| 1001. |
- Sandberg, Camilla, et al.
(författare)
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Complex adult congenital heart disease is associated with impaired skeletal muscle function
- 2013
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Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 34:Supplement: 1, s. 383-383
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Complex congenital heart disease is often associatedwith impaired physical functioning, usually measured as peak oxygen uptake in an exercise test. Skeletal muscle function is, however, less studied in these patients.Methods: Unilateral isotonic shoulder flexion was tested in 79 adultpatients (mean age 36.6±14.8 years, 31 females) with congenital heartdisease, classed as either "complex" (n=41, 51.9%) or "simple" (n=38, 48.1%). The patients were sitting comfortably in a chair with their back touching the wall and holding a weight (2 kg for women and 3 kg for men) in the hand of the tested side. The patients were asked to elevate the arm, from 0 to 90 degrees flexion, as many times as possible. The pace of 20 contractions per minute was held using a metronome.Results: Patients with complex lesions performed less shoulder flexions compared with patients with simple lesions (29.2±10.0 vs. 54.6±25.8, p<0.001). In univariate analysis including a number of demographic and clinical variables, only complexity of cardiac lesion (p<0.001) and on-going cardiac medications (p=0.012) were associated with shouldermuscle function, of which complexity (p<0.001) remained significant in multivariate analysis.Conclusion: There is a marked difference in shoulder muscle functionbetween patients with complex and simple congenital heart disease. Such differences might affect ability to perform daily activities and contribute to impaired overall physical functioning. Rehabilitation targeting muscle function may be indicated in patients with complexcongenital heart disease.
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| 1002. |
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| 1003. |
- Sandberg, Camilla, et al.
(författare)
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Physical activity level in adults with congenital heart disease : effects of gender and complexity of heart lesion
- 2013
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Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 34:Supplement: 1, s. 382-383
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Many adults with congenital heart disease have reduced exercise capacity but only little is known about habitual physical activityin this group. The aim of this study was to investigate habitual physicalactivity level in a cohort of adults with congenital heart disease.Methods: Seventy-five adult patients (29 females) aged 37.2±15.1 yearswith congenital heart disease classed as either simple or complex were studied with a combined accelerometer and heart rate monitor (Actiheart). The patients carried the Actiheart during 5 consecutive days, and where encouraged to proceed with their usual daily activities. Data was analysed with the Actiheart Software version 2.2. A mean ofPhysical Activity Level (PAL) (PAL=Total Energy Expenditure/Resting Energy Expenditure) over 4 days was calculated. PAL < 1.45 was categorised as low, 1.45-1.6 as moderate and >1.6 as high.Results: Forty-three patients (57,3%) had low PAL, 18 (24%) moderate PAL and 14 (16,7%) high PAL. PAL was lower in women compared to men (1.32±0.10 vs. 1.52±0.18, p < 0.001). PAL was higher in patients withsimple compared with complex congenital heart disease (1.50±0.21 vs. 1.39±0.14, p = 0.019). Among men, active smoking (p=0.015) and lower age (p=0.04) were independently associated with higher PAL, whereas no such associations were observed among women.Conclusion: The majority of the observed patients had low PAL and women had lower PAL compared to men. PAL was related to complexity ofheart lesion. Efforts to increase habitual physical activity may beindicated in this population, especially in women and patients withcomplex congenital heart disease.
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| 1004. |
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| 1005. |
- Sandhu, Roopinder K., et al.
(författare)
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The 'obesity paradox' in atrial fibrillation : observations from the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial
- 2016
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Ingår i: European Heart Journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 37:38, s. 2869-2878
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: The prognostic implication of adiposity on clinical outcomes in atrial fibrillation (AF) patients treated with oral anticoagulation is unclear.METHODS AND RESULTS: A total of 17 913 patients in the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation trial had body mass index (BMI) measured at baseline. For the primary analysis, BMI was categorized as normal (18.5 to <25 kg/m(2)), overweight (25 to <30 kg/m(2)), and obese (≥30 kg/m(2)). Waist circumference (WC) was defined as high if >102 cm for men and >88 cm in women. Outcomes were stroke or systemic embolism, a composite endpoint (stroke, systemic embolism, myocardial infarction, or all-cause mortality), all-cause mortality, and major bleeding. Cox models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) across categories of BMI and WC adjusting for established risk factors and treatment allocation. At baseline, 4052 (22.6%) patients had a normal BMI, 6702 (37.4%) were overweight, and 7159 (40.0%) were obese. In multivariable analyses, higher BMI was associated with a lower risk of all-cause mortality [overweight: HR 0.67 (95% CI 0.59-0.78); obese: HR 0.63 (95% CI 0.54-0.74), P < 0.0001] and the composite endpoint [overweight: HR 0.74 (95% CI 0.65-0.84); obese: HR 0.68 (95% CI 0.60-0.78), P < 0.0001] compared with normal BMI. In women, high WC was associated with a 31% lower risk of all-cause mortality (P = 0.001), 27% lower risk of the composite endpoint (P = 0.001), and 28% lower risk of stroke or systemic embolism (P = 0.048) but not in men. There was no significant association between adiposity and major bleeding.CONCLUSION: In patients with AF treated with oral anticoagulants, higher BMI and WC are associated with a more favourable prognosis.
