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Dam Lauridsen M, Rorth R, Butt JH, Schmidt M, Kristensen SL, Kragholm K, Johnsen SP, Moller JE, Hassager C, Kober LV, Fosbol EL. Home care provision and nursing home admission after myocardial infarction in relation to cardiogenic shock and out-of-hospital cardiac arrest status. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Autonomy is of great importance for quality of life. There is a paucity of data on autonomy for those who survive myocardial infarction (MI) with and without cardiogenic shock (CS) and out-of-hospital arrest (OHCA).
Purpose
To examine the association between CS, OHCA, and need for home care provision or nursing home admission as a proxy for impaired autonomy in a first-time MI population.
Methods
Danish nationwide registries were used to identify patients with first-time MI (2009–2019), who prior to the event were living at home without home care and discharged alive. The patients were stratified according to CS and OHCA status. We report 1-year cumulative incidence of a composite outcome of home care provision or nursing home admission with competing risk of death and as a secondary outcome all-cause mortality. Cause specific Cox regression models were used to estimate adjusted hazard ratios (HR) with patients without CS or OHCA as reference.
Results
We identified 61,451 patients in the period with MI (by groups: −OHCA/−CS: 59,316, −OHCA/+CS: 1,597, +OHCA/−CS: 913, and +OHCA/+CS: 669). The 1-year cumulative incidences of home care/nursing home were 6.9% for patients with −OHCA/−CS, 21.1% for −OHCA/+CS, 5.2% for +OHCA/−CS, and 8.1% for those with +OHCA/+CS. With the −OHCA/−CS as reference, the adjusted HRs for home care/nursing home were 3.12 (95% CI: 2.78–3.49) for patients with −OHCA/+CS, 1.27 (95% CI: 0.95–1.70) for +OHCA/−CS, and 2.31 (95% CI: 1.76–3.03) for +OHCA/+CS (Figure). The 1-year cumulative incidences of mortality were 4.8% for patients with −OHCA/−CS, 10.0% for −OHCA/+CS, 2.8% for +OHCA/−CS, and 3.7% for those with +OHCA/+CS (adjusted HRs: 2.81 (95% CI: 2.55–3.10), 1.09 (95% CI: 0.85–1.39) and 1.81 (95% CI: 1.42–2.30) (Figure 1).
Conclusion
In a selected cohort of patients with MI, without previous need for home care/nursing home and surviving until discharge date, patients with CS were independent of OHCA status associated with less autonomy after discharge with a more than two-fold higher 1-year incidence of home care provision or nursing home admission. Further, patients with CS were associated with a two-fold higher 1-year mortality compared with MI patients without CS independent of OHCA status.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): The work was supported by Rigshospitalets Research Foundation, Master cabinetmaker Sophus Jacobsen and Wife Astrid Jacobsen Foundation, and Director Jacob Madsen and Wife Olga Madsens Foundation. The funding source had no role in the design, conduct, analysis, or reporting of the study.
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Affiliation(s)
- M Dam Lauridsen
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - R Rorth
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - J H Butt
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - M Schmidt
- Aarhus University Hospital, Department of Clinical Epidemiology , Aarhus , Denmark
| | - S L Kristensen
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - K Kragholm
- Aalborg University Hospital, Department of Cardiology , Aalborg , Denmark
| | - S P Johnsen
- Aalborg University, Danish Center for Clinical Health Services Research, Department of Clinical Medicine , Aalborg , Denmark
| | - J E Moller
- Odense University Hospital , Odense , Denmark
| | - C Hassager
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - L V Kober
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - E L Fosbol
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
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2
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Abdi Isse Y, Wiberg S, Grand J, Obling L, Frikke-Schmidt R, Kjaergaard J, Hassager C, Meyer MAS. The influence of hemolysis upon admission on the performance of neuron-specific enolase in predicting death after resuscitated out-of-hospital cardiac arrest – a substudy of the IMICA trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The predominant cause of mortality among out-of-hospital cardiac arrest (OHCA) patients admitted to the intensive care unit in a comatose state is hypoxic-ischemic brain injury and consequent withdrawal of life sustaining therapies. Current guideline for post-resuscitation care suggests a multimodal approach for neuroprognostication including measuring a blood-born biomarker of neuronal injury termed neuron-specific enolase (NSE). However, NSE is also present in erythrocytes and therefore hemolysis – which frequently occurs immediately after resuscitation – must be assessed by measuring free-hemoglobin (free-hgb), and samples discarded if the threshold index is surpassed to minimize false positive results. In addition, the plasma half-life of NSE is much longer than free-hgb, and hemolysis occurring prior to the sampling point of NSE measurement, may cause elevated NSE levels due to destruction of erythrocytes rather than neurons, although free-hgb is no longer detectable in plasma.
Purpose
To investigate the relationship between hemolysis at hospital admission and NSE measured at 48 hours, and to determine the influence of hemolysis on the clinical performance of NSE in predicting all-cause mortality in comatose OHCA patients.
Methods
Free-hgb was measured at admission (0h) to quantify hemolysis. NSE was measured at 48 hours after admission. In each NSE sample hemolysis index was measured and mathematically corrected according to standard laboratory procedure. The relationship between free-hgb at 0h and NSE at 48h was investigated by Pearson's correlation analysis. The area under the receiver operating characteristic curves (AUROC) for prediction of all-cause mortality at 30 days were determined for both NSE and free-hgb, and the difference in AUROC between the two was calculated. Further, the positive and negative predictive values (PPV and NPV respectively) of NSE with a cut-off value at >60 μg/l (as recommended by guidelines) in predicting all-cause mortality were calculated.
Results
Admission free-hgb and NSE at 48 hours were available for 64 consecutive patients surviving beyond 48 hours. The 30-day mortality in this population was 33%. There was no correlation between free-hgb at 0h and NSE at 48h (r=0.13, p=0.30; Figure 1). The AUROC for NSE was 0.92 (Figure 2), and 0.59 for free-hgb at 0h. The PPV for NSE>60 μg/l was 1.0 (1.0–1.0) and NPV 0.84 (0.74–0.94).
Conclusions
The performance of NSE at 48 hours for predicting all-cause mortality among out-of-hospital cardiac arrest patients was not influenced by the degree of hemolysis at the time of admission, and NSE at 48 hours had both high positive and negative predictive values irrespectively of early hemolysis.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- Y Abdi Isse
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - S Wiberg
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - J Grand
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - L Obling
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - R Frikke-Schmidt
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - J Kjaergaard
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - C Hassager
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - M A S Meyer
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
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3
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Linde L, Moerk SR, Gregers E, Andreasen JB, Lassen JF, Ravn HB, Schmidt H, Riber LP, Laugesen H, Terkelsen CJ, Moeller-Soerensen PH, Holmvang L, Kjaergaard J, Hassager C, Moeller JE. Selection of patients for mechanical circulatory support for refractory out-of-hospital cardiac arrest: a Danish nationwide multicenter study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Extracorporeal cardiopulmonary resuscitation (ECPR) is a potential salvage therapy for selected patients with refractory out-of-hospital cardiac arrest (OHCA).
Purpose
The objective of this study was to describe the characteristics of potential ECPR patients.
Methods
This retrospective, observational cohort study included 579 patients admitted with refractory OHCA for possible ECPR at all tertiary cardiac arrest centers in Denmark between 2015 and 2020. Presenting characteristics, reasons for refraining from ECPR, and survival to hospital discharge were recorded.
Results
After initial evaluation, 221 patients (38%) proceeded to ECPR, and 358 (62%) were considered futile. Median prehospital low-flow time was 70 minutes [interquartile range 56–85] in ECPR patients and 62 minutes [48–81] in no-ECPR patients, p<0.001. Intra arrest transport was more than 50 km in 92 (42%) ECPR patients and 135 in no-ECPR patients (38%), p=0.25. Treatment decision was taken by a team of three specialists in 513 cases (97%). The leading cause for not initiating ECPR was duration of low flow time (39%). Severe metabolic derangement and low end-tidal CO2 (ETCO2) were contributing factors in 35% and 31%, respectively, Figure 1. 83% of the patients had two or more contributing factors recorded as reasons for not initiating ECPR, Figure 2. The most prevailing combination of contributing factors were non-shockable rhythm, low ETCO2, and metabolic derangement or duration of prehospital low flow time combined with low ETCO2. Survival to discharge was achieved in six patients (1.7%) in the no-ECPR group and 50 (23%) in the ECPR group.
Conclusions
In this large nationwide study of patients admitted for possible ECPR, 62% were not treated with ECPR. The most frequent reasons to abstain from ECPR were duration of prehospital low flow time, metabolic derangement, and low ETCO2.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation
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Affiliation(s)
- L Linde
- Odense University Hospital, Department of Cardiology , Odense , Denmark
| | - S R Moerk
- Aarhus University Hospital, Department of Cardiology , Aarhus , Denmark
| | - E Gregers
- Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - J B Andreasen
- Aalborg University Hospital, Department of Anesthesiology and Intensive Care , Aalborg , Denmark
| | - J F Lassen
- Odense University Hospital, Department of Cardiology , Odense , Denmark
| | - H B Ravn
- Odense University Hospital, Department of Anaesthesiology and Intensive Care , Odense , Denmark
| | - H Schmidt
- Odense University Hospital, Department of Anaesthesiology and Intensive Care , Odense , Denmark
| | - L P Riber
- Odense University Hospital, Department of Thoracic and Vascular Surgery , Odense , Denmark
| | - H Laugesen
- Aalborg University Hospital, Department of Anesthesiology and Intensive Care , Aalborg , Denmark
| | - C J Terkelsen
- Aarhus University Hospital, Department of Cardiology , Aarhus , Denmark
| | - P H Moeller-Soerensen
- Copenhagen University Hospital, Cardiothoracic Anesthesiology , Copenhagen , Denmark
| | - L Holmvang
- Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - J Kjaergaard
- Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - C Hassager
- Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - J E Moeller
- Odense University Hospital, Department of Cardiology , Odense , Denmark
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4
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Byrne C, Barcella C, Krogager ML, Pareek M, Ringgren KB, Wissenberg M, Folke F, Gislason G, Kober L, Lippert F, Kjaergaard J, Hassager C, Torp-Pedersen C, Lip GYH, Kragholm K. External validation of the simple NULL-PLEASE clinical score in predicting outcomes in men and women with out-of-hospital cardiac arrest. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The NULL-PLEASE score (Nonshockable rhythm, Unwitnessed arrest, Long no-flow or Long low-flow period, blood pH <7.2, Lactate >7.0 mmol/L, End-stage renal disease on dialysis, Age ≥85 years, Still resuscitation, and Extracardiac cause) was developed to help identify patients with out-of-hospital cardiac arrest (OHCA) who are unlikely to survive. Although survival after OHCA differs between sexes, the performance of the NULL-PLEASE score according to sex has not been tested previously.
Purpose
To validate the NULL-PLEASE score separately in men and women in a nationwide setting.
Methods
Using Danish nationwide registry data from 2001–2019, we retrospectively identified male and female OHCA survivors with return of spontaneous circulation (ROSC) or ongoing cardiopulmonary resuscitation at hospital arrival. The primary outcome was 1-day mortality. Secondary outcomes were defined as 30-day mortality and the combination of 1-year mortality or anoxic brain damage. Logistic regression with a NULL-PLEASE score of 0 as reference was used for outcome risk estimation. The predictive ability of the score was assessed using area under the receiver operating characteristics (AUCROC) curves.
Results
A total of 2,601 men (median age 67 years (interquartile range (IQR) 56–76 years), and 1,280 women (median age 69 years (IQR 58–79 years) were included. One-day mortality was 31% in men and 42% in women; 30-day mortality was 56% and 71% in men and women, respectively; and 63% of men and 78% of women experienced the combined outcome. For patients with a NULL-PLEASE score ≥9, absolute risks were: 1-day mortality: 82.0% (95% confidence interval [CI]: 75.6–88.4%) for men and 79.1% (95% CI: 71.3–86.8%) for women; 30-day mortality: 98.6% (95% CI: 96.6–100.0) for men and 97.1% (95% CI: 94.0–100.0%) for women; and the combined outcome: 99.3% (95% CI: 97.9–100.0%) for men and 97.1% (95% CI: 94.0–100.0%) for women. AUCROC values for 1-day mortality were 0.827 (95% CI: 0.811–0.844) for men and 0.736 (95% CI: 0.710–0.763) for women. Results were similar for 30-day mortality and for the combined outcome. ROC curves for all outcomes are shown in Figure 1 (men) and Figure 2 (women). For a NULL-PLEASE score cut-point ≥3 to predict 1-day mortality, the positive predictive value was 91.8% in men and 91.1% in women, with a sensitivity of detecting patients who die of 47.3% in men and 51.8% in women. The corresponding negative predictive value for surviving more than 1 day was 54.6% in men and 37.7% in women, and the specificity of detecting patients who survive was 93.7% in men and 85.3% in women.
Conclusions
In a nationwide OHCA-cohort, the NULL-PLEASE score consistently appeared to perform better in men than in women for all outcomes. Nevertheless, its predictive ability was high among both sexes. Sex-specific differences should not be overlooked in clinical decision-making in patients surviving OHCA.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The Danish Heart FoundationThe Danish Foundation TrygFonden
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Affiliation(s)
- C Byrne
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - C Barcella
- Herlev-Gentofte University Hospital , Gentofte , Denmark
| | | | - M Pareek
- Herlev-Gentofte University Hospital , Gentofte , Denmark
| | | | - M Wissenberg
- Herlev-Gentofte University Hospital , Gentofte , Denmark
| | - F Folke
- Herlev-Gentofte University Hospital , Gentofte , Denmark
| | - G Gislason
- Herlev-Gentofte University Hospital , Gentofte , Denmark
| | - L Kober
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - F Lippert
- University of Copenhagen , Copenhagen , Denmark
| | - J Kjaergaard
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - C Hassager
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | | | - G Y H Lip
- Liverpool Heart and Chest Hospital , Liverpool , United Kingdom
| | - K Kragholm
- Aalborg University Hospital , Aalborg , Denmark
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5
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Nyholm B, Obling L, Hassager C, Grand J, Moller JE, Kjaergaard J. Early quantitative pupillary response parameters have high predictive value for 30-day mortality in patients resuscitated from out-of-hospital cardiac arrest. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1487] [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
Despite adequate post-resuscitation treatment following out-of-hospital cardiac arrest (OHCA), early risk of death remains high due to irreversible anoxic brain injury.
Objective
Neuroprognostication is pivotal, and automated quantitative pupillometry has become an essential part of early multimodal approach. Several quantitative pupillary response parameters are now available, but little evidence exist on their value and timing in neuroprognostication.
