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Adrenomedullin and endothelin-1 are associated with myocardial injury and death in septic shock patients.

https://arctichealth.org/en/permalink/ahliterature286934
Source
Crit Care. 2016 06 09;20(1):178
Publication Type
Article
Date
06-09-2016
Author
Oscar H M Lundberg
Lill Bergenzaun
Jörgen Rydén
Mari Rosenqvist
Olle Melander
Michelle S Chew
Source
Crit Care. 2016 06 09;20(1):178
Date
06-09-2016
Language
English
Publication Type
Article
Keywords
Adrenomedullin - analysis - blood
Aged
Aged, 80 and over
Biomarkers - analysis - blood
Cardiomyopathies - mortality
Cohort Studies
Endothelin-1 - analysis - blood
Female
Humans
Intensive Care Units - organization & administration
Male
Middle Aged
Prognosis
Shock, Septic - metabolism - mortality
Survival Analysis
Sweden
Abstract
Adrenomedullin and endothelin-1 are hormones with opposing effects on the cardiovascular system. Adrenomedullin acts as a vasodilator and seems to be important for the initiation and continuation of the hyperdynamic circulatory response in sepsis. Endothelin-1 is a vasoconstrictor and has been linked to decreased cardiac performance. Few studies have studied the relationship between adrenomedullin and endothelin-1, and morbidity and mortality in septic shock patients. High-sensitivity troponin T (hsTNT) is normally used to diagnose acute cardiac injury but is also prognostic for outcome in intensive care. We investigated the relationship between mid-regional pro-adrenomedullin (MR-proADM), C-terminal pro-endothelin-1 (CT-proET-1), and myocardial injury, measured using transthoracic echocardiography and hsTNT in septic shock patients. We were also interested in the development of different biomarkers throughout the ICU stay, and how early measurements were related to mortality. Further, we assessed if a positive biomarker panel, consisting of MR-proADM, CT-proET-1, and hsTNT changed the odds for mortality.
A cohort of 53 consecutive patients with septic shock had their levels of MR-proADM, CT-proET-1, hsTNT, and left ventricular systolic functions prospectively measured over 7 days. The relationship between day 1 levels of MR-proADM/CT-proET-1 and myocardial injury was studied. We also investigated the relationship between biomarkers and early (7-day) and later (28-day) mortality. Likelihood ratios, and pretest and posttest odds for mortality were calculated.
Levels of MR-proADM and CT-proET-1 were significantly higher among patients with myocardial injury and were correlated with left ventricular systolic dysfunction. MR-proADM and hsTNT were significantly higher among 7-day and 28-day non-survivors. CT-proET-1 was also significantly higher among 28-day but not 7-day non-survivors. A positive biomarker panel consisting of the three biomarkers increased the odds for mortality 13-fold to 20-fold.
MR-proADM and CT-proET-1 are associated with myocardial injury. A biomarker panel combining MR-proADM, CT-proET-1, and hsTNT increases the odds ratio for death, and may improve currently available scoring systems in critical care.
Notes
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PubMed ID
27282767 View in PubMed
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Evolution of heart rate control after transplantation: conduction versus autonomic innervation.

