427 results on '"Harjola, Veli-Pekka"'
Search Results
2. Quantifying Hemodynamic Cardiac Stress and Cardiomyocyte Injury in Normotensive and Hypertensive Acute Heart Failure
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Nikola Kozhuharov, Eleni Michou, Desiree Wussler, Maria Belkin, Corinna Heinisch, Johan Lassus, Krista Siirilä-Waris, Harjola Veli-Pekka, Nisha Arenja, Thenral Socrates, Albina Nowak, Samyut Shrestha, Julie Valerie Willi, Ivo Strebel, Danielle M. Gualandro, Katharina Rentsch, Micha T. Maeder, Thomas Münzel, Mucio Tavares de Oliveira Junior, Arnold von Eckardstein, Tobias Breidthardt, and Christian Mueller
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acute heart failure ,pathophysiology ,natriuretic peptides ,cardiac troponin ,Biology (General) ,QH301-705.5 - Abstract
Background: The characterization of the different pathophysiological mechanisms involved in normotensive versus hypertensive acute heart failure (AHF) might help to develop individualized treatments. Methods: The extent of hemodynamic cardiac stress and cardiomyocyte injury was quantified by measuring the B-type natriuretic peptide (BNP), N-terminal proBNP (NT-proBNP), and high-sensitivity cardiac troponin T (hs-cTnT) concentrations in 1152 patients presenting with centrally adjudicated AHF to the emergency department (ED) (derivation cohort). AHF was classified as normotensive with a systolic blood pressure (SBP) of 90–140 mmHg and hypertensive with SBP > 140 mmHg at presentation to the ED. Findings were externally validated in an independent AHF cohort (n = 324). Results: In the derivation cohort, with a median age of 79 years, 43% being women, 667 (58%) patients had normotensive and 485 (42%) patients hypertensive AHF. Hemodynamic cardiac stress, as quantified by the BNP and NT-proBNP, was significantly higher in normotensive as compared to hypertensive AHF [1105 (611–1956) versus 827 (448–1419) pg/mL, and 5890 (2959–12,162) versus 4068 (1986–8118) pg/mL, both p < 0.001, respectively]. Similarly, the extent of cardiomyocyte injury, as quantified by hs-cTnT, was significantly higher in normotensive AHF as compared to hypertensive AHF [41 (24–71) versus 33 (19–59) ng/L, p < 0.001]. A total of 313 (28%) patients died during 360 days of follow-up. All-cause mortality was higher in patients with normotensive AHF vs. patients with hypertensive AHF (hazard ratio 1.66, 95%CI 1.31–2.10; p < 0.001). Normotensive patients with a high BNP, NT-proBNP, or hs-cTnT had the highest mortality. The findings were confirmed in the validation cohort. Conclusion: Biomarker profiling revealed a higher extent of hemodynamic stress and cardiomyocyte injury in patients with normotensive versus hypertensive AHF.
