle-Hansen H, Brynildsen J, Lyngbakken MN, Christophersen IE, Myrstad M, Omland T, Steine K, Rosjo H, Smith P, Tveit A. P6622Risk factors for atrial fibrillation at the age of 40 years: 24-year follow-up data from the Norwegian Age 40 program and the Akershus cardiac examination (ACE) 1950 Study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6622] [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: 11/12/2022] Open
Affiliation(s)
- T Berge
- Bærum Hospital, Vestre Viken Hospital Trust, Department of Medical Research, Gjettum, Norway
| | - I Ariansen
- Norwegian Institute of Public Health, Physical and Mental Health, Oslo, Norway
| | - H Ihle-Hansen
- Bærum Hospital, Vestre Viken Hospital Trust, Department of Medical Research, Gjettum, Norway
| | - J Brynildsen
- Akershus University Hospital, Division of Medicine, Lorenskog, Norway
| | - M N Lyngbakken
- Akershus University Hospital, Division of Medicine, Lorenskog, Norway
| | - I E Christophersen
- Bærum Hospital, Vestre Viken Hospital Trust, Department of Medical Research, Gjettum, Norway
| | - M Myrstad
- Bærum Hospital, Vestre Viken Hospital Trust, Department of Medical Research, Gjettum, Norway
| | - T Omland
- University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | - K Steine
- Akershus University Hospital, Division of Medicine, Lorenskog, Norway
| | - H Rosjo
- Akershus University Hospital, Division of Medicine, Lorenskog, Norway
| | - P Smith
- University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | - A Tveit
- University of Oslo, Institute of Clinical Medicine, Oslo, Norway
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29
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Berge T, Lyngbakken MN, Smith P, Omland T, Steine K, Rosjo H, Tveit A. P2530High prevalence of known and unknown type 2 diabetes mellitus among middle-aged Norwegians: Data from the Akershus cardiac examination (ACE) 1950 study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2530] [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)
- T Berge
- Bærum Hospital, Vestre Viken Hospital Trust, Department of Medical Research, Gjettum, Norway
| | - M N Lyngbakken
- Akershus University Hospital, Division of Medicine, Lorenskog, Norway
| | - P Smith
- University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | - T Omland
- University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | - K Steine
- University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | - H Rosjo
- University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | - A Tveit
- University of Oslo, Institute of Clinical Medicine, Oslo, Norway
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Sigurdardottir FD, Lyngbakken MN, Holmen OL, Dalen H, Hveem K, Røsjø H, Omland T. Relative Prognostic Value of Cardiac Troponin I and C-Reactive Protein in the General Population (from the Nord-Trøndelag Health [HUNT] Study). Am J Cardiol 2018; 121:949-955. [PMID: 29496193 DOI: 10.1016/j.amjcard.2018.01.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [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: 09/09/2017] [Revised: 12/23/2017] [Accepted: 01/04/2018] [Indexed: 01/20/2023]
Abstract
C-reactive protein and cardiac troponin I measured with high-sensitivity assays (high-sensitivity C-reactive protein [hs-CRP] and high-sensitivity troponin I [hs-TnI]) have been associated with risk of fatal and nonfatal cardiovascular events in the general population. The relative prognostic merits of hs-CRP and hs-TnI, and whether these markers of inflammation and subclinical myocardial injury provide incremental information to established cardiovascular risk prediction models, remain unclear. hs-CRP and hs-TnI were measured in 9,005 participants from the prospective observational Nord-Trøndelag Health (HUNT) study. All study subjects were free from known cardiovascular disease at baseline. During a median follow-up period of 13.9 years, 733 participants reached the composite end point of hospitalization for acute myocardial infarction or heart failure, or cardiovascular death. In adjusted models, increased hs-TnI concentrations (>10 ng/L for women and >12 ng/L for men) were associated with the incidence of the composite end point (hazard ratio 3.61, 95% confidence interval [CI] 2.89 to 4.51]), whereas the risk associated with increased hs-CRP concentrations (>3 mg/L for both genders) appeared to be weaker (HR 1.71, 95% CI 1.40 to 2.10). The addition of hs-TnI to established cardiovascular risk prediction models led to a net reclassification improvement of 0.35 (95% CI 0.27 to 0.42), superior to that of hs-CRP (0.21, 95% CI 0.13 to 0.28). The prognostic accuracy of hs-TnI, assessed by C-statistics, was significantly greater than that of hs-CRP (0.753, 95% CI 0.735 to 0.772, vs 0.644, 95% CI 0.625 to 0.663). In conclusion, in subjects from the general population without a history of cardiovascular disease, hs-TnI provides prognostic information superior to that provided by hs-CRP and may therefore be a preferred marker for targeted prevention.
