| 1. |
- Johansson, Isabelle, et al.
(författare)
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Is the prognosis in patients with diabetes and heart failure a matter of unsatisfactory management? : An observational study from the Swedish Heart Failure Registry
- 2014
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Ingår i: European Journal of Heart Failure. - : Wiley. - 1388-9842 .- 1879-0844. ; 16:4, s. 409-418
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Tidskriftsartikel (refereegranskat)abstract
- Aims To analyse the long-term outcome, risk factor panorama, and treatment pattern in patients with heart failure (HF) with and without type 2 diabetes (T2DM) from a daily healthcare perspective. Methods and results Patients with (n = 8809) and without (n = 27 465) T2DM included in the Swedish Heart Failure Registry (S-HFR) 2003-2011 due to a physician-based HF diagnosis were prospectively followed for long-term mortality (median follow-up time: 1.9 years, range 0-8.7 years). Left ventricular function expressed as EF did not differ between patients with and without T2DM. Survival was significantly shorter in patients with T2DM, who had a median survival time of 3.5 years compared with 4.6 years (P < 0.0001). In subjects with T2DM. unadjusted and adjusted odds ratios (ORs) for mortality were 1.37 [95% confidence interval (CI) 1.30-1.44) and 1.60 (95% CI 1.50-1.71), and T2DM predicted mortality in all age groups. Ischaemic heart disease was an important predictor for mortality (OR 1.68, 95% CI 1.47-1.94), more abundant in patients with T2DM (59% vs. 45%) among whom only 35% had been subjected to coronary angiography and 32% to revascularization. Evidence-based pharmacological HF treatment was somewhat more extensive in patients with T2DM. Conclusion The combination of T2DM and HF seriously compromises long-term prognosis. Ischaemic heart disease was identified as one major contributor; however, underutilization of available diagnostic and therapeutic facilities for ischaemic heart disease was obvious and may be an important area for future improvement in patients with T2DM and HF.
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| 2. |
- Linde, C., et al.
(författare)
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Rationale and design of the PREFERS (Preserved and Reduced Ejection Fraction Epidemiological Regional Study) Stockholm heart failure study : an epidemiological regional study in Stockholm county of 2.1 million inhabitants
- 2016
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Ingår i: European Journal of Heart Failure. - : John Wiley & Sons. - 1388-9842 .- 1879-0844. ; 18:10, s. 1287-1297
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Tidskriftsartikel (refereegranskat)abstract
- Aims: Heart failure (HF) with preserved (HFpEF) or reduced (HFrEF) ejection fraction is associated with poor prognosis and quality of life. While the incidence of HFrEF is declining and HF treatment is effective, HFpEF is increasing, with no established therapy. PREFERS Stockholm is an epidemiological study with the aim of improving clinical care and research in HF and to find new targets for drug treatment in HFpEF ( https://internwebben.ki.se/sites/default/files/20150605_4d_research_appendix_final.pdf). Methods: Patients with new-onset HF (n = 2000) will be characterized at baseline and after 1-year follow-up by standardized protocols for clinical evaluation, echocardiography, and ECG. In one subset undergoing elective coronary bypass surgery (n = 100) and classified according to LV function, myocardial biopsies will be collected during surgery, and cardiac magnetic resonance (CMR) imaging will be performed at baseline and after 1 year. Blood and tissue samples will be stored in a biobank. We will characterize and compare new-onset HFpEF and HFrEF patients regarding clinical findings and cardiac imaging, genomics, proteomics, and transcriptomics from blood and cardiac biopsies, and by established biomarkers of fibrosis, inflammation, haemodynamics, haemostasis, and thrombosis. The data will be explored by state-of-the-art bioinformatics methods to investigate gene expression patterns, sequence variation, DNA methylation, and post-translational modifications, and using systems biology approaches including pathway and network analysis. Conclusions: In this epidemiological HF study with biopsy studies in a subset of patients, we aim to identify new biomarkers of disease progression and to find pathophysiological mechanisms to support explorations of new treatment regimens for HFpEF.