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- 2024
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3. Effect of Inhaled Xenon on Cardiac Function in Comatose Survivors of Out-of-Hospital Cardiac Arrest—A Substudy of the Xenon in Combination With Hypothermia After Cardiac Arrest Trial
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Saraste, Antti, Ballo, Haitham, Arola, Olli, Laitio, Ruut, Airaksinen, Juhani, Hynninen, Marja, Bäcklund, Minna, Ylikoski, Emmi, Wennervirta, Johanna, Pietilä, Mikko, Roine, Risto O, Harjola, Veli-Pekka, Niiranen, Jussi, Korpi, Kirsi, Varpula, Marjut, Scheinin, Harry, Maze, Mervyn, Vahlberg, Tero, Laitio, Timo, Virtanen, Sami, Parkkola, Riitta, Saunavaara, Jani, Martola, Juha, Silvennoinen, Heli, Tiainen, Marjaana, Grönlund, Juha, Inkinen, Outi, Silvasti, Päivi, Nukarinen, Eija, and Olkkola, Klaus T
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Clinical Sciences ,Cardiovascular ,Clinical Research ,Heart Disease ,Clinical Trials and Supportive Activities ,cardiac arrest ,cardiac function ,cardioprotection ,echocardiography ,ejection fraction ,myocardial strain ,Clinical sciences - Abstract
This explorative substudy aimed at determining the effect of inhaled xenon on left ventricular function by echocardiography in comatose survivors of out-of-hospital cardiac arrest.DesignA randomized two-group single-blinded phase 2 clinical drug trial.SettingA multipurpose ICU in two university hospitals.PatientsOf the 110 randomized comatose survivors after out-of-hospital cardiac arrest with a shockable rhythm in the xenon in combination with hypothermia after cardiac arrest trial, 38 patients (24-76 yr old) with complete echocardiography were included in this study.InterventionsPatients were randomized to receive either inhaled xenon combined with hypothermia (33°C) for 24 hours or hypothermia treatment alone. Echocardiography was performed at hospital admission and 24 ± 4 hours after hypothermia.Measurements and main resultsLeft ventricular ejection fraction, myocardial longitudinal systolic strain, and diastolic function were analyzed blinded to treatment. There were 17 xenon and 21 control patients in whom echocardiography was completed. Clinical characteristics did not differ significantly between the groups. At admission, ejection fraction was similar in xenon and control patients (39% ± 10% vs 38% ± 11%; p = 0.711) but higher in xenon than control patients after hypothermia (50% ± 10% vs 42% ± 10%; p = 0.014). Global longitudinal systolic strain was similar in xenon and control patients at admission (-9.0% ± 3.8% vs -8.1% ± 3.6%; p = 0.555) but better in xenon than control patients after hypothermia (-14.4.0% ± 4.0% vs -10.5% ± 4.0%; p = 0.006). In patients with coronary artery disease, longitudinal strain improved in the nonischemic myocardial segments in xenon patients. There were no changes in diastolic function between the groups.ConclusionsAmong comatose survivors of a cardiac cause out-of-hospital cardiac arrest, inhaled xenon combined with hypothermia was associated with greater recovery of left ventricular systolic function in comparison with hypothermia alone.
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- 2021
4. Characteristics and costs of electric scooter injuries in Helsinki: a retrospective cohort study
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Vasara, Henri, Toppari, Linda, Harjola, Veli-Pekka, Virtanen, Kaisa, Castrén, Maaret, and Kobylin, Arja
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- 2022
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5. The emergency department arrival mode and its relations to ED management and 30-day mortality in acute heart failure: an ancillary analysis from the EURODEM study
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Harjola, Pia, Tarvasmäki, Tuukka, Barletta, Cinzia, Body, Richard, Capsec, Jean, Christ, Michael, Garcia-Castrillo, Luis, Golea, Adela, Karamercan, Mehmet A., Martin, Paul-Louis, Miró, Òscar, Tolonen, Jukka, van Meer, Oene, Palomäki, Ari, Verschuren, Franck, Harjola, Veli-Pekka, and Laribi, Said
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- 2022
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6. Inhaled Xenon Attenuates Myocardial Damage in Comatose Survivors of Out-of-Hospital Cardiac Arrest The Xe-Hypotheca Trial
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Arola, Olli, Saraste, Antti, Laitio, Ruut, Airaksinen, Juhani, Hynninen, Marja, Bäcklund, Minna, Ylikoski, Emmi, Wennervirta, Johanna, Pietilä, Mikko, Roine, Risto O, Harjola, Veli-Pekka, Niiranen, Jussi, Korpi, Kirsi, Varpula, Marjut, Scheinin, Harry, Maze, Mervyn, Vahlberg, Tero, Laitio, Timo, Group, Xe-HYPOTHECA Study, Virtanen, Sami, Parkkola, Riitta, Saunavaara, Jani, Martola, Juha, Silvennoinen, Heli, Tiainen, Marjaana, Grönlund, Juha, Inkinen, Outi, Silvasti, Päivi, Nukarinen, Eija, and Olkkola, Klaus T