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Affiliation(s)
- Fjola D Sigurdardottir
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway and Center for Heart Failure Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Magnus N Lyngbakken
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway and Center for Heart Failure Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Oddgeir L Holmen
- HUNT Research Centre, Department of Public Health and General Practice, Norwegian University of Science and Technology, Levanger, Norway; K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Håvard Dalen
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Department of Cardiology, St. Olav's University Hospital, Trondheim, Norway
| | - Kristian Hveem
- HUNT Research Centre, Department of Public Health and General Practice, Norwegian University of Science and Technology, Levanger, Norway
| | - Helge Røsjø
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway and Center for Heart Failure Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Torbjørn Omland
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway and Center for Heart Failure Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
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Berge T, Lyngbakken MN, Ihle-Hansen H, Vigen T, Pervez OM, Brynildsen J, Christophersen IE, Steine K, Omland T, Smith P, Rosjo H, Tveit A. P865Prevalence and risk factors for atrial fibrillation in 63-65 years olds: data from the Akershus Cardiac Examination (ACE) 1950 study. Europace 2018. [DOI: 10.1093/europace/euy015.468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T Berge
- Vestre Viken HF, Baerum Hospital, Department of Medical Research, Baerum, Norway
| | - M N Lyngbakken
- Akershus University Hospital, Division of Medicine, Lorenskog, Norway
| | - H Ihle-Hansen
- Vestre Viken HF, Baerum Hospital, Department of Medical Research, Baerum, Norway
| | - T Vigen
- Akershus University Hospital, Division of Medicine, Lorenskog, Norway
| | - O M Pervez
- Akershus University Hospital, Division of Medicine, Lorenskog, Norway
| | - J Brynildsen
- Akershus University Hospital, Division of Medicine, Lorenskog, Norway
| | - I E Christophersen
- Vestre Viken HF, Baerum Hospital, Department of Medical Research, Baerum, Norway
| | - K Steine
- University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | - T Omland
- University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | - P Smith
- University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | - H Rosjo
- University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | - A Tveit
- Vestre Viken HF, Baerum Hospital, Department of Medical Research, Baerum, Norway
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Lyngbakken MN, Omland T, Nordstrand N, Norseth J, Hjelmesæth J, Hofsø D. Effect of weight loss on subclinical myocardial injury: A clinical trial comparing gastric bypass surgery and intensive lifestyle intervention. Eur J Prev Cardiol 2015; 23:874-80. [PMID: 26656071 DOI: 10.1177/2047487315618796] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/03/2015] [Indexed: 01/13/2023]
Abstract
AIMS To investigate the effect of weight loss induced by bariatric surgery and intensive lifestyle intervention on levels of circulating high-sensitivity cardiac troponin I. METHODS AND RESULTS We measured high-sensitivity cardiac troponin I concentrations pre- and 12 months post-intervention in 136 subjects with morbid obesity participating in a controlled clinical trial comparing the effect of intensive lifestyle intervention vs. Roux-en-Y gastric bypass. At baseline median (interquartile range) high-sensitivity cardiac troponin I levels were 2.40 (1.28-3.95) ng/L in the bariatric surgery group and 2.35 (1.38-4.40) ng/L in the intensive lifestyle intervention group (p = 0.736). The high-sensitivity cardiac troponin I concentration in a normal-weight control group was 0.90 (0.60-2.13) ng/L. During 12 months of follow-up, high-sensitivity cardiac troponin I decreased significantly more in the bariatric surgery group than in the intensive lifestyle intervention group (0.80 (0-1.80) vs. 0.15 (-0.50 to 1.00) ng/L; p = 0.002). In a multivariate logistic regression model, surgery emerged as a predictor of reduction in high-sensitivity cardiac troponin I levels (odds ratio 2.32; 95% confidence intervals 1.03-5.22; p = 0.041) independent of age, gender and other possible confounding baseline variables. In subsequent multivariate analyses, reductions in body weight and triglycerides emerged as possible mediators of reduction in circulating levels of high-sensitivity cardiac troponin I. CONCLUSION In patients with morbid obesity, bariatric surgery was associated with a significantly greater reduction in high-sensitivity cardiac troponin I, an index of subclinical myocardial injury, than intensive lifestyle intervention. The reduction appeared to be mediated by reductions in body weight and serum triglycerides. This suggests that weight loss following bariatric surgery may reduce cardiometabolic stress and subsequent risk of heart failure.
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Affiliation(s)
- Magnus N Lyngbakken
- K.G. Jebsen Cardiac Research Centre, Institute of Clinical Medicine, University of Oslo, Norway Division of Medicine, Akershus University Hospital, Norway
| | - Torbjørn Omland
- K.G. Jebsen Cardiac Research Centre, Institute of Clinical Medicine, University of Oslo, Norway Division of Medicine, Akershus University Hospital, Norway
| | | | - Jon Norseth
- Department of Medical Biochemistry, Vestre Viken Hospital Trust, Norway
| | - Jøran Hjelmesæth
- Morbid Obesity Centre, Vestfold Hospital Trust, Norway Department of Endocrinology, Morbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, Norway
| | - Dag Hofsø
- Morbid Obesity Centre, Vestfold Hospital Trust, Norway
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