| 1. |
- Bjurman, Christian, 1983, et al.
(author)
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Assessment of a multi-marker risk score for predicting cause-specific mortality at three years in older patients with heart failure and reduced ejection fraction.
- 2015
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In: Cardiology journal. - 1897-5593. ; 22:1, s. 31-6
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Journal article (peer-reviewed)abstract
- Due to increasing co-morbidity associated with aging, heart failure (HF) has become more prevalent and heterogeneous in older individuals, and non-cardiovascular (CV) mortality has increased. Previously, we defined a multi-marker modality that included cystatin C (CysC), troponin T (TnT), and age. Here, we validated this multi-marker risk score by evaluating its predictions of all-cause mortality and CV mortality in an independent population of older individuals with HF and reduced ejection fraction (HFrEF).
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| 2. |
- Holmström, Alexandra, et al.
(author)
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An integrated multiple marker modality is superior to NT-proBNP alone in prognostic prediction in all-cause mortality in a prospective cohort of elderly heart failure patients
- 2013
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In: European Geriatric Medicine. - : Elsevier BV. - 1878-7649. ; 4:6, s. 365-371
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Journal article (peer-reviewed)abstract
- Background: Identifying the individual mortality risk for elderly heart failure (HF) patients is challenging because of heterogeneity, comorbidity and higher age. To overcome this, an integrated multiple marker modality has been proposed for better prognostic prediction than a single variable, this has not been evaluated. Aim: The aim of this study is to identify whether a multiple marker modality is better than N-terminal pro-B-type natriuretic peptide (NT-proBNP) alone for all-cause mortality in elderly HF patients. Methods: A prospective cohort of 361 patients (65 +/- 15 years) referred for echocardiography because of suspected HF was studied, among them, 179 had HF (71 +/- 13). In this cohort blood sampling, electrocardiogram and clinical examinations were performed within approximately 24 hours after the echocardiography. To assess prognostic value of multiple marker modality for all-cause mortality, patients were followed up for 24 +/- 7 months. Results: In the three multivariate analyses, NT-proBNP, cystatin C, red blood cell distribution width (RDW), midregional pro-atrial natriuretic peptide (MR-proANP), pulmonary artery pressure, estimated glomerular filtration rate (eGFR) less than 60 mL/min, anemia, diuretics and sinus rhythm are prognostic predictors of all-cause mortality in elderly HF patients. When analyzing all these variables in one multivariate analysis, only NT-proBNP, eGFR less than 60 mL/min, anemia and diuretics are prognostic predictors of all-cause mortality in elderly HF patients. Two different multiple marker models incorporating NT-proBNP, clinical and laboratory variables were created. The sensitivity and specificity of the two different multiple marker modalities are higher than for NT-proBNP alone. The risk score based on multivariate analysis Wald X-2 values is preferred considering its simplicity and feasibility in daily clinical practice. Conclusion: A multiple marker modality was proven to improve prognostic prediction in elderly HF patients compared to NT-proBNP alone. (C) 2013 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.
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| 3. |
- Holmström, Alexandra, et al.
(author)
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Heart dysfunction in patients with acute ischemic stroke or TIA does not predict all-cause mortality at long-term follow-up
- 2013
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In: Bmc Neurology. - : Springer Science and Business Media LLC. - 1471-2377. ; 13
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Journal article (peer-reviewed)abstract
- Background: Despite heart failure being a substantial risk factor for stroke, few studies have evaluated the predictive value of heart dysfunction for all-cause mortality in patients with acute ischemic stroke, in particular in the elderly. The aim of this study was to investigate whether impaired heart function in elderly patients can predict all-cause mortality after acute ischemic stroke or transient ischemic attack (TIA). Methods: A prospective long-term follow-up analysis was performed on a hospital cohort consisting of n = 132 patients with mean age 73 +/- 9 years, presenting with acute ischemic stroke or transient ischemic attack, without atrial fibrillation. All patients were examined by echocardiography during the hospital stay. Data about all-cause mortality were collected at the end of the follow-up period. The mean follow-up period was 56 +/- 22 months. Results: In this cohort, 58% of patients with acute ischemic stroke or TIA had heart dysfunction. Survival analysis showed that heart dysfunction did not predict all-cause mortality in this cohort. Furthermore, in multivariate regression analysis age (HR 5.401, Cl 1.97-14.78, p < 0.01), smoking (HR 3.181, Cl 1.36-7.47, p < 0.01), myocardial infarction (HR 2.826, Cl 1.17-6.83, p < 0.05) were independent predictors of all-cause mortality. Conclusion: In this population with acute ischemic stroke or TIA and without non-valvular atrial fibrillation, impaired heart function does not seem to be a significant predictor of all-cause mortality at long-term follow-up.