Purpose
To evaluate prognostic value of standard parameters of quantitative pupillometry in OHCA patients.
Methods
In this observational study we included 138 comatose patients resuscitated from OHCA admitted to a tertiary cardiac intensive care unit. With quantitative pupillometry, change in pupil size (%CH, %), Neurological Pupil index (NPi, scalar value 0–5), constriction velocity (CV, mm/s), maximum CV (MCV, mm/s), dilation velocity (DV, mm/s) and latency of constriction (Lat, s) were measured at admission, at the 24 hours (24h), and 48-hours (48h) time points. Receiver operating characteristics (ROC) curves with calculation of area under the curve (AUC) were applied for assessment of association with 30-day mortality.
Results
The population were predominantly males, had a mean age of 61±12 years, and 120 (87%) had shockable primary rhythm, 122 (88%) had witnessed cardiac arrest and 51 (37%) died in the first 30 days.
Median %CH, CV, MCV, DV and NPi values were significantly lower for diseased patients compared to survivors.
ROC analyses (Figure 1) present all parameters, except NPi, at admission with numerically highest values of AUC at 0.82, 0.76, 0.73, and 0.81 for %CH, CV, MCV, and DV respectively, and for NPi at 48h with AUC at 0.81. The admission time point still presented the highest AUC values, >0.84, for CV, MCV, and DV in an adjusted model. Of all the parameters, %CH and NPi maintained the highest prognostic values through all time points, and %CH performed best at admission with AUC at 0.87 and NPi at 24h with AUC at 0.91.
At admission the threshold value with 100% specificity for predicting 30-day mortality were 3.75, 0.09, 0.33, and 0.05, with negative predictive value (NPV [95% confidence interval]) at 71% [67–74], 66% [64–69], 67% [65–70], and 69% [66–72] for %CH, CV, MCV, and DV respectively. NPi had best performance at 24h with a cutoff value of 2.90 and NPV at 64% [63–64].
Conclusion
%CH and NPi were the strongest prognostic tools for 30-day mortality. Values below 3.75% for %CH at admission and 2.90 for NPi at 24h after archived 100% specificity for 30-day mortality, with NPV at 71% [67–74] and 64% [63–64] respectively. Although performance was persistently high, %CH, CV, MCV, and DV presented numerically highest AUC at admission.
Additional parameters of CV, MCV, and DV were also significantly associated with outcome and future research should focus on validation and possible combining these measures into useful indices.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Novo Nordisk Foundation
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Affiliation(s)
- B Nyholm
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - L Obling
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - C Hassager
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - J Grand
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - J E Moller
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - J Kjaergaard
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
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Yafasova A, Butt JH, Nielsen JC, Haarbo J, Eiskjaer H, Brandes A, Thoegersen AM, Gustafsson F, Hassager C, Svendsen JH, Hoefsten DE, Torp-Pedersen C, Pehrson S, Thune JJ, Koeber L. Cardiac resynchronisation therapy and implantable cardioverter-defibrillator in non-ischaemic systolic heart failure: extended follow-up of the DANISH trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.841] [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
In the Danish Study to Assess the Efficacy of Implantable Cardioverter-Defibrillators [ICDs] in Patients with Non-ischaemic Systolic Heart Failure on Mortality (DANISH) trial, ICD implantation did not provide an overall survival benefit in patients with non-ischaemic systolic heart failure. A high proportion of patients in the DANISH trial received a cardiac resynchronisation therapy (CRT) device, which improves the prognosis in patients with heart failure. Therefore, it is of interest to examine whether the effect of ICD implantation in patients with non-ischaemic systolic heart failure is modified by CRT.
Purpose
Adding 4 years of additional follow-up to the DANISH trial, we examined the effect of ICD implantation according to status with respect to CRT implantation at baseline.
Methods
In the DANISH trial, 556 patients with non-ischaemic systolic heart failure were randomised to receive an ICD and 560 to receive usual clinical care (control). Patients fulfilling indications for a CRT device received a CRT-defibrillator (if randomised to ICD arm) or CRT-pacemaker (if randomised to control arm). In the ICD group, 322 patients (57.9%) received a CRT device; in the control group, 323 patients (57.7%) received a CRT device. In this extended follow-up study, patients were followed until May 18, 2020. The primary outcome was death from any cause; secondary outcomes were cardiovascular death and sudden cardiovascular death.
Results
During a median follow-up of 9.5 years, the ICD group did not have significantly lower all-cause mortality compared with the control group (hazard ratio [HR] 0.89 [95% CI, 0.74–1.08]). The results were independent of whether the patient received a CRT device at randomisation (patients with a CRT device: HR 0.92 [95% CI, 0.72–1.18]; patients without a CRT device: HR 0.86 [95% CI, 0.64–1.14]; P for interaction, 0.72). Similarly, ICD implantation did not reduce rates of cardiovascular death overall (HR 0.87 [95% CI, 0.70–1.09]), and this association was not modified by CRT (patients with a CRT device: HR 0.89 [95% CI, 0.66–1.19]; patients without a CRT device: HR 0.85 [95% CI, 0.60–1.20]; P for interaction, 0.86). The ICD group had significantly lower rates of sudden cardiovascular death in the overall population (HR, 0.60 [95% CI, 0.40–0.92]), and this association was not modified by CRT (patients with a CRT device: HR 0.69 [95% CI, 0.40–1.21]; patients without a CRT device: HR 0.51 [95% CI, 0.26–0.97]; P for interaction, 0.47). See Figure 1 for all results.
Conclusions
In this extended follow-up study of the DANISH trial, the effect of ICD implantation in patients with non-ischaemic systolic heart failure was not modified by CRT.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The DANISH trial was supported by unrestricted grants from Medtronic, St Jude Medical, Tryg Fonden, and the Danish Heart Foundation. No further funding was obtained for this follow-up study.
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Affiliation(s)
- A Yafasova
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - J H Butt
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - J C Nielsen
- Aarhus University Hospital , Aarhus , Denmark
| | - J Haarbo
- Herlev Hospital , Herlev , Denmark
| | - H Eiskjaer
- Aarhus University Hospital , Aarhus , Denmark
| | - A Brandes
- Odense University Hospital , Odense , Denmark
| | | | - F Gustafsson
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - C Hassager
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - J H Svendsen
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - D E Hoefsten
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | | | - S Pehrson
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - J J Thune
- Bispebjerg and Frederiksberg Hospital , Frederiksberg , Denmark
| | - L Koeber
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
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7
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Sondergaard F, Beske R, Frydland M, Helgestad O, Jensen LO, Holmvang L, Engstroem T, Moeller JE, Hassager C. Soluble suppression of tumorigenicity associated to post-procedural no-or-slow-reflow phenomenon in ST-elevation myocardial infarction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1357] [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
Over the last decades, the prognosis for patients with ST-elevation myocardial infarction (STEMI) has improved due to primary percutaneous coronary intervention (pPCI). However, no-or-slow-reflow phenomenon after pPCI constrains this benefit. Suppression of tumorigenicity (sST2) is released from vascular endothelial cells in response to myocyte stretch and increased sST2 level in the initial phase of STEMI is a useful prognostic biomarker for predicting mortality and heart failure (HF).
Purpose
To explore the association of sST2 with post-procedural no-or-slow-reflow phenomenon in patients with STEMI.
Method
During a 1-year period in 2015/2016, the study included consecutive STEMI patients from two heart centers who underwent acute coronary angiography (CAG). Blood samples including sST2 levels were collected at admission and before angiography and/or revascularization. Post-procedural coronary flow was assessed according to thrombolysis in myocardial infarction (TIMI) classification for STEMI. We divided patients into two groups: TIMI 0,1 and 2 as no-or-slow-reflow, and TIMI 3 as normal reflow. Both troponin I and troponin T were used and therefore combined and grouped into 10th percentile levels. The association between sST2 and TIMI flow was explored using multiple logistic regression adjusted for age, gender, hypercholesterolemia, diabetes, hypertension, cardiogenic shock, time from onset of symptoms to CAG, and troponin levels.
Results
In total, 1,789 consecutive patients with verified STEMI and available TIMI flow classification were included in the analysis. Of these, 1,693 (94.6%) classified as normal reflow and 96 (5.4%) as no-or-slow-reflow. The proportion of male sex was similar (1,253 (74%) vs 67 (70%), p=0.36) in the two groups. No-or-slow-reflow patients were older (median 68 years (IQR 57–75) vs median 63 years (IQR 54–72), p=0.02) and more likely to develop cardiogenic shock (22 (23%) vs 146 (8.6%), p<0.001). The troponin level was similar in the two groups (no-reflow: 5.50 (2.00, 8.00) vs normal reflow: 5.00 (3.00, 7.00), p=0.38). In the regression model, sST2 was independently associated with post-procedural no-or-slow-flow (two-fold sST2 increase: OR 1.37 (1.09, 1.70, p=0.006)).
Conclusion
In patients with STEMI, sST2 level at admission before coronary angiography is associated with the post-procedural no-or-slow-reflow phenomenon.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Righospitalets Forskningsfond AND Lundbeck Foundation
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Affiliation(s)
- F Sondergaard
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - R Beske
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - M Frydland
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - O Helgestad
- Odense University Hospital, Department of Cardiology - B , Odense , Denmark
| | - L O Jensen
- Odense University Hospital, Department of Cardiology - B , Odense , Denmark
| | - L Holmvang
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - T Engstroem
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - J E Moeller
- Odense University Hospital, Department of Cardiology - B , Odense , Denmark
| | - C Hassager
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
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8
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Stampe NK, Glinge C, Rasmussen BS, Bhardwaj P, Linnet K, Jabbari R, Hassager C, Kjaergaard J, Tfelt-Hansen J, Winkel BG. Untargeted toxicology in sudden cardiac arrest victims. Europace 2022. [DOI: 10.1093/europace/euac053.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Union’s Horizon 2020 research and innovation programme to J.T.-H under acronym ESCAPE-NET
Background
Sudden cardiac arrest (SCA) is a major public health challenge and is associated with poor outcomes. Many drugs are known to increase risk of arrythmias and ultimately sudden cardiac death. To our knowledge an untargeted toxicological analysis has not previously been performed in an initially resuscitated SCA cohort.
Purpose
We aimed to determine the qualitative and quantitative drug composition present in SCA patients by using forensic toxicological analytical chemistry of all illicit, non-prescription and prescribed drugs, and further investigate whether these drugs are in therapeutic levels or overdosed and to correlate the clinical findings with the toxicology results.
Methods
We performed a prospective single-tertiary-center study and included all SCA victims (aged 18-90 years) admitted to our cardiac intensive care unit, between February 2019 to November 2019 (Figure 1). Traumatic and overt overdose related SCA were not included in the study. Drugs used during resuscitation and administered prior to sample collection were identified in each patient and excluded.
Results
We prospectively identified 85 all-cause SCA patients with a median age of 60 years (IQR: 53-71) and male predominance (80%). The majority had a shockable rhythm as first rhythm (95%). The major cause of cardiac arrest was acute and chronic ischemia (56/77, 66%), followed by cardiomyopathy (9/77, 12%), idiopathic ventricular fibrillation (8/77, 10%), bradycardia (2/77, 2.6%), primary arrhythmia (1/77, 1.3%), other (1/77, 1.3%). The remaining 8 patients (9.4%) died prior to diagnosis.
A positive toxicology was identified in 67 patients (79%) with a total of 218 detected drugs. The most frequent drugs were mild analgesics (32/85, 38%), beta-blockers (21/85, 25%) and ACE-inhibitors/ARB (20/85, 24%). A total of 9 (11%) patients had one or more potentially abusable drugs detected, with the most common being opioid agonists in 5 patients (Figure 2). Importantly, all drugs were found at sub-therapeutic or therapeutic concentrations. None had overdose concentrations. Moreover, polypharmacy was common and a median of 2 drugs (IQR: 1-4) were detected (excluding caffeine that was detected in 83 patients).
Conclusion
We found that the majority had drugs detected, and polypharmacy is displayed in a considerable proportion. Potentially abusive drugs were encountered in 11%. However, we did not identify any occult overdose related cardiac arrests among all resuscitated SCA patients. In our setting, toxicological screening in cardiac arrest patients who is not obviously overdosed is excessive.
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Affiliation(s)
- NK Stampe
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - C Glinge
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - BS Rasmussen
- University of Copenhagen, Department of Forensic Medicine, Faculty of Medical Sciences, Copenhagen, Denmark
| | - P Bhardwaj
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - K Linnet
- University of Copenhagen, Department of Forensic Medicine, Faculty of Medical Sciences, Copenhagen, Denmark
| | - R Jabbari
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - C Hassager
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - J Kjaergaard
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - J Tfelt-Hansen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - BG Winkel
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
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Burup Kristensen C, Sattler SM, Myhr KA, Grund FF, Lubberding AF, Vejlstrup N, Tfelt-Hansen J, Jespersen T, Hassager C, Mattu R, Mogelvang R. Left ventricular mass quantification by echocardiography; a novel accurate and more reproducible 2D-method validated by cardiac magnetic resonance in humans and cardiac autopsy in pigs. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.147] [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
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): The research fund of The Heart Center at Rigshospitalet, Denmark
Background
Left ventricular mass (LVM) is a strong independent risk factor for adverse cardiovascular events, but conventional echocardiographic methods used to assess and monitor individuals are currently limited by poor reproducibility and accuracy.
Purpose
We aimed to develop and validate an echocardiographic method for LVM-quantification that is simple, reproducible and accurate.
Methods
Our ‘novel method’ (Figure) adds the left ventricular wall thickness (t) to the left ventricular end-diastolic volume acquired by endocardial tracings using the biplane method of discs. For development of the novel method, cardiac assessment was performed using echocardiography followed immediately by gold standard cardiac magnetic resonance (CMR) in 85 humans with different left ventricular geometries, ranging from patients with various cardiac disorders (n = 41) to individuals without known cardiac disorders (n = 44). We compared the novel two-dimensional (2D) method to various conventional one-dimensional (1D) and 2D methods as well as three-dimensional (3D) echocardiography. Validation against anatomical LVM by cardiac autopsy was performed in thirty-four Danish Landrace pigs, weight 47-59 kg. Echocardiography was performed during anaesthesia, the pigs were euthanised, the heart explanted, and cardiac autopsy was performed where the left ventricle was trimmed and weighed for autopsy LVM.