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Biomedical and Clinical Sciences ,Clinical Sciences ,Heart Disease ,Clinical Research ,Cardiovascular ,Heart Disease - Coronary Heart Disease ,Administration ,Inhalation ,Aged ,Cardiopulmonary Resuscitation ,Coma ,Female ,Finland ,Heart ,Hemodynamics ,Humans ,Hypothermia ,Induced ,Intensive Care Units ,Male ,Middle Aged ,Myocardium ,Out-of-Hospital Cardiac Arrest ,Percutaneous Coronary Intervention ,Treatment Outcome ,Troponin T ,Xenon ,cardioprotection ,hypothermia ,out-of-hospital cardiac arrest ,xenon ,Xe-HYPOTHECA Study Group ,Cardiorespiratory Medicine and Haematology ,Public Health and Health Services ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology - Abstract
BACKGROUND:The authors previously reported that inhaled xenon combined with hypothermia attenuates brain white matter injury in comatose survivors of out-of-hospital cardiac arrest (OHCA). OBJECTIVES:A pre-defined secondary objective was to assess the effect of inhaled xenon on myocardial ischemic damage in the same study population. METHODS:A total of 110 comatose patients who had experienced OHCA from a cardiac cause were randomized to receive either inhaled xenon (40% end-tidal concentration) combined with hypothermia (33°C) for 24 h (n = 55; xenon group) or hypothermia treatment alone (n = 55; control group). Troponin-T levels were measured at hospital admission, and at 24 h, 48 h, and 72 h post-cardiac arrest. All available cases were analyzed for troponin-T release. RESULTS:Troponin-T measurements were available from 54 xenon patients and 54 control patients. The baseline characteristics did not differ significantly between the groups. After adjustments for age, sex, study site, primary coronary percutaneous intervention (PCI), and norepinephrine dose, the mean ± SD post-arrival incremental change of the ln-transformed troponin-T at 72 h was 0.79 ± 1.54 in the xenon group and 1.56 ± 1.38 in the control group (adjusted mean difference -0.66; 95% confidence interval: -1.16 to -0.16; p = 0.01). The effect of xenon on the change in the troponin-T values did not differ in patients with or without PCI or in those with a diagnosis of ST-segment elevation myocardial infarction (group by PCI or ST-segment elevation myocardial infarction interaction effect; p = 0.86 and p = 0.71, respectively). CONCLUSIONS:Among comatose survivors of OHCA, in comparison with hypothermia alone, inhaled xenon combined with hypothermia suggested a less severe myocardial injury as demonstrated by the significantly reduced release of troponin-T.
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- 2017
7. Organ dysfunction, injury and failure in acute heart failure: from pathophysiology to diagnosis and management. A review on behalf of the Acute Heart Failure Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC).
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Harjola, Veli-Pekka, Mullens, Wilfried, Banaszewski, Marek, Bauersachs, Johann, Brunner-La Rocca, Hans-Peter, Chioncel, Ovidiu, Collins, Sean, Doehner, Wolfram, Filippatos, Gerasimos, Flammer, Andreas, Fuhrmann, Valentin, Lainscak, Mitja, Lassus, Johan, Legrand, Matthieu, Masip, Josep, Mueller, Christian, Papp, Zoltán, Parissis, John, Platz, Elke, Rudiger, Alain, Ruschitzka, Frank, Schäfer, Andreas, Seferovic, Petar, Skouri, Hadi, Yilmaz, Mehmet, and Mebazaa, Alexandre
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Heart failure ,Multiple organ failure ,Venous congestion ,Acute Disease ,Cardiology ,Diagnostic Imaging ,Disease Management ,Europe ,Heart Failure ,Humans ,Multiple Organ Failure ,Societies ,Medical - Abstract
Organ injury and impairment are commonly observed in patients with acute heart failure (AHF), and congestion is an essential pathophysiological mechanism of impaired organ function. Congestion is the predominant clinical profile in most patients with AHF; a smaller proportion presents with peripheral hypoperfusion or cardiogenic shock. Hypoperfusion further deteriorates organ function. The injury and dysfunction of target organs (i.e. heart, lungs, kidneys, liver, intestine, brain) in the setting of AHF are associated with increased risk for mortality. Improvement in organ function after decongestive therapies has been associated with a lower risk for post-discharge mortality. Thus, the prevention and correction of organ dysfunction represent a therapeutic target of interest in AHF and should be evaluated in clinical trials. Treatment strategies that specifically prevent, reduce or reverse organ dysfunction remain to be identified and evaluated to determine if such interventions impact mortality, morbidity and patient-centred outcomes. This paper reflects current understanding among experts of the presentation and management of organ impairment in AHF and suggests priorities for future research to advance the field.
