| 1. |
- Anker, Stefan D, et al.
(author)
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Ferric Carboxymaltose in Patients with Heart Failure and Iron Deficiency.
- 2009
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In: New England Journal of Medicine. - 0028-4793. ; 361, s. 2436-2448
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Journal article (peer-reviewed)abstract
- BACKGROUND: Iron deficiency may impair aerobic performance. This study aimed to determine whether treatment with intravenous iron (ferric carboxymaltose) would improve symptoms in patients who had heart failure, reduced left ventricular ejection fraction, and iron deficiency, either with or without anemia. METHODS: We enrolled 459 patients with chronic heart failure of New York Heart Association (NYHA) functional class II or III, a left ventricular ejection fraction of 40% or less (for patients with NYHA class II) or 45% or less (for NYHA class III), iron deficiency (ferritin level <100 mug per liter or between 100 and 299 mug per liter, if the transferrin saturation was <20%), and a hemoglobin level of 95 to 135 g per liter. Patients were randomly assigned, in a 2:1 ratio, to receive 200 mg of intravenous iron (ferric carboxymaltose) or saline (placebo). The primary end points were the self-reported Patient Global Assessment and NYHA functional class, both at week 24. Secondary end points included the distance walked in 6 minutes and the health-related quality of life. RESULTS: Among the patients receiving ferric carboxymaltose, 50% reported being much or moderately improved, as compared with 28% of patients receiving placebo, according to the Patient Global Assessment (odds ratio for improvement, 2.51; 95% confidence interval [CI], 1.75 to 3.61). Among the patients assigned to ferric carboxymaltose, 47% had an NYHA functional class I or II at week 24, as compared with 30% of patients assigned to placebo (odds ratio for improvement by one class, 2.40; 95% CI, 1.55 to 3.71). Results were similar in patients with anemia and those without anemia. Significant improvements were seen with ferric carboxymaltose in the distance on the 6-minute walk test and quality-of-life assessments. The rates of death, adverse events, and serious adverse events were similar in the two study groups. CONCLUSIONS: Treatment with intravenous ferric carboxymaltose in patients with chronic heart failure and iron deficiency, with or without anemia, improves symptoms, functional capacity, and quality of life; the side-effect profile is acceptable. (ClinicalTrials.gov number, NCT00520780.) Copyright 2009 Massachusetts Medical Society.
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| 2. |
- Anker, Stefan D., et al.
(author)
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Rationale and design of Ferinject((R)) Assessment in patients with IRon deficiency and chronic Heart Failure (FAIR-HF) study: a randomized, placebo-controlled study of intravenous iron supplementation in patients with and without anaemia
- 2009
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In: European Journal of Heart Failure. - : Wiley. - 1879-0844 .- 1388-9842. ; 11:11, s. 1084-1091
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Journal article (peer-reviewed)abstract
- Iron deficiency (ID) and anaemia are common in patients with chronic heart failure (CHF). The presence of anaemia is associated with increased morbidity and mortality in CHF, and ID is a major reason for the development of anaemia. Preliminary studies using intravenous (i.v.) iron supplementation alone in patients with CHF and ID have shown improvements in symptom status. FAIR-HF (Clinical Trials.gov NCT00520780) was designed to determine the effect of i.v. iron repletion therapy using ferric carboxymaltose on self-reported patient global assessment (PGA) and New York Heart Association (NYHA) in patients with CHF and ID. This is a multi-centre, randomized, double-blind, placebo-controlled study recruiting ambulatory patients with symptomatic CHF with LVEF < 40% (NYHA II) or < 45% (NYHA III), ID [ferritin < 100 ng/mL or ferritin 100-300 ng/mL when transferrin saturation (TSAT) < 20%], and haemoglobin 9.5-13.5 g/dL. Patients were randomized in a 2:1 ratio to receive ferric carboxymaltose (Ferinject((R))) 200 mg iron i.v. or saline i.v. weekly until iron repletion (correction phase), then monthly until Week 24 (maintenance phase). Primary endpoints are (i) self-reported PGA at Week 24 and (ii) NYHA class at Week 24, adjusted for baseline NYHA class. This study will provide evidence on the efficacy and safety of iron repletion with ferric carboxymaltose in CHF patients with ID with and without anaemia.
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| 3. |
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| 4. |
- Birgander, Mats, et al.
(author)
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Cardiac Structure and Function Before and After Parathyroidectomy in Patients With Asymptomatic Primary Hyperparathyroidism
- 2009
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In: The Endocrinologist. - 1539-9192. ; 19:4, s. 154-158
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Journal article (peer-reviewed)abstract
- Background: Primary hyperparathyroidism (PHPT) is associated with cardiac disease and increased risk of all-cause and cardiovascular mortality. We investigated cardiac structural and functional parameters before and after successful parathyroidectomy in asymptomatic PHPT patients. Methods and Results: Forty-nine PHPT patients (age: 62.9 +/- 11 years, 5 men) and 48 healthy control subjects, matched for age, sex and smoking status were enrolled in the study. PHPT patients were examined preoperatively and 6 and 12 months postoperatively. Structural and functional cardiac parameters were assessed by transthoracic echocardiography. One year after parathyroidectomy left ventricular (LV) mass, left atrial size, LV enddiastolic and endsystolic diameters, LV posterior wall and interventricular septum diameter, and right ventricular enddiastolic diameter were all increased in PHPT patients, although not significantly. As an indication of worsened LV diastolic function, the heart rate adjusted Doppler-derived deceleration time of the transmittal E-wave increased among PHPT patients (276 +/- 82-303 +/- 54 milliseconds, P = 0.004). There was also deterioration of LV ejection fraction (from 62.7 +/- 7 to 59.9 +/- 7.8%, P = 0.868) and mean atrioventricular plane displacement (from 13.2 +/- 2 to 12.6 +/- 2 mm, P = 0.029). Conclusion: There were no significant differences in heart function between hyperparathyroid and control subjects, and 6 months after parathyroidectomy, there was no change in heart function in hyperparathyroid subjects.