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| 3. |
- Nagy, A. I., et al.
(författare)
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Determinants and prognostic implications of the negative diastolic pulmonary pressure gradient in patients with pulmonary hypertension due to left heart disease
- 2017
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Ingår i: European Journal of Heart Failure. - : John Wiley & Sons. - 1388-9842 .- 1879-0844. ; 19:1, s. 88-97
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Tidskriftsartikel (refereegranskat)abstract
- Aims: The diastolic pulmonary pressure gradient (DPG) has recently been introduced as a specific marker of combined pre-capillary pulmonary hypertension (Cpc-PH) in left heart disease (LHD). However, its diagnostic and prognostic superiority compared with traditional haemodynamic indices has been challenged lately. Current recommendations explicitly denote that in the normal heart, DPG values are greater than zero, with DPG ≥7 mmHg indicating Cpc-PH. However, clinicians are perplexed by the frequent observation of DPG <0 mmHg (DPGNEG), as its physiological explanation and clinical impact are unclear to date. We hypothesized that large V-waves in the pulmonary artery wedge pressure (PAWP) curve yielding asymmetric pressure transmission might account for DPGNEG and undertook this study to clarify the physiological and prognostic implications of DPGNEG. Methods and results: Right heart catheterization and echocardiography were performed in 316 patients with LHD due to primary myocardial dysfunction or valvular disease. A total of 256 patients had PH-LHD, of whom 48% demonstrated DPGNEG. The V-wave amplitude inversely correlated with DPG (r = −0.45, P < 0.001) in patients with low pulmonary vascular resistance (PVR), but not in those with elevated PVR (P > 0.05). Patients with large V-waves had negative and lower DPG than those without augmented V-waves (P < 0.001) despite similar PVR (P >0.05). Positive, but normal DPG (0–6 mmHg) carried a worse 2-year prognosis for death and/or heart transplantation than DPGNEG (hazard ratio 2.97; P < 0.05). Conclusion: Our results advocate against DPGNEG constituting a measurement error. We propose that DPGNEG can partially be ascribed to large V-waves and carries a better prognosis than DPG within the normal positive range.
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| 4. |
- Valzania, Cinzia, et al.
(författare)
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Effects of cardiac resynchronization therapy on coronary blood flow : Evaluation by transthoracic Doppler echocardiography
- 2008
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Ingår i: European Journal of Heart Failure. - : Wiley. - 1388-9842 .- 1879-0844. ; 10:5, s. 514-520
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Tidskriftsartikel (refereegranskat)abstract
- Background: Relatively limited and conflicting data are available on the effects of cardiac resynchronization therapy (CRT) on coronary blood flow (CBF). Aims: To investigate changes in the left anterior descending coronary artery (LAD) flow under different CRT pacing modes by means of transthoracic Doppler echocardiography (TTE). Methods: Twenty-two responders to CRT (67 11 years) with idiopathic dilated cardiomyopathy underwent TTE assessment of LAD flow and Tissue Velocity Imaging during 4 programming modes: intrinsic conduction (IC), right ventricular pacing (RV), simultaneous biventricular pacing (BVP), BVP with left ventricular (LV) pre-activation. Results: Mean coronary flow velocity (CFV) was increased by simultaneous BVP (p = 0.0063 vs. IC) and BVP with LV pre-activation (p<0.0001 vs. IC; p=0.027 vs. simultaneous BVP). Peak CFV and LAD flow velocity/time integral were highest during BVP with LV pre-activation. A reduction in septal-to-lateral delay and an increase in peak systolic velocity in the basal septum were observed during simultaneous BVP and BVP with LV pre-activation. Conclusions: In CRT responders with idiopathic dilated cardiomyopathy, an increase in LAD flow, assessed by TTE, was observed during simultaneous BVP and BVP with LV pre-activation. This was associated with an improvement in regional myocardial contraction and a decrease in intraventricular dyssynchrony.
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