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Early echocardiographic deformation analysis for the prediction of sudden cardiac death and life-threatening arrhythmias after myocardial infarction.

https://arctichealth.org/en/permalink/ahliterature108735
Source
JACC Cardiovasc Imaging. 2013 Aug;6(8):851-60
Publication Type
Article
Date
Aug-2013
Author
Mads Ersbøll
Nana Valeur
Mads Jønsson Andersen
Ulrik M Mogensen
Michael Vinther
Jesper Hastrup Svendsen
Jacob Eifer Møller
Joseph Kisslo
Eric J Velazquez
Christian Hassager
Peter Søgaard
Lars Køber
Author Affiliation
The Heart Centre, Department of Cardiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark. mads.ersboell@gmail.com
Source
JACC Cardiovasc Imaging. 2013 Aug;6(8):851-60
Date
Aug-2013
Language
English
Publication Type
Article
Keywords
Aged
Arrhythmias, Cardiac - etiology - mortality - physiopathology - prevention & control
Death, Sudden, Cardiac - etiology - prevention & control
Defibrillators, Implantable
Denmark
Echocardiography - methods
Electric Countershock - instrumentation
Female
Humans
Male
Middle Aged
Multivariate Analysis
Myocardial Infarction - complications - mortality - physiopathology - therapy - ultrasonography
Predictive value of tests
Primary Prevention
Proportional Hazards Models
Prospective Studies
Risk factors
Stroke Volume
Treatment Outcome
Ventricular Function, Left
Abstract
This study sought to hypothesize that global longitudinal strain (GLS) as a measure of infarct size, and mechanical dispersion (MD) as a measure of myocardial deformation heterogeneity, would be of incremental importance for the prediction of sudden cardiac death (SCD) or malignant ventricular arrhythmias (VA) after acute myocardial infarction (MI).
SCD after acute MI is a rare but potentially preventable late complication predominantly caused by malignant VA. Novel echocardiographic parameters such as GLS and MD have previously been shown to identify patients with chronic ischemic heart failure at increased risk for arrhythmic events. Risk prediction during admission for acute MI is important because a majority of SCD events occur in the early period after hospital discharge.
We prospectively included patients with acute MI and performed echocardiography, with measurements of GLS and MD defined as the standard deviation of time to peak negative strain in all myocardial segments. The primary composite endpoint (SCD, admission with VA, or appropriate therapy from a primary prophylactic implantable cardioverter-defibrillator [ICD]) was analyzed with Cox models.
A total of 988 patients (mean age: 62.6 ± 12.1 years; 72% male) were included, of whom 34 (3.4%) experienced the primary composite outcome (median follow-up: 29.7 months). GLS (hazard ratio [HR]: 1.38; 95% confidence interval [CI]: 1.25 to 1.53; p
Notes
Comment In: JACC Cardiovasc Imaging. 2013 Aug;6(8):861-323948377
PubMed ID
23850252 View in PubMed
Less detail

Exercise hemodynamics in patients with and without diastolic dysfunction and preserved ejection fraction after myocardial infarction.