https://arctichealth.org/en/permalink/ahliterature182645
Source
Pediatr Cardiol. 2004 Mar-Apr;25(2):113-8
Publication Type
Article
Author
S. Sanatani
C. Chiu
D. Nykanen
J. Coles
L. West
R. Hamilton
Author Affiliation
Division of Cardiology, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
Source
Pediatr Cardiol. 2004 Mar-Apr;25(2):113-8
Language
English
Publication Type
Article
Keywords
Adolescent
Anastomosis, Surgical
Autonomic Nervous System - physiopathology - surgery
Canada
Cardiomyopathies - mortality - physiopathology - surgery
Child
Child Welfare
Child, Preschool
Electrocardiography, Ambulatory
Electrodes, Implanted
Electrophysiologic Techniques, Cardiac
Female
Heart Atria - physiopathology - surgery
Heart Conduction System - physiopathology - surgery
Heart Defects, Congenital - mortality - physiopathology - surgery
Heart Rate - physiology
Heart Transplantation
Humans
Infant
Infant Welfare
Male
Postoperative Complications - etiology - mortality
Prospective Studies
Survival Analysis
Treatment Outcome
Abstract
In cardiac transplantation, the donor organ is not initially innervated and demonstrates decreased heart rate variability (HRV). However, HRV may improve after several months. The mechanism for HRV improvement has not been elucidated; autonomic "reinnervation" of the donor heart has been proposed. The role of atrioatrial conduction from recipient to donor organ has not been evaluated. We prospectively evaluated cardiac transplant patients with a limited electrophysiology study at the time of their surveillance biopsies. Recordings were made of recipient and donor signals, observing conduction properties between recipient and donor atria. Holter recordings were analyzed and HRV was determined using spectral analysis techniques, recording mean RR interval, low-frequency power (LF), high-frequency power (HF), and the LF/HF ratio. These were compared to published norms. From November 1999 to May 2000, 21 patients (6 female) who underwent cardiac transplantation participated at a median age of 101 months (range, 4.1-217 months). Time posttransplant ranged from 26 days to 71 months. Holter data were available for 20 patients and demonstrated dissociated P waves in 13 (65%). The mean heart rate on Holter was 111 beats per minute (bpm) (range, 85-161 bpm). We were able to record distinct recipient atrial signals in 16 of 21 (76%) patients. The average recipient tissue heart rate was 55% that of the donor heart rate. We documented atrioatrial association in only 1 patient. HRV did not reach normal values for most patients and did not increase with time posttransplantation. The LF values were in the normal range for most patients, whereas 3 patients had normal HF values and 2 patients had values just below normal. Recipients of heart transplantation have a predominantly sympathetic influence of HRV. These preliminary data suggest that atrioatrial conduction does not play a role in reestablishing normal heart rate control following pediatric cardiac transplantation.
PubMed ID
14647999 View in PubMed
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Metformin treatment is associated with a low risk of mortality in diabetic patients with heart failure: a retrospective nationwide cohort study.

https://arctichealth.org/en/permalink/ahliterature140847
Source
Diabetologia. 2010 Dec;53(12):2546-53
Publication Type
Article
Date
Dec-2010
Author
C. Andersson
J B Olesen
P R Hansen
P. Weeke
M L Norgaard
C H Jørgensen
T. Lange
S Z Abildstrøm
T K Schramm
A. Vaag
L. Køber
C. Torp-Pedersen
G H Gislason
Author Affiliation
Department of Cardiology, Gentofte University Hospital, Niels Andersens Vej 65, 2900 Hellerup, Denmark. ca@heart.dk
Source
Diabetologia. 2010 Dec;53(12):2546-53
Date
Dec-2010
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cause of Death
Cohort Studies
Denmark - epidemiology
Diabetes Mellitus, Type 2 - complications - drug therapy - mortality
Diabetic Cardiomyopathies - mortality - prevention & control
Female
Follow-Up Studies
Heart Failure - etiology - mortality - prevention & control
Humans
Hypoglycemic agents - therapeutic use
Insulin - therapeutic use
Male
Metformin - therapeutic use
Middle Aged
Retrospective Studies
Risk factors
Sulfonylurea Compounds - therapeutic use
Survival Analysis
Abstract
The safety of metformin in heart failure has been questioned because of a perceived risk of life-threatening lactic acidosis, though recent studies have not supported this concern. We investigated the risk of all-cause mortality associated with individual glucose-lowering treatment regimens used in current clinical practice in Denmark.
All patients aged = 30 years hospitalised for the first time for heart failure in 1997-2006 were identified and followed until the end of 2006. Patients who received treatment with metformin, a sulfonylurea and/or insulin were included and assigned to mono-, bi- or triple therapy groups. Multivariable Cox proportional hazard regression models were used to assess the risk of all-cause mortality.