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| 1006. |
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| 1007. |
- Saripella, Ganapathi Varma
(författare)
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Genome-wide association analysis in dilated cardiomyopathy reveals two new players in systolic heart failure on chromosomes 3p25.1 and 22q11.23
- 2021
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Ingår i: European Heart Journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 42, s. 2000-2011
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Tidskriftsartikel (refereegranskat)abstract
- Aims: Our objective was to better understand the genetic bases of dilated cardiomyopathy (DCM), a leading cause of systolic heart failure.Methods and results: We conducted the largest genome-wide association study performed so far in DCM, with 2719 cases and 4440 controls in the discovery population. We identified and replicated two new DCM-associated loci on chromosome 3p25.1 [lead single-nucleotide polymorphism (SNP) rs62232870, P = 8.7 x 10(-11) and 7.7 x 10(-4) in the discovery and replication steps, respectively] and chromosome 22q11.23 (lead SNP rs7284877, P = 3.3 x 10(-8) and 1.4 x 10(-3) in the discovery and replication steps, respectively), while confirming two previously identified DCM loci on chromosomes 10 and 1, BAG3 and HSPB7. A genetic risk score constructed from the number of risk alleles at these four DCM loci revealed a 3-fold increased risk of DCM for individuals with 8 risk alleles compared to individuals with 5 risk alleles (median of the referral population). In silico annotation and functional 4C-sequencing analyses on iPSC-derived cardiomyocytes identify SLC6A6 as the most likely DCM gene at the 3p25.1 locus. This gene encodes a taurine transporter whose involvement in myocardial dysfunction and DCM is supported by numerous observations in humans and animals. At the 22q11.23 locus, in silico and data mining annotations, and to a lesser extent functional analysis, strongly suggest SMARCB1 as the candidate culprit gene.Conclusion: This study provides a better understanding of the genetic architecture of DCM and sheds light on novel biological pathways underlying heart failure.[GRAPHICS]
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| 1008. |
- Sarno, Giovanna, et al.
(författare)
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Lower risk of stent thrombosis and restenosis with unrestricted use of onew-generation drug-eluting stents: a report from the nationwide Swedish Coronary Angiography and Angioplasty Registry (SCAAR)
- 2012
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Ingår i: European Heart Journal. - : Oxford University Press (OUP): Policy B. - 0195-668X .- 1522-9645. ; 33:5, s. 606-613
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Tidskriftsartikel (refereegranskat)abstract
- To compare the long-term outcome after percutaneous coronary intervention with onew-generation drug-eluting stents (n-DES) to oolder generation DES (o-DES), and bare-metal stents (BMS) in a real-world population. less thanbrgreater than less thanbrgreater thanWe evaluated 94 384 consecutive stent implantations (BMS, n 64 631; o-DES, n 19 202; n-DES, n 10 551) in Sweden from November 2006 to October 2010. All cases of definite stent thrombosis (ST) and restenosis were documented in the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Older generation DES were classified as: Cypher and Cypher Select (Cordis Corporation, Miami, FL, USA), Taxus Express and Taxus Libert (Boston Scientific Corporation), and Endeavor (Medtronic Inc.) and n-DES as: Endeavor Resolute (Medtronic Inc.), XienceV, Xience Prime (Abbott Laboratories) and Promus, Promus Element (Boston Scientific Corporation). The Cox regression analyses unadjusted and adjusted for clinical and angiographic covariates showed a statistically significant lower risk of restenosis in n-DES compared with BMS [adjusted hazard ratio (HR) 0.29; 95 confidence interval (CI): 0.250.33] and o-DES (HR 0.62; 95 CI: 0.530.72). A lower risk of definite ST was found in n-DES compared with BMS (HR 0.38; 95 CI: 0.280.52) and o-DES (HR, 0.57; 95 CI: 0.410.79). The risk of death was significantly lower in n-DES compared with o-DES (adjusted HR: 0.77; 95 CI: 0.630.95) and BMS (adjusted HR: 0.55; 95 CI: 0.460.67). less thanbrgreater than less thanbrgreater thanPercutaneous coronary intervention with n-DES is associated with a 38 lower risk of clinically meaningful restenosis, a 43 lower risk of definite ST, and a 23 lower risk of death compared with o-DES in this observational study from a large real-world population.
