| 1. |
- Wartig, Maria, et al.
(författare)
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Tricuspid regurgitation influences outcome after heart transplantation.
- 2014
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Ingår i: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation. - : Elsevier BV. - 1557-3117. ; 33:8, s. 829-835
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Tidskriftsartikel (refereegranskat)abstract
- We investigated the correlation between tricuspid regurgitation (TR) and late survival, and its relation to bicaval (BC) and biatrial (BA) technique, after heart transplantation (HTx).
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| 2. |
- Abulmeaty, M. M. A., et al.
(författare)
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Impact of Vitamin D Supplementation on Bone Mineral Density and All-Cause Mortality in Heart Transplant Patients
- 2021
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Ingår i: Biomedicines. - : MDPI AG. - 2227-9059. ; 9:10
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Tidskriftsartikel (refereegranskat)abstract
- Vitamin D (VD) deficiency is frequently reported in heart transplant (HT) recipients and routinely supplemented. However, the efficacy of VD supplementation on bone mineral density (BMD) and its association with all-cause mortality is underinvestigated. The VD levels and BMD were studied for two years, and the association of VD and BMD with all-cause mortality risk was investigated. Ninety-six HT patients (38.18 & PLUSMN; 12.10 years old; 74% men) were followed up during VD, Ca, and Mg supplementation. Anthropometric measurements, BMD by Dual-energy X-ray absorptiometry (DEXA) scan, VD concentrations, and related biochemical parameters were analyzed before, 1 year, and 2 years after HT. Despite significant improvement of VD3 and 25-hydroxy VD (25OHVD) levels especially in the men, BMD parameters were insignificantly changed. After 2 years, the all-cause mortality rate was 15.6%. High pretransplant levels of 25OHVD failed to improve the survival probability. Cox's regression showed a 32.7% increased hazard ratio for each unit increase in body mass index (95% CI: 1.015-1.733, p = 0.038), in the VD-deficient group rather than in the VD-sufficient one. In conclusion, VD supplementation improves the biochemical status, especially in VD-deficient HT. However, its impact on the BMD and mortality was not as usually expected. Further investigation of the disturbed VD metabolism in HT is warranted.
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| 3. |
- Bech-Hanssen, Odd, 1956, et al.
(författare)
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Doppler echocardiography can provide a comprehensive assessment of right ventricular afterload
- 2009
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Ingår i: Journal of the American Society of Echocardiography. - : Elsevier BV. - 0894-7317. ; 22:12, s. 1360-7
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The purpose of this study was to evaluate novel Doppler echocardiographic methods for a comprehensive assessment of right ventricular afterload, including pulmonary artery (PA) mean pressure (PAMP) and the PA pressure waveform. METHODS: The study comprised 109 patients who underwent right-heart catheterization simultaneously (group A, n = 31) with Doppler echocardiography on 35 occasions or nonsimultaneously (group B, n = 78) within 24 hours of Doppler echocardiography. Right ventricular afterload variables were obtained using pulsed Doppler in the PA and continuous Doppler of tricuspid regurgitation. The intervals from QRS to the opening and closing of the pulmonary valve and to the peak velocity of tricuspid regurgitation were measured. PA end-diastolic pressure, PA systolic pressure, and PA notch pressure were calculated. The Doppler-derived pressure curve was separated into 3 parts with fitted second-order curves. RESULTS: Catheter PAMP and Doppler PA systolic pressure in group A were strongly related (R = 0.85). The regression equation from group A (PAMP = 0.65 x Doppler PA systolic pressure - 1.2 mm Hg) was used to calculate PAMP in group B. There was no difference between catheter PAMP (mean, 39 +/- 18 mm Hg; range, 8-95 mm Hg) and Doppler PAMP (mean, 39 +/- 15 mm Hg; range, 12-83 mm Hg) (P = .85). The systolic areas under the curves for catheter and Doppler PAMP in group A were 20 +/- 4.7 and 20 +/- 4.0 mm Hg s, respectively (P = .52), and the diastolic areas were 21 +/- 5.7 and 22 +/- 6.3 mm Hg s, respectively (P = .21). CONCLUSION: A comprehensive assessment of right ventricular afterload that includes PAMP and the PA pressure waveform can be provided by Doppler echocardiography in patients with a wide range of PA pressures and different diagnoses.
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| 4. |
- Bech-Hanssen, Odd, 1956, et al.
(författare)
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Echocardiography can identify patients with increased pulmonary vascular resistance by assessing pressure reflection in the pulmonary circulation.