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| 5. |
- Birgander, Mats, et al.
(author)
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Postexercise Cardiac Performance Among Patients With Mild Primary Hyperparathyroidism
- 2009
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In: The Endocrinologist. - 1539-9192. ; 19:6, s. 263-266
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Journal article (peer-reviewed)abstract
- Primary hyperparathyroidism (pHPT) is associated with cardiac disease. This prospective study was designed to investigate changes in cardiac function before and after parathyroidectomy. Resting and post exercise cardiac function was compared with matched control subjects. Fifty patients (mean age 62.9 +/- 11 years, 45 women) and 50 healthy control subjects, matched for age and sex were studied. Resting and postmaximum exercise echocardiography/Doppler examination were performed at baseline and 6 months after parathyroidectomy. pHPT patients were tested at baseline and 6 months postoperatively. Control subjects were tested only at baseline. Patients were divided into 4 subgroups based on median preoperative levels of PTH and calcium (Ca): high (up arrow) PTI4/ up arrow Ca, up arrow PTH/low (down arrow) Ca, up arrow Ca/ down arrow PTH, and down arrow PTH/ down arrow Ca. No significant difference between pHPT patients and control subjects regarding post exercise systolic function were detected, There was a tendency of lowed E/A among pHPT patients which was significant in subgroup down arrow PTH/ down arrow Ca (1.07 +/- 0.3). Subgroup up arrow PTH/ up arrow Ca showed a lower S/D compared with control subjects at baseline (1.28 +/- 0.3 vs. 1.48 +/- 0.3, P = 0.029). No significant changes regarding post exercise echocardiographic parameters reflecting cardiac function were detected 6 months after parathyriodectomy. Patients with asymptomatic pHPT showed a tendency of elevated filling pressures and signs of impaired diastolic function during exercise.
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| 6. |
- Birgander, Mats, et al.
(author)
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Relationship Between Mild Primary Hyperparathyroidism and Left Ventricular Structure and Diastolic Performance
- 2009
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In: The Endocrinologist. - 1539-9192. ; 19:4, s. 187-191
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Research review (peer-reviewed)abstract
- Aim: This study aims to investigate cardiac structure and function in patients with asymptomatic primary hyperparathyroidism (pHPT) and if there is any relation to severity regarding serum levels of calcium (Ca) and parathyroid hormone. Methods and Results: We consecutively included 50 patients (mean age 62.9 +/- 11 years, 45 women) with clinically diagnosed pHPT. We prospectively recruited 50 healthy control subjects, matched for age and sex. Standard transthoracic echocardiographic examination was performed using the 4 standard views and structural parameters as well as left ventricular (LV) systolic and diastolic function was determined. Mean LV ejection fraction and atrioventricular plane displacement were on average normal and did not differ between patients and controls. However, pHPT patients had significantly greater LV mass (148 +/- 37 vs. 127 +/- 29 g, P = 0.002), LV end diastolic area (81 +/- 20 vs. 68 +/- 18 cm(2), p = 0.003), LV posterior wall diameter (8.9 +/- 1 vs. 8.1 +/- 1 min, P = 0.006), and LA size (21 +/- 3 vs. 19 +/- 2 mm, P < 0.001). A moderate to severe LV diastolic filling impairment was present in substantially more pHPT patients, compared with control subjects (36% vs. 4%, P < 0:001). Conclusion: Patients with asymptomatic pHPT showed LV structural changes and impaired LV diastolic function.
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| 7. |
- Borgquist, Rasmus, et al.
(author)
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Coronary flow velocity reserve reduction is comparable in patients with erectile dysfunction and in patients with impaired fasting glucose or well-regulated diabetes mellitus
- 2007
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In: European Journal of Cardiovascular Prevention & Rehabilitation. - 1741-8275. ; 14:2, s. 258-264
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Journal article (peer-reviewed)abstract
- Background There is growing evidence that erectile dysfunction is a sentinel for future coronary artery disease. Recently published studies have shown signs of impaired coronary endothelial function in patients with erectile dysfunction, without clinical cardiovascular disease and diabetes. We evaluated the magnitude of coronary vasodilatory dysfunction in men with erectile dysfunction, as compared with men with impaired glucose metabolism (impaired fasting glucose or diabetes) and healthy controls. Methods We investigated men aged 68-73 years with erectile dysfunction (n=12), age-matched men with impaired glucose metabolism, who all proved to have erectile dysfunction (n=15), and age-matched male controls (n=12). Erectile dysfunction was evaluated using the International Index of Erectile Function (IIEF)-5 questionnaire. Coronary flow velocity reserve in the left anterior descending artery was examined using Doppler ultrasound and intravenous adenosine provocation. Results Coronary flow velocities at rest did not differ between the three groups, but maximum coronary flow velocity was significantly lower in the erectile dysfunction group (P= 0.004) and in the impaired glucose metabolism group (P= 0.019), as compared with controls. There was no difference between the erectile dysfunction and impaired glucose metabolism groups. Coronary flow velocity reserve was reduced in the erectile dysfunction group (P=0.026) compared to controls, but was similar compared to the impaired glucose metabolism group. In multivariate analysis including all groups, erectile dysfunction score was the only independent predictor of reduced coronary flow velocity reserve (P=0.020). Conclusions The magnitude of early coronary endothelial and smooth muscle cell dysfunction in otherwise healthy men with erectile dysfunction was comparable to that of patients with impaired glucose metabolism: a well known risk factor for coronary artery disease.
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| 8. |
- Borgquist, Rasmus, et al.
(author)
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Erectile dysfunction in healthy subjects predicts reduced coronary flow velocity reserve.