Results
In humans, the novel method had better reproducibility in intra-examiner (coefficients of variation (CV) 8.6% vs. 11.0-14.5%) and inter-examiner analysis (CV 9.0% vs. 10.2-19.6%) than any other method, including 3D (CV intra-examiner 14.3%, inter-examiner 16.6%). Accuracy of the novel method against CMR was similar to 3D (mean difference ± 95% limits of agreement, CV): Novel: 2 ± 50g, 15.4% vs. 3D: 2 ± 51g, 15.6%; and better than the 1D-method by Devereux (7 ± 76g, 23.0%). Feasibility for the novel method was 95%. Autopsy validation in pigs confirmed high reproducibility; intra-examiner (CV 8.7% vs. 9.1-11.4%) and inter-examiner-analysis (CV 8.7% vs. 8.8-10.0%). Accuracy of the novel method against autopsy LVM was better than for the conventional echocardiographic methods: Novel -1 ± 20g, 7.8% vs. Devereux 26 ± 37g, 11.3%. 3D-validation was not available in pigs.
Conclusions
The novel 2D-based method for LVM-quantification had better reproducibility than any other echocardiographic method. Accuracy was similar to 3D and better than any conventional method. Autopsy validation in pigs supported our findings amongst the human population. As endocardial tracings using the biplane method forms part of the standard echocardiographic protocol, the novel method can easily be integrated into any echocardiographic software without substantially increasing analysis time, and provides an equivalent yet simpler alternative to 3D echocardiography. Abstract Figure.
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Affiliation(s)
- C Burup Kristensen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - SM Sattler
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - KA Myhr
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - FF Grund
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - AF Lubberding
- University of Copenhagen, Department of Biomedical Sciences, Copenhagen, Denmark
| | - N Vejlstrup
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J Tfelt-Hansen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - T Jespersen
- University of Copenhagen, Department of Biomedical Sciences, Copenhagen, Denmark
| | - C Hassager
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - R Mattu
- Kettering General Hospital, Kettering, United Kingdom of Great Britain & Northern Ireland
| | - R Mogelvang
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
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Arentz Taraldsen I, Mogelvang R, Hassager C, Burup Kristensen C. Preload augmentation has significant impact on diastolic echocardiographic measurements in patients with cardiac disease but not controls. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Diastolic diagnostics are important among patients with significant heart failure, where large alterations in preload are more common. We hypothesised that preload augmentation has larger impact in hearts with diastolic dysfunction, and that potential re-classification of diastolic parameters induced by increased preload may impact the grading of diastolic function.
Purpose
The purpose of this study was to demonstrate the impact of preload augmentation on the most commonly used parameters applied for assessment of diastolic function.
Methods
We included 132 subjects from two different cohorts; the dialysis cohort (n = 50) and the infusion-cohort (n = 82). Cardiac assessment by echocardiography was performed immediately before and after hemodialysis or saline infusion; low loading condition (baseline) and high loading condition (increased preload). The population was divided in two groups defined as controls (n = 50) and cardiac disease (n = 82). Cardiac disease was defined as ischemic heart disease, cardiomyopathy, moderate/severe aortic valve disease, hypertrophy defined by echocardiography, left ventricular ejection fraction <50% or cardiac arrythmia. We compared echocardiographic parameters for diastolic evaluation; early (E) and late (A) diastolic left ventricular filling, E/A, early diastolic mitral annular velocity (e’) and E/e’. Abnormal values applied for re-classification after preload augmentation: E/e’ >14, septal e’ <7 cm/s, lateral e’ <10 cm/s.
Results
There were no significant differences in indexed augmented preload between controls and cardiac disease; 0.9 ± 0.3 L/m2 vs. 1.0 ± 0.5 L/m2. The control group contained more patients from the infusion- (74%) than the hemodialysis-cohort (26%) p < 0.05. As expected, baseline measurements differed significantly between controls and cardiac disease (Table 1). Preload augmentation significantly increased E and A in the control group, other parameters remained unchanged. In cardiac disease E, but not A, increased significantly. Lateral e’ remained unchanged whereas septal e’ and average E/e’ increased significantly. Re-classification from normal to abnormal values in controls and cardiac disease was: average E/e’ 4% vs. 8%, septal e’ 5% vs. 18%, lateral e’ 3% vs. 16% (Table 2). None of these differences in re-classification between controls and cardiac disease were significant.
Conclusion
The most commonly applied diastolic parameters are significantly affected by augmented preload amongst patients with cardiac disease, but not controls. Re-classification from normal to abnormal diastolic parameters was not statistically more common in cardiac disease. Hemodynamic status at the time of echocardiography should be considered in the assessment among patients with cardiac disease, as it may have impact on the interpretation of diastolic dysfunction. Abstract Table 1 Abstract Table 2
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Affiliation(s)
| | - R Mogelvang
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - C Hassager
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
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11
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Burup Kristensen C, Sigvardsen PE, Myhr KA, Kofoed KF, Vejlstrup N, Hassager C, Mogelvang R. Multi-modality comparison of volumes and ejection fraction by echocardiography, cardiac magnetic resonance and cardiac computed tomography in various left ventricular geometries. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): The research fund of the Heart Center, Rigshospitalet, Denmark
Background
Assessment of left ventricular (LV) volumes and function is crucial in managing patients. New imaging modalities are becoming more common. It is therefore important to compare them with the standard echocardiographic method that most treatments rely on and to determine if they are suitable for all LV geometries.
Purpose
The purpose was to compare end-diastolic volume (EDV), end-systolic volume (ESV) and LV ejection fraction (LVEF) for the three most common imaging modalities; echocardiography, cardiac magnetic resonance (CMR) and cardiac computed tomography (CCT).
Methods
We included 85 subjects with various LV geometries; no cardiac disease (n = 44) and various cardiac disorders (n = 41). Cardiac assessment was performed using echocardiography followed immediately by CMR; re-examination after median 6 days, interquartile range 3-18 days using echocardiography followed immediately by CCT. We compared EDV, ESV and LVEF by three-dimensional echocardiography (echo-3D), CMR and CCT to echocardiographic biplane method of discs (echo-BP). The population was divided in four LV geometry profiles (normal, dilatation, hypertrophy, dilatation and hypertrophy) according to gender, age and indexed CMR-values of EDV and LV mass. We calculated inter-modality-ratios by dividing the values from echo-3D, CMR and CCT with echo-BP, to evaluate variances between the LV geometries.
Results
The figure demonstrates the agreement to echo-BP divided by geometry. Echo-3D had overall best agreement to EDV, ESV and LVEF. CMR overestimated both EDV and ESV. CCT overestimated EDV but not ESV. CCT overestimated LVEF by 4-16% in absolute values, whereas CMR and echo-3D had better agreement for LVEF. The correlation between echo-BP and echo-3D, CMR, and CCT, respectively was; EDV 0.91, 0.94, 0.90, ESV 0.86, 0.86, 0.79, and LVEF 0.40, 0.46, 0.38, all p < 0.001. CMR especially overestimated EDV and ESV in "hypertrophy and dilatation" whereas CCT especially underestimated EDV and ESV in solely "hypertrophy", with larger overestimation of LVEF. ANOVA-analysis of inter-modality-ratios between LV geometries indicated significant variation for EDV but not ESV by echo-3D (F = 2.9, p < 0.05 and F = 1.6, NS), no significant variation for EDV or ESV by CMR (F = 0.01 and 2.4, both NS), and significant variation for both EDV and ESV by CCT (F = 5.4, p < 0.01 and 7.2, p < 0.001). No significant variation for LVEF by echo-3D (F = 1.0, NS), but significant variation for CMR and CCT (CMR: F = 4.5, p < 0.01 and CCT: F = 8.6, p < 0.001) with slightly higher variation for CCT.
Conclusions
Echo-3D had the overall best agreement of volumes and LVEF, compared to echo-BP as a reference. CMR overestimated EDV and ESV whereas CCT overestimated EDV but not ESV, resulting in overestimation of LVEF by CCT but not CMR. In hypertrophic non-dilated LVs; CCT underestimated both EDV and especially ESV, with larger overestimation of LVEF. In general, CMR appears to be less dependent on LV geometry compared to echo-3D and CCT. Abstract Figure.
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Affiliation(s)
- C Burup Kristensen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - PE Sigvardsen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - KA Myhr
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - KF Kofoed
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - N Vejlstrup
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - C Hassager
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - R Mogelvang
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
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12
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Meyer M, Wiberg S, Grand J, Meyer ASP, Obling L, Johansson P, Kjaergaard J, Hassager C. Tocilizumab mitigates hypercoagulability after out-of-hospital cardiac arrest – results from a randomized controlled trial (IMICA). Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1543] [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
Systemic inflammation constitutes a key element of the post cardiac arrest syndrome (PCAS) which affects initially comatose resuscitated cardiac arrest patients. We have recently shown that treatment with tocilizumab, an IL-6 receptor antagonist, reduces systemic inflammation and myocardial injury after out-of-hospital cardiac arrest (OHCA). Inflammation and coagulation are interconnected, and changes in coagulation often accompany inflammatory states.
Purpose
To investigate if conventional coagulation parameters or a viscoelastic hemostatic assay differ in patients treated with tocilizumab compared to placebo.
Methods
Eighty comatose OHCA patients were randomized 1:1 in a double-blinded placebo-controlled trial to a single infusion of tocilizumab or placebo in addition to standard of care including targeted temperature management. Trial registration: Clinicaltrials.gov NCT03863015. Endpoints were plasma fibrinogen, platelet count, and Thrombelastography (TEG) variables. TEG analysis was performed utilizing whole blood in a citrated kaolin assay with heparinase (to neutralize any unfractionated or low molecular weight heparin that had been administered), and the following variables were analyzed: reaction time (R), angle, maximum amplitude (MA), and lysis at 30 minutes (Ly30) which represents clot initiation, propagation, strength and dissolution respectively. Data reported as median (Q1; Q3), statistical analysis performed by constrained linear mixed models, and a p<0.05 was considered statistically significant.
Results
Admission median levels of the investigated coagulation parameters were within normal levels for both the tocilizumab and placebo group. At 48 hours, for the placebo group, fibrinogen levels (figure 1) had risen to supra-normal levels, TEG angle had increased from 64 (10; 67) till 72 (69; 74), and TEG MA (figure 2) had increased to the hypercoagulable range (all p<0.05), while for the tocilizumab group fibrinogen levels and TEG MA remained within normal values. Both groups had a significant fall in platelet count from admission till 48h [placebo: from 252 109/L (208; 282) till 151 (126; 189); tocilizumab from 217 (183; 260) till 152 (127; 183)], with no group differences. Also for both groups there was significant shortening of the TEG R time [placebo: from 8 min (6; 10) till 6 (6; 8); tocilizumab from 8 (6; 9) till 7 (6; 8)], again with no difference between groups. Ly30 did not change over time or differ between groups.
Conclusion
Treatment with tocilizumab following resuscitated OHCA aids in maintaining a normo-coagulable state, whereas placebo patients developed supra-normal fibrinogen levels and a hypercoagulable TEG clot strength.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The Danish Heart Foundation (Reference no. 19-R135-A9302-22125); Region Hovedstadens Forskningsfond til sundhedsforskning (CapitalRegion Research Foundation, Denmark; reference no. A6030) Figure 1. FibrinogenFigure 2. Thrombelastography MA
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Affiliation(s)
- M Meyer
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - S Wiberg
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J Grand
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - A S P Meyer
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - L Obling
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - P Johansson
- Rigshospitalet - Copenhagen University Hospital, Capital Region Blood Bank, Copenhagen, Denmark
| | - J Kjaergaard
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - C Hassager
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
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Moerk SR, Stengaard C, Linde L, Moller JE, Andreasen JB, Laugesen H, Thomassen SA, Freeman PM, Christensen S, Tang M, Gregers E, Kjaergaard J, Hassager C, Eiskjaer H, Terkelsen CJ. Mechanical circulatory support for refractory out-of-hospital cardiac arrest: a nationwide multicentre study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1500] [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
Extracorporeal cardiopulmonary resuscitation (ECPR) has shown potential as a salvage therapy for patients with refractory out-of-hospital cardiac arrest (OHCA). Despite growing interest in and a growing body of literature on ECPR for refractory OHCA, robust evidence on patient eligibility is still lacking.
Purpose
To describe the survival, neurological outcome, and adherence to the national consensus with respect to use of ECPR for OHCA, and to identify factors associated with outcome.
Methods
Retrospective, observational cohort study of patients who underwent ECPR for OHCA at four cardiac arrest centres. Binary logistic regression and Kaplan-Meier survival curves were performed to assess association with 30-day mortality.
Results
A total of 259 patients receiving ECPR for OHCA between July 2011 and December 2020 were included in the study. Thirty-day survival was 26% and a good neurological outcome Cerebral Performance Category (CPC) 1–2 was observed in 94% of patients at discharge. Strict adherence to the national consensus showed a 30-day survival rate of 30%. Adding one or more of the following criteria to the national consensus: signs of life during cardiopulmonary resuscitation (CPR), pre-hospital low-flow <100 minutes, pH >6.8 and lactate <15 mmol/L increased the survival rate to 48%, but would exclude 58% of the survivors from the current cohort. Logistic regression identified initial presenting rhythm with asystole (RR 1.36, 95% CI 1.18–1.57), pulseless electrical activity (PEA) (RR 1.20, 95% CI 1.03–1.41), initial pH <6.8 (RR 1.28, 95% CI 1.12–1.46) and lactate levels >15 mmol/L (RR 1.16, 95% CI 1.16–1.53) as factors associated with increased risk of 30-day mortality. Patients presenting signs of life during CPR had threefold higher survival rate than patients without signs of life (45% versus 13%, p<0.001)
Conclusion
A high survival rate with a good neurological outcome was observed in this population of patients treated with ECPR for OHCA. Signs of life during CPR may aid the decision-making in the selection of appropriate candidates. Stringent patient selection for ECPR may produce higher survival rates but potentially withholds life-saving treatment in a significant proportion of survivors, why optimization of the selection criteria is still necessary.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): This work was supported by the Danish Heart Foundation [20-R142-A9498-22178]; and Health Research Foundation of Central Denmark Region [R64-A3178-B1349] Survival and adherence to consensusSigns of life during CPR
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Affiliation(s)
- S R Moerk
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - C Stengaard
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - L Linde
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - J E Moller
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - J B Andreasen
- Aalborg University Hospital, Department of Anaestesiology and Intensive Care, Aalborg, Denmark
| | - H Laugesen
- Aalborg University Hospital, Department of Anaestesiology and Intensive Care, Aalborg, Denmark
| | - S A Thomassen
- Aalborg University Hospital, Department of Anaestesiology and Intensive Care, Aalborg, Denmark
| | - P M Freeman
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - S Christensen
- Aarhus University Hospital, Department of Anaesthesiology and Intensive Care, Aarhus, Denmark
| | - M Tang
- Aarhus University Hospital, Department of Thoracic and Vascular Surgery, Aarhus, Denmark
| | - E Gregers
- Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J Kjaergaard
- Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - C Hassager
- Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - H Eiskjaer
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - C J Terkelsen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
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14
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Borup A, Donkin I, Boon M, Frydland M, Martinez-Tellez B, Loft A, Keller S, Kjaer A, Kjaergaard J, Hassager C, Barres R, Rensen P, Christoffersen C. ASsociation of the apolipoprotein M and sphingosine-1-phosphate complex with brown adipose tissue after cold exposure in humans. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Bahrami H, Kjaergaard J, Thomsen J, Lippert F, Koeber L, Hassager C, Soeholm H. Heart failure in survivors of out-of-hospital cardiac arrest – factors associated with reduced systolic ventricular function at follow-up. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1859] [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
Survival after out-of-hospital cardiac arrest (OHCA) has increased in recent years but is still only 10%. Little is known about the association between post-resuscitation comorbidity and heart failure after discharge from the initial OHCA-admission.