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- 2017
8. Reply to: High levels of plasma biomarkers at 24 h were found to be strong predictors of 90-day mortality: beware of some potential confounders!
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Jäntti, Toni, Harjola, Veli-Pekka, Haapio, Mikko, and Lassus, Johan
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- 2021
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9. Systematic geriatric assessment for older patients with frailty in the emergency department: a randomised controlled trial
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Alakare, Janne, Kemp, Kirsi, Strandberg, Timo, Castrén, Maaret, Jakovljević, Dimitrije, Tolonen, Jukka, and Harjola, Veli-Pekka
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- 2021
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10. Effect of Inhaled Xenon on Cerebral White Matter Damage in Comatose Survivors of Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial
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Laitio, Ruut, Hynninen, Marja, Arola, Olli, Virtanen, Sami, Parkkola, Riitta, Saunavaara, Jani, Roine, Risto O, Grönlund, Juha, Ylikoski, Emmi, Wennervirta, Johanna, Bäcklund, Minna, Silvasti, Päivi, Nukarinen, Eija, Tiainen, Marjaana, Saraste, Antti, Pietilä, Mikko, Airaksinen, Juhani, Valanne, Leena, Martola, Juha, Silvennoinen, Heli, Scheinin, Harry, Harjola, Veli-Pekka, Niiranen, Jussi, Korpi, Kirsi, Varpula, Marjut, Inkinen, Outi, Olkkola, Klaus T, Maze, Mervyn, Vahlberg, Tero, and Laitio, Timo
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Biomedical and Clinical Sciences ,Clinical Sciences ,Health Sciences ,Clinical Trials and Supportive Activities ,Neurosciences ,Rehabilitation ,Clinical Research ,Cardiovascular ,Biomedical Imaging ,Brain Disorders ,Good Health and Well Being ,Administration ,Inhalation ,Adult ,Aged ,Anisotropy ,Cardiopulmonary Resuscitation ,Coma ,Diffusion Magnetic Resonance Imaging ,Female ,Finland ,Humans ,Hypothermia ,Induced ,Male ,Middle Aged ,Out-of-Hospital Cardiac Arrest ,Single-Blind Method ,Statistics ,Nonparametric ,Survival Analysis ,Survivors ,Time Factors ,Treatment Outcome ,White Matter ,Xenon ,Medical and Health Sciences ,General & Internal Medicine ,Biomedical and clinical sciences ,Health sciences - Abstract
ImportanceEvidence from preclinical models indicates that xenon gas can prevent the development of cerebral damage after acute global hypoxic-ischemic brain injury but, thus far, these putative neuroprotective properties have not been reported in human studies.ObjectiveTo determine the effect of inhaled xenon on ischemic white matter damage assessed with magnetic resonance imaging (MRI).Design, setting, and participantsA randomized single-blind phase 2 clinical drug trial conducted between August 2009 and March 2015 at 2 multipurpose intensive care units in Finland. One hundred ten comatose patients (aged 24-76 years) who had experienced out-of-hospital cardiac arrest were randomized.InterventionsPatients were randomly assigned to receive either inhaled xenon combined with hypothermia (33°C) for 24 hours (n = 55 in the xenon group) or hypothermia treatment alone (n = 55 in the control group).Main outcomes and measuresThe primary end point was cerebral white matter damage as evaluated by fractional anisotropy from diffusion tensor MRI scheduled to be performed between 36 and 52 hours after cardiac arrest. Secondary end points included neurological outcome assessed using the modified Rankin Scale (score 0 [no symptoms] through 6 [death]) and mortality at 6 months.ResultsAmong the 110 randomized patients (mean age, 61.5 years; 80 men [72.7%]), all completed the study. There were MRI data from 