- 2006
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In: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 112:2, s. 166-170
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Journal article (peer-reviewed)abstract
- Background: Erectile dysfunction is associated with, and may be the first sign of coronary artery disease. We aimed to assess whether men with erectile dysfunction but without cardiovascular disease have reduced coronary flow reserve, as a sign of early coronary atherosclerosis. Methods: We investigated 12 men aged 68-73 years with erectile dysfunction, and 12 age-matched controls. Erectile function was evaluated using the validated IIEF-5 questionnaire. A score <= 18 (of 25) was defined as erectile dysfunction and >= 21 was considered non-nal. Patients with neurological or psychological reasons for erectile dysfunction were excluded, as were patients with symptoms of or prescribed medication for cardiovascular disease, hypertension or diabetes. Coronary flow velocity reserve was measured non-invasively by Doppler in the left anterior descending artery, before and during adenosine infusion. Results: Coronary flow velocity reserve was significantly reduced in subjects with erectile dysfunction: 2.36 versus 3.19; P=0.024. In logistic regression analysis, compared to control subjects, men with erectile dysfunction had significantly increased risk of reduced coronary flow velocity reserve (<= 3.0): odds ratio 15.4, P = 0.02. In multivariate analysis, adjusting for age, tobacco use, systolic blood pressure, heart rate and body mass index, erectile dysfunction was the only significant predictor of reduced coronary flow velocity reserve, P=0.016. Conclusions: Men with erectile dysfunction but without diabetes or clinical cardiovascular disease have early signs of coronary artery disease. Our findings suggest that a cardiac risk evaluation may be indicated in men with suspected vasculogenic erectile dysfunction, and these individuals should be considered for primary prevention measures regarding cardiovascular disease risk factors. (c) 2005 Elsevier Ireland Ltd. All rights reserved.
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| 9. |
- Borgquist, Rasmus, et al.
(author)
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Self-rated health and classical risk factors for coronary heart disease predict development of erectile dysfunction 25 years later.
- 2008
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In: International Journal of Clinical Practice. - : Hindawi Limited. - 1742-1241 .- 1368-5031. ; 62:2, s. 206-213
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Journal article (peer-reviewed)abstract
- Aim: To investigate the impact of classical coronary heart disease (CHD) risk factors on the development of future erectile dysfunction (ED). Methods and results: A total of 830 randomly selected subjects were included. Baseline CHD risk factors were evaluated in relation to ED (evaluated by the International Index of Erectile Function-5 questionnaire) 25 years later. At follow-up, 499 men (60%) had some degree of ED. In age-adjusted logistic regression analysis, self-rated health [odds ratio (OR) 1.59, 95% confidence interval (CI): 1.09-2.31], family history of CHD (OR 1.75, CI: 1.17-2.61), fasting blood glucose (OR 1.52, CI: 1.14-2.02), triglycerides (OR 1.25, CI: 1.01-1.54), systolic blood pressure (SBP) (OR 1.19, CI: 1.04-1.35), body mass index (OR 1.08, CI: 1.03-1.13) and serum glutamyl transferase (GT) (OR 1.81, CI: 1.23-2.68), predicted ED. Independent predictors were higher age, low self-rated health, higher blood glucose, higher GT and a family history of CHD. Higher SBP was borderline significantly independent (p = 0.05). Furthermore, baseline age-adjusted Framingham risk score for CHD, also predicted future ED (OR 1.20, CI: 1.03-1.38). Conclusions: Our study supports and expands previous findings that ED and CHD share many risk factors, further underscoring the close link between ED and CHD. Men presenting with ED should be evaluated for the presence of other CHD risk factors.
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| 10. |
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| 11. |
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| 12. |
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| 13. |
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| 14. |
- Dobre, Daniela, et al.
(author)
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Clinical effects of initial 6 months monotherapy with bisoprolol versus enalapril in the treatment of patients with mild to moderate chronic heart failure. Data from the CIBIS III trial
- 2008
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In: Cardiovascular Drugs and Therapy. - : Springer Science and Business Media LLC. - 0920-3206 .- 1573-7241. ; 22:5, s. 399-405
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Journal article (peer-reviewed)abstract
- Purpose To assess the clinical effects and safety profile of initial monotherapy with either bisoprolol or enalapril in elderly patients with heart failure (HF). Methods In CIBIS III, 1010 patients with mild to moderate HF and age >= 65 years were randomized to monotherapy with either bisoprolol or enalapril for 6 months. Results Bisoprolol had a similar effect as enalapril on the combined end-point of all-cause mortality or hospitalization (HR 1.02; p=0.90), as well as on each of the individual end-points. A trend towards fewer sudden deaths was observed with bisoprolol (NS). On the other hand, more cases of worsening HF requiring hospitalization or occurring while in hospital were observed in the bisoprolol group (HR 1.67; p=0.03). The two groups were similar with regard to treatment cessations and early introduction of the second drug. Conclusions Bisoprolol and enalapril had a similar effect on the combined end-point of mortality or hospitalization during 6 months monotherapy. However, more worsening HF events were observed in the bisoprolol group.
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| 15. |
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| 16. |
- Gudmundsson, Petri, et al.
