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Balloon pulmonary angioplasty in patients with inoperable chronic thromboembolic pulmonary hypertension.

https://arctichealth.org/en/permalink/ahliterature108764
Source
Heart. 2013 Oct;99(19):1415-20
Publication Type
Article
Date
Oct-2013
Author
Arne K Andreassen
Asgrimur Ragnarsson
Einar Gude
Odd Geiran
Rune Andersen
Author Affiliation
Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway. aandreas@ous-hf.no
Source
Heart. 2013 Oct;99(19):1415-20
Date
Oct-2013
Language
English
Publication Type
Article
Keywords
Aged
Angioplasty, Balloon - adverse effects - mortality
Arterial Pressure
Biological Markers - blood
Cardiac Catheterization
Cardiac output
Chronic Disease
Endarterectomy
Exercise Test
Exercise Tolerance
Female
Humans
Hypertension, Pulmonary - blood - diagnosis - mortality - physiopathology - surgery - therapy
Male
Middle Aged
Natriuretic Peptide, Brain - blood
Norway
Peptide Fragments - blood
Predictive value of tests
Prospective Studies
Pulmonary Embolism - blood - diagnosis - mortality - physiopathology - surgery - therapy
Recovery of Function
Time Factors
Treatment Outcome
Troponin T - blood
Ventricular Function, Right
Abstract
To examine the effect of balloon pulmonary angioplasty (BPA) on chronic thromboembolic pulmonary hypertension (CTEPH) in patients with inoperable disease or persistent pulmonary hypertension after pulmonary endarterectomy.
Observational cohort study.
Referred patients with inoperable or persistent CTEPH.
Twenty consecutive CTEPH patients (10 females), aged 60±10 years.
Right heart catheterisation, functional capacity (cardiopulmonary exercise testing (CPET) and NYHA class) and blood sampled biomarkers N-terminal pro-brain natriuretic peptide (NT-proBNP) and troponin T examined at the time of diagnosis and repeated in all patients 3 months after the last BPA.
Seventy-three catheterisations were performed with 18.6±6.1 BPAs per patient on segmental and subsegmental arteries. Two deaths occurred following the first BPA, with an overall 10% periprocedural death rate. Reperfusion oedema complicated seven procedures. Comparisons before and after BPA showed significant haemodynamic improvements, including decreased mean pulmonary artery pressure (mPAP) (45±11 mm Hg vs 33±10 mm Hg; p
PubMed ID
23846611 View in PubMed
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Echocardiographic evaluation of left ventricular filling pressure in heart transplant recipients.

https://arctichealth.org/en/permalink/ahliterature264607
Source
Scand Cardiovasc J. 2014 Dec;48(6):349-56
Publication Type
Article
Date
Dec-2014
Author
Kaspar Broch
Ahmed Al-Ani
Einar Gude
Lars Gullestad
Svend Aakhus
Source
Scand Cardiovasc J. 2014 Dec;48(6):349-56
Date
Dec-2014
Language
English
Publication Type
Article
Keywords
Adult
Aged
Blood pressure
Cardiac Catheterization - methods
Echocardiography - methods
Female
Follow-Up Studies
Heart Transplantation - adverse effects - methods
Humans
Male
Middle Aged
Norway
Pulmonary Wedge Pressure
Reproducibility of Results
Transplant Recipients
Ventricular Dysfunction, Left - diagnosis - etiology - physiopathology
Ventricular Pressure
Abstract
Diastolic dysfunction is a major cause of morbidity in heart transplant recipients. A reliable, non-invasive marker of left ventricular (LV) filling pressure would simplify follow-up in these patients. We aimed to test the validity of echocardiographic indices of LV filling pressure in a contemporary population of heart transplant recipients.
Eighty-three patients were examined by right-sided heart catheterisation and echocardiography one year after heart transplantation. We explored the association between echocardiographic parameters of LV filling pressure and invasively measured pulmonary capillary wedge pressure (PCWP).
Peak early mitral flow velocity divided by septal early mitral relaxation velocity (E/e'(septal)) was the echocardiographic parameter that best correlated with PCWP (r = 0.47; p
PubMed ID
25414078 View in PubMed
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Effect of everolimus introduction on cardiac allograft vasculopathy--results of a randomized, multicenter trial.