https://arctichealth.org/en/permalink/ahliterature123376
Source
Circ Heart Fail. 2012 Jul 1;5(4):444-51
Publication Type
Article
Date
Jul-1-2012
Author
Mads J Andersen
Mads Ersbøll
John Bro-Jeppesen
Finn Gustafsson
Christian Hassager
Lars Køber
Barry A Borlaug
Søren Boesgaard
Jasper Kjærgaard
Jacob E Møller
Author Affiliation
Department of Cardiology, the Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. madsand@dadlnet.dk
Source
Circ Heart Fail. 2012 Jul 1;5(4):444-51
Date
Jul-1-2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Analysis of Variance
Cardiac Catheterization
Cardiac output
Case-Control Studies
Chi-Square Distribution
Denmark
Diastole
Disease Progression
Echocardiography, Doppler
Exercise
Exercise Test
Female
Heart Failure - etiology - physiopathology
Hemodynamics
Humans
Male
Middle Aged
Myocardial Infarction - complications - diagnosis - physiopathology
Prospective Studies
Stroke Volume
Ventricular Dysfunction, Left - diagnosis - etiology - physiopathology
Ventricular Function, Left
Ventricular Pressure
Abstract
Left ventricular diastolic dysfunction (DD) is common after myocardial infarction (MI) despite preservation of left ventricular ejection fraction, yet it remains unclear how or whether DD affects cardiac hemodynamics with stress.
Invasive hemodynamic exercise testing was performed in 46 patients with a recent MI and left ventricular ejection fraction >45% and in 10 healthy volunteers. MI patients were enrolled prospectively and divided into those with DD (MI+DD; left atrial volume index >34 mL/m(2) and diastolic E/e' ratio>8; n=35) and those without DD (MI-DD; left atrial volume index 15 (14?4 mm Hg), whereas none of the MI-DD (10?2 mm Hg) or controls (9?2 mm Hg) displayed pulmonary capillary wedge pressure elevation (P=0.03). During exercise, an abnormal rise in pulmonary capillary wedge pressure (>25 mm Hg) was observed in 94% of MI+DD (36?6 mm Hg) compared with 36% of MI-DD (24?6 mm Hg) and none of the controls (16?6 mm Hg; P
PubMed ID
22705767 View in PubMed
Less detail

Incidence of atrial fibrillation in patients with either heart failure or acute myocardial infarction and left ventricular dysfunction: a cohort study.

https://arctichealth.org/en/permalink/ahliterature134526
Source
BMC Cardiovasc Disord. 2011;11:19
Publication Type
Article
Date
2011
Author
Michelle D Schmiegelow
Ole D Pedersen
Lars Køber
Marie Seibæk
Steen Z Abildstrøm
Christian Torp-Pedersen
Author Affiliation
Department of Cardiology, Gentofte University Hospital, Niels Andersens Vej 65, 2900 Hellerup, Denmark. mdschmiegelow@gmail.com
Source
BMC Cardiovasc Disord. 2011;11:19
Date
2011
Language
English
Publication Type
Article
Keywords
Aged
Anti-Arrhythmia Agents - therapeutic use
Atrial Fibrillation - mortality - physiopathology - prevention & control
Chi-Square Distribution
Cohort Studies
Denmark - epidemiology
Electrocardiography
Female
Heart Failure - drug therapy - mortality - physiopathology
Humans
Incidence
Kaplan-Meier Estimate
Male
Multicenter Studies as Topic
Myocardial Infarction - drug therapy - mortality - physiopathology
Phenethylamines - therapeutic use
Proportional Hazards Models
Randomized Controlled Trials as Topic
Retrospective Studies
Risk assessment
Risk factors
Stroke Volume
Sulfonamides - therapeutic use
Time Factors
Treatment Outcome
Ventricular Dysfunction, Left - drug therapy - mortality - physiopathology
Ventricular Function, Left
Abstract
We examined the incidence of new-onset atrial fibrillation in patients with left ventricular dysfunction. Patients either had a recent myocardial infarction (with or without clinical heart failure) or symptomatic heart failure (without a recent MI). Patients were with and without treatment with the class III antiarrhythmic drug dofetilide over 36 months.
The Danish Investigations of Arrhythmia and Mortality ON Dofetilide (DIAMOND) studies included 2627 patients without atrial fibrillation at baseline, who were randomised to treatment with either dofetilide or placebo.
The competing risk analyses estimated the cumulative incidences of atrial fibrillation during the 42 months of follow-up to be 9.6% in the placebo-treated heart failure-group, and 2.9% in the placebo-treated myocardial infarction-group. Cox proportional hazard regression found a 42% significant reduction in the incidence of new-onset AF when assigned to dofetilide compared to placebo (hazard ratio 0.58, 95% confidence interval 0.40-0.82) and there was no interaction with study (p = 0.89). In the heart failure-group, the incidence of atrial fibrillation was significantly reduced to 5.6% in the dofetilide-treated patients (hazard ratio 0.57, 95% confidence interval 0.38-0.86). In the myocardial infarction-group the incidence of atrial fibrillation was reduced to 1.7% with the administration of dofetilide. This reduction was however not significant (hazard ratio 0.61, 95% confidence interval 0.30-1.24).
In patients with left ventricular dysfunction the incidence of AF in 42 months was 9.6% in patients with heart failure and 2.9% in patients with a recent MI. Dofetilide significantly reduced the risk of developing atrial fibrillation compared to placebo in the entire study group and in the subgroup of patients with heart failure. The reduction in the subgroup with recent MI was not statistically significant, but the hazard ratio was similar to the hazard ratio for the heart failure patients, and there was no difference between the effect in the two studies (p = 0.89 for interaction).
Notes
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PubMed ID
21569543 View in PubMed
Less detail