(author)
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Head to head comparisons of two modalities of perfusion adenosine stress echocardiography with simultaneous SPECT
- 2009
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In: Cardiovascular Ultrasound. - : BioMed Central. - 1476-7120. ; 7:19
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Journal article (peer-reviewed)abstract
- Background: Real-time perfusion (RTP) contrast echocardiography can be used during adenosine stress echocardiography (ASE) to evaluate myocardial ischemia. We compared two different types of RTP power modulation techniques, angiomode (AM) and high-resolution grayscale (HR), with 99mTc-tetrofosmin single-photon emission computed tomography (SPECT) for the detection of myocardial ischemia. Methods: Patients with known or suspected coronary artery disease (CAD), admitted to SPECT, were prospectively invited to participate. Patients underwent RTP imaging (SONOS 5500) using AM and HR during Sonovue® infusion, before and throughout the adenosine stress, also used for SPECT. Analysis of myocardial perfusion and wall motion by RTP-ASE were done for AM and HR at different time points, blinded to one another and to SPECT. Each segment was attributed to one of the three main coronary vessel areas of interest. Results: In 50 patients, 150 coronary areas were analyzed by SPECT and RTP-ASE AM and HR. SPECT showed evidence of ischemia in 13 out of 50 patients. There was no significant difference between AM and HR in detecting ischemia (p = 0.08). The agreement for AM and HR, compared to SPECT, was 93% and 96%, with Kappa values of 0.67 and 0.75, respectively (p < 0.001). Conclusion: There was no significant difference between AM and HR in correctly detecting myocardial ischemia as judged by SPECT. This suggests that different types of RTP modalities give comparable data during RTP-ASE in patients with known or suspected CAD.
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| 17. |
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| 18. |
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| 19. |
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| 20. |
- Gudmundsson, Petri, et al.
(author)
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Quantitative detection of myocardial ischaemia by stress echocardiography; a comparison with SPECT
- 2009
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In: Cardiovascular Ultrasound. - : BioMed Central. - 1476-7120. ; 7:28
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Journal article (peer-reviewed)abstract
- Aims: Real-time perfusion (RTP) adenosine stress echocardiography (ASE) can be used to visually evaluate myocardial ischaemia. The RTP power modulation technique angio-mode (AM), provides images for off-line perfusion quantification using Qontrast® software, generating values of peak signal intensity (A), myocardial blood flow velocity (β) and myocardial blood flow (Axβ). By comparing rest and stress values, their respective reserve values (A-r, β-r, Axβ-r) are generated. We evaluated myocardial ischaemia by RTP-ASE Qontrast® quantification, compared to visual perfusion evaluation with 99mTc-tetrofosmin singlephoton emission computed tomography (SPECT). Methods and Results: Patients admitted to SPECT underwent RTP-ASE (SONOS 5500) using AM during Sonovue® infusion, before and throughout adenosine stress, also used for SPECT. Visual myocardial perfusion and wall motion analysis, and Qontrast® quantification, were blindly compared to one another and to SPECT, at different time points off-line. We analyzed 201 coronary territories (left anterior descendent [LAD], left circumflex [LCx] and right coronary [RCA] artery territories) in 67 patients. SPECT showed ischaemia in 18 patients and 19 territories. Receiver operator characteristics and kappa values showed significant agreement with SPECT only for β-r and Axβ-r in all segments: area under the curve 0.678 and 0.665; P < 0.001 and < 0.01, respectively. The closest agreements were seen in the LAD territory: kappa 0.442 for both β-r and Axβ- r; P < 0.01. Visual evaluation of ischaemia showed good agreement with SPECT: accuracy 93%; kappa 0.67; P < 0.001; without non-interpretable territories. Conclusion: In this agreement study with SPECT, RTP-ASE Qontrast® quantification of myocardial ischaemia was less accurate and less feasible than visual evaluation and needs further development to be clinically useful.
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| 21. |
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| 23. |
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| 24. |
- Holst, Marie, 1959-, et al.
(author)
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Description of self-reported fluid intake and its effects on body weight, symptoms, quality of life and physical capacity in patients with stable chronic heart failure
- 2008
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In: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 17:17, s. 2318-2326
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Journal article (peer-reviewed)abstract
- Aim. To describe the self-reported fluid intake and its effects on body weight, signs and symptoms of heart failure, quality of life, physical capacity and thirst, in patients with stabilised chronic heart failure. Background. Patients with chronic heart failure are often recommended a fluid restriction of 1.5 l/day but there is no evidence in the literature for this recommendation and little is known about the fluid intake consequences. Design. Crossover study. Methods. Chronic heart failure patients, clinically stabilised after an unstable state, were randomised to a 32-week cross-over study assessing the clinical importance of fluid prescription. In a secondary analysis of 63 patients, efficacy variables were analysed in relation to the self-reported median fluid intake of 19 ml/kg body weight/day. Results. The mean fluid intake was 16 ml/kg/day in the below-median group and 24 ml/kg/day in the above-median group. No between-group differences were found in change in body weight, signs and symptoms, diuretic use, quality of life or physical capacity. However, the above-median group significantly decreased sense of thirst and difficulties to adhere to the fluid prescription compared with the below-median group. Conclusion. In clinically stabilised chronic heart failure patients on optimal pharmacological treatment, a larger fluid intake was associated with decreasing thirst without any measurable negative effects on signs and symptoms of heart failure, diuretic use or physical capacity. Thus, a more liberal fluid intake may be advisable in chronic heart failure patients who have been stabilised after an initial unstable clinical state. Relevance to clinical practice. Nurses involved in the care for patients with heart failure known how troublesome thirst can be and how difficult it can be to follow a restricted fluid intake. This study indicates that it is possible to reassess and recommend a less strict fluid intake in stabilised patients with chronic heart failure. © 2008 The Authors.
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| 25. |
- Holst, Marie, 1959-, et al.
