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- Mirza, K. K., et al.
(author)
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Iron Deficiency in Left Ventricular Assist Device Recipients
- 2020
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In: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation. - : Elsevier BV. - 1557-3117. ; 39:4 SUPPL, s. 157-158
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Conference paper (peer-reviewed)abstract
- PURPOSE: The prevalence of iron deficiency (ID) in Left Ventricular Assist Device (LVADs) recipients is not known nor has the association between ID and peak oxygen uptake (VO2) been reported. The aim of this study was to study to investigate the prevalence of ID in this population and the association between ID and VO2. METHODS: Data was included from LVAD recipients at Rigshospitalet, Denmark (DK), and Skåne University Hospital, Lund, Sweden (SE), retrospectively for the prevalence investigation and prospectively between 2013 and 2019 from Rigshospitalet, DK, for the investigation of VO2. Blood samples were collected retrospectively at both sites. ID was defined transferrin saturation (TSAT)≤20%. Anemia was defined as Hb<7.0 mmol/L. RESULTS: TSAT was available from 52 patients (DK: 36, SE: 16) 415±562 days post implantation. Most patients were male (12% female), implanted with a HeartMate(HM) 3 device (72%) and the average age at time of implantation was 56±12years. ID was present in 77% (30% with vs 70% without concurrent anemia, see figure). TSAT was 16±8% in the total cohort. ID (regardless of anemia) was associated with non-ischemic (NICM) HF (R2= 12%, P=0.045) but not age, gender, device indication or N terminal proBNP (P>0.05). The peak VO2 was 47±16% of predicted for age and gender (RER 1.15 (range 0.8 to 1.39), duration: 394±215sec). Linear regression revealed no association between TSAT and VO2 (P=0.5) nor was VO2 lower in patients with ID. After a mean±SD follow up time of 641±721days most patients remained ongoing on device (n=28, 54%), while 14 (27%) were transplanted, 1 was (2%) explanted and 9 (17%) died. Cox regression revealed no difference in survival between patients with ID (TSAT<20%) and those without (P>0.05). CONCLUSION: ID was common in LVADs often with no concurrent anemia, and more prevalent in patients with NICM. ID was not associated with impaired functional capacity or survival.
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| 3. |
- Gjesdal, S, et al.
(author)
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Sickness absence with musculoskeletal or mental diagnoses, transition into disability pension and all-cause mortality: a 9-year prospective cohort study
- 2009
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In: Scandinavian journal of public health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 37:4, s. 387-394
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Journal article (peer-reviewed)abstract
- Aims: Increased early mortality indicates poor health. This study assessed mortality among men and women after long-term sickness absence (LTSA) with musculoskeletal or mental diagnoses. A special focus was on possible differences in mortality among women and men who obtained disability pension (DP) as compared to those who did not. Methods: This was a 9-year prospective cohort study in Hordaland County, Norway, including 1417 women and 1075 men aged 16—62 years with a spell of LTSA 48 weeks, and with a musculoskeletal or mental diagnosis. The endpoint was death from all causes. Age-standardised mortality rates for those who obtained DP and those who did not were calculated and compared. Cox proportional hazards analysis was used to assess DP status and other possible predictors of premature death. All analyses were stratified for gender. Results: Overall, 36% obtained a DP and 3.2% died. Among the men, 7.2% with mental diagnoses and 4.4% with musculoskeletal sick-leave diagnoses died. Among the women, 1.9% died in both groups. Among the men, 5.6% of the DP recipients died, as compared to 4.6% among those without DP. The respective figures for the women were 2.9% and 1.3%. Male gender, increasing age and low income among men increased the mortality risk significantly. After adjustments for these variables, the hazard ratios associated with DP were 2.9 (95% confidence interval (CI) 1.2—7.0) for women and 2.3 (95% CI 1.2—4.5) for men. Conclusions: When monitoring those on LTSA, one should be aware of the high mortality among those who obtain DP and male workers with low income, and preventive actions should be considered.
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| 5. |
- Ammirati, Enrico, et al.
(author)
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Outcome of patients on heart transplant list treated with a continuous-flow left ventricular assist device : Insights from the TRans-Atlantic registry on VAd and TrAnsplant (TRAViATA)
- 2021
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In: International Journal of Cardiology. - : Elsevier BV. - 0167-5273. ; 324
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Journal article (peer-reviewed)abstract
- Background: Geographic variations in management and outcomes of individuals supported by continuous-flow left ventricular assist devices (CF-LVAD) between the United States (US) and Europe (EU) is largely unknown. Methods: We created a retrospective, multinational registry of 524 patients who received a CF-LVAD (either HVAD or Heartmate II) between January 2008 and April 2017. Follow up spanned from date of CF-LVAD implant to post-HTx period with a median follow up of 44.8 months. Results: The cohort included 299 (57.1%) EU and 225 (42.9%) US patients. Although the US cohort was significantly older with a higher prevalence of comorbidities, survival was similar between the cohorts (US 63.1%, EU 68.4% at 5 years, unadjusted log-rank test p = 0.43).Multivariate analyses suggested that older age, higher body mass index, elevated creatinine, use of temporary mechanical circulatory support prior CF-LVAD, and implantation of HVAD were associated with increased mortality. Among CF-LVAD patients undergoing HTx, the median time on CF-LVAD support was shorter in the US, meanwhile US donors were younger. Finally, the pattern of adverse events (stroke, gastrointestinal bleedings, late right ventricular failure, and driveline infection) during support differed significantly between US and EU. Conclusions: Although waitlisted patients in the US on CF-LVAD have higher risk comorbid conditions, the overall outcome is similar in US and EU. Geographic variations with regards to donor characteristics, duration of CF-LVAD support prior to transplant, and adverse events on support can explain the disparity in the utilization of mechanical bridge to transplant strategy between US and EU.