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| 4. |
- Holmström, Alexandra, et al.
(author)
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Increased comorbidities in heart failure patients >/=85years but declined from >90years: Data from the Swedish Heart Failure Registry
- 2013
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In: International journal of cardiology. - : Elsevier BV. - 1874-1754 .- 0167-5273. ; 167:6, s. 2747-2752
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Journal article (peer-reviewed)abstract
- OBJECTIVES: Epidemiological studies of elderly heart failure (HF) patients (>/=85years) are limited with inconsistent findings. Our objective is to confirm and extend epidemiological study in elderly (>/=85years) patients using the Swedish Heart Failure Registry database. METHODS: This retrospective study included 8,347 HF patients aged /=85years. Elderly population was further divided into two subgroups: 11,412 patients were 85-90years and 4,477 patients were >90years. RESULTS: The >/=85year group was characterized by more women, higher systolic blood pressure (SBP), lower body-mass index (BMI), more than twice as many HF with normal left ventricular ejection fraction (HFNEF), higher incidence of cardiovascular and non-cardiovascular comorbidities and less use of proven therapeutics compared with the 90year subgroup had a decline in cardiovascular and non-cardiovascular comorbidities except renal insufficiency and anaemia which continued to increase with ageing (p<0.01). Tendency was the same regardless of gender but slightly different between systolic HF (SHF) and HFNEF. In the group with HFNEF, there were more women, higher SBP, lower N-terminal pro-B-type natriuretic peptide levels, less ischaemic heart disease, more hypertension and left bundle branch block regardless of age. Atrial fibrillation was more frequent in patients with HFNEF than with SHF in the elderly group (p<0.01). Patients with HFNEF in the >90year subgroup had increasing incidence of ischaemic heart disease compared to 85-90year group (p<0.01). CONCLUSIONS: HF patients >/=85years had increased cardiovascular and non-cardiovascular comorbidities but with a decline from >90years.
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| 5. |
- Holmström, Alexandra, et al.
(author)
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Levels of copeptin among elderly patients in relation to systolic heart failure and heart failure with normal ejection fraction
- 2013
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In: European Geriatric Medicine. - : Elsevier BV. - 1878-7649. ; 4:3, s. 139-144
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Journal article (peer-reviewed)abstract
- Background: High copeptin levels are linked to a poor prognosis in heart failure (HF). Studies of copeptin levels in elderly HF patients with normal left ventricular ejection fraction (HFNEF) have reported conflicting results. Aim: The aim is to study the relationship between copeptin levels and HF in the elderly. Methods: In a prospective cohort of 261 patients with a mean age of 70 +/- 11 years, referred for echocardiography due to suspected HF. Electrocardiography, blood sampling and clinical examination were performed within approximately 24 hours after echocardiography. The study group was categorised according to the following definitions: systolic HF (SHF) (39%), HFNEF (previously called diastolic HF) (19%), uncertain HFNEF (19%), where only symptoms and partial echocardiography signs supported the diagnosis and a group in which HF was excluded (Non-HF) (23%). Results: Copeptin levels were higher in patients with SHF and HFNEF compared with non-HF patients. Patients with uncertain HFNEF had similar copeptin levels as the non-HF group. Copeptin across quartiles was related to an increased proportion of SHF, low ejection fraction (LVEF), high pulmonary artery pressure (PA) (all P < 0.01), signs of increased preload (LVDD) (P < 0.05), and higher levels of a panel of biomarkers (P < 0.01), but not to the incidence of HFNEF. In a stepwise multiple linear regression analysis there was a positive relationship between copeptin and cystatin C, high-sensitivity troponin T (both P < 0.001) and male gender (P < 0.05). Conclusion: Copeptin levels are elevated in both SHF and HFNEF in the elderly but not in patients in whom the HFNEF diagnosis is based only on symptoms and partial echocardiography findings.