A total of 10,920 patients were included. The median observational time was 844 days (interquartile range 365-1,395 days). In total, 6,187 (57%) patients died. With sulfonylurea monotherapy used as the reference, adjusted hazard ratios for all-cause mortality associated with the different treatment groups were as follows: metformin 0.85 (95% CI 0.75-0.98, p = 0.02), metformin + sulfonylurea 0.89 (95% CI 0.82-0.96, p = 0.003), metformin + insulin 0.96 (95% CI 0.82-1.13, p = 0.6), metformin + insulin + sulfonylurea 0.94 (95% CI 0.77-1.15, p = 0.5), sulfonylurea + insulin 0.97 (95% CI 0.86-1.08, p = 0.5) and insulin 1.14 (95% CI 1.06-1.20, p = 0.0001).
Treatment with metformin is associated with a low risk of mortality in diabetic patients with heart failure compared with treatment with a sulfonylurea or insulin.
PubMed ID
20838985 View in PubMed
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Outcomes of children with cardiomyopathy listed for transplant: a multi-institutional study.

https://arctichealth.org/en/permalink/ahliterature148341
Source
J Heart Lung Transplant. 2009 Dec;28(12):1312-21
Publication Type
Article
Date
Dec-2009
Author
Anne I Dipchand
David C Naftel
Brian Feingold
Robert Spicer
Delphine Yung
Beth Kaufman
James K Kirklin
Tina Allain-Rooney
Daphne Hsu
Author Affiliation
Hospital for Sick Children, Ontario, Canada. anne.dipchand@sickkids.ca
Source
J Heart Lung Transplant. 2009 Dec;28(12):1312-21
Date
Dec-2009
Language
English
Publication Type
Article
Keywords
Canada - epidemiology
Cardiomyopathies - mortality - surgery
Cause of Death - trends
Child
Child, Preschool
Female
Follow-Up Studies
Heart Transplantation
Humans
Male
Prognosis
Retrospective Studies
Risk factors
Survival Rate - trends
Time Factors
United States - epidemiology
Waiting Lists
Abstract
Dilated (DCM), restrictive (RCM), and hypertrophic (HCM) cardiomyopathies (CM) in children have varying clinical courses and therapeutic options. Heart transplantation (HTx) offers a chance for long-term survival; but outcomes after listing have not been well defined.
A multi-institutional registry of 3,147 patients listed for HTx (January 1993-December 2006) was used to compare outcomes of 1,320 children with CM (42%) and 1,827 with non-CM (58%) etiologies. Comparisons were made between sub-groups: 1,098 DCM (83%), 145 RCM (11%), and 77 HCM (6%).
CM patients had a waitlist mortality of 17% vs 32% for non-CM patients (p
PubMed ID
19782592 View in PubMed
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Predicting mortality in people with type 2 diabetes mellitus after major complications: a study using Swedish National Diabetes Register data.

https://arctichealth.org/en/permalink/ahliterature261400
Source
Diabet Med. 2014 Aug;31(8):954-62
Publication Type
Article
Date
Aug-2014
Author
P J Kelly
P M Clarke
A J Hayes
U-G Gerdtham
J. Cederholm
P. Nilsson
B. Eliasson
S. Gudbjornsdottir
Source
Diabet Med. 2014 Aug;31(8):954-62
Date
Aug-2014
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Amputation - adverse effects
Diabetes Mellitus, Type 2 - complications - diagnosis - epidemiology - mortality
Diabetic Angiopathies - mortality - surgery
Diabetic Cardiomyopathies - mortality
Diabetic Nephropathies - mortality
Female
Follow-Up Studies
Heart Failure - complications - mortality
Humans
Life expectancy
Male
Models, Biological
Mortality
Myocardial Infarction - complications - mortality
Prognosis
Prospective Studies
Registries
Renal Insufficiency - complications - mortality
Risk factors
Stroke - complications - mortality
Sweden - epidemiology
Abstract
To predict mortality risk and life expectancy for patients with type 2 diabetes after a major diabetes-related complication.
The study sample, taken from the Swedish National Diabetes Register, consisted of 20 836 people with type 2 diabetes who had their first major complication (myocardial infarction, stroke, heart failure, amputation or renal failure) between January 2001 and December 2007. A Gompertz proportional hazards model was derived which determined significant risk factors associated with mortality and was used to estimate life expectancies.
