| 1. |
- Anker, Stefan D, et al.
(författare)
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Ferric Carboxymaltose in Patients with Heart Failure and Iron Deficiency.
- 2009
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Ingår i: New England Journal of Medicine. - 0028-4793. ; 361, s. 2436-2448
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Iron deficiency may impair aerobic performance. This study aimed to determine whether treatment with intravenous iron (ferric carboxymaltose) would improve symptoms in patients who had heart failure, reduced left ventricular ejection fraction, and iron deficiency, either with or without anemia. METHODS: We enrolled 459 patients with chronic heart failure of New York Heart Association (NYHA) functional class II or III, a left ventricular ejection fraction of 40% or less (for patients with NYHA class II) or 45% or less (for NYHA class III), iron deficiency (ferritin level <100 mug per liter or between 100 and 299 mug per liter, if the transferrin saturation was <20%), and a hemoglobin level of 95 to 135 g per liter. Patients were randomly assigned, in a 2:1 ratio, to receive 200 mg of intravenous iron (ferric carboxymaltose) or saline (placebo). The primary end points were the self-reported Patient Global Assessment and NYHA functional class, both at week 24. Secondary end points included the distance walked in 6 minutes and the health-related quality of life. RESULTS: Among the patients receiving ferric carboxymaltose, 50% reported being much or moderately improved, as compared with 28% of patients receiving placebo, according to the Patient Global Assessment (odds ratio for improvement, 2.51; 95% confidence interval [CI], 1.75 to 3.61). Among the patients assigned to ferric carboxymaltose, 47% had an NYHA functional class I or II at week 24, as compared with 30% of patients assigned to placebo (odds ratio for improvement by one class, 2.40; 95% CI, 1.55 to 3.71). Results were similar in patients with anemia and those without anemia. Significant improvements were seen with ferric carboxymaltose in the distance on the 6-minute walk test and quality-of-life assessments. The rates of death, adverse events, and serious adverse events were similar in the two study groups. CONCLUSIONS: Treatment with intravenous ferric carboxymaltose in patients with chronic heart failure and iron deficiency, with or without anemia, improves symptoms, functional capacity, and quality of life; the side-effect profile is acceptable. (ClinicalTrials.gov number, NCT00520780.) Copyright 2009 Massachusetts Medical Society.
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| 2. |
- Anker, Stefan D., et al.
(författare)
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Rationale and design of Ferinject((R)) Assessment in patients with IRon deficiency and chronic Heart Failure (FAIR-HF) study: a randomized, placebo-controlled study of intravenous iron supplementation in patients with and without anaemia
- 2009
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Ingår i: European Journal of Heart Failure. - : Wiley. - 1879-0844 .- 1388-9842. ; 11:11, s. 1084-1091
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Tidskriftsartikel (refereegranskat)abstract
- Iron deficiency (ID) and anaemia are common in patients with chronic heart failure (CHF). The presence of anaemia is associated with increased morbidity and mortality in CHF, and ID is a major reason for the development of anaemia. Preliminary studies using intravenous (i.v.) iron supplementation alone in patients with CHF and ID have shown improvements in symptom status. FAIR-HF (Clinical Trials.gov NCT00520780) was designed to determine the effect of i.v. iron repletion therapy using ferric carboxymaltose on self-reported patient global assessment (PGA) and New York Heart Association (NYHA) in patients with CHF and ID. This is a multi-centre, randomized, double-blind, placebo-controlled study recruiting ambulatory patients with symptomatic CHF with LVEF < 40% (NYHA II) or < 45% (NYHA III), ID [ferritin < 100 ng/mL or ferritin 100-300 ng/mL when transferrin saturation (TSAT) < 20%], and haemoglobin 9.5-13.5 g/dL. Patients were randomized in a 2:1 ratio to receive ferric carboxymaltose (Ferinject((R))) 200 mg iron i.v. or saline i.v. weekly until iron repletion (correction phase), then monthly until Week 24 (maintenance phase). Primary endpoints are (i) self-reported PGA at Week 24 and (ii) NYHA class at Week 24, adjusted for baseline NYHA class. This study will provide evidence on the efficacy and safety of iron repletion with ferric carboxymaltose in CHF patients with ID with and without anaemia.
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| 3. |
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| 4. |
- Birgander, Mats, et al.