(author)
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Liberal versus restricted fluid prescription in stabilised patients with chronic heart failure : Result of a randomised cross-over study of the effects on health-related quality of life, physical capacity, thirst and morbidity
- 2008
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In: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 42:5, s. 316-322
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Journal article (peer-reviewed)abstract
- Objective. To compare the effects of a restrictive versus a liberal fluid prescription, on quality of life, physical capacity, thirst and hospital admissions, in patients who had improved from NYHA class (III-)IV CHF to a stable condition without clinical signs of significant fluid overload. Design. The present study is a randomised cross-over study. Seventy-four patients (mean age 70±10 years, 16% women) - with mild-moderate CHF - were randomised 1:1 to either of two 16-week interventions. Intervention 1 prescribed a maximum fluid intake of 1.5 L/day. Intervention 2 prescribed a maximum fluid intake of 30-35 ml/kg body weight/day. Sixty-five patients completed the study. Results. There were no significant between-intervention differences in end-of-intervention quality of life, physical capacity or hospitalisation. However, there was a significant favourable effect on thirst and less difficulties to adhere to the fluid prescription during the liberal fluid prescription intervention. Conclusion. The results from this study indicate that it may be beneficial and safe to recommend a liberal fluid prescription, based on body weight, in stabilised CHF patients. These results warrant further investigation of the effects of fluid advice in CHF. © 2008 Informa UK Ltd.
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| 26. |
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| 27. |
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| 28. |
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| 29. |
- Kennedy, Linn, et al.
(author)
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Impact of neurohormonal blockade on association between body mass index and mortality.
- 2007
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In: International Journal of Cardiology. - : Elsevier BV. - 0167-5273. ; 119, s. 33-40
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Journal article (peer-reviewed)abstract
- The prognostic impact of body mass index ( BMI) in patients following acute myocardial infarction ( AMI) may be altered by neurohormonal blockade. Methods: The impact of neurohormonal blockade on the association between BMI and mortality was examined in 5548 patients following AMI ( CONSENSUS II), 50% receiving enalapril and 7% beta- blockade, and in 4367 patients with coronary artery disease ( CAD) ( 4S), 79% with prior AMI, 12% receiving ACEi and 67% beta- blockade. Median follow- up was 0.4 and 5.2 years, respectively. Patients were categorized into 4 BMI groups: Underweight, b22.00; normal- weight, 22.00 - 24.99; overweight, 25.00 - 29.99; obese, = 30.00 kg/ m(2). Multivariable analysis adjusted for demographics, patient history, physical examination, biochemistry and medication. Results: CONSENSUS II: Overall, adjusted mortality ( n= 301) risk was similar across BMI groups. Comparing overweight with normalweight patients, the hazard ratios ( HRs) for mortality differed significantly ( P= 0.028) between patients randomized to placebo ( HR 1.41) and enalapril ( HR 0.75). 4S: Overall, adjusted mortality ( n= 421) risk was similar for normal- weight, overweight and obese patients. In a time- dependent analysis for drug use, comparing obese with normal- weight patients, the HRs for mortality differed significantly ( P= 0.047) between patients without ( HR 1.86) and those with ( HR 0.97) neurohormonal blockade. Conclusion: In patients after AMI or with CAD, high BMI was associated with increased mortality risk among patients not receiving neurohormonal blockade, but with decreased or neutral mortality risk among those receiving neurohormonal blockade. Tests for interaction indicate that neurohormonal blockade may attenuate the relationship between high BMI and increased mortality risk. Neurohormonal blockade may thus partly explain the so- called obesity paradox. (C) 2006 Elsevier Ireland Ltd. All rights reserved.
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| 30. |
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| 31. |
- Kennedy, Linn, et al.
(author)
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Weight-change as a prognostic marker in 12 550 patients following acute myocardial infarction or with stable coronary artery disease.
- 2006
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In: European Heart Journal. - : Oxford University Press (OUP). - 1522-9645 .- 0195-668X. ; 27, s. 2755-2762
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Journal article (peer-reviewed)abstract
- Aims To examine the prognostic importance of weight-change in patients with coronary artery disease (CAD), especially following acute myocardial infarction (AMI). Methods and results In 4360 AMI patients (OPTIMAAL trial) without baseline oedema, we assessed 3-month weight-change, baseline body mass index (BMI), demographics, patient history, medication, physical examination, and biochemical analyses. Weight-change was defined as change >+/- 0.1 kg/baseline BMI-unit. Patients were accordingly categorized into three groups; weight-loss, weight-stability, and weight-gain. Our findings were validated in 4012 AMI patients (CONSENSUS II trial) and 4178 stable CAD patients (79% with prior AMI, 4S trial). Median follow-up was 2.7 years, 3 months, and 4.4 years, respectively. In OPTIMAAL, 3-month weight-loss (vs. weight-stability) independently predicted increased all-cause death [n=471; hazard ratio (HR) 1.26; 95% CI 1.01-1.56; P=0.039] and cardiac death (n=299, HR 1.33, 95% CI 1.02-1.73, P=0.034). Weight-gain yielded risk similar to weight-stability (HR 1.07, P=0.592 and 0.97, P=0.866, respectively). In CONSENSUS II, 3-month weight-loss independently predicted increased mortality (HR 3.87, P=0.008). Weight-gain yielded risk similar to weight-stability (HR 1.11, P=0.860). In 4S, 1-year weight-loss independently predicted increased mortality (HR 1.44, P=0.004). Weight-gain conferred risk similar to weight-stability (HR 1.05, P=0.735). Conclusion In patients following AMI or with stable CAD, weight-loss but not weight-gain was independently associated with increased mortality risk.
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| 32. |
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| 33. |
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| 35. |
- Magnusson, Martin, et al.
(author)
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Natriuretic peptides as indicators of cardiac remodeling in hypertensive patients.