Purpose
In OHCA-survivors we aimed to describe predictors of left ventricular (LV) dysfunction, defined as LV ejection fraction (LVEF) <40%, at follow-up.
Methods
A consecutive cohort of OHCA-patients with cardiac cause from 2007 to 2011 without a pre-OHCA congestive heart failure diagnosis (according to the Danish National Patient Registry, which holds data on all Danish citizens) were retrospectively examined. Logistic regression analyses were used to assess factors associated with LV dysfunction (LVEF <40%) at follow-up after a median of 6 months. Follow-up was not performed systematically in the OHCA-survivors and data from follow-up was assessed by reading of patient charts.
Results
A total of 365 OHCA-survivors with a mean age of 61 years were discharged alive from hospital. LVEF <40% at hospital discharge was seen in 54% (n=184, 7% missing), and at follow-up after a median of 6 months 19% (n=69) of the total OHCA-cohort of survivors still had LV dysfunction. Factors associated with LV dysfunction at follow-up were chronic ischemic heart disease (IHD) prior to OHCA (odds ratio (OR) = 2.9 (95% CI: 1.2 – 7.1)) and ST-elevation myocardial infarction (STEMI) as cause of OHCA (OR = 2.9 (1.4–6.0)), whereas age, gender, high comorbidity burden prior to OHCA or pre-hospital circumstances (including shockable cardiac arrest rhythm) were not.
Conclusion
More than half of OHCA-survivors with LVEF <40% at hospital discharge improved LV function and LV dysfunction at follow-up after a median of 6 months after discharge was present in 1 in 5 (19%) of the cohort. Chronic IHD and STEMI were the only factors significantly associated with LV dysfunction at follow-up. A systematic follow-up including echocardiography in the outpatient clinic for OHCA-survivors is recommended especially in patients with reduced LV function at discharge and in STEMI-patients in order to assess the appropriateness of heart failure medication and an implantable cardiac defibrillator.
Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Danish Foundation Trygfonden
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Affiliation(s)
- H.S.Z Bahrami
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J Kjaergaard
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J.H Thomsen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - F Lippert
- University of Copenhagen, Copenhagen Emergency Medical Services, Copenhagen, Denmark
| | - L Koeber
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - C Hassager
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - H Soeholm
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
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16
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Lauridsen MD, Butt JH, Østergaard L, Møller JE, Hassager C, Gerds T, Kragholm K, Phelps M, Schou M, Torp-Pedersen C, Gislason G, Køber L, Fosbøl EL. Incidence of acute myocardial infarction-related cardiogenic shock during corona virus disease 19 (COVID-19) pandemic. Int J Cardiol Heart Vasc 2020; 31:100659. [PMID: 33072848 PMCID: PMC7553065 DOI: 10.1016/j.ijcha.2020.100659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/03/2020] [Indexed: 12/13/2022]
Abstract
Aims The hospitalization of patients with MI has decreased during global lockdown due to the COVID-19 pandemic. Whether this decrease is associated with more severe MI, e.g. MI-CS, is unknown. We aimed to examine the association of Corona virus disease (COVID-19) pandemic and incidence of acute myocardial infarction with cardiogenic shock (MI-CS). Methods On March 11, 2020, the Danish government announced national lock-down. Using Danish nationwide registries, we identified patients hospitalized with MI-CS. Incidence rates (IR) and incidence rate ratios (IRR) were used to compare MI-CS before and after March 11 in 2015–2019 and in 2020. Results We identified 11,769 patients with MI of whom 696 (5.9%) had cardiogenic shock in 2015–2019. In 2020, 2132 MI patients were identified of whom 119 had cardiogenic shock (5.6%). The IR per 100,000 person years before March 11 in 2015–2019 was 9.2 (95% CI: 8.3–10.2) and after 8.9 (95% CI: 8.0–9.9). In 2020, the IR was 7.5 (95% CI: 5.8–9.7) before March 11 and 7.7 (95% CI: 6.0–9.9) after. The IRRs comparing the 2020-period with the 2015–2019 period before and after March 11 (lockdown) were 0.81 (95% CI: 0.59–1.12) and 0.87 (95% CI: 0.57–1.32), respectively. The IRR comparing the 2020-period during and before lockdown was 1.02 (95% CI: 0.74–1.41). No difference in 7-day mortality or in-hospital management was observed between study periods. Conclusion We could not identify a significant association of the national lockdown on the incidence of MI-CS, along with similar in-hospital management and mortality in patients with MI-CS.
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Key Words
- CABG, Coronary artery bypass grafting
- CAG, Coronary angiography
- COVID-19
- COVID-19, Corona Virus disease
- Cardiogenic shock
- Corona virus
- ECMO, Extra-corporeal membrane oxygenation
- IABP, Intra-aortic balloon pump
- ICD, International Classification of Diseases
- Incidence
- MI, Acute myocardial infarction
- MI-CS, Acute myocardial infarction-related cardiogenic shock
- Myocardial infarction
- PCI, Percutaneous coronary intervention
- STEMI, ST-segment elevation myocardial infarction
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Affiliation(s)
- M D Lauridsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - J H Butt
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - L Østergaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - J E Møller
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - C Hassager
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - T Gerds
- Department of Biostatistics, Copenhagen University, Copenhagen, Denmark.,The Danish Heart Foundation, Copenhagen, Denmark
| | - K Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - M Phelps
- The Danish Heart Foundation, Copenhagen, Denmark
| | - M Schou
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Hellerup, Denmark
| | - C Torp-Pedersen
- Department of Cardiology and Clinical Research, Nordsjaellands Hospital, Hillerød, Denmark
| | - G Gislason
- The Danish Heart Foundation, Copenhagen, Denmark.,Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Hellerup, Denmark
| | - L Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - E L Fosbøl
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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17
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Myhr KA, Kristensen CB, Pedersen FHG, Hassager C, Vejlstrup N, Mattu R, Pecini R, Mogelvang R. Accuracy and sensitivity of three-dimensional echocardiography to detect changes in right ventricular volumes: comparison study with cardiac magnetic resonance. Int J Cardiovasc Imaging 2020; 37:493-502. [PMID: 32914403 DOI: 10.1007/s10554-020-02017-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/04/2020] [Indexed: 11/26/2022]
Abstract
We aimed to investigate the ability of three-dimensional transthoracic echocardiography (3DE) to detect changes in RV volumes compared to cardiac magnetic resonance (CMR). Eighty-five subjects including 45 with no known cardiac disease and 40 patients with a variety of cardiac diseases were included. Two- and three-dimensional echocardiography as well as CMR of the RV was performed before and after infusion of on average two litres of saline. Examinations were analysed with estimation of RV dimensions, volumes and ejection fraction (RVEF). Intra- and inter-examiner variability was evaluated in 25 patients randomly selected from the cohort. Three-dimensional echocardiography underestimated volumes and RVEF compared to CMR with mean differences and 95% limits of agreement of 110.3 ± 59 mL for RV end-diastolic volume (RVEDV), 43.3 ± 32 mL for RV end-systolic volume (RVESV) and 3.5 ± 10.7% for RVEF. CMR was more reproducible than 3DE, with intra-observer coefficient of variation (CV) of 4% vs. 14.2% for RVEDV, 9.7% vs. 16.7% for RVESV and 6.3% vs. 8.6% for RVEF. The RVEDV, RVESV and RV stroke volume (RVSV) by CMR significantly increased after saline infusion by 15.3 ± 16.2 mL, 3.5 ± 14.2 mL and 11.8 ± 12.6 mL, respectively, as well as RVEF by 1.5 ± 4.6% (p < 0.05). However, 3DE was not able to detect any of these changes in RV volumes (p ≥ 0.05). Compared to CMR imaging of the RV, three-dimensional echocardiography appears unable and unreliable in detecting RV volume changes of less than 15%, highlighting the need for cautious utility of 3DE in these circumstances.
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Affiliation(s)
- K A Myhr
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen O, Denmark.
| | - C B Kristensen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen O, Denmark
| | - F H G Pedersen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen O, Denmark
| | - C Hassager
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen O, Denmark
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3B, 2100, Copenhagen O, Denmark
| | - N Vejlstrup
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen O, Denmark
| | - R Mattu
- Kettering General Hospital NHS Foundation Trust, Rothwell Road, Kettering, Northants, NN16 8UZ, UK
- Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK
| | - R Pecini
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen O, Denmark
| | - R Mogelvang
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen O, Denmark
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3B, 2100, Copenhagen O, Denmark
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Àlle 15, 5700, Svendborg, Denmark
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18
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Meyer ASP, Ostrowski SR, Kjærgaard J, Frydland M, Thomsen JH, Johansson PI, Hassager C. Low dose Iloprost effect on platelet aggregation in comatose out-of-hospital cardiac arrest patients: A predefined sub-study of the ENDO-RCA randomized -phase 2- trial. J Crit Care 2020; 56:197-202. [PMID: 31945586 DOI: 10.1016/j.jcrc.2019.12.025] [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: 08/17/2019] [Revised: 12/27/2019] [Accepted: 12/27/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE This is a predefined sub-study of the Endothelial Dysfunction in Resuscitated Cardiac Arrest (ENDO-RCA) trial. We aim to investigate Iloprost, a prostacyclin analogue, safety by evaluating change in whole blood platelet aggregometry (Multiplate) in out of hospital cardiac arrest (OHCA) patients from baseline to 96-h post randomization. METHODS A randomized, placebo controlled double-blinded trial in 46 OHCA patients. Patients were allocated 1:2 to 48 h Iloprost infusion, (1 ng/kg/min) or placebo (saline infusion). Platelet aggregation was determined by platelet aggregation tests ASPI-test (arachidonic acid); TRAP-test (thrombin-receptor activating peptide (TRAP)-6; RISTO test (Ristocetin); ADP test (adenosin diphosphat). RESULTS There was no significant difference between the iloprost and placebo groups according to ASPI, TRAP, RISTO and ADP platelet aggregation assays. Further, no significant differences regarding risk of bleeding were found between groups (Risk of bleeding: ASPI <40 U; TRAP <92 U; RISTO <35 U; ADP <50 U). CONCLUSIONS In conclusion, the iloprost infusion did not influence platelet aggregation as evaluated by the ASPI, TRAP, RISTO and ADP assays. There was no increased risk of bleeding or transfusion therapy. A decline in platelet aggregation was observed for the ASPI and ADP assays during the initial 96 h after OHCA. TRIAL REGISTRATION Trial registration at clinicaltrials.gov (identifier NCT02685618) on 18-02-2016.
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Affiliation(s)
- A S P Meyer
- Section for Transfusion Medicine, Blood Bank, Rigshospitalet, 2034, Blegdamsvej 9, DK-2100 Copenhagen, Denmark; Dept. of Cardiology, Copenhagen University Rigshospitalet, 2143, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
| | - S R Ostrowski
- Section for Transfusion Medicine, Blood Bank, Rigshospitalet, 2034, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - J Kjærgaard
- Dept. of Cardiology, Copenhagen University Rigshospitalet, 2143, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - M Frydland
- Dept. of Cardiology, Copenhagen University Rigshospitalet, 2143, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - J H Thomsen
- Dept. of Cardiology, Copenhagen University Rigshospitalet, 2143, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - P I Johansson
- Section for Transfusion Medicine, Blood Bank, Rigshospitalet, 2034, Blegdamsvej 9, DK-2100 Copenhagen, Denmark; Dept. of Surgery, University of Texas Health Medical School, 6410 Fannin Street UPB 1100, Houston, TX 77030, USA
| | - C Hassager
- Dept. of Cardiology, Copenhagen University Rigshospitalet, 2143, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
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19
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Backman S, Cronberg T, Friberg H, Ullén S, Horn J, Kjaergaard J, Hassager C, Wanscher M, Nielsen N, Westhall E. Corrigendum to "Highly malignant routine EEG predicts poor prognosis after cardiac arrest in the Target Temperature Management trial" [Resuscitation 131 (2019) 24-28]. Resuscitation 2019; 145:82. [PMID: 31726401 DOI: 10.1016/j.resuscitation.2019.10.023] [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: 11/26/2022]
Affiliation(s)
- S Backman
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Clinical Neurophysiology, Lund, Sweden.
| | - T Cronberg
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Neurology, Lund, Sweden.
| | - H Friberg
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Intensive and Perioperative Care, Lund, Sweden.
| | - S Ullén
- Clinical Studies Sweden - Forum South, Skane University Hospital, Lund, Sweden.
| | - J Horn
- Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - J Kjaergaard
- Department of Cardiology, Rigshospitalet and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - C Hassager
- Department of Cardiology, Rigshospitalet and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - M Wanscher
- Department of Cardiothoracic Anaesthesia, Rigshospitalet and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - N Nielsen
- Lund University, Helsingborg Hospital, Department of Clinical Sciences Lund, Intensive and Perioperative Care, Lund, Sweden.
| | - E Westhall
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Clinical Neurophysiology, Lund, Sweden.
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20
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Soeholm H, Hassager C, Pedersen F, Abildgaard U, Haahr-Pedersen S, Lippert FK, Kober L, Kjaergaard J. 6031Out -of-hospital cardiac arrest - incidence of coronary artery disease, co-morbidity and survival. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Data from the European Cardiovascular Disease Statistics from 2012 shows that 20% of all deaths are caused by coronary artery disease with cardiac arrest (CA) as the most common scenario. Historic data have shown that coronary artery disease was present in approximately 70% of unselected out-of-hospital CA (OHCA) patients byangiography. As registry and retrospective data are prone to bias it remains unknown whether an early invasive strategy translates into improved outcome, we present our experience from a large urban region of Denmark.
