20 research outputs found
Patient-reported outcomes and home-based self-swabs for influenza-like illness events:Leassons learned from the DANFLU-2 HomeSwab PRO Study
No full textPatient-reported outcomes and home-based self-swabs for influenza-like illness events:Leassons learned from the DANFLU-2 HomeSwab PRO Study
No full textProANP and proBNP in plasma as biomarkers of heart failure
No full textAim: To compare the measurement of proANP and proBNP in plasma for the diagnosis of heart failure. Methods: In the PubMed search, a process of combining subject headings and terms regarding comparison of natriuretic peptides (proANP and proBNP) was performed. Results: 21 abstracts from research articles were screened with 14 articles assessed for eligibility. 11 papers were included for final analysis. We report comparable diagnostic accuracies of N-Terminal proBNP and mid-regional proANP. Older methods for proANP measurement seem obsolete. Conclusion: Similar diagnostic performance of proANP and proBNP measurement for the diagnosis of heart failure was identified. Consequently, mid-regional proANP can be used when considering a diagnosis of heart failure.</p
Global longitudinal strain predicts cardiovascular events after coronary artery bypass grafting
No full textOBJECTIVE: To determine the prognostic value of global longitudinal strain (GLS) after coronary artery bypass grafting (CABG).METHODS: We performed a retrospective cohort study on patients undergoing CABG between 2006 and 2011 who had an echocardiogram available for strain analysis. The patients were followed up through nationwide registries for development of all-cause mortality, cardiovascular death (CVD) and major adverse cardiovascular events (MACEs) defined as heart failure hospitalisation and/or CVD. Multivariable Cox regression was applied to adjust for the European System for Cardiac Operative Risk Evaluation II (EuroSCORE-II). Additive value was assessed by Net Reclassification Index (NRI) improvement.RESULTS: Of the 709 patients included, 80 died during a median follow-up of 3.8 years. Of these, 45 had CVD, and 72 patients experienced MACE. Mean age was 68 years and 85% were men. Left ventricular ejection fraction (LVEF) was 50% and GLS was -13%.GLS was an independent predictor when adjusted for the EuroSCORE-II (all-cause mortality: HR=1.07 (1.01-1.13), p=0.018; CVD: HR=1.11 (1.03-1.20), p=0.007; MACE: HR=1.12 (1.06-1.19), p<0.001, per 1% absolute decrease). GLS significantly improved the NRI score by 0.30 when added to the EuroSCORE-II for predicting MACE, but not significantly for the other endpoints.LVEF modified the association between GLS and outcomes (p for interaction<0.05 for CVD and MACE). GLS remained an independent predictor of outcomes in patients with preserved LVEF (LVEF≥50%) and improved the NRI score when added to the EuroSCORE-II for predicting CVD and MACE, but not all-cause mortality in these patients.CONCLUSION: GLS is an independent predictor of long-term outcomes after CABG. The predictive value appears strongest among patients with preserved LVEF.</p
Long-term effects on cardiac function and symptoms in patients with myocarditis following COVID-19 vaccination:the ECHOVID-19 Long-term Study
No full textBACKGROUND: The long-term effects of myocarditis following COVID-19 vaccination on cardiac function and symptoms remain unclear.PURPOSE: To assess the long-term effects of myocarditis following COVID-19 vaccination on cardiac function, inflammatory biomarkers and symptoms.METHODS: Patients with myocarditis within 50 days of receiving COVID-19 vaccination (2021-2022) were invited to follow-up approximately 2 years after initial hospitalisation. Follow-up assessment included echocardiography, biomarkers, ECG, lung ultrasound (LUS) and symptom questionnaires. Patients with myocarditis following COVID-19 vaccination (V-myocarditis) were compared with non-vaccine-related myocarditis (NV-myocarditis) controls admitted during the same period.RESULTS: 17 patients with V-myocarditis (median age 47 (27-59) years, 53% women) were included. Median time from vaccination to admission was 6 days, with 88% admitted within 30 days. At follow-up (28±6 months), patients with V-myocarditis showed mildly impaired left ventricular (LV) function (median global longitudinal