- 2010
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Ingår i: Circ Cardiovasc Imaging.. - 1941-9651. ; 3:4, s. 424-432
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Tidskriftsartikel (refereegranskat)abstract
- Background— Pulmonary hypertension is a frequent finding in patients with cardiopulmonary disorders. It is important to recognize pulmonary hypertension due to increased pulmonary vascular resistance (PVR), as this affects treatment and prognosis. Patients with increased PVR have an increased pulmonary pressure reflection. We hypothesized that pressure reflection can be described by echocardiography and that variables related to pressure reflection can identify patients with increased PVR. Methods and Results— The study comprised 98 patients investigated within 24 hours of right heart catheterization and 20 control subjects. The pressure reflection variables were obtained by pulsed Doppler in the pulmonary artery and continuous Doppler of tricuspid regurgitation. We selected 3 variables related to pressure reflection: the interval from valve opening to peak velocity in the pulmonary artery (AcT, ms), the interval between pulmonary artery peak velocity and peak tricuspid velocity (tPV-PP, ms), and the right ventricular pressure increase after peak velocity in the pulmonary artery (augmented pressure, AP, mm Hg). The correlation between simultaneous catheter- and echocardiography-determined AP was strong (n=19, R=0.83). The AcT, tPV-PP, and AP in patients with a PVR of >3 Woods units (n=71) was (mean±SD) 77±16 ms, 119±36 ms, and 22±12 mm Hg, respectively, and differed from patients with a PVR of ≤3 Woods units (n=27, P<0.0001), 111±32 ms, 39±54 ms, and 3±4 mm Hg, and from controls, 153±32 ms, −19±45 ms, and 0 mm Hg, respectively (P<0.0001). The AcT, tPV-PP, and AP values were not correlated with capillary wedge pressure (R=0.08–0.16). The areas under the receiver operator characteristic curve (95%CI) for AcT, tPV-PP, and AP were 0.87 (0.82 to 0.95), 0.94 (0.89 to 0.99), and 0.98 (0.95 to 1.0), respectively. Conclusions— In this study, we describe a novel echocardiography method for assessing pressure reflection in the pulmonary circulation. This method can be used to identify patients with pulmonary hypertension due to increased PVR.
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| 5. |
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| 6. |
- Dellgren, Göran, 1961, et al.
(författare)
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Three decades of heart transplantation in Scandinavia: long-term follow-up
- 2013
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Ingår i: European Journal of Heart Failure. - : Wiley. - 1879-0844 .- 1388-9842. ; 15:3, s. 308-315
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Tidskriftsartikel (refereegranskat)abstract
- Aim Heart transplantation (HTx) has become a standard treatment for patients with end-stage heart disease. The aim of this study was to report the long-term outcome after HTx in Scandinavia. Methods and results During the period, 1983-2009,2333 HTxs were performed in 2293 patients (mean age 45 +/- 16 years, range 0-70,78% mate). The main indications for HTx were non-ischaemic cardiomyopathy (50%), ischaemic cardiomyopathy (34%), valvular cardiomyopathy (3%), congenital heart disease (7%), retransplantation (2%), and miscellaneous (4%). The registry consists of pre-operative data from recipients and donors, data from pre-operative procedures, and long-term follow-up data. Mean follow-up was 7.8 +/- 6.6 years (median 6.9, interquartile range 2.5-12.3, interval 0-27) and no patients were lost to follow-up. Long-term survival for HTx patients was 85, 76, 61, 43, and 30% at 1, 5, 10, 15, and 20 years of follow-up, respectively. Ten-year survival in patients bridged with mechanical circulatory support, in children, after retransplantation, and after concomitant other organ transplantation was 56, 74, 38, and 43%, respectively. Older patients (age >55 years) had a significantly worse survival (P < 0.001). Patients transplanted more recently had a significantly better survival (P < 0.001). In a multivariate Cox regression analysis, independent predictors of long-term survival were recipient age (P < 0.001), donor age (P < 0.001), diagnosis (P = 0.001), and era of transplantation (P < 0.001). Conclusions HTx in Scandinavia proves to have a significantly better survival among patients transplanted in the last decade. HTxs from mechanical circulatory support, in children, after retransplantation, and with concomitant other organ transplantation were performed with acceptable results.
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| 7. |
- Selimovic, Nedim, 1960, et al.
(författare)
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Assessment of pulmonary vascular resistance by Doppler echocardiography in patients with pulmonary arterial hypertension.