Purpose
The aim was to describe a consecutive OHCA-cohort with regards to incidence of coronary artery disease, comorbidity and survival rate.
Methods
A consecutive unselected cohort of patients with OHCA in the Capital Region of Denmark was included (n=1,003) from 2007 to 2011. After successful resuscitation patients were admitted for post-resuscitation care at 1 of 8 hospitals including coronary angiography and percutaneous coronary interventions (PCI) when indicated.
Results
Patients were 65±15 years old, 71% were male, 52% had shockable primary rhythm, median time to return of spontaneous circulation (ROSC) was 22 minutes (Q1–Q3: 13–37 min), the majority was unconscious at hospital admission (89%), and no previous comorbidity was noted in 52%. The majority of the cohort had OHCA due to a cardiac cause (n=806, 80%). Acute coronary syndrome (ACS) was diagnosed in 39% of the total cohort (n=389), and in 48% of patients with cardiac cause with ST-segment elevation myocardial infarction being more frequent (n=236, 60% of ACS).
30-day mortality was 59% in the total cohort and 46% in patients with ACS (plogrank<0.001). A favourable neurological outcome (Cerebral Performance Category 1 or 2) was noted in 84% of all patients discharged alive (n=347), and in 85% of patients with ACS (n=178). In the total cohort ACS was independently associated with a lower 30-day mortality rate (hazard ratio (HR) = 0.62, 95% confidence interval (CI) 0.51–0.75, p<0.001) after adjustment for age, pre-hospital OHCA circumstances (bystander CPR, public arrest and witnessed arrest), time to ROSC, primary admission to a tertiary heart centre, and degree of comorbidity. In OHCA-patients with ACS only, successful PCI was independently associated with a lower 30-day mortality after adjustment for the mentioned prognostic factors (HR all ACS= 0.46, 95% CI 0.31–0.67, p<0.001, HR STEMI= 0.43, 0.27–0.69, p<0.001, HR NSTEMI= 0.12, 0.03–0.51, p=0.004).
Conclusion
In an unselected clinical cohort of out-of-hospital cardiac arrest survivors less than half of the patients was diagnosed with acute coronary syndrome. ACS was associated with a better prognosis even after adjustment for prognostic factors. Successful PCI was likewise an independent prognostic factor, however this may be due to selection bias and a direct support of acute angiography in all OHCA-survivors should await the results of randomised clinical trials.
Acknowledgement/Funding
Trygfonden
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Affiliation(s)
- H Soeholm
- Rigshospitalet - Copenhagen University Hospital, Heart Centre, Department of Cardiology, Copenhagen, Denmark
| | - C Hassager
- Rigshospitalet - Copenhagen University Hospital, Heart Centre, Department of Cardiology, Copenhagen, Denmark
| | - F Pedersen
- Rigshospitalet - Copenhagen University Hospital, Heart Centre, Department of Cardiology, Copenhagen, Denmark
| | - U Abildgaard
- Gentofte University Hospital, Cardiology, Gentofte, Denmark
| | | | - F K Lippert
- Emergency Medicine and EMS, Head Office, Copenhagen, Denmark
| | - L Kober
- Rigshospitalet - Copenhagen University Hospital, Heart Centre, Department of Cardiology, Copenhagen, Denmark
| | - J Kjaergaard
- Rigshospitalet - Copenhagen University Hospital, Heart Centre, Department of Cardiology, Copenhagen, Denmark
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21
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Grand J, Hassager C, Bro-Jeppesen J, Wanscher M, Kjaergaard J. P6383Cardiac output during targeted temperature management and renal function after out-of-hospital cardiac arrest. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0979] [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
After resuscitation from out-of-hospital cardiac arrest (OHCA), renal injury and hemodynamic instability are common. Low blood pressure during targeted temperature management (TTM) is associated with acute renal injury (AKI). The aim of this study is to test the hypothesis, that low cardiac output during TTM is associated with acute kidney injury after OHCA.
Methods
Single-center substudy of 171 patients included in the prospective, randomized TTM-trial. Hemodynamic evaluation was performed with serial measurements by pulmonary artery catheter. Mean arterial pressure ≥65 mmHg and central venous pressure of 10 to 15 mmHg were hemodynamic treatment goals. Acute kidney injury (AKI) was the primary endpoint and was defined according to the KDIGO-criteria. Differences between groups were tested by repeated measurements mixed models.
Measurements and main results
Of 152 patients with available hemodynamic data, 49 (32%) had AKI and 21 (14%) had AKI with need for renal replacement therapy (RRT) in the first three days. At admission, cardiac index was higher in the AKI-group (mean (confidence interval): 2.6 (2.2–3.0) L/min/m2 versus 2.2 (2.0–2.3) L/min/m2, p=0.003). During 24 hours of targeted temperature management, patients with AKI had increased heart rate (11 beats/min, pgroup<0.0001) and increased lactate (1 mmol/L, pgroup<0.0001) compared to patients without AKI. However, there was no overall difference in cardiac index (pgroup = 0.25) (Figure). In multivariate models, adjusting for potential confounders including targeted temperature, mean arterial pressure (odds ratio: 0.69 (0.50–0.96) per 5 mmHg increase, p=0.03), heart rate (1.04 (1.01–1.08) per beat/min increase, p=0.01) and lactate (1.59 (1.14–2.2) per mmol/L increase, p=0.006) were independently associated with AKI, but cardiac index remained unrelated with AKI.
Figure 1
Conclusions
Blood pressure, heart rate and lactate, but not cardiac output, during 24 hours of targeted temperature management were associated with renal injury in comatose OHCA-patients.
Acknowledgement/Funding
The research fund Gangstedfonden and the Research fund of Rigshospitalet has supported this study with unrestricted salary in Dr. Grand's PhD project.
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Affiliation(s)
- J Grand
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - C Hassager
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J Bro-Jeppesen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - M Wanscher
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiothoracic Anaesthesia, Copenhagen, Denmark
| | - J Kjaergaard
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
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22
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Josiassen J, Helgestad OKL, Moeller JE, Kjaergaard J, Schmidt H, Jensen LO, Holmvang L, Ravn HB, Hassager C. P1728Cardiogenic shock patients: those with and those without out-of-hospital cardiac arrest are different clinical entities. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Cardiogenic shock (CS) due to myocardial infarction (MI) carries 30-day mortality rates as high as 50%. The vast majority of study cohorts assessing mortality in CS comprise both patients presenting with and without out-of-hospital cardiac arrest (OHCA). Patients with and without OHCA are likely to represent two distinctive entities, which may be problematic to combine in an intervention trial.
Purpose
The aim of the study was to compare CS due to MI patients presenting with and without OHCA in terms of patient characteristics and outcome.
Methods
In the period from 2010–2017 all patients admitted at two tertiary heart centres in Denmark with CS following MI were individually identified and validated through patient records. The two centres have a catchment area of 3.9 million citizens corresponding to two-thirds of the Danish population.
Results
A total of 1716 CS patients were identified, of which 42% presented with OHCA. OHCA patients were younger (mean 63 vs 67 years), more frequently male (85 vs 67%), had higher lactate concentration (median 6.2 vs 5.0 mmol/L) on admission and higher left ventricular ejection fraction (median 30 vs 25%) compared to patients without OHCA (p<0.0001 for all). Patients presenting with OHCA had lower 30-day mortality compared to patients without OHCA (49% vs. 57%, respectively, plogrank<0.0001, Figure). Cause of in hospital death differed markedly between the two groups. Not surprisingly, anoxic brain damage was the leading cause of in hospital death in the OHCA group (56%) and only seen in 4% of patients without OHCA. In contrast, cardiac failure was the main cause of death in hospital death among patients without OHCA (60%), compared to 27% in patients with OHCA (p<0.0001).
Figure 1
Conclusion
Among patients with CS due to MI, overall 30-day mortality was significantly lower in patients presenting with OHCA. Anoxic brain damage was the main cause of in hospital death among OHCA patients, whereas fatal heart failure prevailed in patients without OHCA. Combining these two groups in a single trial with one specific intervention seems inappropriate and likely to cause an imbalance in the signal-to-noise ratio.
Acknowledgement/Funding
The Danish Heart Foundation and a research grant from Abiomed
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Affiliation(s)
- J Josiassen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - O K L Helgestad
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - J E Moeller
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - J Kjaergaard
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - H Schmidt
- Odense University Hospital, Department of Cardiothoracic Anaesthesia, Odense, Denmark
| | - L O Jensen
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - L Holmvang
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - H B Ravn
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiothoracic Anaesthesia, Copenhagen, Denmark
| | - C Hassager
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
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23
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Mark P, Frydland M, Moeller-Helgested OK, Holmvang L, Moeller JE, Johansson PI, Ostrowski SR, Prickett TCR, Hassager C, Goetze JP. P4625On women with ST-elevation myocardial infarction: raised concentrations of pro-C-type natriuretic peptide predict increased one-year mortality. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1007] [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
Introduction
Endothelial C-type natriuretic peptide (CNP) contributes to the local regulation of vascular homeostasis including a vasodilatory function in the microcirculation when studied in animal models. Clinical investigations have shown that high concentrations of C-type natriuretic peptides in plasma are associated with adverse clinical outcome in subgroups of patients with cardiac disease.
Purpose
To determine the prognostic potential of pro-C-type natriuretic peptide (proCNP) measurement in plasma sampled on admission of patients with ST-elevation myocardial infarction (STEMI).
Methods
In 1760 patients (470 women, 1290 men) with confirmed STEMI, we measured proCNP concentration in plasma obtained on hospital admission before coronary angiography. We divided patients into groups of low, normal or raised proCNP concentrations based on lower and upper cut-off values of sex- and age-specific 95% reference intervals from a reference population (688 individuals). We estimated differences in baseline characteristics including medical history and determined the prognostic value of proCNP measurement by Kaplan-Meier plots including log-rank tests and Cox regression survival analyses (expressed as hazard ratio (HR) and 95% confidence interval).
Results
Raised proCNP concentrations in plasma were associated with a higher prevalence of hypertension (P<0.001), diabetes mellitus (P=0.009), and peripheral artery disease (P=0.023), and a higher one-year all-cause mortality rate compared with normal proCNP concentrations (Plog-rank = 0.009, HR: 1.6 (1.1–2.4)). However, when adjusted for sex, an interaction between sex and groups of normal vs. raised proCNP was found (P=0.030). In sex-stratified analyses only women with raised proCNP concentrations showed an increased one-year all-cause mortality rate (women: Plog-rank <0.001, HR: 2.6 (1.5–4.6), men: Plog-rank= 0.66, HR: 1.1 (0.6–1.9)). Furthermore, in women, stepwise increases of proCNP concentration in the upper range (proCNP concentration > median) were independently associated with increased risk of death within one year after adjusting for age, plasma concentrations of creatinine and proANP, and quartiles of plasma troponins (HR: 1.02 (1.00–1.05) per 1 pmol/L increase of proCNP, P=0.047).
One-year all-cause mortality rates
Conclusion
In patients with STEMI, a raised concentration of proCNP from plasma sampled on admission was associated with a higher risk of death within one year. However, only women displayed this difference of mortality rate in sex-specific estimates. Moreover, stepwise increases of proCNP concentration in the upper range independently predicted a higher risk of one-year death in women following STEMI after adjusting for potential confounders.
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Affiliation(s)
- P Mark
- Rigshospitalet - Copenhagen University Hospital, Department of Clinical Biochemistry, Copenhagen, Denmark
| | - M Frydland
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | | | - L Holmvang
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J E Moeller
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - P I Johansson
- Rigshospitalet - Copenhagen University Hospital, Department of Clinical Immunology, Copenhagen, Denmark
| | - S R Ostrowski
- Rigshospitalet - Copenhagen University Hospital, Department of Clinical Immunology, Copenhagen, Denmark
| | - T C R Prickett
- University of Otago Christchurch, Department of Medicine, Christchurch, New Zealand
| | - C Hassager
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J P Goetze
- Rigshospitalet - Copenhagen University Hospital, Department of Clinical Biochemistry, Copenhagen, Denmark
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Chamat S, Dahl A, Hassager C, Arpi M, Oestergaard L, Bundgaard H, Lauridsen TK, Oestergaard LB, Gislason GH, Fosboel EL, Voldstedlund M, Bruun NE. P2754Streptococcal infective endocarditis: distribution of species and their prognosis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1071] [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
Infective endocarditis (IE) is frequently caused by streptococcal species. However, there is limited knowledge about the relationship between different streptococcal species and IE, and their associated outcomes.
Purpose
To examine the prevalence of streptococci at species level in IE, and to relate these different species to outcomes.
Methods
From 2002–2012 we prospectively collected consecutive patients with IE admitted to two tertiary heart centres covering a catchment area of 2.4 million people. The registry comprises 915 IE patients, 366 (40%) with streptococcal IE. Based on phylogenetic relationship, streptococcal species were classified into seven main groups: Mitis, Bovis, Mutans, Anginosus, Salivarius, Pyogenic and Nutritionally Variant Streptococcus (NVS). Classification at species level was not possible in 51 patients, who were excluded. Complications and prognosis of streptococcal IE were compared between the subgroups, and at species level.
Results
We included 315 patients with streptococcal IE. Mean age was 63 (IQR 52–76) years, and most were men (67%). A total of 115 patients (37%) had a previous heart valve disease, 58 (18%) had a prosthetic valve, 22 (7%) had previously had IE and 29 (9%) had a cardiac electronic device. With 148 episodes (47%) the Mitis group was the most common cause of IE. Other frequent groups were the Pyogenic group and the Bovis group, accounting for 66 (21%) and 51 (16%) of the cases, respectively. Surgery was carried out in 55% (n=173) of all cases. Patients infected with S. pneumoniae or S. agalactiae had a significantly higher rate of surgery, 72.2% (n=13) and 71.9% (n=23) respectively, whereas the Bovis group had a significantly lower rate, 35.5% (n=18) (p=0.048). The aortic valve was infected in 137 patients (43.5%), mitral valve in 105 patients (33.3%) and both valves were infected in 53 patients (16.8%). Twenty patients (6.3%) had right-sided IE, including pacemaker lead IE. There was no significant difference between the species subgroups regarding type of infected valve. Embolization and osteitis were observed in 76 (24.1%) and 30 (9.5%) patients, respectively. There was no significant difference between the species groups, as was the case with mortality: 23 patients (7.3%) died in-hospital and the one-year mortality was 16% (n=50).
