5 results on '"Anna Axelsson Raja"'
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2. Long term mortality in patients with hypertrophic cardiomyopathy – A Danish nationwide study
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Mads-Holger Bang Jacobsen, Jeppe Kofoed Petersen, Daniel Modin, Jawad Haider Butt, Jens Jakob Thune, Henning Bundgaard, Christian Torp Pedersen, Lars Køber, Emil Loldrup Fosbøl, and Anna Axelsson Raja
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Hypertrophic cardiomyopathy ,Long-term mortality ,Sudden cardiac death ,Registry ,Background population ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background: Patients with hypertrophic cardiomyopathy (HCM) are generally regarded as having increased risk of arrhythmia, stroke, heart failure, and sudden cardiac death, but reported mortality rates vary considerably and originate from selected populations. Study objective: We aimed to investigate the long-term mortality rate in a nationwide cohort of patients with HCM compared to a matched cohort from the general Danish population. Methods: All patients with a first-time HCM diagnosis in Denmark between January 1, 2007 and December 31, 2018 were identified through nationwide registries. In the main analysis, two visits in an outpatient clinic were required in order to increase specificity. Patients were matched to controls from the background population in a 1:3 ratio based on age, sex, selected comorbidities and date of HCM. Mortalities were compared using Kaplan Meier estimator and multivariable Cox regression models. Results: We identified 3126 patients with a first-time diagnosis of HCM. 1197 patients had at least two visits in the outpatient clinic (43 % female, median age 63.1 [25th–75th percentile 52.1–72.1] years). All-cause mortality was significantly higher in HCM patients than in matched controls: 10-year probabilities of death were 36.4 % (95 % CI 30.2–43.5 %) for HCM patients and 19.4 % (95 % CI 16.8–22.5 %) for controls. After adjusting for additional comorbidities and medications, a diagnosis with HCM was associated with an increased mortality rate (HR 1.48 (95 % CI 1.18–1.84, p = 0.001)). Conclusion: Compared to matched controls from the background population, presence of HCM was associated with a significant increase in mortality rate.
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- 2023
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3. Left-sided heart disease and risk of death in patients with end-stage kidney disease receiving haemodialysis: an observational study
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Anna Axelsson Raja, Peder E. Warming, Ture L. Nielsen, Louis L. Plesner, Mads Ersbøll, Morten Dalsgaard, Morten Schou, Casper Rydahl, Lisbet Brandi, and Kasper Iversen
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Cardiovascular ,End-stage renal failure ,Dialysis ,Echocardiography ,Left ventricular systolic dysfunction ,Heart failure ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Abstract Background Cardiovascular disease is the most common cause of death in patients with end-stage kidney disease on haemodialysis. The potential clinical consequence of systematic echocardiographic assessment is however not clear. In an unselected, contemporary population of patients on maintenance haemodialysis we aimed to assess: the prevalence of structural and functional heart disease, the potential therapeutic consequences of echocardiographic screening and whether left-sided heart disease is associated with prognosis. Methods Adult chronic haemodialysis patients in two large dialysis centres had transthoracic echocardiography performed prior to dialysis and were followed prospectively. Significant left-sided heart disease was defined as moderate or severe left-sided valve disease or left ventricular ejection fraction (LVEF) ≤40%. Results Among the 247 included patients (mean 66 years of age [95%CI 64–67], 68% male), 54 (22%) had significant left-sided heart disease. An LVEF ≤40% was observed in 31 patients (13%) and severe or moderate valve disease in 27 (11%) patients. The findings were not previously recognized in more than half of the patients (56%) prior to the study. Diagnosis had a potential impact on management in 31 (13%) patients including for 18 (7%) who would benefit from initiation of evidence-based heart failure therapy. After 2.8 years of follow-up, all-cause mortality among patients with and without left-sided heart disease was 52 and 32% respectively (hazard ratio [HR] 1.95 (95%CI 1.25–3.06). A multivariable adjusted Cox proportional hazard analysis showed that left-sided heart disease was an independent predictor of mortality with a HR of 1.60 (95%CI 1.01–2.55) along with age (HR per year 1.05 [95%CI 1.03–1.07]). Conclusion Left ventricular systolic dysfunction and moderate to severe valve disease are common and often unrecognized in patients with end-stage kidney failure on haemodialysis and are associated with a higher risk of death. For more than 10% of the included patients, systematic echocardiographic assessment had a potential clinical consequence.