- 2009
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In: Blood Pressure. - : Informa UK Limited. - 0803-7051 .- 1651-1999. ; 18, s. 196-203
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Journal article (peer-reviewed)abstract
- Aims. This study was performed to evaluate the relationship between three different natriuretic peptides and left ventricular mass, function and diameter, and kidney function in patients with hypertension. Methods. One hundred and thirty-nine patients with moderate hypertension were consecutively included. N-terminal brain natriuretic peptide (Nt-BNP), brain natriuretic peptide (BNP) and N-terminal pro-atrial natriuretic peptide (Nt-ANP) were analyzed. Cardiac remodeling was assessed by echocardiography (UCG) and glomerular filtration was estimated by cystatin C. Results. Patients were stratified into four groups with regard to the extent of cardiac remodeling: (1) no remodeling; (2) one of left ventricular hypertrophy, left ventricular dysfunction or left ventricular dilatation; (3) two of above and (4) all three parameters. All peptides differed significantly between the groups (all p<0.001), with a continuous stepwise increase from groups 1 through 4. Receiver operating characteristic analysis showed equal diagnostic performances for the detection of any cardiac abnormalities for Nt-BNP [area under curve, AUC= 0.63 (0.52-0.75), p= 0.026] and BNP [AUC= 0.64 (0.53-0.76), p= 0.019], both, however superior to Nt-ANP [AUC=0.59 (0.47-0.70), p= 0.139]. In multivariable linear regression analysis, all three indicators of cardiac remodeling were independently correlated with ln Nt-BNP and ln BNP, whereas only left ventricular diameter was independently correlated with ln Nt-ANP. Conclusions. Natriuretic peptide levels increased with increasing number of markers of cardiac remodeling. Nt-BNP and BNP are useful to discriminate between patients with regard to cardiac remodeling and might be considered a screening tool in order select patients eligible for further examination with UCG examination.
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| 36. |
- Mårtensson, Jan, et al.
(author)
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Nurse-led heart failure follow-up in primary care in Sweden
- 2009
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In: EUROPEAN JOURNAL OF CARDIOVASCULAR NURSING. - : Oxford University Press (OUP). - 1474-5151 .- 1873-1953. ; 8:2, s. 119-124
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Journal article (peer-reviewed)abstract
- Background: Little or no knowledge is available about which service is offered to patients with heart failure in primary care. Aims: To describe nurse-led follow-up of patients with heart failure in primary care in Sweden. Methods and results: A questionnaire was sent to all primary health care centres in Sweden and 6 10 of 939 centres returned the questionnaire. Special nurses had designated time for follow-up of heart failure patients at 18% (n = 111) of the centres, compared to 93% and 78% for diabetes and obstructive lung disease. Centres with nurse-led follow-up of heart failure patients more frequently provided heart failure information (pandlt;0.001), had more doctors interested in heart failure (pandlt;0.001), more often had special care programmes (Pandlt;0.001) and had more co-operation with the hospitals around patients with heart failure (pandlt;0.01), compared to centres without such follow-up (n = 499). Conclusion: In primary care in Sweden, nurse-led follow-up is uncommon for patients with heart failure, despite being common for patients with diabetes and obstructive pulmonary disease. To improve this situation in primary care, an increased number of specially trained nurses is needed, together with further research to ensure a high quality follow-up in primary care.
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| 37. |
- Ostenfeld, Ellen, et al.
(author)
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Comparison of different views with three-dimensional echocardiography : apical views offer superior visualization compared with parasternal and subcostal views
- 2008
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In: Clinical Physiology and Functional Imaging. - 1475-0961 .- 1475-097X. ; 28:6, s. 409-416
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Journal article (peer-reviewed)abstract
- Studies seeking to validate real-time three-dimensional echocardiography (3DE) with regard to cardiac function and dimensions have almost exclusively used apical views. However, it has never been examined whether apical views are preferable to parasternal or subcostal views. In the present study, we compared the feasibility of 3DE volumetric measurements of the four heart chambers in three different views. We included 40 patients planned for a routine two-dimensional transthoracic echocardiography examination (2DE). All patients were scanned with both 2DE and 3DE (Sonos 7500; Philips Medical Systems Andover, MA, USA). Parasternal, apical and subcostal views were used for 3DE. Volumes were calculated using manual tracing in 16 planes. 2DE was performed in parasternal longaxis, subcostal and apical four- and two-chamber views. Manual tracing was used for area calculations. To be judged fully traceable, 5/6 (85%) or more of the ventricular and atrial walls had to be adequately visualized in each plane. The left ventricle and left atrium were adequately visualized in the 3DE apical view in 34 (85%) and 40 (100%) patients, respectively. Visualization of the right atrium was adequate in 31 (78%) patients, whereas the right ventricle was adequately visualized in only 12 (30%) patients. The apical view of 3DE provided superior visualization of all four heart chambers compared with the parasternal and subcostal views, when applying a slight off-axis approach for both ventricles when needed. Thus, in the present study, there was no incremental value of assessment of chamber volumes in the parasternal and subcostal views.
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| 38. |
- Rossebo, Anne B., et al.
(author)
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Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis
- 2008
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In: New England Journal of Medicine. - 0028-4793 .- 1533-4406. ; 359:13, s. 1343-1356
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Journal article (peer-reviewed)abstract
- Background: Hyperlipidemia has been suggested as a risk factor for stenosis of the aortic valve, but lipid-lowering studies have had conflicting results. Methods: We conducted a randomized, double-blind trial involving 1873 patients with mild-to-moderate, asymptomatic aortic stenosis. The patients received either 40 mg of simvastatin plus 10 mg of ezetimibe or placebo daily. The primary outcome was a composite of major cardiovascular events, including death from cardiovascular causes, aortic-valve replacement, nonfatal myocardial infarction, hospitalization for unstable angina pectoris, heart failure, coronary-artery bypass grafting, percutaneous coronary intervention, and nonhemorrhagic stroke. Secondary outcomes were events related to aortic-valve stenosis and ischemic cardiovascular events. Results: During a median follow-up of 52.2 months, the primary outcome occurred in 333 patients (35.3%) in the simvastatin-ezetimibe group and in 355 patients (38.2%) in the placebo group (hazard ratio in the simvastatin-ezetimibe group, 0.96; 95% confidence interval [CI], 0.83 to 1.12; P=0.59). Aortic-valve replacement was performed in 267 patients (28.3%) in the simvastatin-ezetimibe group and in 278 patients (29.9%) in the placebo group (hazard ratio, 1.00; 95% CI, 0.84 to 1.18; P=0.97). Fewer patients had ischemic cardiovascular events in the simvastatin-ezetimibe group (148 patients) than in the placebo group (187 patients) (hazard ratio, 0.78; 95% CI, 0.63 to 0.97; P=0.02), mainly because of the smaller number of patients who underwent coronary-artery bypass grafting. Cancer occurred more frequently in the simvastatin-ezetimibe group (105 vs. 70, P=0.01). Conclusions: Simvastatin and ezetimibe did not reduce the composite outcome of combined aortic-valve events and ischemic events in patients with aortic stenosis. Such therapy reduced the incidence of ischemic cardiovascular events but not events related to aortic-valve stenosis. (ClinicalTrials.gov number, NCT00092677.).