97 patients (88.2%) a median of 53 hours (interquartile range [IQR], 47-64 hours) after cardiac arrest. The mean global fractional anisotropy values were 0.433 (SD, 0.028) in the xenon group and 0.419 (SD, 0.033) in the control group. The age-, sex-, and site-adjusted mean global fractional anisotropy value was 3.8% higher (95% CI, 1.1%-6.4%) in the xenon group (adjusted mean difference, 0.016 [95% CI, 0.005-0.027], P = .006). At 6 months, 75 patients (68.2%) were alive. Secondary end points at 6 months did not reveal statistically significant differences between the groups. In ordinal analysis of the modified Rankin Scale, the median (IQR) value was 1 (1-6) in the xenon group and 1 (0-6) in the control group (median difference, 0 [95% CI, 0-0]; P = .68). The 6-month mortality rate was 27.3% (15/55) in the xenon group and 34.5% (19/55) in the control group (adjusted hazard ratio, 0.49 [95% CI, 0.23-1.01]; P = .053).Conclusions and relevanceAmong comatose survivors of out-of-hospital cardiac arrest, inhaled xenon combined with hypothermia compared with hypothermia alone resulted in less white matter damage as measured by fractional anisotropy of diffusion tensor MRI. However, there was no statistically significant difference in neurological outcomes or mortality at 6 months. These preliminary findings require further evaluation in an adequately powered clinical trial designed to assess clinical outcomes associated with inhaled xenon among survivors of out-of-hospital cardiac arrest.Trial registrationclinicaltrials.gov Identifier: NCT00879892.
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- 2016
11. Speed and Nighttime Usage Restrictions and the Incidence of Shared Electric Scooter Injuries
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Pakarinen, Oskari, primary, Kobylin, Arja, additional, Harjola, Veli-Pekka, additional, Castrén, Maaret, additional, and Vasara, Henri, additional
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- 2023
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12. Acute heart failure and valvular heart disease: A scientific statement of the Heart Failure Association, the Association for Acute CardioVascular Care and the European Association of Percutaneous Cardiovascular Interventions of the European Society of Cardiology
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Chioncel, Ovidiu, primary, Adamo, Marianna, additional, Nikolaou, Maria, additional, Parissis, John, additional, Mebazaa, Alexandre, additional, Yilmaz, Mehmet Birhan, additional, Hassager, Christian, additional, Moura, Brenda, additional, Bauersachs, Johann, additional, Harjola, Veli‐Pekka, additional, Antohi, Elena‐Laura, additional, Ben‐Gal, Tuvia, additional, Collins, Sean P., additional, Iliescu, Vlad Anton, additional, Abdelhamid, Magdy, additional, Čelutkienė, Jelena, additional, Adamopoulos, Stamatis, additional, Lund, Lars H., additional, Cicoira, Mariantonietta, additional, Masip, Josep, additional, Skouri, Hadi, additional, Gustafsson, Finn, additional, Rakisheva, Amina, additional, Ahrens, Ingo, additional, Mortara, Andrea, additional, Janowska, Ewa A., additional, Almaghraby, Abdallah, additional, Damman, Kevin, additional, Miro, Oscar, additional, Huber, Kurt, additional, Ristic, Arsen, additional, Hill, Loreena, additional, Mullens, Wilfried, additional, Chieffo, Alaide, additional, Bartunek, Jozef, additional, Paolisso, Pasquale, additional, Bayes‐Genis, Antoni, additional, Anker, Stefan D., additional, Price, Susanna, additional, Filippatos, Gerasimos, additional, Ruschitzka, Frank, additional, Seferovic, Petar, additional, Vidal‐Perez, Rafael, additional, Vahanian, Alec, additional, Metra, Marco, additional, McDonagh, Theresa A., additional, Barbato, