| 1. |
- Blomström, Per, et al.
(författare)
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Cost effectiveness of cardiac resynchronization therapy in the Nordic region : an analysis based on the CARE-HF trial
- 2008
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Ingår i: European Journal of Heart Failure. - : Wiley. - 1388-9842 .- 1879-0844. ; 10:9, s. 869-877
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The aim of this study was to investigate the cost-effectiveness of cardiac resynchronization therapy (CRT) in Denmark, Finland and Sweden. The analysis was based on the CARE-HF trial, a randomised clinical trial investigating the efficacy of adding CRT (n=409) to optimal pharmacological treatment (n=404) in patients with moderate to severe heart failure with markers of cardiac dyssynchrony. The average follow-up time was 29.4 months. METHODS: The health effects were measured in terms of quality-adjusted life years (QALYs) gained. Data on health care resource consumption from CARE-HF was combined with costs for CRT implantation and hospitalisation from university hospitals in Denmark, Finland and Sweden. Calculations were based on patients' expected life time. The expected device lifetime (6 years) was used for CRT, and no additional gains in clinical effects were assumed after the 6 years. RESULTS: The cost-effectiveness ratio per QALY gained was 4800 euros in Denmark, 3600 euros in Finland and 6700 euros in Sweden. The 95% confidence intervals for the cost per QALY gained varied between a lower limit of 1169 euros in Finland to an upper limit of 17,482 euros in Sweden. These values were all below the threshold for being cost-effective in Denmark, Finland and Sweden. CONCLUSIONS: The study indicates that CRT is a cost-effective treatment in Scandinavian health care settings compared to traditional pharmacological therapy and can therefore be recommended for routine use in patients with moderate to severe heart failure and markers of dyssynchrony.
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| 2. |
- Classen, Jean-Francois, et al.
(författare)
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Lack of evidence of stimulatory autoantibodies to platelet-derived growth factor receptor in patients with systemic sclerosis
- 2009
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Ingår i: Arthritis and Rheumatism. - : Wiley. - 0004-3591 .- 1529-0131. ; 60:4, s. 1137-1144
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Systemic sclerosis (SSc) is a severe connective tissue disease of unknown etiology, characterized by fibrosis of the skin and multiple internal organs. Recent findings suggested that the disease is driven by stimulatory autoantibodies to platelet-derived growth factor receptor (PDGFR), which stimulate the production of reactive oxygen species (ROS) and collagen by fibroblasts. These results opened novel avenues of research into the diagnosis and treatment of SSc. The present study was undertaken to confirm the presence of anti-PDGFR antibodies in patients with SSc. METHODS: Immunoglobulins from 37 patients with SSc were purified by protein A/G chromatography. PDGFR activation was tested using 4 different sensitive bioassays, i.e., cell proliferation, ROS production, signal transduction, and receptor phosphorylation; the latter was also tested in a separate population of 7 patients with SSc from a different research center. RESULTS: Purified IgG samples from patients with SSc were positive when tested for antinuclear autoantibodies, but did not specifically activate PDGFRalpha or PDGFRbeta in any of the tests. Cell stimulation with PDGF itself consistently produced a strong signal. CONCLUSION: The present results raise questions regarding the existence of agonistic autoantibodies to PDGFR in SSc.
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| 3. |
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| 4. |
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| 5. |
- Lindqvist, Per, et al.
(författare)
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Right ventricular myocardial isovolumic relaxation time and pulmonary pressure
- 2006
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Ingår i: Clinical Physiology and Functional Imaging. - 1475-0961 .- 1475-097X. ; 26:1, s. 1-8
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: Non-invasive assessment of pulmonary artery systolic pressure (PASP) has several limitations. As previously described by Burstin, the right ventricular (RV) isovolumic relaxation time (IVRt) is sensitive to changes in PASP. We therefore compared RV myocardial IVRt, derived by Doppler tissue imaging (DTI), with simultaneously measured invasive PASP. METHODS AND RESULTS: Twenty-six consecutive patients (18 males, mean age 52 +/- 12 years, range 23-75) underwent a simultaneous Doppler echocardiography, including DTI, and cardiac catheterization examination for measurement of PASP and right atrial mean pressures. IVRt was measured using the myocardial velocities by pulsed DTI at both basal and mid cavity segments of the RV free wall. As diastolic time intervals are influenced by heart rate IVRt was corrected for heart rate (IVRt/RR%). A significant correlation was found between PASP and regional IVRt/RR% at both the basal (r = 0.42, P<0.05) and mid cavity segment (r = 0.71, P<0.001). Furthermore, when only patients with normal right atrial pressures (<7 mmHg) were taken into account, the correlation coefficient improved at both basal and mid cavity segments (r = 0.74, P<0.05 and r = 0.83, P<0.01). CONCLUSION: Pulsed Doppler-derived IVRt correlates well with PASP. The use of pulsed DTI for measurement of IVRt is simple, reproducible and easy to obtain. We propose this method as an additional non-invasive tool in the assessment of PASP.
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| 6. |
- Lindqvist, Per, et al.