strain (GLS) 16.0% (13.2%-18.2%)) and diastolic dysfunction in 71%. Right ventricular (RV) and LUS findings were preserved. Biomarkers normalised from admission to follow-up with significant reductions in troponin-I (p<0.001) and C-reactive protein (p=0.001), while 35% showed persistent low-grade inflammation. Symptoms were common at follow-up, including fatigue (35%) and chest pain (41%). Compared with NV-myocarditis, patients with V-myocarditis had similar symptoms and biomarker recovery, but lower GLS at follow-up (NV-myocarditis: 18.5% (15.4%-20.3%), p=0.04).CONCLUSION: In one of the longest reported follow-up studies of myocarditis following COVID-19 vaccination, patients exhibited mild LV and diastolic dysfunction, preserved RV function and overall normalised biomarkers. A notable proportion continued reporting symptoms, highlighting the need for long-term follow-up.</p
Measures of left atrial function and risk of incident atrial fibrillation in patients with heart failure with reduced ejection fraction
No full textBACKGROUND: Measures of left atrial (LA) function have demonstrated prognostic value in relation to incident atrial fibrillation.AIMS: This study aimed to investigate the relationship between measures of LA function and the risk of incident atrial fibrillation (AF) in outpatients with HFrEF.METHODS: Subjects were retrospectively included from a HF clinic and followed using the Danish National Patient Registry. Measures included LA emptying fraction (LAEF), peak atrial longitudinal strain (PALS), and peak atrial contractile strain (PACS). Prognostic value was assessed with Cox proportional hazards regressions. Effect modification by sex, valve disease, and LA enlargement was assessed using interaction terms.RESULTS: The final study population consisted of 452 subjects (mean age 65.5±11.8 years, male sex 70.1%) free from AF at baseline. During a median follow-up of 9.4 years [IQR: 5.2, 12.7], 118 (26.1%) developed AF. These subjects exhibited higher LAVi, while LAEF, PALS, and PACS were all significantly lower. All three measures of LA function were significantly associated with incident AF in univariable and adjusted Cox regression analysis (Adjusted analysis: LAEF: HR 1.03 per 1% decrease, 95% CI 1.02-1.04, p=0.009, PALS: HR 1.06 per 1% decrease, 95% CI 1.04-1.09, p=0.037, PACS: HR 1.07 per 1% decrease, 95% CI 1.03-1.10, p=0.021). The prognostic value of LAEF was modified by sex and valve disease (p for interaction=0.007 and 0.041, respectively), while the value of PACS was modified by valve disease (p for interaction=0.011).CONCLUSION: Impaired PALS, LAEF, and PACS were all associated with an increased risk of incident AF in outpatients with HFrEF.</p
Cardiac Structure and Function Among Patients With Heart Failure With Reduced Ejection Fraction and Kidney Disease
No full textBACKGROUND: Kidney disease (KD) is a common comorbidity of heart failure with reduced ejection fraction (HFrEF). In this retrospective study, we sought to investigate measures of cardiac structure and function in relation to prevalent and incident kidney failure in subjects with HFrEF.METHODS: Subjects with a left ventricular ejection fraction (LVEF) ≤ 45% were included retrospectively from a large HF clinic. Patients were stratified into three groups: (1) no KD at baseline or during follow-up, (2) incident KD during follow-up, (3) prevalent KD. Echocardiographic parameters included LVEF, global longitudinal strain (GLS), tricuspid annular plane systolic excursion (TAPSE), and E/e' ratio. Associations with incident KD were assessed using uni- and multivariable Cox regression.RESULTS: The final population consisted of 1138 subjects (mean age 68.1 years (SD 11.8), male sex 72.8%), of which 53 (4.7%) had prevalent KD. During a median follow-up period of 9.9 years, 229 (21.1%) of those without KD at baseline developed KD, and the remaining 856 (75.2%) did not. At baseline, LVEF, GLS, TAPSE, and E/e' ratio were incrementally impaired across groups 1 through 3. While all four measures were associated with incident KD in univariable Cox regression, only LVEF (p = 0.023), TAPSE (p = 0.009), and E/e' ratio (p = 0.041) remained significant in adjusted analysis.CONCLUSION: Among HFrEF patients, future onset of KD and prevalent KD were increasingly associated with impaired GLS, LVEF, TAPSE, and E/e' ratio. Furthermore, LVEF, TAPSE, and E/e' ratio were independent predictors of incident KD.</p