https://arctichealth.org/en/permalink/ahliterature133675
Source
Transplantation. 2011 Jul 27;92(2):235-43
Publication Type
Article
Date
Jul-27-2011
Author
Satish Arora
Thor Ueland
Bertil Wennerblom
Vilborg Sigurdadottir
Hans Eiskjær
Hans E Bøtker
Bjorn Ekmehag
Kjell Jansson
Svend-Aage Mortensen
Kari Saunamaki
Svein Simonsen
Einar Gude
Bjørn Bendz
Dag Solbu
Pål Aukrust
Lars Gullestad
Author Affiliation
Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
Source
Transplantation. 2011 Jul 27;92(2):235-43
Date
Jul-27-2011
Language
English
Publication Type
Article
Keywords
Aged
Azathioprine - therapeutic use
C-Reactive Protein - metabolism
Calcineurin - antagonists & inhibitors
Disease Progression
Dose-Response Relationship, Drug
Drug Therapy, Combination
Female
Follow-Up Studies
Heart Transplantation - immunology
Humans
Immunosuppressive Agents - therapeutic use
Incidence
Male
Middle Aged
Mycophenolic Acid - analogs & derivatives - therapeutic use
Risk factors
Scandinavia
Sirolimus - analogs & derivatives - therapeutic use
Ultrasonography, Interventional
Vascular Cell Adhesion Molecule-1 - blood
Vascular Diseases - epidemiology - prevention & control - ultrasonography
von Willebrand Factor - metabolism
Abstract
Everolimus reduces the progression of cardiac allograft vasculopathy (CAV) in de novo heart transplant (HTx) recipients, but the influence on established CAV is unknown.
In this Nordic Certican Trial in Heart and lung Transplantation substudy, 111 maintenance HTx recipients (time post-HTx 5.8 ± 4.3 years) randomized to everolimus+reduced calcineurin inhibitor (CNI) or standard CNI had matching (intravascular ultrasound) examinations at baseline and 12 months allowing accurate assessment of CAV progression.
No significant difference in CAV progression was evident between the treatment groups (P = 0.30). When considering patients receiving concomitant azathioprine (AZA) therapy (n = 39), CAV progression was attenuated with everolimus versus standard CNI (?maximal intimal thickness 0.00 ± 0.04 and 0.04 ± 0.04 mm, ?percent atheroma volume 0.2% ± 3.0% and 2.6% ± 2.5%, and ?total atheroma volume 0.25 ± 14.1 and 19.8 ± 20.4 mm(3), respectively [P
Notes
Comment In: Transplantation. 2011 Jul 27;92(2):127-821555972
PubMed ID
21677600 View in PubMed
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Everolimus with reduced calcineurin inhibitor in thoracic transplant recipients with renal dysfunction: a multicenter, randomized trial.

https://arctichealth.org/en/permalink/ahliterature146175
Source
Transplantation. 2010 Apr 15;89(7):864-72
Publication Type
Article
Date
Apr-15-2010
Author
Lars Gullestad
Martin Iversen
Svend-Aage Mortensen
Hans Eiskjaer
Gerdt C Riise
Lena Mared
Oystein Bjørtuft
Björn Ekmehag
Kjell Jansson
Svein Simonsen
Einar Gude
Bengt Rundqvist
Hans E Fagertun
Dag Solbu
Claes-Håkan Bergh
Author Affiliation
Department of Cardiology, Oslo University Hospital, Rikshospitalet, and Faculty of Medicine, University of Oslo, Oslo, Norway.
Source
Transplantation. 2010 Apr 15;89(7):864-72
Date
Apr-15-2010
Language
English
Publication Type
Article
Keywords
Aged
Calcineurin - antagonists & inhibitors
Cyclosporine - administration & dosage - adverse effects
Drug Therapy, Combination
Female
Glomerular Filtration Rate - drug effects
Graft Rejection - etiology - prevention & control
Graft Survival - drug effects
Heart Transplantation
Humans
Immunosuppressive Agents - administration & dosage - adverse effects
Kidney Diseases - complications - physiopathology
Lung Transplantation
Male
Middle Aged
Scandinavia
Sirolimus - administration & dosage - adverse effects - analogs & derivatives
Tacrolimus - administration & dosage - adverse effects
Time Factors
Treatment Outcome
Abstract
The proliferation signal inhibitor everolimus offers the potential to reduce calcineurin inhibitor (CNI) exposure and alleviate CNI-related nephrotoxicity. Randomized trials in maintenance thoracic transplant patients are lacking.
In a 12-month, open-labeled, multicenter study, maintenance thoracic transplant patients (glomerular filtration rate > or =20 mL/min/1.73m and 1 year posttransplant were randomized to continue their current CNI-based immunosuppression or start everolimus with predefined CNI exposure reduction.
Two hundred eighty-two patients were randomized (140 everolimus, 142 controls; 190 heart, 92 lung transplants). From baseline to month 12, mean cyclosporine and tacrolimus trough levels in the everolimus cohort decreased by 57% and 56%, respectively. The primary endpoint, mean change in measured glomerular filtration rate from baseline to month 12, was 4.6 mL/min with everolimus and -0.5 mL/min in controls (P
PubMed ID
20061999 View in PubMed
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Improvement in renal function after everolimus introduction and calcineurin inhibitor reduction in maintenance thoracic transplant recipients: the significance of baseline glomerular filtration rate.