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| 6. |
- Holmström, Alexandra, et al.
(author)
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Re-evaluation of prognostic significance of NT-proBNP in a 5-year follow-up study assessing all-cause mortality in elderly patients (≥ 75 years) admitted to hospital due to suspect heart failure
- 2013
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In: European Geriatric Medicine. - : Elsevier BV. - 1878-7649. ; 4:1, s. 8-14
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Journal article (peer-reviewed)abstract
- Background: N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a prognostic biomarker in heart failure (HF), especially in younger population. The prognostic value of NT-proBNP in an elderly HF population (≥ 75 years) remains less studied. The purpose of this study is to evaluate the prognostic value of NT-proBNP in patients aged ≥ 75 years and admitted to hospital due to suspect HF with a median follow-up of 5 years. Methods: A prospective hospital cohort of 243 patients (82 ± 4 years) who had NT-proBNP analyzed due to suspect HF during 2005-2007 was studied. Results: Among the study population, 75% had acute decompensated HF. Multivariable Cox proportional-hazard regression analysis and univariable Kaplan-Meier survival analysis demonstrated that NT-proBNP was not prognostic significant in HF cohort ≥ 75 years old, and instead, pulmonary hypertension, history of valvular surgery and use of aldosterone receptor antagonist were significant prognostic indicators. However, subgroup analysis showed that in patients with NT-proBNP levels > 8000 (ng/L), NT-proBNP is the only significant independent indicator for 5-year mortality whereas in patients with NT-proBNP ≤ 8000 (ng/L), enlargement of left atrium and pulmonary hypertension, instead of NT-proBNP, were significant prognostic indicators for mortality. Conclusion: In a HF population ≥ 75 years old with acute decompensated HF, NT-proBNP was not significant prognostic indicator, except in a subgroup with NT-proBNP > 8000 (ng/L). Therefore, the prognostic value of NT-proBNP in those HF patients ≥ 75 years has to be interpreted with caution due to higher age and comorbidity. Crown Copyright © 2012 Published by Elsevier Masson SAS. All rights reserved.
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| 7. |
- Holmström, Alexandra, et al.
(author)
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Red blood cell distribution width and its relation to cardiac function and biomarkers in a prospective hospital cohort referred for echocardiography
- 2012
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In: European Journal of Internal Medicine. - : Elsevier BV. - 0953-6205. ; 23:7, s. 604-609
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Journal article (peer-reviewed)abstract
- Background: Red blood cell distribution width (RDW), a measure of anisocytosis, is a prognostic biomarker for heart failure (HF). However it is still unclear how RDW is associated with heart function and established cardiac biomarkers. Methods and results: In a prospective hospital cohort of 296 patients referred for echocardiography because of suspected HF, blood sampling and clinical examination were performed within 24 h after echocardiography. The patients were divided into four HF groups, including one group where the HF diagnosis was uncertain (gray zone). In the patients the mean age was 70 +/- 11 years, 44% with systolic HF (SHF), 18% with heart failure with normal ejection fraction (HFNEF), 17% with gray zone and 21% without HF (non-HF). RDW was higher among patients with SHF and HFNEF, compared with gray zone and non-HF patients. The distribution of different variables over the RDW quartiles showed an inverse correlation between RDW levels and LVEF and a positive correlation between RDW and NT-proBNP levels. Further analysis with stepwise multiple linear regression demonstrated that NT-proBNP levels, but not LVEF, were independently correlated with RDW. Conclusion: In patients referred for echocardiography because of suspected HF, RDW levels were higher in patients with SHF and HFNEF. Moreover, NT-proBNP levels were independently linked with elevated RDW. (C) 2012 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
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| 8. |
- Nordlund, Arto, 1962, et al.