Myocardial fibrosis in patients with myotonic dystrophy type 1: a cardiovascular magnetic resonance study.

https://arctichealth.org/en/permalink/ahliterature265807
Source
J Cardiovasc Magn Reson. 2014;16:59
Publication Type
Article
Date
2014
Author
Helle Petri
Kiril Aleksov Ahtarovski
Niels Vejlstrup
John Vissing
Nanna Witting
Lars Køber
Henning Bundgaard
Source
J Cardiovasc Magn Reson. 2014;16:59
Date
2014
Language
English
Publication Type
Article
Keywords
Adult
Aged
Cardiomyopathies - diagnosis - epidemiology - pathology - physiopathology - ultrasonography
Case-Control Studies
Denmark - epidemiology
Electrocardiography, Ambulatory
Female
Fibrosis
Humans
Magnetic Resonance Imaging, Cine
Male
Middle Aged
Myocardial Contraction
Myocardium - pathology
Myotonic Dystrophy - epidemiology
Predictive value of tests
Prevalence
Stroke Volume
Ventricular Function, Left
Abstract
Myotonic dystrophy type 1 (DM1) is associated with increased cardiac morbidity and mortality. Therefore, assessment of cardiac involvement and risk stratification for sudden cardiac death is crucial. Nevertheless, optimal screening-procedures are not clearly defined. ECG, echocardiography and Holter-monitoring are useful but insufficient. Cardiovascular magnetic resonance (CMR) can provide additional information of which myocardial fibrosis may be relevant. The purpose of this study was to describe the prevalence of myocardial fibrosis in patients with DM1 assessed by CMR, and the association between myocardial fibrosis and abnormal findings on ECG, Holter-monitoring and echocardiography.
We selected 30 unrelated patients with DM1: 18 patients (10 men, mean age 51 years) with, and 12 patients (7 men, mean age 41 years) without abnormal findings on ECG and Holter-monitoring. Patients were evaluated with medical history, physical examination, ECG, Holter-monitoring, echocardiography and CMR.
Myocardial fibrosis was found in 12/30 (40%, 9 men). The presence of myocardial fibrosis was associated with the following CMR-parameters: increased left ventricular mass (median (range) 55 g/m² (43-83) vs. 46 g/m² (36-64), p = 0.02), increased left atrial volume (median (range) 52 ml/m² (36-87) vs. 46 ml/m² (35-69), p = 0.04) and a trend toward lower LVEF (median (range) 63% (38-71) vs. 66% (60-80), p = 0.06). Overall, we found no association between the presence of myocardial fibrosis and abnormal findings on: ECG (p = 0.71), Holter-monitoring (p = 0.27) or echocardiographic measurements of left ventricular volumes, ejection fraction or global longitudinal strain (p = 0.18).
Patients with DM1 had a high prevalence of myocardial fibrosis which was not predicted by ECG, Holter-monitoring or echocardiography. CMR add additional information to current standard cardiac assessment and may prove to be a clinically valuable tool for risk stratification in DM1.
Notes
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PubMed ID
25086734 View in PubMed
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Prevalence and prognosis of heart failure with preserved ejection fraction and elevated N-terminal pro brain natriuretic peptide: a 10-year analysis from the Copenhagen Hospital Heart Failure Study.