https://arctichealth.org/en/permalink/ahliterature127001
Source
J Heart Lung Transplant. 2012 Mar;31(3):259-65
Publication Type
Article
Date
Mar-2012
Author
Satish Arora
Einar Gude
Vilborg Sigurdardottir
Svend Aage Mortensen
Hans Eiskjær
Gerdt Riise
Lena Mared
Oystein Bjørtuft
Bjørn Ekmehag
Kjell Jansson
Svein Simonsen
Pål Aukrust
Dag Solbu
Martin Iversen
Lars Gullestad
Author Affiliation
Oslo University Hospital Rikshospitalet, Oslo, Norway. satish.arora@medisin.uio.no
Source
J Heart Lung Transplant. 2012 Mar;31(3):259-65
Date
Mar-2012
Language
English
Publication Type
Article
Keywords
Adaptor Proteins, Signal Transducing - antagonists & inhibitors
Aged
Cyclosporine - pharmacology - therapeutic use
Female
Follow-Up Studies
Glomerular Filtration Rate - drug effects - physiology
Heart Transplantation
Humans
Immunosuppressive Agents - pharmacology - therapeutic use
Kidney - drug effects - physiopathology
Lung Transplantation
Male
Middle Aged
Postoperative Complications
Renal Insufficiency - physiopathology - prevention & control
Scandinavia
Sirolimus - analogs & derivatives - pharmacology - therapeutic use
Tacrolimus - pharmacology - therapeutic use
Time Factors
Abstract
The NOCTET (NOrdic Certican Trial in HEart and lung Transplantation) trial demonstrated that everolimus improves renal function in maintenance thoracic transplant (TTx) recipients. Nevertheless, introduction of everolimus is not recommended for patients with advanced renal failure. We evaluated NOCTET data to assess everolimus introduction amongst TTx recipients with advanced renal failure.
This 12-month multicenter Scandinavian study randomized 282 maintenance TTx recipients to everolimus introduction with calcineurin inhibitor (CNI) reduction or standard CNI therapy. The measured glomerular filtration rate (mGFR) was noted at baseline and after 1-year using Cr-ethylenediaminetetraacetic acid clearance.
In 21 patients with a baseline mGFR of 20 to 29 ml/min/1.73 m(2), renal function improved in the everolimus group compared with the control group ((?mGFR 6.7 ± 9.0 vs -1.6 ± 5.1 ml/min/1.73 m(2); p = 0.03). Amongst 173 patients with moderate renal impairment (mGFR 30-59 ml/min/1.73 m(2)), renal function improvement was also greater amongst everolimus patients than in controls (?mGFR 5.1 ± 11.1 vs -0.5 ± 8.7 ml/min/1.73 m(2); p
PubMed ID
22333403 View in PubMed
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Intra-aortic balloon counterpulsation as a bridge to heart transplantation does not impair long-term survival.