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| 39. |
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| 40. |
- Tasevska, Gordana, et al.
(author)
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Gender aspects on heart failure incidence and mortality in a middle-aged, urban, community-based population sample: the Malmö preventive project.
- 2009
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In: European Journal of Epidemiology. - : Springer Science and Business Media LLC. - 1573-7284 .- 0393-2990. ; 24, s. 249-257
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Journal article (peer-reviewed)abstract
- There is little epidemiological data on heart failure (HF) in the younger age groups dominating clinical HF trials. We assessed gender-specific long-term HF incidence and mortality in an urban community-based sample of middle-aged subjects. Between 1974 and 1992, 33,342 HF-free subjects (10,900 [32.7%] women, mean age 45.7 +/- 7.4 years) were included in the Malmö Preventive Project, on average 21.7 +/- 4.3 years before study end. Patients hospitalised for or dying of HF were categorised as HF patients, and 120 (1.1%) women versus 644 (2.9%) men experienced HF: 6.0 vs. 12.3 cases per 10,000 person years; hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.50-0.74, P < 0.0001. Among all subjects, women compared with men had lower all-cause (49.3 vs. 84.0 cases per 10,000 person years; HR 0.68, 95% CI 0.64-0.73, P < 0.0001) and HF-related (2.6 vs. 7.4 cases per 10,000 person years; HR 0.50, 95% CI 0.37-0.67, P < 0.0001) mortality risk. Female and male HF patients had similar age-adjusted mortality risk: 1,314 vs. 1,602 cases per 10,000 patient years; HR 0.78, 95% CI 0.58-1.07, P = 0.12. Among HF patients, 55.3% of deaths in women and 40.6% in men were non-cardiovascular, and only 7.9% deaths were due to HF. In conclusion: In a middle-aged, urban, community-based sample, women had lower risk of HF, all-cause death and HF-related death over two decades of follow-up. Female and male HF patients had similar mortality risk after the diagnosis of HF. In these comparatively young HF patients, few deaths were due to HF and more than 4 out of 10 deaths were non -cardiovascular.
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| 41. |
- Tasevska, Gordana, et al.
(author)
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Gender aspects on survival among patients admitted to hospital with suspected or diagnosed heart failure.
- 2008
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In: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1651-2006 .- 1401-7431. ; 42, s. 383-391
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Journal article (peer-reviewed)abstract
- Objectives and design. There are conflicting data on gender differences in survival among heart failure (HF) patients. We prospectively assessed gender differences in survival among 930 consecutive patients (464 [49.9%] women, mean age 76.1 +/- 10.1 years), admitted to hospital with suspected or diagnosed HF. Results. Overall, women had lower unadjusted mortality hazard ratio (HR) than men: HR 0.827; 95% confidence interval (CI) 0.690-0.992; p = 0.040. Adjusted HR was 0.786; 95% CI 0.601-1.028; p = 0.079. Unadjusted mortality was significantly higher among patients with a discharge HF diagnosis, compared to those without: HR 1.330; 95% CI 1.107-1.597; p = 0.002; adjusted p = 0.289. Women and men with a discharge HF diagnosis had similar survival: unadjusted HR 1.052; 95% CI 0.829-1.336; p = 0.674; adjusted HR 0.875; 95% CI 0.625-1.225; p = 0.437. Women had lower mortality risk among patients without a discharge HF diagnosis: HR 0.630, 95% CI 0.476-0.833, p = 0.001; adjusted HR 0.611, p = 0.036. Conclusion. Prognosis was poor among patients hospitalised with suspected or diagnosed HF. Among all patients, women had better survival, whereas both sexes had similar survival when the HF diagnosis was certified.
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| 42. |
- Tasevska, Gordana, et al.
(author)
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Gender Differences in Predictors of Heart Failure Morbidity and Mortality in an Urban Swedish Population: The Malmo Preventive Project
- 2008
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In: Open Heart Failure Journal. - : Bentham Science Publishers Ltd.. - 1876-5351. ; 1, s. 1-8
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Journal article (pop. science, debate, etc.)abstract
- Objective/Background: Reports on heart failure (HF) predictors are scarce. We assessed gender-specific HF predictors. Design: Preventive case-finding programme, register study. Setting: City population-based sample. Methods: We examined 33,342 HF-free subjects, 32.7% women, included in Malmo Preventive Project. Mean inclusion age was 49.7±7.4 years for women and 43.7±6.6 years for men. Results: During 21.7±4.3 years of average follow-up, 764 (2.3%) subjects were diagnosed with HF, 120 (1.1%) women and 644 (2.9%) men. Following bootstrap analysis, the only strong independent predictor of HF among women was smoking. Independent predictors of HF among men were diastolic blood pressure (BP), fasting blood-glucose, smoking, family history of myocardial infarction, and previous cardiovascular disease (CVD). During follow-up, 5,370 (16.1%) subjects died, 978 (9.0%) women and 4,392 (19.6%) men. Among both women and men, strong independent predictors of combined HF or all-cause death were high serum-triglycerides, fasting blood-glucose and estimated glomerular filtration rate, smoking, and previous CVD. Among men, also underweight, high BMI, and systolic and diastolic BP, were strong independent predictors of HF or death. Conclusions: Although women and men shared many predictors of HF, there were several important differences between sexes.