- 2007
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Ingår i: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation. - : Elsevier BV. - 1557-3117. ; 26:9, s. 927-34
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Assessment of pulmonary artery pressures, cardiac output (CO) and pulmonary vascular resistance (PVR) is crucial in the management of patients with pulmonary arterial hypertension (PAH). The aim of the present study was to investigate whether Doppler echocardiography can be used to determine PVR in patients with PAH. METHODS: Forty-two patients were included and Doppler echocardiography was performed simultaneously (n = 22) and non-simultaneously (n = 60) with right heart catheterization. The tricuspid regurgitation velocity was used to estimate pulmonary arterial peak systolic and diastolic (PADP) pressures (Bernoulli equation). At the time of pulmonary valve opening, right ventricular pressure equals PADP. The tricuspid regurgitation velocity at the time of pulmonary valve opening was measured by superimposing the time from the QRS to the onset of pulmonary flow on the tricuspid regurgitation velocity envelope. Pulmonary capillary wedge pressure, right atrial pressure and CO were assessed using standard Doppler echocardiography methods. Right heart catheterization was performed using Swan-Ganz catheters and thermodilution for CO determination. RESULTS: The differences (mean +/- SD) between catheter and simultaneous/non-simultaneous Doppler echocardiography were 0.3 +/- 0.8 (p = 0.10)/-0.3 +/- 1.1 (p = 0.06) liter/min for CO, 2.9 +/- 5.1 (p = 0.02)/-1.2 +/- 7.4 (p = 0.2) mm Hg for the transpulmonary gradient (TPG) and 0.3 +/- 2.1 (p = 0.65)/0.8 +/- 2.4 (p = 0.02) Wood unit for PVR. The correlation coefficients between catheter and simultaneous/non-simultaneous Doppler echocardiography were 0.86/0.75 for CO, 0.92/0.90 for TPG and 0.93/0.92 for PVR. CONCLUSIONS: A comprehensive hemodynamic assessment that includes CO, TPG and PVR can be provided by Doppler echocardiography in patients with severe pulmonary hypertension.
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| 8. |
- Selimovic, Nedim, 1960, et al.
(författare)
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Endothelin-1 across the lung circulation in patients with pulmonary arterial hypertension and influence of epoprostenol infusion.
- 2009
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Ingår i: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation. - : Elsevier BV. - 1557-3117. ; 28:8, s. 808-14
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The endothelin-1 (ET-1) system plays a pathophysiologic role in patients with pulmonary arterial hypertension (PAH). Results from previous studies assessing the transpulmonary gradient of ET-1 have been inconsistent. The influence of an intravenous epoprostenol infusion on the transpulmonary ET-1 gradient is unknown. METHODS: In a prospective investigation, serum concentrations of ET-1 were measured in 39 consecutive patients (31 women; mean age, 20-77 years) with pulmonary hypertension (33 with PAH) and compared with 20 controls. The effect of intravenous epoprostenol administration on the transpulmonary gradient of ET-1 was analyzed in 13 patients with pulmonary hypertension. Blood samples were taken simultaneously from the pulmonary artery and radial artery. RESULTS: The serum levels of ET-1 were significantly higher in the arterial (3.9 +/- 1.28 vs 2.53 +/- 0.24 pg/ml, p < 0.001) and mixed venous blood samples (3.9 +/- 1.21 vs 2.52 +/- 0.29 pg/ml, p < 0.001) in patients with pulmonary hypertension than in controls. The arterial/venous ratio of ET-1 in patients (1.0 +/- 0.1) and in the control group (1.0 +/- 0.05) was similar (p = 0.79). During intravenous epoprostenol infusion, there were no changes in the mean transpulmonary ET-1 gradient (0.98 +/- 0.07 vs 0.96 +/- 0.09, p = 0.52), despite significant hemodynamic changes. CONCLUSION: The ET-1 radial artery/pulmonary artery ratio of unity indicates a balanced release and clearance of ET-1 across the lung circulation in controls and in patients with different forms of pulmonary hypertension. ET-1 levels across the pulmonary circulation did not change during epoprostenol infusion.
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| 9. |
- Selimovic, Nedim, 1960, et al.
(författare)
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Growth factors and interleukin-6 across the lung circulation in pulmonary hypertension.