https://arctichealth.org/en/permalink/ahliterature127206
Source
Eur J Heart Fail. 2012 Mar;14(3):240-7
Publication Type
Article
Date
Mar-2012
Author
Christian Malchau Carlsen
Morten Bay
Vibeke Kirk
Jens Peter Gøtze
Lars Køber
Olav Wendelboe Nielsen
Author Affiliation
Department of Cardiology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark. cmc@dadlnet.dk
Source
Eur J Heart Fail. 2012 Mar;14(3):240-7
Date
Mar-2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Confidence Intervals
Denmark - epidemiology
Enzyme-Linked Immunosorbent Assay
Female
Heart Failure - epidemiology - mortality - ultrasonography
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Natriuretic Peptide, Brain - blood
Peptide Fragments - blood
Prevalence
Prognosis
Stroke Volume
Time Factors
Ventricular Function, Left
Young Adult
Abstract
The aim of this study was to assess the epidemiological features and prognosis of heart failure with preserved ejection fraction (HFPEF) and to compare these findings with those from patients with reduced ejection fraction. Furthermore the effects of N-terminal pro brain natriuretic peptide (NT-proBNP) requirement in the heart failure diagnosis were assessed by repeating the analyses in the subgroup of patients with elevated NT-proBNP.
In 1844 patients admitted, a clinical diagnosis of heart failure was made in 433; amongst these 61% had HFPEF. An elevated NT-proBNP applied to the heart failure diagnosis reduced the number of heart failure patients to 191, and amongst these 29% had preserved ejection fraction. Use of NT-proBNP reduced clinical differences between heart failure patients with preserved and reduced ejection fraction. When not using NT-proBNP, patients with reduced ejection fraction had higher mortality [hazard ratio (HR) 1.24, 95% confidence interval (CI) 1.01-1.52; P = 0.04], even after adjustment for other significant predictors of mortality, except NT-proBNP (HR 1.29, 95% CI 1.04-1.59; P = 0.02). However, no difference in mortality was observed when NT-proBNP was adjusted for (HR 0.90, 95% CI 0.71-1.15; P = 0.4), or used for the heart failure diagnosis (HR 0.96; 95% CI 0.71-1.29; P = 0.8).
Using a heart failure diagnosis requiring elevated NT-proBNP reduces the prevalence of HFPEF and results in a survival similar to that of heart failure with reduced ejection fraction. In contrast, when NT-proBNP is not used for the heart failure diagnosis or adjusted for, HFPEF is associated with a lower mortality in both univariate and multivariate analysis.
PubMed ID
22315457 View in PubMed
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The prognostic importance of a history of hypertension in patients with symptomatic heart failure is substantially worsened by a short mitral inflow deceleration time.