(författare)
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Cardiac Structure and Function Before and After Parathyroidectomy in Patients With Asymptomatic Primary Hyperparathyroidism
- 2009
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Ingår i: The Endocrinologist. - 1539-9192. ; 19:4, s. 154-158
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Tidskriftsartikel (refereegranskat)abstract
- Background: Primary hyperparathyroidism (PHPT) is associated with cardiac disease and increased risk of all-cause and cardiovascular mortality. We investigated cardiac structural and functional parameters before and after successful parathyroidectomy in asymptomatic PHPT patients. Methods and Results: Forty-nine PHPT patients (age: 62.9 +/- 11 years, 5 men) and 48 healthy control subjects, matched for age, sex and smoking status were enrolled in the study. PHPT patients were examined preoperatively and 6 and 12 months postoperatively. Structural and functional cardiac parameters were assessed by transthoracic echocardiography. One year after parathyroidectomy left ventricular (LV) mass, left atrial size, LV enddiastolic and endsystolic diameters, LV posterior wall and interventricular septum diameter, and right ventricular enddiastolic diameter were all increased in PHPT patients, although not significantly. As an indication of worsened LV diastolic function, the heart rate adjusted Doppler-derived deceleration time of the transmittal E-wave increased among PHPT patients (276 +/- 82-303 +/- 54 milliseconds, P = 0.004). There was also deterioration of LV ejection fraction (from 62.7 +/- 7 to 59.9 +/- 7.8%, P = 0.868) and mean atrioventricular plane displacement (from 13.2 +/- 2 to 12.6 +/- 2 mm, P = 0.029). Conclusion: There were no significant differences in heart function between hyperparathyroid and control subjects, and 6 months after parathyroidectomy, there was no change in heart function in hyperparathyroid subjects.
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| 5. |
- Birgander, Mats, et al.
(författare)
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Postexercise Cardiac Performance Among Patients With Mild Primary Hyperparathyroidism
- 2009
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Ingår i: The Endocrinologist. - 1539-9192. ; 19:6, s. 263-266
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Tidskriftsartikel (refereegranskat)abstract
- Primary hyperparathyroidism (pHPT) is associated with cardiac disease. This prospective study was designed to investigate changes in cardiac function before and after parathyroidectomy. Resting and post exercise cardiac function was compared with matched control subjects. Fifty patients (mean age 62.9 +/- 11 years, 45 women) and 50 healthy control subjects, matched for age and sex were studied. Resting and postmaximum exercise echocardiography/Doppler examination were performed at baseline and 6 months after parathyroidectomy. pHPT patients were tested at baseline and 6 months postoperatively. Control subjects were tested only at baseline. Patients were divided into 4 subgroups based on median preoperative levels of PTH and calcium (Ca): high (up arrow) PTI4/ up arrow Ca, up arrow PTH/low (down arrow) Ca, up arrow Ca/ down arrow PTH, and down arrow PTH/ down arrow Ca. No significant difference between pHPT patients and control subjects regarding post exercise systolic function were detected, There was a tendency of lowed E/A among pHPT patients which was significant in subgroup down arrow PTH/ down arrow Ca (1.07 +/- 0.3). Subgroup up arrow PTH/ up arrow Ca showed a lower S/D compared with control subjects at baseline (1.28 +/- 0.3 vs. 1.48 +/- 0.3, P = 0.029). No significant changes regarding post exercise echocardiographic parameters reflecting cardiac function were detected 6 months after parathyriodectomy. Patients with asymptomatic pHPT showed a tendency of elevated filling pressures and signs of impaired diastolic function during exercise.
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| 6. |
- Birgander, Mats, et al.
(författare)
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Relationship Between Mild Primary Hyperparathyroidism and Left Ventricular Structure and Diastolic Performance
- 2009
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Ingår i: The Endocrinologist. - 1539-9192. ; 19:4, s. 187-191
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Forskningsöversikt (refereegranskat)abstract
- Aim: This study aims to investigate cardiac structure and function in patients with asymptomatic primary hyperparathyroidism (pHPT) and if there is any relation to severity regarding serum levels of calcium (Ca) and parathyroid hormone. Methods and Results: We consecutively included 50 patients (mean age 62.9 +/- 11 years, 45 women) with clinically diagnosed pHPT. We prospectively recruited 50 healthy control subjects, matched for age and sex. Standard transthoracic echocardiographic examination was performed using the 4 standard views and structural parameters as well as left ventricular (LV) systolic and diastolic function was determined. Mean LV ejection fraction and atrioventricular plane displacement were on average normal and did not differ between patients and controls. However, pHPT patients had significantly greater LV mass (148 +/- 37 vs. 127 +/- 29 g, P = 0.002), LV end diastolic area (81 +/- 20 vs. 68 +/- 18 cm(2), p = 0.003), LV posterior wall diameter (8.9 +/- 1 vs. 8.1 +/- 1 min, P = 0.006), and LA size (21 +/- 3 vs. 19 +/- 2 mm, P < 0.001). A moderate to severe LV diastolic filling impairment was present in substantially more pHPT patients, compared with control subjects (36% vs. 4%, P < 0:001). Conclusion: Patients with asymptomatic pHPT showed LV structural changes and impaired LV diastolic function.
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| 7. |
- Borgquist, Rasmus, et al.