- 2009
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Ingår i: The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology. - : European Respiratory Society (ERS). - 1399-3003. ; 34:3, s. 662-8
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Tidskriftsartikel (refereegranskat)abstract
- The aim of our study was to assess the levels of growth factors and interleukin (IL)-6 across the pulmonary circulation in patients with pulmonary arterial hypertension (PAH) and correlate them with clinical and haemodynamic data and outcome. Simultaneous arterial and pulmonary arterial blood samples in patients with PAH (n = 44) and controls (n = 20) were obtained during right heart catheterisation. Vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF)-BB, transforming growth factor (TGF)-beta1 and IL-6 were measured using ELISA. Arterial median (interquartile range) values for VEGF, PDGF-BB, TGF-beta1 and IL-6 were significantly higher in patients (377 (218-588) versus 9.0 pg.mL(-1); 1,955 (1,371-2,519) versus 306 (131-502) pg.mL(-1); 26.42 (11.3-41.1) versus 7.0 (1.8-18.4) ng.mL(-1); and 3.98 (0.7-8.1) versus 0.7 pg.mL(-1), respectively; p<0.001 for all variables). There was a consistent step-up of VEGF, PDGF-BB and TGF-beta1 across the lungs in PAH patients (p<0.001, p = 0.002 and p<0.001, respectively), whereas in controls, arterial and pulmonary arterial serum levels of IL-6 and growth factors were similar (statistically nonsignificant). In multivariate analysis, increased IL-6 levels predicted mortality (hazard ratio 1.08 (95% confidence interval 1.02-1.15); p = 0.012). Our findings indicate increased release and/or decreased clearance of growth factors at the lung vascular level, which may contribute to vascular remodelling in PAH.
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| 10. |
- Selimovic, Nedim, 1960
(författare)
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Pulmonary hypertension. Clinical and pathophysiological studies
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Pulmonary hypertension (PH) is a common abnormality, most often associated with various cardiopulmonary diseases. Pulmonary arterial hypertension (PAH) is a devastating pulmonary vascular disease characterised by the proliferation of endothelial, smooth-muscle cells and fibroblasts. The processes that initiate the pathological changes seen in PH are still unknown. Pulmonary hypertension is defined by increased pulmonary artery mean pressure over 25 mm Hg at rest. Right heart catheterisation is required to confirm the diagnosis and to estimate the severity of PH. The aims of this thesis were to evaluate whether Doppler echocardiography can be used to determine pulmonary vascular resistance (PVR) in patients with PAH; to evaluate the association between PH in patients with lung diseases awaiting lung transplantation (LTx) and mortality; to assess circulating levels of growth factors, vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF), transforming growth factor β1 (TGF-β1), interleukin-6 (IL-6) and endothelin-1 (ET-1) across the lung circulation in patients with PAH and their association with the severity of disease; to examine the influence of intravenous epoprostenol on the arterial to venous ET-1 ratio in PAH patients. Forty-two patients with PAH underwent Doppler echocardiography simultaneously (n=22) and non-simultaneously (n=60) with right heart catheterisation. Retrospectively, 177 patients with advanced lung disease accepted for lung transplantation were studied. Blood samples for the analysis of growth factors, ET-1 and IL-6 were obtained simultaneously from the pulmonary artery (PA) and the radial artery (RA) in patients with PAH (n=44) during right heart catheterisation and were compared with control subjects (n=20). The correlation coefficient between catheter and simultaneous/non-simultaneous Doppler echocardiography was 0.93/0.92 for PVR. In multivariate analysis, PVR and forced vital capacity (FVC) % of predicted were independently associated with death in patients on the waiting list for LTx. Serum levels of VEGF, PDGF, TGF-1, ET-1 and IL-6 were significantly higher in patients with PAH as compared with controls. There was a consistent step-up of VEGF, PDGF and TGF-1 across the lungs in PAH patients whereas arterial and PA serum levels of growth factors, ET-1 and IL-6 were similar in the controls (p=NS). IL-6 appeared as a predictor of mortality in multivariate analysis. There were significant correlations between serum levels of ET-1, hemodynamic data and clinical variables. In conclusion, Doppler echocardiography can be used for estimating of PVR in patients with PAH and may reduce the need for invasive follow-up in these patients. Patients with increased PVR and a lower FVC % of predicted awaiting LTx should be considered for a higher organ allocation priority. The finding of increased circulating levels of growth factors indicates increased release and/or decreased clearance of growth factors at the lung vascular level. These changes may contribute to vascular remodelling in PAH. IL-6 emerged as an independent predictor of adverse outcome in patients with PAH. The ET-1 RA/PA ratio of unity indicates that the clearance and release of ET-1 across the lungs are balanced in controls, PAH patients and during intravenous epoprostenol infusion in treatment-naïve PAH patients. ET-1 serum levels correlated with hemodynamic and clinical markers of PAH severity.
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