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- Borer, J. S., et al.
(författare)
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Efficacy and safety of ivabradine in patients with severe chronic systolic heart failure (from the SHIFT study)
- 2014
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Ingår i: American Journal of Cardiology. - : Elsevier BV. - 0002-9149. ; 113:3, s. 497-503
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Tidskriftsartikel (refereegranskat)abstract
- A post hoc analysis of Systolic Heart failure treatment with the I f inhibitor ivabradine Trial (SHIFT) explored the efficacy and safety of ivabradine in severe heart failure (HF) as denoted by left ventricular ejection fraction (LVEF) ≤20% and/or New York Heart Association (NYHA) class IV. The SHIFT population (LVEF ≤35%, heart rate ≥70 beats/min, and sinus rhythm) comprised 712 patients with severe (defined previously) and 5,973 with less severe (NYHA classes II or III and LVEF >20%) HF, all randomized to ivabradine or placebo on a background of guideline-defined standard care. The rate of primary composite end point of cardiovascular death or HF hospitalization with placebo was higher in severe (42%) than less severe (27%) HF (p <0.001). Treatment with ivabradine in severe HF was associated with relative risk reductions indistinguishable from those of less severe disease for the primary end point (16% reduction), all-cause death (22%), cardiovascular death (22%), HF death (37%), and HF hospitalization (17%; all p values for interaction: NS). NYHA class improved in 38% (n = 129) ivabradine-treated patients with severe HF versus 29% (n = 104) placebo-treated patients (p = 0.009). In the 272 patients with severe HF and baseline heart rate ≥75 beats/min (the indication approved by the European Medicines Agency), ivabradine reduced the primary end point by 25% (p = 0.045), HF hospitalization by 30% (p = 0.042), and cardiovascular death by 32% (p = 0.034). Ivabradine's safety profile in severe HF was indistinguishable from less severe. In conclusion, our analysis confirms that heart rate reduction with ivabradine can be safely used in severe HF and may improve clinical outcomes independently of disease severity. © 2014 Elsevier Inc. All rights reserved.
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- Perez-Moreno, A. C., et al.
(författare)
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Fatigue as a predictor of outcome in patients with heart failure. Analysis of CORONA (Controlled rosuvastatin multinational trial in heart failure)
- 2014
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Ingår i: JACC: Heart Failure. - : Elsevier BV. - 2213-1779. ; 2:2, s. 187-197
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The purpose of this study was to examine the relationship between fatigue and clinical outcomes, using dyspnea as a comparator, in patients with left ventricular ejection fraction (LVEF)≤35% enrolled in the CORONA (Controlled Rosuvastatin Multinational Trial in Heart Failure) study. Background: Although fatigue is a common symptom in heart failure (HF), little is known about its association with prognosis. Methods: At baseline in CORONA, fatigue "during the past few days" was measured using a 5-point exertion scale (0= none, 1= heavy exertion, 2= moderate exertion, 3= slight exertion, 4= rest); a 4-point scale was used for dyspnea (1to4 as for fatigue). Patients were grouped into 3 categories: a fatigue score 0 to 1 (n= 535), fatigue score 2(n=1,632), and fatigue score 3 to 4 (n= 1,663); and a dyspnea score of 1 (n= 292), dyspnea score of 2(n=1,695), and dyspnea score of 3 to 4 (n= 1,843). The association between fatigue and dyspnea and the composite outcome of cardiovascular (CV) death or HF hospital stay and each component separately was examined using Kaplan-Meier analysis and Cox proportional-hazard models. We also examined all-cause mortality. Results: In univariate analyses, symptom severity was associated with a higher risk of CV death or HF hospital stay (fatigue: group 3, 49% [n= 810], vs. group 1, 30% [n= 160]; dyspnea: group 3, 50% [n= 918], vs. group 1, 28% [n= 82]) and all-cause mortality (fatigue: group 3, 38% [n= 623], vs. group 1, 24% [n= 130]; dyspnea: group 3, 38% [n=697], vs. group 1, 23% [n= 66], log-rank p< 0.0001 for all). After adjusting for other prognostic variables, including LVEF, New York Heart Association class, and N-terminal pro-B-type natriuretic peptide level, worse fatigue remained associated with higher risk of HF hospital stay but not mortality (worse dyspnea remained associated with a higher risk of both). An increase in fatigue (or dyspnea) between baseline and 6 months was also associated with worse outcomes. Conclusions: In HF, greater fatigue is associated with worse clinical outcomes. Closer attention should be paid to this symptom in clinical practice, with more done to standardize its measurement and understand its origins, with a view to improving treatment. © 2014 American College of Cardiology Foundation.
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- Böhm, Michael, et al.