Risk of death changed over time according to type of complication, with myocardial infarction initally having the highest initial risk of death, but after the first month, the risk was higher for heart failure, renal failure and amputation. Other factors that increased the risk of death were male gender (hazard ratio 1.06, 95% CI 1.02-1.12), longer duration of diabetes (hazard ratio 1.07 per 10 years, 95% CI 1.04-1.10), smoking (hazard ratio 1.51, 95% CI 1.40-1.63) and macroalbuminuria (hazard ratio 1.14, 95% CI 1.06-1.22). Low BMI, low systolic blood pressure and low estimated GFR also increased mortality risk. Life expectancy was highest after a stroke, myocardial infarction or heart failure, lower after amputation and lowest after renal failure. Smoking and poor renal function were the risk factors which had the largest impact on reducing life expectancy.
Risk of death and life expectancy differs substantially among the major complications of diabetes, and factors significantly increasing risk included smoking, low estimated GFR and albuminuria.
PubMed ID
24750341 View in PubMed
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[Sudden out of hospital cardiac death in children, adolescents, and subjects younger than 45 years].

https://arctichealth.org/en/permalink/ahliterature146768
Source
Kardiologiia. 2009;49(11):33-8
Publication Type
Article
Date
2009
Author
L M Makarov
Iu A Solokhin
Source
Kardiologiia. 2009;49(11):33-8
Date
2009
Language
Russian
Publication Type
Article
Keywords
Adolescent
Adult
Age Distribution
Age Factors
Cardiomyopathies - mortality
Child
Child, Preschool
Death, Sudden, Cardiac - epidemiology
Female
Heart Defects, Congenital - mortality
Humans
Incidence
Infant
Male
Middle Aged
Moscow - epidemiology
Myocardial Ischemia - mortality
Outpatients
Retrospective Studies
Young Adult
Abstract
Aim of this study was determination of incidence and structure of sudden out of hospital cardiac death (SCD) in subjects aged 1-45 years in Moscow. We analyzed rate and structure of SD among persons who had succumbed in 2005-2007 in several districts of Moscow with population of 2,502,836. Of the total number of 19,557 autopsies 7702 (39.4% or 92/100 000/year) and 1265 (6.5%, 19.4% of autopsies in this age group, or 16.8/100000/year) in all age groups and in the age 1-45 years, respectively, were performed because of SCD. In most cases (44%) age at SCD was 41-45 years, only in 1% of cases it was less than 18 years. Eighty two percent of autopsied SD victims were men. Most frequent postmortem diagnosis was "cardiomyopathy" (69% overall, 80-96% in the age 19-35 years) established on the basis of detection of both specific and nonspecific changes in the myocardium. In 25% of SD cases in the age group before 18 years congenital heart disease was found. After 35 years rose portion of diseases of ischemic nature (22-32%). Percentages of hypertensive disease and other diseases among all diagnoses were 7 and 1, respectively. Beginning with 19 years in large percentage of cases presence of alcohol in blood was detected. This percentage was especially high in the age group 19-25 years (66.6%). SCD of most persons aged 20-45 years was registered at home, while in 50% of younger persons it occurred outside home often during physical effort. Rate of SCD, its circumstances and structure elicited in this study might serve as basis for elaboration of the system of early detection of groups of risk and prevention of SD in young age.
PubMed ID
20001980 View in PubMed
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Three decades of heart transplantation in Scandinavia: long-term follow-up.

https://arctichealth.org/en/permalink/ahliterature119361
Source
Eur J Heart Fail. 2013 Mar;15(3):308-15
Publication Type
Article
Date
Mar-2013
Author
Göran Dellgren
Odd Geiran
Karl Lemström
Finn Gustafsson
Hans Eiskjaer
Bansi Koul
Inger Hagerman
Nedim Selimovic
Author Affiliation
Transplant Institute and Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, University of Gothenburg, SE-413 45 Gothenburg, Sweden. goran.dellgren@vgregion.se
Source
Eur J Heart Fail. 2013 Mar;15(3):308-15
Date
Mar-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Cardiomyopathies - mortality - surgery
Child
Child, Preschool
Female
Follow-Up Studies
Heart Defects, Congenital - mortality - surgery
Heart Transplantation
Humans
Infant
Male
Middle Aged
Proportional Hazards Models
Registries
Reoperation
Scandinavia - epidemiology
Treatment Outcome
Young Adult
Abstract
Heart transplantation (HTx) has become a standard treatment for patients with end-stage heart disease. The aim of this study was to report the long-term outcome after HTx in Scandinavia.
