| 1. |
- Lund, Lars H., et al.
(author)
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Age, prognostic impact of QRS prolongation and left bundle branch block, and utilization of cardiac resynchronization therapy: findings from 14713 patients in the Swedish Heart Failure Registry
- 2014
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In: European Journal of Heart Failure. - : Oxford University Press (OUP): Policy B / Wiley. - 1388-9842 .- 1879-0844. ; 16:10, s. 1073-1081
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Journal article (peer-reviewed)abstract
- AimsAge is not a contraindication to cardiac resynchronization therapy (CRT), but the prevalence and prognostic impact of QRS prolongation with intraventricular conduction delay (IVCD) and left bundle branch block (LBBB), as well as CRT utilization, may differ with age. We tested the hypotheses that in the elderly: (i) IVCD and LBBB are more prevalent, (ii) IVCD and LBBB are more harmful, and (iii) CRT is underutilized. Methods and resultsWe studied 14713 patients with ejection fraction 39% in the Swedish Heart Failure Registry and divided into age groups 65years, 66-80years and greater than80years. Among 13782 patients without CRT, IVCD was present in the three age groups in 11% vs. 15% vs. 19% and LBBB was present in 20% vs. 27% vs. 28%, respectively, (Pless than0.001). The multivariable hazard ratio (HR) for all-cause mortality over a median (interquartile range) follow-up of 29 (12-53) months for IVCD vs. narrow QRS was 1.31 (1.06-1.63, P=0.013) in the 65year group, 1.32 (1.17-1.47, Pless than0.001) in the 66-80year group, and 1.26 (1.21-1.41, pless than0.001) in the greater than80year group. For LBBB vs. narrow QRS it was 1.29 (1.07-1.56, P=0.009), 1.17 (1.06-1.30, P=0.002), and 1.10 (0.99-1.22, P=0.091), respectively. The adjusted P for interaction between age and QRS morphology was 0.664. In the three age groups, CRT was present in 6% vs. 8% vs. 4% and absent but with indication in 23% vs. 32% vs. 37%, respectively (Pless than0.001). ConclusionsBoth IVCD and LBBB were more common with increasing age and were similarly strong independent predictors of mortality and in all ages. The underutilization of CRT was worse with increasing age.
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| 2. |
- Sahlén, Anders, et al.
(author)
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Cardiac fatigue in long-distance runners is associated with ventricular repolarization abnormalities.
- 2009
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In: Heart rhythm : the official journal of the Heart Rhythm Society. - : Elsevier BV. - 1556-3871 .- 1547-5271. ; 6:4, s. 512-9
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Journal article (peer-reviewed)abstract
- BACKGROUND: Prolonged exercise can induce cardiac fatigue, which is characterized by biomarker release and impaired myocardial function. The impact on ventricular electrophysiology is largely unknown. OBJECTIVE: The objective of this study was to examine changes in ventricular repolarization after a 30-km cross-country race in runners aged >or=55 years. METHODS: Fifteen healthy participants (62 +/- 5 years) were assessed using biomarkers (N-terminal pro-brain natriuretic peptide [NT-proBNP], troponin T [TnT]), tissue Doppler echocardiography, and vectorcardiography at baseline, within 1 hour postrace and on days 1 and 6 postrace. RESULTS: During the race, NT-proBNP increased from 42 ng/L (interquartile range 25-117) to 187 ng/L (113-464), and TnT increased from undetectable levels to 0.03 microg/L (0.015-0.05). Global strain (19.1% +/- 2.2%) decreased on day 1 (17.2% +/- 1.8%) and day 6 (17.9% +/- 1.5%; P <.01). QT(c) increased from 431 +/- 15 ms prerace to 445 +/- 22 ms postrace and 445 +/- 15 ms on day 1 (P <.05), mainly because of an increased T(peak-end) interval (prerace 108 +/- 13 ms, postrace 127 +/- 43 ms, day 1 127 +/- 43 ms; P <.05). Postrace, T(area) (baseline 75 +/- 26 microVs) peaked on day 1 (105 +/- 42 microVs) and remained high on day 6 (89 +/- 37 microVs; P <.05). Runners with higher baseline NT-proBNP developed greater impairment of myocardial velocities (rho = -0.68 to -0.54; P <.05) and a larger increase in T(area) (rho = 0.73; P <.01). CONCLUSION: Cardiac fatigue induced by prolonged exertion is associated with sustained abnormalities in ventricular repolarization. Runners with higher baseline NT-proBNP are especially liable to such alterations of cardiac function.