(författare)
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Right ventricular myocardial velocities and timing estimate pulmonary artery systolic pressure
- 2009
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 137:2, s. 130-136
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Non-invasive estimation of pulmonary artery systolic pressure (PASP) is important for identifying and following up patients. We aimed at revisiting the accuracy of various right ventricular (RV) Doppler echocardiographic measurements of PASP. METHODS: Twenty-eight patients were studied with simultaneous right heart catheterization (RHC), conventional and tissue Doppler echocardiography (TDE). We measured RV-right atrial (RA) peak pressure drop, RV spectral filling and myocardial velocities and timings. RESULTS: RV-RA peak pressure drop (r=0.89, p<0.001) strongly correlated with PASP. Both RV spectral and myocardial measurements of isovolumic relaxation time (IVRT) modestly correlated with PASP (r=0.63, p<0.01 and <0.001). Time interval measurements missed 6 and 9 cases with normal PASP by using proposed cut off values. Combining myocardial IVRT and isovolumic contraction velocity (IVCV) in a formula, predicted PASP in all but 3 of our patients. In addition, TDE measurements were obtainable in all cases compared to RV-RA gradient which were measurable in only 64% of patients. CONCLUSION: RV-RA peak pressure drop is the most accurate non-invasive method for assessing PASP. Combining myocardial IVCV and IVRT can be used accurately in estimating PASP being more feasible than RV-RA drop. Such additional measurement might be important in patients follow-up when RV-RA gradient is difficult to obtain.
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| 7. |
- Lindqvist, Per, et al.
(författare)
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The use of E/Em and the time interval difference of isovolumic relaxation (TIVRT-IVRTm) in estimating left ventricular filling pressures
- 2008
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Ingår i: European Journal of Heart Failure. - : Wiley. - 1388-9842 .- 1879-0844. ; 10:5, s. 490-497
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND AIMS: The ratio of the transmitral and myocardial early diastolic velocities (E/Em) can be used to estimate LV filling pressures (LVFP). Additionally, the time difference between the onset of E and Em also correlates to LVFP. The aim of this study was to evaluate which of these two indices is the best marker of LVFP in a heterogeneous group of patients during a simultaneous invasive procedure. METHODS AND RESULTS: Thirty two patients were studied. Em and the isovolumic relaxation time (IVRTm) at four segments of the LV were measured using pulsed tissue Doppler echocardiography. Pulsed Doppler echocardiography was used to measure E and IVRT. E/Em and IVRT-IVRTm (T IVRT-IVRTm) were then calculated. Highly significant correlations were found between T IVRT-IVRTm and PCWP at the lateral (r= -0.80, p<0.001) and posterior (r= -0.71, p<0.001) segments whereas only a weak relationship was found between PCWP and E/Em (p<0.05). The sensitivity and specificity of using a negative T IVRT-IVRTm for identifying patients with PCWP >12 mm Hg were 89 and 90%, respectively. CONCLUSION: We found a highly significant correlation between T IVRT-IVRTm and PCWP, which was not seen for E/Em. We propose T IVRT-IVRTm as a stronger predictor of LVFP. T IVRT-IVRTm also seems to correlate to LVFP for many different clinical aetiologies of elevated LVFP.
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| 9. |
- Mutschler, Diana K., et al.
(författare)
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Etanercept reduces late endotoxin-induced pulmonary hypertension in the pig
- 2006
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Ingår i: Journal of Interferon and Cytokine Research. - : Mary Ann Liebert Inc. - 1079-9907 .- 1557-7465. ; 26:9, s. 661-667
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Tidskriftsartikel (refereegranskat)abstract
- To evaluate whether etanercept, a tumor necrosis factor (TNF)-blocking agent, may counteract hemodynamic deterioration in endotoxemic shock, we designed a prospective, randomized placebo-controlled trial with parallel groups, consisting of 13 pigs aged 10-14 weeks receiving general anesthesia. Five pigs were given 25 mg of etanercept, 1 h before the start of a 4-h continuous infusion of endotoxin. Another 5 pigs were given the corresponding volume of saline, 1 h before the start of a 4-h continuous infusion of endotoxin. Three pigs were given 25 mg of etanercept, 1 hr before the start of a 4-h continuous infusion of saline. At 1 h of endotoxemia, mean pulmonary arterial pressure (MPAP) and pulmonary vascular resistance index (PVRI) increased identically in both groups of pigs receiving endotoxin. Thereafter, two distinct different patterns in hemodynamics were observed. TNF-blocked pigs showed significantly lower MPAP and PVRI compared to controls. In the etanercept-treated endotoxemic pigs, Doppler analysis of the diastolic mitral inflow demonstrated a significantly increased E/A-ratio (early mitral wave inflow was divided by the atrial wave) at 2 h. The TNFblocking agent etanercept normalized two hemodynamic features of endotoxin-induced septic shock in pigs: (1) the sustained pulmonary hypertension and (2) diastolic dysfunction.
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| 10. |
- Sartipy, Ulrik, et al.
(författare)
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Left ventricular reconstruction as an alternative to heart transplantation : a case report
- 2006
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Ingår i: Heart Surgery Forum. - 1098-3511 .- 1522-6662. ; 9:3, s. E638-E640
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Tidskriftsartikel (refereegranskat)abstract
- A 57-year-old man with dilated cardiomyopathy was referred to our institution to be assessed for heart transplantation. He had symptoms of severe heart failure and left ventricular dysfunction. We proposed surgical ventricular restoration (the Dor procedure) as an alternative to heart transplantation. The patient underwent successful surgery and an uneventful postoperative course. Pre- and postoperative investigations are presented. One year after surgery, the patient is in good clinical and functional condition. This case illustrates that surgical ventricular restoration can be an alternative to heart transplantation.
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