(författare)
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Heart rate as a risk factor in chronic heart failure (SHIFT): the association between heart rate and outcomes in a randomised placebo-controlled trial
- 2010
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Ingår i: Lancet. - 0140-6736. ; 376:9744, s. 886-894
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Raised resting heart rate is a marker of cardiovascular risk. We postulated that heart rate is also a risk factor for cardiovascular events in heart failure. In the SHIFT trial, patients with chronic heart failure were treated with the selective heart-rate-lowering agent ivabradine. We aimed to test our hypothesis by investigating the association between heart rate and events in this patient population. METHODS: We analysed cardiovascular outcomes in the placebo (n=3264) and ivabradine groups (n=3241) of this randomised trial, divided by quintiles of baseline heart rate in the placebo group. The primary composite endpoint was cardiovascular death or hospital admission for worsening heart failure. In the ivabradine group, heart rate achieved at 28 days was also analysed in relation to subsequent outcomes. Analysis adjusted to change in heart rate was used to study heart-rate reduction as mechanism for risk reduction by ivabradine directly. FINDINGS: In the placebo group, patients with the highest heart rates (>or=87 beats per min [bpm], n=682, 286 events) were at more than two-fold higher risk for the primary composite endpoint than were patients with the lowest heart rates (70 to <72 bpm, n=461, 92 events; hazard ratio [HR] 2.34, 95% CI 1.84-2.98, p<0.0001). Risk of primary composite endpoint events increased by 3% with every beat increase from baseline heart rate and 16% for every 5-bpm increase. In the ivabradine group, there was a direct association between heart rate achieved at 28 days and subsequent cardiac outcomes. Patients with heart rates lower than 60 bpm at 28 days on treatment had fewer primary composite endpoint events during the study (n=1192; event rate 17.4%, 95% CI 15.3-19.6) than did patients with higher heart rates. The effect of ivabradine is accounted for by heart-rate reduction, as shown by the neutralisation of the treatment effect after adjustment for change of heart rate at 28 days (HR 0.95, 0.85-1.06, p=0.352). INTERPRETATION: Our analysis confirms that high heart rate is a risk factor in heart failure. Selective lowering of heart rates with ivabradine improves cardiovascular outcomes. Heart rate is an important target for treatment of heart failure. FUNDING: Servier, France.
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- Böhm, S, et al.
(författare)
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Growth guidance of angular lower limb deformities using a one-third two-hole tubular plate
- 2013
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Ingår i: Journal of children's orthopaedics. - : SAGE Publications. - 1863-2521 .- 1863-2548. ; 7:4, s. 289-94
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Tidskriftsartikel (refereegranskat)abstract
- The eight-plate system for angular deformity correction is well known, reliable and effective at any age during growth. Due to high implant costs, we sought to evaluate the effectiveness and safety of a less expensive alternative. Methods Between 2006 and 2011, 41 children with angular deformities were managed using a two-hole one-third tubular plate in cases where an eight plate would normally be indicated. Inclusion criteria in this retrospective study were: genu valgum and genu varum. X-ray documentation was performed before and after surgery and patients were followed clinically every 3 months after surgery. The cost per implant was 361.40 Sfr (Swiss Francs) compared to the eight plate at 737 Sfr. Results Mean time for correction was 13 months. A mean LDFA/MPTA after correction of 89.9°/86.8° was recorded, as well as a mean correction angle of 6.8°/6.6°. The complication rate was 6.6 % (one superficial wound infection and one insufficient correction in an older child). These results compare favourably with published data on the eight plate. Conclusion The two hole one-third tubular plate seems to be a clinically and also cost effective alternative to the eight plate. Full deformity correction is gained for a fraction of the cost. Level of Evidence: Level III
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- Davani, Hooman A., et al.
(författare)
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Widely Electro Thermal Tunable Bulk-Micromachined MEMS-VCSEL Operating Around 850nm
- 2011
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Ingår i: Conference on Lasers and Electro-Optics/Pacific Rim, CLEOPR 2011; Sydney; Australia; 28 August 2011 through 1 September 2011. - 2162-2701. - 9780977565771 ; , s. 32-34
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Konferensbidrag (refereegranskat)abstract
- We present the highest reported continues tuning range of 37 nm and fastest electro thermal tuning speed of 700 Hz achieved with tunable vertical-cavity surface-emitting lasers (VCSEL) and semiconductor DBRs at 850 nm wavelength range.
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- Davani, Hooman A., et al.
(författare)
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Widely tunable high-speed bulk-micromachined short-wavelength MEMS-VCSEL
- 2010
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Ingår i: Semiconductor Laser Conference (ISLC), 2010 22nd IEEE International. - 0899-9406. - 9781424456833 ; , s. 9-10
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Konferensbidrag (refereegranskat)abstract
- We present the first results of a high-speed bulk-micromachined tunable vertical-cavity surface-emitting laser (VCSEL) operating near 850nm using a half-symmetric resonator with a movable curved microelectromechanical system (MEMS) membrane.
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- Dobrovolný, Petr, et al.
(författare)
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Monthly, seasonal and annual temperature reconstructions for Central Europe derived from documentary evidence and instrumental records since AD 1500
- 2010
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Ingår i: Climatic Change. - Netherlands : Springer. - 0165-0009 .- 1573-1480. ; 101:1-2, s. 69-107
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Tidskriftsartikel (refereegranskat)abstract
- Monthly temperature series for Central Europe back to AD 1500 aredeveloped from documentary index series from Germany, Switzerland and theCzech Republic (1500–1854) and 11 instrumental temperature records (1760–2007).Documentary evidence from the Low Countries, the Carpathian Basin and Polandare used for cross-checking for earlier centuries. The instrumental station recordsare corrected for inhomogeneities, including insufficient radiation protection ofearly thermometers and the urban heat island effect. For overlapping period (1760–1854), the documentary data series correlate with instrumental temperatures, moststrongly in winter (86% explained variance in January) and least in autumn (56%in September). For annual average temperatures, 81% of the variance is explained.Verification statistics indicate high reconstruction skill for most months and seasons.The last 20 years (since 1988) stand out as very likely the warmest 20-year period,accounting for the calibration uncertainty and decreases in proxy data quality beforethe calibration period. The new reconstruction displays a previously unobserved long-term decrease in DJF, MAM and JJA temperature variability over last fivecenturies. Compiled monthly, seasonal and annual series can be used to improve therobustness of gridded large-scale European temperature reconstructions and possibleimpact studies. Further improvement of the reconstruction would be achieved ifdocumentary data from other European countries are further developed.
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