(författare)
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Coronary flow velocity reserve reduction is comparable in patients with erectile dysfunction and in patients with impaired fasting glucose or well-regulated diabetes mellitus
- 2007
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Ingår i: European Journal of Cardiovascular Prevention & Rehabilitation. - 1741-8275. ; 14:2, s. 258-264
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Tidskriftsartikel (refereegranskat)abstract
- Background There is growing evidence that erectile dysfunction is a sentinel for future coronary artery disease. Recently published studies have shown signs of impaired coronary endothelial function in patients with erectile dysfunction, without clinical cardiovascular disease and diabetes. We evaluated the magnitude of coronary vasodilatory dysfunction in men with erectile dysfunction, as compared with men with impaired glucose metabolism (impaired fasting glucose or diabetes) and healthy controls. Methods We investigated men aged 68-73 years with erectile dysfunction (n=12), age-matched men with impaired glucose metabolism, who all proved to have erectile dysfunction (n=15), and age-matched male controls (n=12). Erectile dysfunction was evaluated using the International Index of Erectile Function (IIEF)-5 questionnaire. Coronary flow velocity reserve in the left anterior descending artery was examined using Doppler ultrasound and intravenous adenosine provocation. Results Coronary flow velocities at rest did not differ between the three groups, but maximum coronary flow velocity was significantly lower in the erectile dysfunction group (P= 0.004) and in the impaired glucose metabolism group (P= 0.019), as compared with controls. There was no difference between the erectile dysfunction and impaired glucose metabolism groups. Coronary flow velocity reserve was reduced in the erectile dysfunction group (P=0.026) compared to controls, but was similar compared to the impaired glucose metabolism group. In multivariate analysis including all groups, erectile dysfunction score was the only independent predictor of reduced coronary flow velocity reserve (P=0.020). Conclusions The magnitude of early coronary endothelial and smooth muscle cell dysfunction in otherwise healthy men with erectile dysfunction was comparable to that of patients with impaired glucose metabolism: a well known risk factor for coronary artery disease.
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| 8. |
- Borgquist, Rasmus, et al.
(författare)
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Erectile dysfunction in healthy subjects predicts reduced coronary flow velocity reserve.
- 2006
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 112:2, s. 166-170
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Tidskriftsartikel (refereegranskat)abstract
- Background: Erectile dysfunction is associated with, and may be the first sign of coronary artery disease. We aimed to assess whether men with erectile dysfunction but without cardiovascular disease have reduced coronary flow reserve, as a sign of early coronary atherosclerosis. Methods: We investigated 12 men aged 68-73 years with erectile dysfunction, and 12 age-matched controls. Erectile function was evaluated using the validated IIEF-5 questionnaire. A score <= 18 (of 25) was defined as erectile dysfunction and >= 21 was considered non-nal. Patients with neurological or psychological reasons for erectile dysfunction were excluded, as were patients with symptoms of or prescribed medication for cardiovascular disease, hypertension or diabetes. Coronary flow velocity reserve was measured non-invasively by Doppler in the left anterior descending artery, before and during adenosine infusion. Results: Coronary flow velocity reserve was significantly reduced in subjects with erectile dysfunction: 2.36 versus 3.19; P=0.024. In logistic regression analysis, compared to control subjects, men with erectile dysfunction had significantly increased risk of reduced coronary flow velocity reserve (<= 3.0): odds ratio 15.4, P = 0.02. In multivariate analysis, adjusting for age, tobacco use, systolic blood pressure, heart rate and body mass index, erectile dysfunction was the only significant predictor of reduced coronary flow velocity reserve, P=0.016. Conclusions: Men with erectile dysfunction but without diabetes or clinical cardiovascular disease have early signs of coronary artery disease. Our findings suggest that a cardiac risk evaluation may be indicated in men with suspected vasculogenic erectile dysfunction, and these individuals should be considered for primary prevention measures regarding cardiovascular disease risk factors. (c) 2005 Elsevier Ireland Ltd. All rights reserved.
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| 9. |
- Borgquist, Rasmus, et al.
(författare)
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Self-rated health and classical risk factors for coronary heart disease predict development of erectile dysfunction 25 years later.
- 2008
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Ingår i: International Journal of Clinical Practice. - : Hindawi Limited. - 1742-1241 .- 1368-5031. ; 62:2, s. 206-213
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To investigate the impact of classical coronary heart disease (CHD) risk factors on the development of future erectile dysfunction (ED). Methods and results: A total of 830 randomly selected subjects were included. Baseline CHD risk factors were evaluated in relation to ED (evaluated by the International Index of Erectile Function-5 questionnaire) 25 years later. At follow-up, 499 men (60%) had some degree of ED. In age-adjusted logistic regression analysis, self-rated health [odds ratio (OR) 1.59, 95% confidence interval (CI): 1.09-2.31], family history of CHD (OR 1.75, CI: 1.17-2.61), fasting blood glucose (OR 1.52, CI: 1.14-2.02), triglycerides (OR 1.25, CI: 1.01-1.54), systolic blood pressure (SBP) (OR 1.19, CI: 1.04-1.35), body mass index (OR 1.08, CI: 1.03-1.13) and serum glutamyl transferase (GT) (OR 1.81, CI: 1.23-2.68), predicted ED. Independent predictors were higher age, low self-rated health, higher blood glucose, higher GT and a family history of CHD. Higher SBP was borderline significantly independent (p = 0.05). Furthermore, baseline age-adjusted Framingham risk score for CHD, also predicted future ED (OR 1.20, CI: 1.03-1.38). Conclusions: Our study supports and expands previous findings that ED and CHD share many risk factors, further underscoring the close link between ED and CHD. Men presenting with ED should be evaluated for the presence of other CHD risk factors.
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