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| 1009. |
- Savarese, Gianluigi, et al.
(författare)
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Association between renin-angiotensin system inhibitor use and mortality/morbidity in elderly patients with heart failure with reduced ejection fraction: a prospective propensity score matched cohort study
- 2018
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Ingår i: European Heart Journal. - : OXFORD UNIV PRESS. - 0195-668X .- 1522-9645. ; 39:48, s. 4257-4265
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Tidskriftsartikel (refereegranskat)abstract
- Aims In heart failure with reduced ejection fraction (HFrEF), renin angiotensin system inhibitors (RASi) improve morbidity and mortality. However, patients aged amp;gt;80 years constituted a small minority in trials. We assessed the association between RASi use and mortality/morbidity in HFrEF patients aged amp;gt;80 years. Methods and results We included patients with ejection fraction amp;lt;40% and age amp;gt;80 years from the Swedish Heart Failure Registry. Propensity scores for RASi use were calculated from 37 variables. Cox regression models for RASi vs. non-RASi with all-cause mortality and all-cause mortality/heart failure (HF) hospitalization as outcomes were fitted in a 1:1 propensity-score-matched cohort. To assess consistency, the same analyses were performed in a positive control cohort aged amp;lt;= 80 years. Of 6710 patients [median age (interquartile range) 85 (82-87) years; 38% women], 5384 (80%) received RASi. Propensity-score matching yielded 2416 patients, [age 86 (83-91) years]. RASi use was associated with hazard ratio (HR) (95% confidence interval) 0.78 (0.72-0.86) for all-cause mortality and 0.86 (0.79-0.94) for all-cause mortality/HF hospitalization. In positive control patients aged amp;lt;= 80 years (17 842 patients in the overall cohort, 2126 after matching), HR for all-cause mortality was 0.81 (0.71-0.91), whereas it was 0.85 (0.76-0.94) for all-cause mortality/HF hospitalization. Conclusion In HFrEF patients with age amp;gt;80years, RASi were relatively underused compared with in younger patients, despite similar association with reduced morbidity and mortality and no apparent association with risk of syncope-related hospitalization. These results may be interpreted as hypothesis generating for randomized clinical trials on RASi in this elderly HFrEF subpopulation.
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| 1010. |
- Savarese, G, et al.
(författare)
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Iron deficiency and cardiovascular disease
- 2023
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Ingår i: European heart journal. - : Oxford University Press (OUP). - 1522-9645 .- 0195-668X. ; 44:1, s. 14-27
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Tidskriftsartikel (refereegranskat)abstract
- Iron deficiency (ID) is common in patients with cardiovascular disease. Up to 60% of patients with coronary artery disease, and an even higher proportion of those with heart failure (HF) or pulmonary hypertension have ID; the evidence for cerebrovascular disease, aortic stenosis and atrial fibrillation is less robust. The prevalence of ID increases with the severity of cardiac and renal dysfunction and is probably more common amongst women. Insufficient dietary iron, reduced iron absorption due to increases in hepcidin secondary to the low-grade inflammation associated with atherosclerosis and congestion or reduced gastric acidity, and increased blood loss due to anti-thrombotic therapy or gastro-intestinal or renal disease may all cause ID. For older people in the general population and patients with HF with reduced ejection fraction (HFrEF), both anaemia and ID are associated with a poor prognosis; each may confer independent risk. There is growing evidence that ID is an important therapeutic target for patients with HFrEF, even if they do not have anaemia. Whether this is also true for other HF phenotypes or patients with cardiovascular disease in general is currently unknown. Randomized trials showed that intravenous ferric carboxymaltose improved symptoms, health-related quality of life and exercise capacity and reduced hospitalizations for worsening HF in patients with HFrEF and mildly reduced ejection fraction (<50%). Since ID is easy to treat and is effective for patients with HFrEF, such patients should be investigated for possible ID. This recommendation may extend to other populations in the light of evidence from future trials.
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