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| 6. |
- Bodegard, J., et al.
(author)
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Symptom-limited exercise testing, ST depressions and long-term coronary heart disease mortality in apparently healthy middle-aged men
- 2004
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In: Eur J Cardiovasc Prev Rehabil. - : Oxford University Press (OUP). - 1741-8267. ; 11:4, s. 320-7
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Journal article (peer-reviewed)abstract
- BACKGROUND: Previous studies have shown that ST depressions > or =1.0 mm during or post-exercise increase long-term risk of dying from coronary heart disease (CHD), the need for coronary artery bypass grafting (CABG) or the development of acute myocardial infarction (AMI) in healthy men. In the present prospective cohort study we investigate whether less marked ST depressions may influence CHD mortality, incidence of AMI, the need for a CABG or having a non-fatal stroke. METHODS: During 1972-75, 2014 men aged 40-59 years, free from somatic diseases and not using any drugs, underwent an examination programme including case history, clinical examination, various blood tests and a symptom-limited exercise ECG-test. ECG was registered during exercise and at 30 s, 1, 2, 3 and 5 min post-exercise. The possible prognostic impact of ST-changes of 0.50-0.99 mm and > or =1.00 mm compared with normal ST-segments were studied separately and combined. Horizontal, down-sloping and slowly up-sloping ST-segment patterns were combined. RESULTS: After adjustment for age, smoking, blood pressure, cholesterol, maximal heart rate, left ventricular hypertrophy and physical fitness ST depressions > or =0.50 mm--during and/or post-exercise--were associated with a 1.47-fold [95% confidence interval (CI) 1.10-1.95], and 1.54-fold (95% CI of 1.17-2.04) increased 26 years risk of CHD-mortality, respectively. The same ST-changes also increased 22 years risk of developing non-fatal AMI or needing CABG but not developing non-fatal stroke. CONCLUSIONS: Even an ST depression > or =0.50 mm during and/or after exercise increases the long-term risk of CHD-death, developing an AMI or needing CABG. No association was found between ST-changes and incidence of non-fatal strokes.
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| 8. |
- Broch, Kaspar, et al.
(author)
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Cholesterol lowering with EVOLocumab to prevent cardiac allograft Vasculopathy in De-novo heart transplant recipients : Design of the randomized controlled EVOLVD trial
- 2020
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In: Clinical Transplantation. - : Wiley. - 0902-0063 .- 1399-0012. ; 34:9
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Journal article (peer-reviewed)abstract
- Background: Cardiac allograft vasculopathy (CAV) is characterized by diffuse thickening of the arterial intima. Statins reduce the incidence of CAV, but despite the use of statins, CAV remains one of the leading causes of long-term death after heart transplant. Inhibitors of proprotein convertase subtilisin-kexin type 9 (PCSK9) substantially reduce cholesterol levels but have not been tested in heart transplant recipients. Methods: The Cholesterol lowering with EVOLocumab to prevent cardiac allograft Vasculopathy in De-novo heart transplant recipients (EVOLVD) trial (ClinicalTrials.gov Identifier: NCT03734211) is a randomized, double-blind trial designed to test the effect of the PCSK9 inhibitor evolocumab on coronary intima thickness in heart transplant recipients. Adults who have received a cardiac transplant within the past 4-8 weeks are eligible. Exclusion criteria include an estimated glomerular filtration rate < 20 mL/min/1.73 m2, renal replacement therapy, or contraindications to coronary angiography with intravascular ultrasound. 130 patients will be randomized (1:1) to 12-month treatment with evolocumab or matching placebo. The primary endpoint is the coronary artery intima thickness as measured by intravascular ultrasound. Conclusion: The EVOLVD trial is a randomized clinical trial designed to show whether treatment with the PCSK9 inhibitor evolocumab can ameliorate CAV over the first year after heart transplant.
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| 10. |
- Gjesdal, K, et al.
(author)
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Digitalis: a dangerous drug in atrial fibrillation? An analysis of the SPORTIF III and V data
- 2008
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In: Heart. - : BMJ. - 1355-6037. ; 94:2, s. 191-196
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Journal article (peer-reviewed)abstract
- OBJECTIVE: In heart failure, digitalis increases exercise capacity and reduces morbidity, but has no effect on survival. This raises the suspicion that the inotropic benefits of digitalis may be counteracted by serious adverse effects. Patients with atrial fibrillation (AF) were studied to clarify this. DESIGN: In the Stroke Prevention using an ORal Thrombin Inhibitor in atrial Fibrillation (SPORTIF) III and V studies, 7329 patients with AF at moderate-to-high risk were randomised to preventive treatment of thromboembolism, either with warfarin or the oral direct thrombin inhibitor ximelagatran. The survival of users and non-users of digitalis was investigated. RESULTS: At baseline, 53.4% of the study population used digitalis, and these patients had a higher mortality than non-users (255/3911 (6.5%) vs 141/3418 (4.1%), p<0.001; hazard ratio (HR) = 1.58 (95% CI 1.29 to 1.94)). Digitalis users also had more baseline risk factors. After multivariate risk factor adjustment, the increased mortality persisted (p<0.001; HR = 1.53 (95% CI 1.22 to 1.92 vs 1.23 to 1.92)). CONCLUSIONS: The results suggest that digitalis, like other inotropic drugs, may increase mortality. This may be concealed in heart failure, but be revealed in patients with AF, who need the rate-reducing effect of digitalis, but do not benefit much from an increased inotropy. Cautious interpretation of the data is mandatory since the patients were not randomised with respect to digitalis use.
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