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- 2020
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4. Prevention of sudden cardiac death in hypertrophic cardiomyopathy: Risk assessment using left atrial diameter predicted from left atrial volume
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Anna Axelsson Raja, Kiri Espersen, Kasper Iversen, H. Mills, Henning Bundgaard, and Rebecca Jurlander
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Cardiac Volume ,Denmark ,Clinical Investigations ,030204 cardiovascular system & hematology ,implantable cardioverter‐defibrillator ,Risk Assessment ,Sudden cardiac death ,03 medical and health sciences ,Risk model ,risk prediction ,0302 clinical medicine ,implantable cardioverter-defibrillator ,risk model ,Left atrial ,Interquartile range ,Internal medicine ,medicine ,echocardiography ,Humans ,030212 general & internal medicine ,cardiovascular diseases ,Heart Atria ,Retrospective Studies ,business.industry ,Incidence ,Hypertrophic cardiomyopathy ,General Medicine ,Cardiomyopathy, Hypertrophic ,Middle Aged ,medicine.disease ,Implantable cardioverter-defibrillator ,Prognosis ,Survival Rate ,surgical procedures, operative ,Death, Sudden, Cardiac ,Parasternal line ,Echocardiography ,Cardiology ,cardiovascular system ,Female ,Cardiology and Cardiovascular Medicine ,Risk assessment ,business ,circulatory and respiratory physiology - Abstract
Background: Left atrial diameter (LAd) is included in the European Society for Cardiology's (ESC) risk model for assessment of sudden cardiac death (SCD) risk in hypertrophic cardiomyopathy (HCM), but the recommended measure of LA size is left atrial volume (LAv). Hypothesis: We hypothesized that LAv could be used instead of LAd in the HCM risk-SCD model. We aimed to determine the relation between LAd and LAv and to assess the impact of using LAv instead of LAd. Methods: Echocardiographic measurements of anteroposterior LAd in the parasternal long-axis window and LAv from Simpson's biplane method of disks were used. The 5-year risk of SCD by measured LAd and by LAd predicted from LAv were estimated using the ESC risk-SCD model. Results: In 205 HCM patients (age 56 ± 14 years, 62% male), the relation between LAd and LAv was linear. Median 5-year risk of SCD was 2.4% (interquartile range [IQR]: 1.6; 3.8) using measured LAd and 2.4% (IQR: 1.6; 3.7) using predicted LAd. The correlation between the SCD risk assessed by measured vs predicted LAd was excellent (r2 = 0.96). Use of predicted LAd resulted in four patients (2%) being recategorized between the moderate and high-risk categories. Conclusions: The relation between LAd and LAv was linear with good agreement. On a population level, the correlation between the risk of SCD using measured LAd or LAd predicted from LAv was excellent. On a patient level, using LAd predicted from LAv resulted in the vast majority remaining in the same risk category; however, for a minority of patients, it changed the recommendation.
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- 2020
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5. Cardiac Involvement in Women With Pathogenic Dystrophin Gene Variants
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Tuva Åsatun Solheim, Freja Fornander, John Vissing, Morten Duno, Rasmus Mogelvang, Anna Axelsson Raja, Henning Bundgaard, and Nanna S. Poulsen
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musculoskeletal diseases ,medicine.medical_specialty ,cardiac ,030204 cardiovascular system & hematology ,Left ventricular hypertrophy ,030218 nuclear medicine & medical imaging ,Cardiac dysfunction ,03 medical and health sciences ,0302 clinical medicine ,Cardiac magnetic resonance imaging ,Internal medicine ,cardiac MRI ,cardiac involvement ,Medicine ,Late gadolinium enhancement ,echocardiography ,cardiovascular diseases ,RC346-429 ,Cardiac imaging ,Original Research ,medicine.diagnostic_test ,business.industry ,Cardiac muscle ,medicine.disease ,female carriers ,Dystrophin gene ,medicine.anatomical_structure ,Neurology ,Cardiology ,cardiovascular system ,Myocardial fibrosis ,Neurology. Diseases of the nervous system ,Neurology (clinical) ,dystrophinopathy ,business - Abstract
Objective: To determine the frequency and extent of cardiac involvement in female carriers of pathogenic variants in DMD, 53 women were examined through an observational, cross-sectional study.Methods: Genetically verified female carriers of pathogenic DMD variants were examined by cardiac magnetic resonance imaging (CMR) with late gadolinium enhancement, echocardiography, 24-h Holter monitoring, ECG, and blood concentrations of skeletal and cardiac muscle biomarkers.Results: Fifty-three female carriers of pathogenic DMD variants (mean age 49.6 years, 33 associated with DMD, and 20 with BMD) were included in the study. Sixty-two percent had cardiac dysfunction on echocardiography. On CMR, 49% had myocardial fibrosis, 35% had dilated left ventricles, and 10% had left ventricular hypertrophy. ECGs were abnormal in 72%, and abnormal Holter monitoring was found in 43%. Age did not correlate with myocardial fibrosis or cardiac dysfunction. Myocardial fibrosis was more frequent in carriers of pathogenic variants associated with DMD vs. BMD (61 vs. 28%, p = 0.02).Conclusion: This study shows that cardiac involvement, affecting both structure and function of the heart, is found in over 2/3 of women with a pathogenic DMD variant. The study supports early cardiac screening, including ECG, Holter, and cardiac imaging, in this group of carriers, so that symptoms related to pathogenic variants in DMD can be recognized, and relevant treatment can be initiated. Longitudinal studies are needed to assess morbidity and mortality related to single, pathogenic DMD variants in women.
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- 2021
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