Distribution of streptococcal IE
Conclusion
Species of the Mitis group were the most frequent Streptococci causing IE. Patients infected with S. pneumonia or S. agalactiae had significantly higher rate of surgery, and patients infected with S. bovis group had lower rate of surgery. There was no significant difference in rate of complications such as abscesses, embolization, osteitis or mortality between the streptococcal species.
Acknowledgement/Funding
Supported by grants from Herlev-Gentofte University Hospital Research Foundation
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Affiliation(s)
- S Chamat
- Gentofte University Hospital, Copenhagen, Denmark
| | - A Dahl
- Gentofte University Hospital, Copenhagen, Denmark
| | - C Hassager
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - M Arpi
- Herlev Hospital - Copenhagen University Hospital, Department of Clinical Microbiology, Copenhagen, Denmark
| | - L Oestergaard
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - H Bundgaard
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | | | | | - G H Gislason
- Gentofte University Hospital, Copenhagen, Denmark
| | - E L Fosboel
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - M Voldstedlund
- Statens Serum Institut, Department of Infectious Disease Epidemiology, Copenhagen, Denmark
| | - N E Bruun
- Zealand University Hospital, Department of Cardiology, Roskilde, Denmark
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Grand J, Kjaergaard J, Bro-Jeppesen J, Wanscher M, Hassager C. 5230Association of cardiac output during targeted temperature management with mortality after out-of-hospital cardiac arrest. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0077] [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
Purpose
Myocardial dysfunction and low cardiac output are common after out-of-hospital cardiac arrest (OHCA) as part of the post-cardiac arrest syndrome. This study investigates the association of cardiac output during targeted temperature management (TTM) with mortality. We hypothesized that low cardiac output during TTM is associated with mortality.
Methods
In the TTM-trial, which randomly allocated patients to TTM of 33°C or 36°C for 24 hours, we prospectively and consecutively monitored 171 patients with protocolized measurements from pulmonary artery catheters (PAC). Clinical and hemodynamic variables were registered at pre-specified time points in addition to 30-day survival status. Lactate, heart rate and cardiac index were measured at 3 time-points during TTM and averaged. We defined low cardiac output as a cardiac index during TTM <2.4 l/min/m2 in the TTM36-group and <1.8 l/min/m2 in the TTM33-group, since hypothermia affects cardiac output. We further stratified patients according to serum lactate (above/below 2 mmol/L) and heart rate (above/below median, which was 65 beats/min.).
Results
Of 152 patients with available hemodynamic measurements, 71 (47%) had low cardiac output during TTM (TTM33: 38 (49%), TTM36: 33 (44%)). Low cardiac output was not associated with mortality in univariate analysis (hazard ratio (HR): 1.47 [0.83–2.59], p=0.19) or multivariate analysis adjusted for potential confounders (HRadjusted: 0.74 [0.38–1.44], p=0.37). Low cardiac output combined with HR>65 was associated with increased mortality (HR: 2.69 [1.51–4.79], p=0.0007) in univariate, but not in multivariate analysis (p=0.22) (Figure). Low cardiac output and HR<65 was associated with decreased mortality in multivariate analysis (HRadjusted: 0.36 [0.14–0.93], p=0.03). Low cardiac output and lactate>2mmol/L was associated with increased mortality (HR: 2.73 [1.49–4.99], p=0.001) in univariate, but not in multivariate analysis (p=0.53), whereas patients with low cardiac output and lactate<2mmol/L had low mortality (HRadjusted: 0.58 [0.27–1.24], p=0.16) compared to the rest of the population (Figure).
Figure 1
Conclusion
This study found, that a frequent symptom during TTM is low cardiac output, which was not associated with mortality. However, patients with low cardiac output combined with either increased lactate or heart rate seems to be a population at risk. Whether low cardiac output should be corrected by inotropes or mechanical support to reduce mortality remains to be studied in prospective trials, but the efficacy of goal-directed therapy to increase cardiac output during TTM may be modest, especially if lactate and heart rate are normal.
Acknowledgement/Funding
The research fund Gangstedfonden and the Research fund of Rigshospitalet has supported this study with unrestricted salary in Dr. Grand's PhD project.
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Affiliation(s)
- J Grand
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J Kjaergaard
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J Bro-Jeppesen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - M Wanscher
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiothoracic Anaesthesia, Copenhagen, Denmark
| | - C Hassager
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
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Düring J, Dankiewicz J, Cronberg T, Hassager C, Hovdenes J, Kjaergaard J, Kuiper M, Nielsen N, Pellis T, Stammet P, Vulto J, Wanscher M, Wise M, Åneman A, Friberg H. Lactate, lactate clearance and outcome after cardiac arrest: A post-hoc analysis of the TTM-Trial. Acta Anaesthesiol Scand 2018; 62:1436-1442. [PMID: 29926901 DOI: 10.1111/aas.13172] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 05/01/2018] [Accepted: 05/02/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Admission lactate and lactate clearance are implemented for risk stratification in sepsis and trauma. In out-of-hospital cardiac arrest, results regarding outcome and lactate are conflicting. METHODS This is a post-hoc analysis of the Target Temperature Management trial in which 950 unconscious patents after out-of-hospital cardiac arrest were randomized to a temperature intervention of 33°C or 36°C. Serial lactate samples during the first 36 hours were collected. Admission lactate, 12-hour lactate, and the clearance of lactate within 12 hours after admission were analyzed and the association with 30-day mortality assessed. RESULTS Samples from 877 patients were analyzed. In univariate logistic regression analysis, the odds ratio for death by day 30 for each mmol/L was 1.12 (1.08-1.16) for admission lactate, P < .01, 1.21 (1.12-1.31) for 12-hour lactate, P < .01, and 1.003 (1.00-1.01) for each percentage point increase in 12-hour lactate clearance, P = .03. Only admission lactate and 12-hour lactate levels remained significant after adjusting for known predictors of outcome. The area under the receiver operating characteristic curve was 0.65 (0.61-0.69), P < .001, 0.61 (0.57-0.65), P < .001, and 0.53 (0.49-0.57), P = .15 for admission lactate, 12-hour lactate, and 12-hour lactate clearance, respectively. CONCLUSIONS Admission lactate and 12-hour lactate values were independently associated with 30-day mortality after out-of-hospital cardiac arrest while 12-hour lactate clearance was not. The clinical value of lactate as the sole predictor of outcome after out-of-hospital cardiac arrest is, however, limited.
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Affiliation(s)
- J. Düring
- Department of Clinical Sciences, Intensive and Perioperative Care Lund University Skane University Hospital Malmö Sweden
| | - J. Dankiewicz
- Department of Clinical Sciences, Cardiology Lund University Skane University Hospital Lund Sweden
| | - T. Cronberg
- Department of Clinical Sciences, Neurology Lund University Skane University Hospital Lund Sweden
| | - C. Hassager
- Department of Cardiology The Heart Centre Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - J. Hovdenes
- Division of Emergencies and Critical Care Department of Anesthesiology Oslo University Hospital Rikshospitalet Oslo Norway
| | - J. Kjaergaard
- Department of Cardiology The Heart Centre Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - M. Kuiper
- Department of Intensive Care Medical Center Leeuwarden Leeuwarden The Netherlands
| | - N. Nielsen
- Department of Clinical Sciences, Department of Anesthesiology and Intensive Care Lund University Helsingborg Hospital Helsingborg Sweden
| | - T. Pellis
- Department of Anaesthesia and Intensive Care Azienda Ospedaliera ‘Card. G. Panico’ Tricase Italy
| | - P. Stammet
- Medical Department National Rescue Services Luxembourg City Luxembourg
| | - J. Vulto
- Department of Emergency Medicine Medical Centre Leeuwarden Leeuwarden The Netherlands
| | - M. Wanscher
- Department of Cardiothoracic Anaesthesia 4142 The Heart Center Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - M. Wise
- Department of Adult Critical Care University Hospital of Wales Cardiff UK
| | - A. Åneman
- Intensive Care Unit Liverpool Hospital South Western Sydney Local Health District Sidney NSW Australia
- South Western Clinical School University of New South Wales Sydney NSW Australia
- The Ingham Institute for Applied Medical Research Sydney NSW Australia
| | - H. Friberg
- Department of Clinical Sciences, Intensive and Perioperative Care Lund University Skane University Hospital Malmö Sweden
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Winther‐Jensen M, Hassager C, Lassen JF, Køber L, Torp‐Pedersen C, Hansen SM, Lippert F, Kragholm K, Christensen EF, Kjaergaard J. Neurological prognostication tools in out-of-hospital cardiac arrest patients in Danish intensive care units from 2005 to 2013. Acta Anaesthesiol Scand 2018; 62:1412-1420. [PMID: 29947076 DOI: 10.1111/aas.13177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/31/2017] [Revised: 05/07/2018] [Accepted: 05/09/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Neurological prognostication is an essential part of post-resuscitation care in out-of-hospital cardiac arrest (OHCA). This study aims to assess the use of computed tomography (CT) and magnetic resonance imaging (MR) of the head, electroencephalography (EEG), and somatosensory evoked potentials (SSEP) in neurological prognostication in resuscitated OHCA patients and factors associated with their use in Danish tertiary and non-tertiary centers from 2005 to 2013 and associations with outcome. METHODS We used the Danish Cardiac Arrest Registry to identify patients ≥18 years of age admitted to intensive care units due to OHCA of presumed cardiac etiology. CT 0-20 days and MR, SSEP, and EEG ≥2-20 days post OHCA were considered related to prognostication. Incidence and factors associated with procedures were assessed by multiple Cox regression with death as competing risk. RESULTS Use of CT, MR, EEG, and SSEP increased during the study period (CT: 51%-67%, HRCT : 1.06, CI: 1.03-1.08, MR: 2%-5%, P = .08, EEG: 6%-33%, HREEG : 1.25, CI: 1.19-1.30, SSEP: 4%-15%, HRSSEP : 1.23, CI: 1.15-1.32). EEG and SSEP were more used in tertiary centers than non-tertiary (HREEG : 1.86, CI: 1.51-2.29, HRSSEP : 4.44, CI: 2.86-6.89). Use of CT, SSEP, and EEG were associated with higher 30-day mortality, and MR was associated with lower (HRCT : 1.15, CI: 1.01-1.30, HRMR : 0.53, CI: 0.37-0.77, HRSSEP : 1.90, CI: 1.57-2.32, HREEG : 1.75, CI: 1.49-2.05). CONCLUSION Use of neurological prognostication procedures increased during the study period. EEG and SSEP were more used in tertiary centers. CT, EEG and SSEP were associated with increased mortality.