(author)
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Frequent Mild Cognitive Deficits in Several Functional Domains in Elderly Patients With Heart Failure Without Known Cognitive Disorders
- 2015
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In: Journal of Cardiac Failure. - : Elsevier BV. - 1071-9164. ; 21:9, s. 702-707
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Journal article (peer-reviewed)abstract
- Background: The objective of the present study was to investigate whether mild cognitive deficits are present in patients with heart failure (HF) despite absence of any known cognitive disorder. Methods and Results: A well defined group of patients (n = 40) with heart failure completed a cognitive screening check list, a depression screening questionnaire, and a battery consisting of neuropsychological tests assessing 5 different cognitive domains: speed/attention, episodic memory, visuospatial functions, language, and executive functions. The neuropsychological results were compared with those from a group of healthy control subjects (n = 41). The patients with HF displayed cognitive impairment compared with the control group within the domains speed and attention, episodic memory, visuospatial functions, and language. Among them, 34 HF patients (85%) could be classified with mild cognitive impairment (MCI), the majority as nonamnestic MCI, ie, with no memory impairment. Conclusions: Considering the high occurrence of mild cognitive deficits among HF patients without known cognitive disorders, closer attention should be paid to their self-care and compliance. Inadequate self-care and compliance could lead to more frequent hospitalizations. Furthermore, the HF patients may be at increased risk of dementia.
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| 9. |
- Schwartz, David A., et al.
(author)
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Placental Tissue Destruction and Insufficiency From COVID-19 Causes Stillbirth and Neonatal Death From Hypoxic-Ischemic Injury : A Study of 68 Cases With SARS-CoV-2 Placentitis From 12 Countries
- 2022
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In: Archives of Pathology & Laboratory Medicine. - : Archives of Pathology and Laboratory Medicine. - 0003-9985 .- 1543-2165. ; 146:6, s. 660-676
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Journal article (peer-reviewed)abstract
- Context: Perinatal death is an increasingly important problem as the coronavirus disease 2019 (COVID-19) pandemic continues, but the mechanism of death has been unclear.Objective: To evaluate the role of the placenta in causing stillbirth and neonatal death following maternal infection with COVID-19 and confirmed placental positivity for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).Design: Case-based retrospective clinicopathologic analysis by a multinational group of 44 perinatal specialists from 12 countries of placental and autopsy pathology findings from 64 stillborns and 4 neonatal deaths having placentas testing positive for SARS-CoV-2 following delivery to mothers with COVID-19.Results: Of the 3 findings constituting SARS-CoV-2 placentitis, all 68 placentas had increased fibrin deposition and villous trophoblast necrosis and 66 had chronic histiocytic intervillositis. Sixty-three placentas had massive perivillous fibrin deposition. Severe destructive placental disease from SARS-CoV-2 placentitis averaged 77.7% tissue involvement. Other findings included multiple intervillous thrombi (37%; 25 of 68) and chronic villitis (32%; 22 of 68). The majority (19; 63%) of the 30 autopsies revealed no significant fetal abnormalities except for intrauterine hypoxia and asphyxia. Among all 68 cases, SARS-CoV-2 was detected from a body specimen in 16 of 28 cases tested, most frequently from nasopharyngeal swabs. Four autopsied stillborns had SARS-CoV-2 identified in internal organs.Conclusions: The pathology abnormalities composing SARS-CoV-2 placentitis cause widespread and severe placental destruction resulting in placental malperfusion and insufficiency. In these cases, intrauterine and perinatal death likely results directly from placental insufficiency and fetal hypoxic-ischemic injury. There was no evidence that SARS-CoV-2 involvement of the fetus had a role in causing these deaths.
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