Empagliflozin to elderly and obese patients with increased risk of developing heart failure:Study protocol for the Empire Prevent trial program
No full textINTRODUCTION: Sodium-glucose cotransporter 2 (SGLT2) inhibitors have previously demonstrated cardioprotective properties in patients with type 2 diabetes, suggesting a preventive effect on heart failure (HF). The Empire Prevent trial program investigates the therapeutic potential for HF prevention by evaluating the cardiac, metabolic, and renal effects of the SGLT2 inhibitor empagliflozin in patients with increased risk of developing HF, but without diabetes or established HF.METHODS: The Empire Prevent trial program is an investigator-initiated, double-blind, randomized clinical trial program including elderly and obese patients (60-84 years, body mass index >28 kg/m2) with at least one manifestation of hypertension, cardiovascular or chronic kidney disease, but no history of diabetes or HF. The aims are to investigate the effects of empagliflozin on 1) physical capacity and left ventricular and atrial structural changes with peak oxygen consumption and left ventricular mass as primary endpoints (Empire Prevent Cardiac), and 2) cardiac-adipose tissue interaction and volume homeostasis with primary endpoints of changes in epicardial adipose tissue and estimated extracellular volume (Empire Prevent Metabolic). At present, 138 of 204 patients have been randomized in the Empire Prevent trial program. Patients are randomized 1:1 to 180 days treatment with empagliflozin 10 mg daily or placebo, while undergoing a comprehensive examination program at baseline and follow-up.DISCUSSION: The Empire Prevent trial program will mark the first step towards elucidating the potential of SGLT2 inhibition for HF prevention in an outpatient setting in elderly and obese patients with increased risk of developing HF, but with no history of diabetes or established HF. Furthermore, the Empire Prevent trial program will supplement the larger event-driven trials by providing mechanistic insights to the beneficial effects of SGLT2 inhibition.TRIAL REGISTRATION: Both parts of the trial program have been registered on September 13th 2021 (Clinical Trial Registration numbers: NCT05084235 and NCT05042973) before enrollment of the first patient. All patients will provide oral and written informed consent. The trial is approved by The Regional Committee on Health Research Ethics and the Danish Medicines Agency. Data will be disseminated through scientific meetings and peer-reviewed journals irrespective of outcome.</p
Calcium Channel Blockers and the Risk of Exacerbation in Patients with Chronic Obstructive Pulmonary Disease: A Nationwide Study of 48,488 Outpatients
No full textPatients with chronic obstructive pulmonary disease (COPD) are prone to developing arterial hypertension, and many patients are treated with the calcium channel blocker amlodipine. However, it remains unclear whether using this drug potentially affects the risk of acute severe exacerbations (AECOPD) and all-cause mortality in these patients. The data were collected from Danish national registries, containing complete information on health, prescriptions, hospital admissions, and outpatient clinic visits. The COPD patients (n = 48,488) were matched via propensity score on known predictors of the primary outcome in an active comparator design. One group was exposed to amlodipine treatment, and the other was exposed to bendroflumethiazide, since both of these drugs are considered to be the first choice for the treatment of arterial hypertension according to Danish guidelines. The use of amlodipine was associated with a reduced risk of death from all causes at the 1-year follow-up (hazard ratio 0.69, 95% confidence interval: 0.62-0.76) compared with the use of bendroflumethiazide in the matched patients. No difference in the risk of severe AECOPD was found. In the COPD patients, amlodipine use was associated with a lower risk of death from all causes compared with the use of bendroflumethiazide. Amlodipine seems to be a safe first choice for the treatment of arterial hypertension in COPD patients.</p