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Affiliation(s)
- M. Winther‐Jensen
- Department of Cardiology The Heart Centre Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - C. Hassager
- Department of Cardiology The Heart Centre Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - J. F. Lassen
- Department of Cardiology The Heart Centre Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - L. Køber
- Department of Cardiology The Heart Centre Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - C. Torp‐Pedersen
- Unit of Epidemiology and Biostatistics Aalborg University Hospital Forskningens Hus Aalborg Denmark
| | - S. M. Hansen
- Unit of Epidemiology and Biostatistics Aalborg University Hospital Forskningens Hus Aalborg Denmark
| | - F. Lippert
- Emergency Medical Services Copenhagen University of Copenhagen Copenhagen Denmark
| | - K. Kragholm
- Department of Anesthesiology and Intensive Care Medicine Cardiovascular Research Centre Aalborg Denmark
| | - E. F. Christensen
- Department of Cardiology Aalborg University Hospital Aalborg Denmark
| | - J. Kjaergaard
- Department of Cardiology The Heart Centre Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
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28
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Backman S, Cronberg T, Friberg H, Ullén S, Horn J, Kjaergaard J, Hassager C, Wanscher M, Nielsen N, Westhall E. Highly malignant routine EEG predicts poor prognosis after cardiac arrest in the Target Temperature Management trial. Resuscitation 2018; 131:24-28. [DOI: 10.1016/j.resuscitation.2018.07.024] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/12/2018] [Accepted: 07/24/2018] [Indexed: 12/01/2022]
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29
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Pedersen FHG, Myhr KA, Bahrami SHZ, Hassager C, Mogelvang R. P1762Global, but not basal, longitudinal strain improves after aortic valve replacement in severe aortic stenosis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1762] [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)
- F H G Pedersen
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - K A Myhr
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - S H Z Bahrami
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - C Hassager
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - R Mogelvang
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
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30
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Grand J, Meyer AS, Kjaergaard J, Wiberg S, Thomsen JH, Frydland M, Ostrowski SR, Johansson PI, Hassager C. 47165 mmHg versus 72 mmHg mean arterial pressure target after out-of-hospital cardiac arrest: a randomized double-blinded trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.471] [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)
- J Grand
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - A S Meyer
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J Kjaergaard
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - S Wiberg
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J H Thomsen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - M Frydland
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - S R Ostrowski
- Rigshospitalet - Copenhagen University Hospital, Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen, Denmark
| | - P I Johansson
- Rigshospitalet - Copenhagen University Hospital, Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen, Denmark
| | - C Hassager
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
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31
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Westhall E, Rosén I, Rundgren M, Bro-Jeppesen J, Kjaergaard J, Hassager C, Lindehammar H, Horn J, Ullén S, Nielsen N, Friberg H, Cronberg T. Time to epileptiform activity and EEG background recovery are independent predictors after cardiac arrest. Clin Neurophysiol 2018; 129:1660-1668. [DOI: 10.1016/j.clinph.2018.05.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/24/2018] [Accepted: 05/31/2018] [Indexed: 01/30/2023]
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Myhr KA, Pedersen FHG, Bahrami SHZ, Hassager C, Mogelvang R. P847Global longitudinal strain: clinical significance of feasibility and variation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K A Myhr
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - F H G Pedersen
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - S H Z Bahrami
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - C Hassager
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - R Mogelvang
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
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33
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Roerth R, Thune JJ, Nielsen JC, Haarbo J, Videbaek L, Korup E, Bruun NE, Eiskjaer H, Hassager C, Svendsen JH, Hoefsten D, Torp-Pedersen C, Pehrson S, Kober L, Kristensen SL. 3382Diabetes and risk of death in non-ischemic systolic heart failure. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.3382] [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)
- R Roerth
- Rigshospitalet - Copenhagen University Hospital, Heart Center, Department of Cardiology, Copenhagen, Denmark
| | - J J Thune
- Rigshospitalet - Copenhagen University Hospital, Heart Center, Department of Cardiology, Copenhagen, Denmark
| | - J C Nielsen
- Aarhus University Hospital, Cardiology, Aarhus, Denmark
| | - J Haarbo
- Gentofte University Hospital, Department of cardiology, Gentofte, Denmark
| | - L Videbaek
- Odense University Hospital, Odense, Denmark
| | - E Korup
- Aalborg University Hospital, Cardiology, Aalborg, Denmark
| | - N E Bruun
- Gentofte University Hospital, Department of cardiology, Gentofte, Denmark
| | - H Eiskjaer
- Aarhus University Hospital, Cardiology, Aarhus, Denmark
| | - C Hassager
- Rigshospitalet - Copenhagen University Hospital, Heart Center, Department of Cardiology, Copenhagen, Denmark
| | - J H Svendsen
- Rigshospitalet - Copenhagen University Hospital, Heart Center, Department of Cardiology, Copenhagen, Denmark
| | - D Hoefsten
- Rigshospitalet - Copenhagen University Hospital, Heart Center, Department of Cardiology, Copenhagen, Denmark
| | - C Torp-Pedersen
- Aalborg University, Department of Health, Science and Technology, Aalborg, Denmark
| | - S Pehrson
- Rigshospitalet - Copenhagen University Hospital, Heart Center, Department of Cardiology, Copenhagen, Denmark
| | - L Kober
- Rigshospitalet - Copenhagen University Hospital, Heart Center, Department of Cardiology, Copenhagen, Denmark
| | - S L Kristensen
- Rigshospitalet - Copenhagen University Hospital, Heart Center, Department of Cardiology, Copenhagen, Denmark
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Obling L, Wiberg S, Winther-Jensen M, Illum C, Flensted Lassen J, Hassager C, Kjaergaard J. P2740Prognostic value of automated infrared pupillometry following out of hospital cardiac arrest. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2740] [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)
- L Obling
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - S Wiberg
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - M Winther-Jensen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - C Illum
- Rigshospitalet - Copenhagen University Hospital, Trauma Center, Copenhagen, Denmark
| | - J Flensted Lassen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - C Hassager
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J Kjaergaard
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
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35
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Korshin A, Grønlykke L, Nilsson JC, Møller-Sørensen H, Ihlemann N, Kjøller M, Damgaard S, Lehnert P, Hassager C, Kjaergaard J, Ravn HB. The feasibility of tricuspid annular plane systolic excursion performed by transesophageal echocardiography throughout heart surgery and its interchangeability with transthoracic echocardiography. Int J Cardiovasc Imaging 2018; 34:1017-1028. [DOI: 10.1007/s10554-018-1306-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 01/24/2018] [Indexed: 11/27/2022]
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36
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Frydland M, Ostrowski S, Moeller J, Wiberg S, Hadziselimovic E, Holmvang L, Ravn H, Jensen L, Pettersson A, Kjaergaard J, Lindholm M, Johansson P, Hassager C. P4640Biomarkers of endothelial damage are associated with cardiogenic shock in patients admitted with suspected ST-elevation myocardial infarction. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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37
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Dahl A, Lauridsen T, Hassager C, Arpi M, Moser C, Sogaard P, Bundgaard H, Ihlemann N, Bruun N. P4544Enterococcus faecalis endocarditis: prognostic factors, and 1-year survival vs propensity score matched patients with streptococcal endocarditis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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38
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Devaux Y, Salgado-Somoza A, Dankiewicz J, Boileau A, Stammet P, Schritz A, Zhang L, Vausort M, Gilje P, Erlinge D, Hassager C, Wise M, Kuiper M, Friberg H, Nielsen N. P6294Incremental value of circulating miR-122-5p to predict outcome after out of hospital cardiac arrest. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6294] [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)
- Y. Devaux
- Luxembourg Institute of Health, CVRU, Strassen, Luxembourg
| | | | - J. Dankiewicz
- Skane University Hospital, Department of Cardiology, Lund, Sweden
| | - A. Boileau
- Luxembourg Institute of Health, CVRU, Strassen, Luxembourg
| | | | - A. Schritz
- Luxembourg Institute of Health, CVRU, Strassen, Luxembourg
| | - L. Zhang
- Luxembourg Institute of Health, CVRU, Strassen, Luxembourg
| | - M. Vausort
- Luxembourg Institute of Health, CVRU, Strassen, Luxembourg
| | - P. Gilje
- Skane University Hospital, Department of Anesthesia and Intensive Care, Lund, Sweden
| | | | - C. Hassager
- Rigshospitalet University Hospital, Department of Cardiology B The Heart Centre, Copenhagen, Denmark
| | - M.P. Wise
- University Hospital of Wales, Department of Intensive Care, Cardiff, United Kingdom
| | - M. Kuiper
- Medical Center Leeuwarden, Department of Intensive Care, Leeuwarden, Netherlands
| | - H. Friberg
- Hospital of Helsingborg, Department of Anesthesia and Intensive Care, Helsingborg, Sweden
| | - N. Nielsen
- Hospital of Helsingborg, Department of Anesthesia and Intensive Care, Helsingborg, Sweden
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Winther-Jensen M, Hassager C, Lassen J, Kober L, Torp-Pedersen C, Hansen S, Lippert F, Kragholm K, Christensen E, Kjaergaard J. P1356A nationwide study: Differences in use of neurological prognostication procedures in out-of-hospital cardiac arrest patients in intensive care units from 2004-2013. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Winther-Jensen M, Kjaergaard J, Lassen J, Kober L, Torp-Pedersen C, Hansen S, Lippert F, Kragholm K, Christensen E, Hassager C. P2740Use of dialysis in out-of-hospital cardiac arrest patients in Danish intensive care units from 2004-2013 and implications for outcome. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Burup Kristensen C, Kofoed K, De Knegt M, Host N, Hassager C, De Backer O, Sondergaard L, Mogelvang R. P5240Transthoracic echocardiography may rule-out leaflet dysfunction after transcatheter aortic valve replacement, a novel algorithm based on leaflet morphology and color doppler flow characteristics. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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de Knegt MC, Fuchs A, Weeke P, Møgelvang R, Hassager C, Kofoed KF. Optimisation of coronary vascular territorial 3D echocardiographic strain imaging using computed tomography: a feasibility study using image fusion. Int J Cardiovasc Imaging 2016; 32:1715-1723. [PMID: 27539731 DOI: 10.1007/s10554-016-0964-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 08/17/2016] [Indexed: 10/21/2022]
Abstract
Current echocardiographic assessments of coronary vascular territories use the 17-segment model and are based on general assumptions of coronary vascular distribution. Fusion of 3D echocardiography (3DE) with multidetector computed tomography (MDCT) derived coronary anatomy may provide a more accurate assessment of left ventricular (LV) territorial function. We aimed to test the feasibility of MDCT and 3DE fusion and to compare territorial longitudinal strain (LS) using the 17-segment model and a MDCT-guided vascular model. 28 patients underwent 320-slice MDCT and transthoracic 3DE on the same day followed by invasive coronary angiography. MDCT (Aquilion ONE, ViSION Edition, Toshiba Medical Systems) and 3DE apical full-volume images (Artida, Toshiba Medical Systems) were fused offline using a dedicated workstation (prototype fusion software, Toshiba Medical Systems). 3DE/MDCT image alignment was assessed by 3 readers using a 4-point scale. Territorial LS was assessed using the 17-segment model and the MDCT-guided vascular model in territories supplied by significantly stenotic and non-significantly stenotic vessels. Successful 3DE/MDCT image alignment was obtained in 86 and 93 % of cases for reader one, and reader two and three, respectively. Fair agreement on the quality of automatic image alignment (intra-class correlation = 0.40) and the success of manual image alignment (Fleiss' Kappa = 0.40) among the readers was found. In territories supplied by non-significantly stenotic left circumflex arteries, LS was significantly higher in the MDCT-guided vascular model compared to the 17-segment model: -15.00 ± 7.17 (mean ± standard deviation) versus -11.87 ± 4.09 (p < 0.05). Fusion of MDCT and 3DE is feasible and provides physiologically meaningful displays of myocardial function.
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Affiliation(s)
- Martina Chantal de Knegt
- Department of Cardiology 2014, Faculty of Health Sciences, The Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark. .,Department of Cardiology, Faculty of Health Sciences, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - A Fuchs
- Department of Cardiology 2014, Faculty of Health Sciences, The Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - P Weeke
- Department of Cardiology 2014, Faculty of Health Sciences, The Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - R Møgelvang
- Department of Cardiology 2014, Faculty of Health Sciences, The Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - C Hassager
- Department of Cardiology 2014, Faculty of Health Sciences, The Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - K F Kofoed
- Department of Cardiology 2014, Faculty of Health Sciences, The Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Department of Radiology, Faculty of Health Sciences, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Korshin A, Grønlykke L, Nilsson J, Kjaergaard J, Ihlemann N, Hassager C, Damgaard S, Lehnert P, Kjøller S, Møller-Sørensen H, Berg Ravn H. The main reduction in tricuspid annular plane systolic excursion (TAPSE) after heart surgery doesn’t happen at the moment of pericardiotomy. J Cardiothorac Vasc Anesth 2016. [DOI: 10.1053/j.jvca.2016.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Dankiewicz J, Cronberg T, Erlinge D, Friberg H, Hassager C, Horn J, Hovdenes J, Kjaergaard J, Kuiper M, Gasche Y, Pellis T, Stammet P, Wanscher M, Wetterslev J, Wise MP, Åneman A, Nielsen N. Time to start of cardiopulmonary resuscitation and the effect of target temperature management at 33°C and 36°C. Intensive Care Med Exp 2015. [PMCID: PMC4798472 DOI: 10.1186/2197-425x-3-s1-a844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Lilja G, Nilsson G, Nielsen N, Friberg H, Hassager C, Koopmans M, Kuiper M, Martini A, Mellinghoff J, Pelosi P, Wanscher M, Wise MP, Östman I, Cronberg T. Anxiety and depression among out-of-hospital cardiac arrest survivors. Resuscitation 2015; 97:68-75. [PMID: 26433116 DOI: 10.1016/j.resuscitation.2015.09.389] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [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: 06/30/2015] [Revised: 09/14/2015] [Accepted: 09/18/2015] [Indexed: 10/23/2022]
Abstract
AIM Survivors of out-of-hospital cardiac arrest (OHCA) may experience psychological distress but the actual prevalence is unknown. The aim of this study was to investigate anxiety and depression within a large cohort of OHCA-survivors. METHODS OHCA-survivors randomized to targeted temperature of 33 °C or 36 °C within the Target Temperature Management trial (TTM-trial) attended a follow-up after 6 months that included the questionnaire Hospital Anxiety and Depression Scale (HADS). A control group with ST-elevation myocardial infarction (STEMI) completed the same follow-up. Correlations to variables assumed to be associated with anxiety and depression in OHCA-survivors were tested. RESULTS At follow-up 278 OHCA-survivors and 119 STEMI-controls completed the HADS where 24% of OHCA-survivors (28% in 33 °C group/22% in 36 °C group, p=0.83) and 19% of the STEMI-controls reported symptoms of anxiety (OR 1.32; 95% CI (0.78-2.25), p=0.30). Depressive symptoms were reported by 13% of OHCA-survivors (equal in both intervention groups, p=0.96) and 8% of STEMI-controls (OR 1.76; 95% CI (0.82-3.79), p=0.15). Anxiety and depression among OHCA-survivors correlated to Health-Related Quality-of-Life, and subjectively reported cognitive deterioration by patient or observer. In addition, depression was associated with a poor neurological outcome. CONCLUSION One fourth of OHCA-survivors reported symptoms of anxiety and/or depression at 6 months which was similar to STEMI-controls and previous normative data. Subjective cognitive problems were associated with an increased risk for psychological distress. Since psychological distress affects long-term prognosis of cardiac patients in general it should be addressed during follow-up of survivors with OHCA due to a cardiac cause. ClinicalTrials.gov NCT01020916/NCT01946932.
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Affiliation(s)
- G Lilja
- Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, 221 85 Lund, Sweden; Department of Clinical Sciences, Neurology, Lund University, 221 85 Lund, Sweden.
| | - G Nilsson
- Department of Clinical Sciences, Neurology, Lund University, 221 85 Lund, Sweden.
| | - N Nielsen
- Department of Intensive care and Anesthesiology, Helsingborg Hospital, Södra Vallgatan 5, 251 87 Helsingborg, Sweden; Department of Clinical Sciences, Anesthesiology and Intensive Care, Lund University, 221 85 Lund, Sweden.
| | - H Friberg
- Department of Clinical Sciences, Anesthesiology and Intensive Care, Lund University, 221 85 Lund, Sweden; Department of Intensive and Perioperative Care, Skåne University Hospital, 221 85 Lund, Sweden.
| | - C Hassager
- Department of Cardiology, The Heart Centre, Copenhagen University, Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - M Koopmans
- Department of Intensive Care, Medisch Centrum Leeuwarden, PO Box 888, 8901 BR Leeuwarden, The Netherlands.
| | - M Kuiper
- Department of Intensive Care, Medisch Centrum Leeuwarden, PO Box 888, 8901 BR Leeuwarden, The Netherlands; Department of Intensive Care, Academic Medical Center, Meibergdreef 9, 1105, Amsterdam, AZ, The Netherlands.
| | - A Martini
- Department of Anaesthesia, Intensive Care and Emergency Medical Service, Santa Maria degli Angeli Hospital, Via Montereale 24, 33170 Pordenone (PN), Italy.
| | - J Mellinghoff
- Department of Intensive and Perioperative Care, St. George's University Hospitals NHS Foundation Trust, 1st floor St. James Wing, Blackshaw Road, London SW17 0QT, United Kingdom.
| | - P Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, IRCCS AOU San Martino IST, University-Hospital Genoa, Genoa 16132, Italy.
| | - M Wanscher
- Department of Cardiothoracic Anaesthesia 4142, The Heart Center, Copenhagen University Hospital, Rigshospitalet, 9 Blegdamsvej, 2100 Copenhagen, Denmark.
| | - M P Wise
- Adult Critical Care, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom.
| | - I Östman
- Department of Cardiology, Örebro University Hospital, Södra Grevrosengatan, 701 85 Örebro, Sweden.
| | - T Cronberg
- Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, 221 85 Lund, Sweden; Department of Clinical Sciences, Neurology, Lund University, 221 85 Lund, Sweden.
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Eissmann M, Kahlert P, Erbel R, Janosi R, Soeholm H, Hassager C, Vejlstrup N, Arendrup H, Jensen M, Lund J, Ihlemann N, Neykova A, Molcard D, Moulla M, Valizadeh R, Alghandour M, Mahmoud M, Shimbo M, Watanabe H, Iino K, Ito H, Piriou N, Sassier J, Pallardy A, Valette F, Serfaty J, Trochu J, Cordovil A, Tude Rodrigues A, Piveta R, De Oliveira W, Ponchirolli A, Monaco C, De Lira Filho E, Vieira M, Fischer C, Morhy S. Case-based session: unusual and multitrouble cases: Saturday 6 December 2014, 08:30-10:0 * Location: Agora. Eur Heart J Cardiovasc Imaging 2014. [DOI: 10.1093/ehjci/jeu260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Domingos J, Augustine D, Leeson P, Noble J, Doan HL, Boubrit L, Cheikh-Khalifa R, Laveau F, Djebbar M, Pousset F, Isnard R, Hammoudi N, Lisi M, Cameli M, Di Tommaso C, Curci V, Reccia R, Maccherini M, Henein MY, Mondillo S, Leitman M, Vered Z, Rashid H, Yalcin MU, Gurses KM, Kocyigit D, Evranos B, Yorgun H, Sahiner L, Kaya B, Aytemir K, Ozer N, Bertella E, Petulla' M, Baggiano A, Mushtaq S, Russo E, Gripari P, Innocenti E, Andreini D, Tondo C, Pontone G, Necas J, Kovalova S, Hristova K, Shiue I, Bogdanva V, Teixido Tura G, Sanchez V, Rodriguez-Palomares J, Gutierrez L, Gonzalez-Alujas T, Garcia-Dorado D, Forteza A, Evangelista A, Timoteo AT, Aguiar Rosa S, Cruz Ferreira R, Campbell R, Carrick D, Mccombe C, Tzemos N, Berry C, Sonecki P, Noda M, Setoguchi M, Ikenouchi T, Nakamura T, Yamamoto Y, Murakami T, Katou Y, Usui M, Ichikawa K, Isobe M, Kwon B, Roh J, Kim H, Ihm S, Barron AJ, Francis D, Mayet J, Wensel R, Kosiuk J, Dinov B, Bollmann A, Hindricks G, Breithardt O, Rio P, Moura Branco L, Galrinho A, Cacela D, Pinto Teixeira P, Afonso Nogueira M, Pereira-Da-Silva T, Abreu J, Teresa Timoteo A, Cruz Ferreira R, Pavlyukova E, Tereshenkova E, Karpov R, Piatkowski R, Kochanowski J, Opolski G, Barbier P, Mirea O, Guglielmo M, Savioli G, Cefalu C, Pudil R, Horakova L, Rozloznik M, Balestra C, Rimbas R, Enescu O, Calin S, Vinereanu D, Karsenty C, Hascoet S, Hadeed K, Semet F, Dulac Y, Alacoque X, Leobon B, Acar P, Dharma S, Sukmawan R, Soesanto A, Vebiona K, Firdaus I, Danny S, Driessen MMP, Sieswerda G, Post M, Snijder R, Van Dijk A, Leiner T, Meijboom F, Chrysohoou C, Tsitsinakis G, Tsiachris D, Aggelis A, Herouvim E, Vogiatzis I, Pitsavos C, Koulouris G, Stefanadis C, Erdei T, Edwards J, Braim D, Yousef Z, Fraser A, Avenatti E, Magnino C, Omede' P, Presutti D, Moretti C, Iannaccone A, Ravera A, Gaita F, Milan A, Veglio F, Barbier P, Scali M, Simioniuc A, Guglielmo M, Savioli G, Cefalu C, Mirea O, Fusini L, Dini F, Okura H, Murata E, Kataoka T, Zaroui A, Ben Halima M, Mourali M, Mechmeche R, Rodriguez Palomares JF, Gutierrez L, Maldonado G, Garcia G, Otaegui I, Garcia Del Blanco B, Teixido G, Gonzalez Alujas M, Evangelista A, Garcia Dorado D, Godinho AR, Correia A, Rangel I, Rocha A, Rodrigues J, Araujo V, Almeida P, Macedo F, Maciel M, Rekik B, Mghaieth F, Aloui H, Boudiche S, Jomaa M, Ayari J, Tabebi N, Farhati A, Mourali S, Dekleva M, Markovic-Nikolic N, Zivkovic M, Stankovic A, Boljevic D, Korac N, Beleslin B, Arandjelovic A, Ostojic M, Galli E, Guirette Y, Auffret V, Daudin M, Fournet M, Mabo P, Donal E, Chin CWL, Luo E, Hwan J, White A, Newby D, Dweck M, Carstensen HG, Larsen LH, Hassager C, Kofoed KF, Jensen JS, Mogelvang R, Kowalczyk M, Debska M, Kolesnik A, Dangel J, Kawalec W, Migliore R, Adaniya M, Barranco M, Miramont G, Gonzalez S, Tamagusuku H, Davidsen ES, Kuiper KKJ, Matre K, Gerdts E, Igual Munoz B, Maceira Gonzalez A, Erdociain Perales M, Estornell Erill J, Valera Martinez F, Miro Palau V, Piquer Gil M, Sepulveda Sanchez P, Cervera Zamora A, Montero Argudo A, Placido R, Silva Marques J, Magalhaes A, Guimaraes T, Nobre E Menezes M, Goncalves S, Ramalho A, Robalo Martins S, Almeida A, Nunes Diogo A, Abid L, Ben Kahla S, Charfeddine S, Abid D, Kammoun S, Tounsi A, Abid L, Abid D, Charfeddine S, Hammami R, Triki F, Akrout M, Mallek S, Hentati M, Kammoun S, Sirbu CF, Berrebi A, Huber A, Folliguet T, Yang LT, Shih J, Liu Y, Li Y, Tsai L, Luo C, Tsai W, Babukov R, Bartosh F, Bazilev V, Muraru D, Cavalli G, Addetia K, Miglioranza M, Veronesi F, Mihaila S, Tadic M, Cucchini U, Badano L, Lang R, Miyazaki S, Slavich M, Miyazaki T, Figini F, Lativ A, Chieffo A, Montrfano M, Alfieri O, Colombo A, Agricola E, Liu D, Hu K, Herrmann S, Stoerk S, Kramer B, Ertl G, Bijnens B, Weidemann F, Brand M, Butz T, Tzikas S, Van Bracht M, Roeing J, Wennemann R, Christ M, Grett M, Trappe HJ, Scherzer S, Geroldinger A, Krenn L, Roth C, Gangl C, Maurer G, Rosenhek R, Neunteufl T, Binder T, Bergler-Klein J, Martins E, Pinho T, Leite S, Azevedo O, Belo A, Campelo M, Amorim S, Rocha-Goncalves F, Goncalves L, Silva-Cardoso J, Ahn H, Kim K, Jeon H, Youn H, Haland T, Saberniak J, Leren I, Edvardsen T, Haugaa K, Ziolkowska L, Boruc A, Kowalczyk M, Turska-Kmiec A, Zubrzycka M, Kawalec W, Monivas Palomero V, Mingo Santos S, Goirigolzarri Artaza J, Rodriguez Gonzalez E, Rivero Arribas B, Castro Urda V, Dominguez Rodriguez F, Mitroi C, Gracia Lunar I, Fernadez Lozano I, Palecek T, Masek M, Kuchynka P, Fikrle M, Spicka I, Rysava R, Linhart A, Saberniak J, Hasselberg N, Leren I, Haland T, Borgquist R, Platonov P, Edvardsen T, Haugaa K, Ancona R, Comenale Pinto S, Caso P, Coopola M, Arenga F, Rapisarda O, D'onofrio A, Sellitto V, Calabro R, Rosca M, Popescu B, Calin A, Mateescu A, Beladan C, Jalba M, Rusu E, Zilisteanu D, Ginghina C, Pressman G, Cepeda-Valery B, Romero-Corral A, Moldovan R, Saenz A, Orban M, Samuel S, Fijalkowski M, Fijalkowska M, Gilis-Siek N, Blaut K, Galaska R, Sworczak K, Gruchala M, Fijalkowski M, Nowak R, Gilis-Siek N, Fijalkowska M, Galaska R, Gruchala M, Ikonomidis I, Triantafyllidi H, Trivilou P, Tzortzis S, Papadopoulos C, Pavlidis G, Paraskevaidis I, Lekakis J, Kaymaz C, Aktemur T, Poci N, Ozturk S, Akbal O, Yilmaz F, Tokgoz Demircan H, Kirca N, Tanboga I, Ozdemir N, Greiner S, Jud A, Aurich M, Hess A, Hilbel T, Hardt S, Katus H, D'ascenzi F, Cameli M, Alvino F, Lisi M, Focardi M, Solari M, Bonifazi M, Mondillo S, Konopka M, Krol W, Klusiewicz A, Burkhard K, Chwalbinska J, Pokrywka A, Dluzniewski M, Braksator W, King GJ, Coen K, Gannon S, Fahy N, Kindler H, Clarke J, Iliuta L, Rac-Albu M, Placido R, Robalo Martins S, Guimaraes T, Nobre E Menezes M, Cortez-Dias N, Francisco A, Silva G, Goncalves S, Almeida A, Nunes Diogo A, Kyu K, Kong W, Songco G, Galupo M, Castro M, Shin Hnin W, Ronald Lee C, Poh K, Milazzo V, Di Stefano C, Tosello F, Leone D, Ravera A, Sabia L, Sobrero G, Maule S, Veglio F, Milan A, Jamiel AM, Ahmed AM, Farah I, Al-Mallah MH, Petroni R, Magnano R, Bencivenga S, Di Mauro M, Petroni S, Altorio S, Romano S, Penco M, Kumor M, Lipczynska M, Klisiewicz A, Wojcik A, Konka M, Kozuch K, Szymanski P, Hoffman P, Rimbas R, Rimbas M, Enescu O, Mihaila S, Calin S, Vinereanu D, Donal E, Reynaud A, Lund L, Persson H, Hage C, Oger E, Linde C, Daubert J, Maria Oliveira Lima M, Costa H, Gomes Da Silva M, Noman Alencar M, Carmo Pereira Nunes M, Costa Rocha M, Abid L, Charfeddine S, Ben Kahla S, Abid D, Siala A, Hentati M, Kammoun S, Kovalova S, Necas J, Ozawa K, Funabashi N, Takaoka H, Kobayashi Y, Matsumura Y, Wada M, Hirakawa D, Yasuoka Y, Morimoto N, Takeuchi H, Kitaoka H, Sugiura T, Lakkas L, Naka K, Ntounousi E, Gkirdis I, Koutlas V, Bechlioulis A, Pappas K, Katsouras C, Siamopoulos K, Michalis L, Naka K, Evangelou D, Kalaitzidis R, Bechlioulis A, Lakkas L, Gkirdis I, Tzeltzes G, Nakas G, Katsouras C, Michalis L, Generati G, Bandera F, Pellegrino M, Labate V, Alfonzetti E, Guazzi M, Zagatina A, Zhuravskaya N, Al-Mallah M, Alsaileek A, Qureshi W, Karsenty C, Hascoet S, Peyre M, Hadeed K, Alacoque X, Amadieu R, Leobon B, Dulac Y, Acar P, Yamanaka Y, Sotomi Y, Iwakura K, Inoue K, Toyoshima Y, Tanaka K, Oka T, Tanaka N, Orihara Y, Fujii K, Soulat-Dufour L, Lang S, Boyer-Chatenet L, Van Der Vynckt C, Ederhy S, Adavane S, Haddour N, Boccara F, Cohen A, Huitema M, Boerman S, Vorselaars V, Grutters J, Post M, Gopal AS, Saha S, Toole R, Kiotsekoglou A, Cao J, Reichek N, Meyer CG, Altiok E, Al Ateah G, Lehrke M, Becker M, Lotfi S, Autschbach R, Marx N, Hoffmann R, Frick M, Nemes A, Sepp R, Kalapos A, Domsik P, Forster T, Caro Codon J, Blazquez Bermejo Z, Lopez Fernandez T, Valbuena Lopez SC, Iniesta Manjavacas AM, De Torres Alba F, Dominguez Melcon F, Pena Conde L, Moreno Yanguela M, Lopez-Sendon JL, Nemes A, Lengyel C, Domsik P, Kalapos A, Orosz A, Varkonyi T, Forster T, Rendon J, Saldarriaga CI, Duarte N, Nemes A, Domsik P, Kalapos A, Forster T, Nemes A, Domsik P, Kalapos A, Sepp R, Foldeak D, Borbenyi Z, Forster T, Hamdy A, Fereig H, Nabih M, Abdel-Aziz A, Ali A, Broyd C, Wielandts JY, De Buck S, Michielsen K, Louw R, Garweg C, Nuyts J, Ector J, Maes F, Heidbuchel H, Gillis K, Bala G, Tierens S, Cosyns B, Maurovich-Horvat P, Horvath T, Jermendy A, Celeng C, Panajotu A, Bartykowszki A, Karolyi M, Tarnoki A, Jermendy G, Merkely B. Poster session 2: Thursday 4 December 2014, 08:30-12:30 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2014. [DOI: 10.1093/ehjci/jeu252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Ihlemann N, Landex N, Soeholm H, Hassager C, Gustafsson F, Matshela MR, Butz T, Faber L, Brand M, Wiemer M, Piper C, Noelke J, Sasko B, Horstkotte D, Trappe H, Cruz I, Dymarkowski S, Bogaert J, Kudaiberdiev T, Strachinaru M, Catez E, Jousten I, Pavel O, Janssen C, Morissens M, Gazagnes MD, Rodriguez Diego S, Delgado M, Ruiz M, Pardo L, Hidalgo FJ, Romo E, Ortega R, Mesa D, Suarez De Lezo Cruz Conde J. Oral Abstract session: Pericardial diseases, masses and sources of embolism: Thursday 4 December 2014, 11:00-12:30 * Location: Agora. Eur Heart J Cardiovasc Imaging 2014. [DOI: 10.1093/ehjci/jeu244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Carstensen H, Larsen L, Hassager C, Kofoed K, Kristensen C, Jensen J, Mogelvang R, Dulgheru R, Magne J, Kou S, Machado C, Henri C, Voilliot D, Laaraibi S, Pierard L, Lancellotti P, Sato K, Seo Y, Ishizu T, Takeuchi M, Izumo M, Suzuki K, Yamashita E, Miyake F, Otsuji Y, Aonuma K, Rao CM, Benedetto F, Luca F, Van Garsse L, Parise O, Benedetto D, Aguglia D, Maessen J, Gensini GF, Gelsomino S, Knebel F, Spethmann S, Baldenhofer G, Sanad W, Stangl V, Laule M, Dreger H, Mueller E, Baumann G, Stangl K. Oral Abstract sessions * 2 D strain in aortic stenosis: clinical impact: 13/12/2013, 14:00-15:30 * Location: Bursa. Eur Heart J Cardiovasc Imaging 2013. [DOI: 10.1093/ehjci/jet224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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