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| 43. |
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| 44. |
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| 45. |
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| 46. |
- Willenheimer, Ronnie, et al.
(author)
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Definition av diastolisk hjärtsvikt
- 2007
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In: Läkartidningen. - 0023-7205 .- 1652-7518. ; 104:34, s. 2333-2337
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Journal article (peer-reviewed)
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| 47. |
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| 48. |
- Willenheimer, Ronnie, et al.
(author)
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Effect on Survival and Hospitalization of Initiating Treatment for Chronic Heart Failure With Bisoprolol Followed by Enalapril, as Compared With the Opposite Sequence. Results of the Randomized Cardiac Insufficiency Bisoprolol Study (CIBIS) III.
- 2005
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In: Circulation. - 1524-4539. ; 112:16, s. 2426-2435
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Journal article (peer-reviewed)abstract
- Background - In patients with chronic heart failure (CHF), a beta-blocker is generally added to a regimen containing an angiotensin-converting-enzyme ( ACE) inhibitor. It is unknown whether beta-blockade as initial therapy may be as useful. Methods and Results - We randomized 1010 patients with mild to moderate CHF and left ventricular ejection fraction <= 35%, who were not receiving ACE inhibitor, beta-blocker, or angiotensin receptor blocker therapy, to open-label monotherapy with either bisoprolol ( target dose 10 mg QD; n = 505) or enalapril ( target dose 10 mg BID; n = 505) for 6 months, followed by their combination for 6 to 24 months. The 2 strategies were blindly compared with regard to the combined primary end point of all-cause mortality or hospitalization and with regard to each of these end point components individually. Bisoprolol-first treatment was noninferior to enalapril-first treatment if the upper limit of the ;95% confidence interval (CI) for the absolute between-group difference was < 5%, corresponding to a hazard ratio (HR) of 1.17. In the intention-to-treat sample, the primary end point occurred in 178 patients allocated to bisoprolol-first treatment versus 186 allocated to enalapril-first treatment ( absolute difference - 1.6%, 95% CI - 7.6 to 4.4%, HR 0.94; 95% CI 0.77 to 1.16). In the per-protocol sample, 163 patients allocated to bisoprolol-first treatment had a primary end point, versus 165 allocated to enalapril-first treatment ( absolute difference - 0.7%, 95% CI - 6.6 to 5.1%, HR 0.97; 95% CI 0.78 to 1.21). With bisoprolol-first treatment, 65 patients died, versus 73 with enalapril-first treatment ( HR 0.88; 95% CI 0.63 to 1.22), and 151 versus 157 patients were hospitalized ( HR 0.95; 95% CI 0.76 to 1.19). Conclusion - Although noninferiority of bisoprolol-first versus enalapril-first treatment was not proven in the per-protocol analysis, our results indicate that it may be as safe and efficacious to initiate treatment for CHF with bisoprolol as with enalapril.
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| 49. |
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| 50. |
- Willenheimer, Ronnie
(author)
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How to begin treatment in chronic heart failure? Results of CIBISIII
- 2006
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In: European Heart Journal Supplements. - : Oxford University Press (OUP). - 1520-765X .- 1554-2815 .- 1520-1554. ; 8:C, s. 43-50
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Journal article (peer-reviewed)abstract
- Aims To compare the effect of initial monotherapy with either bisoprolot or enalapril, followed by their combination, on mortality and hospitalization in patients with mild-to-moderate CHF. Methods and results One thousand and ten patients with mild-to-moderate CHF and left ventricular ejection fraction <= 35%, without ACE-inhibitor, beta-blocker, or angiotensin-receptor-blocker therapy were randomized to open-label monotherapy with either bisoprolot (target dose 10 mg od, n = 505) or enalapril (target dose 10 mg bid, n = 505) for 6 months, followed by their combination for 6-24 months. The combined primary endpoint was all-cause mortality or hospitalization; bisoprolol-first was considered non-inferior to enalapril-first if the upper limit of the 95% Cl for the absolute between-group difference was below +5%, corresponding to HR 1.17. In the intention-to-treat population, the primary endpoint occurred in 178 patients allocated bisoprotol-first vs. 186 allocated enalapril-first: absolute difference, -1.6%; 95% Cl, -7.6 to +4.4%; HR, 0.94; 95% Cl, 0.77-1.16. Thus, non-inferiority was demonstrated in the intention-to-treat population. In the per-protocol population, the primary endpoint occurred in 163 patients in the bisoprolol-first group vs. 165 in the enalapril-first group: absolute difference, -0.7%; 95% Cl, -6.6 to +5.1%; HR, 0.97; 95% Cl, 0.78-1.21. With bisoprolol-first, 65 patients died vs. 73 with enalapril-first (HR, 0.88; 95% Cl, 0.63-1.22; between-group difference P = 0.44), and 151 vs. 157 patients were hospitalized (HR, 0.95; 95% Cl, 0.76-1.19; between-group difference P = 0.66). Post hoc analysis of data from the first year indicated that a bisoprolol-first strategy reduced mortality by 31%, compared with an enalapril-first strategy (HR, 0.69; 95% CI, 0.46-1.02; between-group difference P = 0.065). Conclusion Initiating treatment with bisoprolot is as effective and well-tolerated as initiating treatment with enalapril. Post hoc analysis suggests that starting treatment with enalapril may reduce the risk of death, especially in the first year of treatment.
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