https://arctichealth.org/en/permalink/ahliterature150384
Source
Eur J Heart Fail. 2009 Jul;11(7):709-14
Publication Type
Article
Date
Jul-2009
Author
Ola Gjesdal
Einar Gude
Satish Arora
Torbjørn Leivestad
Arne K Andreassen
Lars Gullestad
Lars Aaberge
Harald Brunvand
Thor Edvardsen
Odd R Geiran
Svein Simonsen
Author Affiliation
Department of Cardiology, Rikshospitalet, N-0027 Oslo, Norway. ola.gjesdal@medisin.uio.no
Source
Eur J Heart Fail. 2009 Jul;11(7):709-14
Date
Jul-2009
Language
English
Publication Type
Article
Keywords
Analysis of Variance
Aspartate Aminotransferases - blood
Case-Control Studies
Counterpulsation
Creatinine - blood
Female
Heart Failure - therapy
Heart Transplantation - adverse effects - mortality
Hemodynamics
Humans
Intra-Aortic Balloon Pumping - adverse effects - mortality
Male
Middle Aged
Norway
Postoperative Period
Retrospective Studies
Survival Analysis
Time Factors
Abstract
There are few studies of the use of intra-aortic balloon pump (IABP) treatment as a bridge to heart transplantation (HTx). This is the first study to compare long-term clinical and haemodynamic outcomes in IABP-treated HTx patients and electively transplanted patients.
This was a retrospective study of all adult HTx recipients between 2001 and 2007. Thirty-two patients (aged 50 +/- 13 years) treated with IABP, as a bridge to HTx due to severe hypo-perfusion, were compared with 135 electively transplanted patients (aged 54 +/- 11 years). The mean time from onset of IABP to HTx was 21 +/- 16 days. Clinical condition improved during IABP treatment. Serum creatinine decreased from 128 +/- 56 to 102 +/- 29 micromol/L (P
PubMed ID
19515719 View in PubMed
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Long-term outcomes of thoracic transplant recipients following conversion to everolimus with reduced calcineurin inhibitor in a multicenter, open-label, randomized trial.

https://arctichealth.org/en/permalink/ahliterature285154
Source
Transpl Int. 2016 Jul;29(7):819-29
Publication Type
Article
Date
Jul-2016
Author
Lars Gullestad
Hans Eiskjaer
Finn Gustafsson
Gerdt C Riise
Kristjan Karason
Göran Dellgren
Göran Rådegran
Lennart Hansson
Einar Gude
Øystein Bjørtuft
Kjell Jansson
Hans Henrik Schultz
Dag Solbu
Martin Iversen
Source
Transpl Int. 2016 Jul;29(7):819-29
Date
Jul-2016
Language
English
Publication Type
Article
Keywords
Adult
Aged
Calcineurin Inhibitors - therapeutic use
Denmark
Everolimus - therapeutic use
Female
Follow-Up Studies
Glomerular Filtration Rate
Graft Rejection
Graft Survival
Heart Transplantation - methods
Humans
Immunosuppressive Agents - therapeutic use
Lung Transplantation - methods
Male
Middle Aged
Norway
Pneumonia - etiology
Sweden
Transplant Recipients
Treatment Outcome
Abstract
The NOCTET study randomized 282 patients =1 year after heart or lung transplantation to continue conventional calcineurin inhibitor (CNI) therapy or to start everolimus with reduced-exposure CNI. Last follow-up, at =5 years postrandomization (mean: 5.6 years) was attended by 72/140 everolimus patients (51.4%) and 91/142 controls (64.1%). Mean measured GFR remained stable in the everolimus group from randomization (51.3 ml/min) to last visit (51.4 ml/min) but decreased in controls (from 50.5 ml/min to 45.3 ml/min) and was significantly higher with everolimus at last follow-up (P = 0.004). The least squares mean (SE) change from randomization was -1.5 (1.7)ml/min with everolimus versus -7.2 (1.7)ml/min for controls (difference: 5.7 [95% CI 1.7; 9.6]ml/min; P = 0.006). The difference was accounted for by heart transplant patients (difference: 6.9 [95% 2.3; 11.5]ml/min; P = 0.004). Lung transplant patients showed no between-group difference at last follow-up. Rates of rejection, death, and major cardiac events were similar between groups, as was graft function. Pneumonia was more frequent with everolimus (18.3% vs. 6.4%). In conclusion, introducing everolimus in maintenance heart transplant patients, with reduced CNI, achieves a significant improvement in renal function which is maintained for at least 5 years, but an early renal benefit in lung transplant patients was lost. Long-term immunosuppressive efficacy was maintained.
PubMed ID
27067532 View in PubMed
Less detail

Pregnancy in heart- and heart/lung recipients can be problematic.

https://arctichealth.org/en/permalink/ahliterature131764
Source
Scand Cardiovasc J. 2011 Dec;45(6):349-53
Publication Type
Article
Date
Dec-2011
Author
Mette Estensen
Einar Gude
Bjorn Ekmehag
Jyri Lommi
Oystein Bjortuft
Svend Mortensen
Ulla M Nystrom
Svein Simonsen
Author Affiliation
National Resource Centre for Women's Health, Oslo University Hospital, Rikshospitalet, Oslo, Norway. mestense@ous-hf.no
Source
Scand Cardiovasc J. 2011 Dec;45(6):349-53
Date
Dec-2011
Language
English
Publication Type
Article
Keywords
Abortion, Induced
Abortion, Spontaneous - etiology
Adolescent
Adult
Cesarean Section
Child
Comorbidity
Female
Graft Rejection - etiology - mortality
Heart-Lung Transplantation - adverse effects - mortality
Humans
Infant
Infant mortality
Infant, Newborn
Live Birth
Pre-Eclampsia - etiology
Pregnancy
Pregnancy Complications - etiology - mortality
Renal Insufficiency - etiology
Retrospective Studies
Risk assessment
Risk factors
Scandinavia - epidemiology
Time Factors
Young Adult
Abstract
The first successful pregnancy after heart transplantation was reported in 1988. Worldwide experience with heart and heart/lung transplanted (H-HLTx) pregnant women is limited. To expand this knowledge the collaborating Nordic thoracic transplant centers wanted to collect information on all such pregnancies from their centers.
Information was retrospectively collected on all H-HLTx pregnancies in the Nordic countries.
A total of 25 women have had 42 pregnancies and all survived the gestation. Minor complications were increasing incidence of proteinuria, hypertension and diabetes. Major problems were two rejections (early post partum), two severe renal failures, seven pre-eclampsias and 17 abortions. Five women died two to 12 years after delivery. Of 25 live born children, one was born with cancer and one died early after inheriting the mother's cardiomyopathy.
Pregnancy after H-HLTx can be successful for both mother and child. There are, however, many obstacles which should be addressed. Respecting the couple's desire for children the attitude should be carefully, not too optimistic, after proper pre-pregnant information and counseling. Delivery should preferably take place at the transplant center.
PubMed ID
21879798 View in PubMed
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[Treatment of idiopathic pulmonary arterial hypertension.]

https://arctichealth.org/en/permalink/ahliterature101561
Source
Tidsskr Nor Laegeforen. 2011 Jul 1;131(13-14):1285-1288
Publication Type
Article
Date
Jul-1-2011
Author
Arne K Andreassen
Einar Gude
Ole Geir Solberg
Thor Ueland
Source
Tidsskr Nor Laegeforen. 2011 Jul 1;131(13-14):1285-1288
Date
Jul-1-2011
Language
Norwegian
Publication Type
Article
Abstract
Background. In the past 5-10 years, drug treatment of idiopathic pulmonary arterial hypertension has evolved considerably. Experience and results from use of such updated treatment in Norway has not been reported. Material and method. 32 patients newly diagnosed with idiopathic pulmonary arterial hypertension, were consecutively assessed with respect to hemodynamics and physical capacity. The results after three months were compared with those after 12 months. Observed survival was compared with estimated survival from the time when only conventional treatment was available. Results. The patients (78% women) were 42 ± 14 years, had dyspnea in NYHA class 2.9 ± 0.4 and a maximal oxygen uptake of 12.0 ± 3.9 ml/kg/min (37 ± 13% of the expected). Updated treatment led to significantly improved hemodynamics and physical capacity, which persisted during follow-up. During 43 ± 31 months follow-up, seven patients died while two underwent bilateral lung transplantation. Observed transplantation-free survival was 81% after one, two and three years, while that for estimated transplantation-free survival was 70%, 58% and 49% respectively. Interpretation. Treatment of idiopathic pulmonary arterial hypertension with updated treatment improves hemodynamics and thereby symptoms. Mortality remains high, but is probably lower than it was when only conventional treatment was available.
PubMed ID
21725387 View in PubMed
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9 records – page 1 of 1.