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| 3. |
- Schrage, Benedikt, et al.
(author)
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Association Between Use of Primary-Prevention Implantable Cardioverter-Defibrillators and Mortality in Patients With Heart Failure A Prospective Propensity Score-Matched Analysis From the Swedish Heart Failure Registry
- 2019
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In: Circulation. - : LIPPINCOTT WILLIAMS & WILKINS. - 0009-7322 .- 1524-4539. ; 140:19, s. 1530-1539
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Journal article (peer-reviewed)abstract
- Background: Most randomized trials on implantable cardioverter-defibrillator (ICD) use for primary prevention of sudden cardiac death in heart failure with reduced ejection fraction enrolled patients amp;gt;20 years ago. We investigated the association between ICD use and all-cause mortality in a contemporary heart failure with reduced ejection fraction cohort and examined relevant subgroups. Methods: Patients from the Swedish Heart Failure Registry fulfilling the European Society of Cardiology criteria for primary-prevention ICD were included. The association between ICD use and 1-year and 5-year all-cause and cardiovascular (CV) mortality was assessed by Cox regression models in a 1:1 propensity score-matched cohort and in prespecified subgroups. Results: Of 16 702 eligible patients, only 1599 (10%) had an ICD. After matching, 1305 ICD recipients were compared with 1305 nonrecipients. ICD use was associated with a reduction in all-cause mortality risk within 1 year (hazard ratio, 0.73 [95% CI, 0.60-0.90]) and 5 years (hazard ratio, 0.88 [95% CI, 0.78-0.99]). Results were consistent in all subgroups including patients with versus without ischemic heart disease, men versus women, those aged amp;lt;75 versus amp;gt;= 75 years, those with earlier versus later enrollment in the Swedish heart failure registry, and patients with versus without cardiac resynchronization therapy. Conclusions: In a contemporary heart failure with reduced ejection fraction population, ICD for primary prevention was underused, although it was associated with reduced short- and long-term all-cause mortality. This association was consistent across all the investigated subgroups. These results call for better implementation of ICD therapy.
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| 4. |
- Thorvaldsen, Tonje, et al.
(author)
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Triage of Patients With Moderate to Severe Heart Failure
- 2014
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In: Journal of the American College of Cardiology. - : Elsevier. - 0735-1097 .- 1558-3597. ; 63:7, s. 661-671
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Journal article (peer-reviewed)abstract
- Objectives The purpose of this study was to evaluate simple criteria for referral of patients from the general practitioner to a heart failure (HF) center. Background In advanced HF, the criteria for heart transplantation, left ventricular assist device, and palliative care are well known among HF specialists, but criteria for referral to an advanced HF center have not been developed for generalists. Methods We assessed observed and expected all-cause mortality in 10,062 patients with New York Heart Association (NYHA) functional class III to IV HF and ejection fraction less than 40% registered in the Swedish Heart Failure Registry between 2000 and 2013. Next, 5 pre-specified universally available risk factors were assessed as potential triggers for referral, using multivariable Cox regression: systolic blood pressure less than= 90 mm Hg; creatinine greater than= 160 mmol/l; hemoglobin less than= 120 g/l; no renin-angiotensin system antagonist; and no beta-blocker. Results In NYHA functional class III to IV and age groups less than= 65 years, 66 to 80 years, and greater than 80 years, there were 2,247, 4,632, and 3,183 patients, with 1-year observed versus expected survivals of 90% versus 99%, 79% versus 97%, and 61% versus 89%, respectively. In the age less than= 80 years group, the presence of 1, 2, or 3 to 5 of these risk factors conferred an independent hazard ratio for all-cause mortality of 1.40, 2.30, and 4.07, and a 1-year survival of 79%, 60%, and 39%, respectively (p less than 0.001). Conclusions In patients less than= 80 years of age with NYHA functional class III to IV HF and ejection fraction less than 40%, mortality is predominantly related to HF or its comorbidities. Potential heart transplantation/left ventricular assist device candidacy is suggested by greater than= 1 risk factor and potential palliative care by multiple universally available risk factors. These patients may benefit from referral to an advanced HF center.
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