https://arctichealth.org/en/permalink/ahliterature124935
Source
BMC Cardiovasc Disord. 2012;12:30
Publication Type
Article
Date
2012
Author
Charlotte Andersson
Gunnar H Gislason
Peter Weeke
Jesper Kjaergaard
Christian Hassager
Dilek Akkan
Jacob E Møller
Lars Køber
Christian Torp-Pedersen
Author Affiliation
Department of Cardiology, Gentofte Hospital, Hellerup, Denmark. ca@heart.dk
Source
BMC Cardiovasc Disord. 2012;12:30
Date
2012
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cardiovascular Agents - therapeutic use
Chi-Square Distribution
Comorbidity
Double-Blind Method
Echocardiography, Doppler, Pulsed
Female
Heart Failure - drug therapy - mortality - physiopathology - ultrasonography
Humans
Hypertension - mortality - physiopathology - ultrasonography
Kaplan-Meier Estimate
Male
Middle Aged
Mitral Valve - physiopathology
Multivariate Analysis
Predictive value of tests
Prognosis
Proportional Hazards Models
Risk assessment
Risk factors
Scandinavia - epidemiology
Stroke Volume
Tetrahydronaphthalenes - therapeutic use
Time Factors
Ventricular Function, Left
Abstract
Hypertension is a common comorbidity in patients with heart failure and may contribute to development and course of disease, but the importance of a history of hypertension in patients with prevalent heart failure remains uncertain.
3078 consecutively hospitalized heart failure patients (NYHA classes II-IV) were screened for the EchoCardiography and Heart Outcome Study (ECHOS). The left ventricular ejection fraction (LVEF) was estimated by 2 dimensional transthoracic echocardiography in all patients and a subgroup of 878 patients had additional data on pulsed wave Doppler assessment of transmitral flow available. A restrictive filling (RF) was defined as a mitral inflow deceleration time =140 ms. Patients were followed for a median of 6.8 (Inter Quartile Range 6.6-7.0) years and multivariable Cox regression models were used to assess the risk of all-cause mortality associated with hypertension.
The study population had a mean age of 73 ± 11 years. 39% were female, 27% had a history of hypertension and 48% had a RF. Over the study period, 64% of the population died. Hypertension was not associated with increased risk of mortality, hazard ratio (HR) 0.95 (0.85-1.05). LVEF did not modify this relationship (p for interaction = 0.7), but RF pattern substantially influenced the outcomes associated with hypertension (p for interaction
Notes
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PubMed ID
22533520 View in PubMed
Less detail

The relationship between mitral regurgitation and ejection fraction as predictors for the prognosis of patients with heart failure.

https://arctichealth.org/en/permalink/ahliterature131896
Source
Eur J Heart Fail. 2011 Oct;13(10):1121-5
Publication Type
Article
Date
Oct-2011
Author
Redi Pecini
Jens Jakob Thune
Christian Torp-Pedersen
Christian Hassager
Lars Køber
Author Affiliation
Department of Cardiology and Endocrinology, Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark. redpecini@gmail.com
Source
Eur J Heart Fail. 2011 Oct;13(10):1121-5
Date
Oct-2011
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Echocardiography
Female
Heart Failure - complications - mortality - physiopathology
Hospitalization
Humans
Male
Middle Aged
Mitral Valve Insufficiency - complications - mortality - physiopathology
Prognosis
Randomized Controlled Trials as Topic
Registries
Risk factors
Scandinavia
Severity of Illness Index
Stroke Volume
Survival Analysis
Abstract
To study whether there is interaction between mitral regurgitation (MR) and left ventricular ejection fraction (LVEF) in the mortality risk of heart failure (HF) patients.
We studied a large group of patients hospitalized for symptoms and clinical signs of HF in the period 2001-02. Mitral regurgitation was diagnosed on echocardiography and qualitatively graded as no/trace, mild, moderate, and severe using the colour Doppler method. Median follow-up time was 4.5 years. Three thousand and seventy-eight patients with HF were included, of whom 1890 patients (61%) had no/trace MR, 628 (20%) had mild MR, 452 (15%) had moderate MR, and 108 (4%) had severe MR. During follow-up, 1660 deaths (54%) were registered. In univariate analysis, increasing severity of MR carried an increasing mortality risk, hazard ratio (HR) 1.10, 95% confidence interval (CI) 1.04-1.16, P = 0.0006 for each increasing degree of MR. In multivariable analysis, with adjustments made for age, sex, ejection fraction, serum creatinine, presence of ischaemic heart disease, chronic obstructive pulmonary disease, diabetes, and stroke, similar results were found, but only in patients with LVEF
PubMed ID
21865237 View in PubMed
Less detail

Renal dysfunction, restrictive left ventricular filling pattern and mortality risk in patients admitted with heart failure: a 7-year follow-up study.

https://arctichealth.org/en/permalink/ahliterature105869
Source
BMC Nephrol. 2013;14:267
Publication Type
Article
Date
2013
Author
Morten Schou
Jesper Kjaergaard
Christian Torp-Pedersen
Christian Hassager
Finn Gustafsson
Dilek Akkan
Jacob E Moller
Lars Kober
Author Affiliation
Department of Cardiology, The Heart Centre and University of Copenhagen, Rigshospitalet, DK-2100 Copenhagen, Denmark. m.schou@dadlnet.dk.
Source
BMC Nephrol. 2013;14:267
Date
2013
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Causality
Comorbidity
Denmark - epidemiology
Female
Follow-Up Studies
Heart Failure - diagnosis - mortality
Humans
Incidence
Male
Middle Aged
Prognosis
Proportional Hazards Models
Renal Insufficiency - mortality
Risk factors
Stroke Volume
Survival Rate
Ventricular Dysfunction, Left - diagnosis - mortality
Abstract
Renal dysfunction is associated with a variety of cardiac alterations including left ventricular (LV) hypertrophy, LV dilation, and reduction in systolic and diastolic function. It is common and associated with an increased mortality risk in heart failure (HF) patients. This study was designed to evaluate whether severe diastolic dysfunction contribute to the increased mortality risk observed in HF patients with renal dysfunction.
Using Cox Proportional Hazard Models on data (N = 669) from the EchoCardiography and Heart Outcome Study (ECHOS) study we evaluated whether estimated glomerular filtration rate (eGFR) was associated with mortality risk before and after adjustment for severe diastolic dysfunction. Severe diastolic dysfunction was defined by a restrictive left ventricular filling pattern (RF) (=deceleration time
Notes
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PubMed ID
24299462 View in PubMed
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Targeted temperature management at 33°C versus 36°C and impact on systemic vascular resistance and myocardial function after out-of-hospital cardiac arrest: a sub-study of the Target Temperature Management Trial.

https://arctichealth.org/en/permalink/ahliterature264654
Source
Circ Cardiovasc Interv. 2014 Oct;7(5):663-72
Publication Type
Article
Date
Oct-2014
Author
John Bro-Jeppesen
Christian Hassager
Michael Wanscher
Morten Østergaard
Niklas Nielsen
David Erlinge
Hans Friberg
Lars Køber
Jesper Kjaergaard
Source
Circ Cardiovasc Interv. 2014 Oct;7(5):663-72
Date
Oct-2014
Language
English
Publication Type
Article
Keywords
Aged
Cold Temperature - adverse effects
Denmark
Echocardiography
Female
Heart rate
Hemodynamics
Humans
Hypothermia, Induced - methods
Male
Middle Aged
Myocardium - chemistry - metabolism
Out-of-Hospital Cardiac Arrest - physiopathology - therapy
Stroke Volume
Vascular Resistance
Abstract
Cardiovascular dysfunction is common after out-of-hospital cardiac arrest as part of the postcardiac arrest syndrome, and hypothermia may pose additional impact on hemodynamics. The aim was to investigate systemic vascular resistance index (SVRI), cardiac index, and myocardial performance at a targeted temperature management of 33°C (TTM33) versus 36°C (TTM36).
Single-center substudy of 171 patients included in the Target Temperature Management Trial (TTM Trial) randomly assigned to TTM33 or TTM36 for 24 hours after out-of-hospital cardiac arrest. Mean arterial pressure =65 mm Hg and central venous pressure of 10 to 15 mm Hg were hemodynamic treatment goals. Hemodynamic evaluation was performed by serial right heart catheterization and transthoracic echocardiography. Primary end point was SVRI after 24 hours of cooling and secondary end points included mean SVRI, cardiac index, systolic function, and lactate levels. The TTM33 group had a significant increase in SVRI compared with TTM36 (2595; 95% confidence interval, 2422-2767) versus 1960 (95% confidence interval, 1787-2134) dynes m(2)/s per cm(5); P
PubMed ID
25270900 View in PubMed
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