During the period, 1983-2009, 2333 HTxs were performed in 2293 patients (mean age 45 ± 16 years, range 0-70, 78% male). The main indications for HTx were non-ischaemic cardiomyopathy (50%), ischaemic cardiomyopathy (34%), valvular cardiomyopathy (3%), congenital heart disease (7%), retransplantation (2%), and miscellaneous (4%). The registry consists of pre-operative data from recipients and donors, data from pre-operative procedures, and long-term follow-up data. Mean follow-up was 7.8 ± 6.6 years (median 6.9, interquartile range 2.5-12.3, interval 0-27) and no patients were lost to follow-up. Long-term survival for HTx patients was 85, 76, 61, 43, and 30% at 1, 5, 10, 15, and 20 years of follow-up, respectively. Ten-year survival in patients bridged with mechanical circulatory support, in children, after retransplantation, and after concomitant other organ transplantation was 56, 74, 38, and 43%, respectively. Older patients (age > 55 years) had a significantly worse survival (P
PubMed ID
23109651 View in PubMed
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Type 2 diabetes and 1-year mortality in intensive care unit patients.

https://arctichealth.org/en/permalink/ahliterature118109
Source
Eur J Clin Invest. 2013 Mar;43(3):238-47
Publication Type
Article
Date
Mar-2013
Author
Christian F Christiansen
Martin B Johansen
Steffen Christensen
James M O'Brien
Else Tønnesen
Henrik T Sørensen
Author Affiliation
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark. cc@dce.au.dk
Source
Eur J Clin Invest. 2013 Mar;43(3):238-47
Date
Mar-2013
Language
English
Publication Type
Article
Keywords
Adult
Age Distribution
Aged
Aged, 80 and over
Chronic Disease
Cohort Studies
Denmark - epidemiology
Diabetes Mellitus, Type 2 - mortality
Diabetic Cardiomyopathies - mortality
Diabetic Nephropathies - mortality
Female
Heart Failure - mortality
Humans
Intensive Care - statistics & numerical data
Kaplan-Meier Estimate
Male
Middle Aged
Myocardial Infarction - mortality
Abstract
Data on the prognostic impact of diabetes and diabetic complications in intensive care unit (ICU) patients are limited and inconsistent. We, therefore, examined mortality in ICU patients with type 2 diabetes with and without pre-existing heart and kidney diseases compared with nondiabetic patients.
We conducted this population-based cohort study in Northern Denmark during 2005-2011. We included all ICU patients aged 40 years or older from the 17 ICUs in the area and identified type 2 diabetes by either a filled prescription for an antidiabetic drug, a previous diagnosis of diabetes, or an elevated glycosylated haemoglobin level. Diabetic patients were disaggregated according to pre-existing diagnoses of heart disease (myocardial infarction or heart failure) and kidney disease. We estimated 1-year mortality by the Kaplan-Meier method and hazard ratios of death (HRs) during follow-up using Cox regression, controlling for confounding factors and stratified by relevant subgroups.
Among 45 018 ICU patients, 7219 (16·0%) had type 2 diabetes. Overall, 1-year mortality was 36·0% in ICU patients with type 2 diabetes, rising to 54·6% in patients with pre-existing heart and kidney diseases, compared with 29·1% in nondiabetic patients. Comparing diabetic with nondiabetic patients, the adjusted 0- to 30-day HR was 1·20 (95% confidence interval (CI): 1·13-1·26) and 1·19 (95% CI: 1·10-1·28) during the 31- to 365-day follow-up period. Pre-existing kidney disease further increased the impact of diabetes, while heart disease alone had no such effect.
ICU patients with type 2 diabetes had higher 1-year mortality compared with nondiabetic ICU patients, particularly those with pre-existing kidney disease.
PubMed ID
23240763 View in PubMed
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9 records – page 1 of 1.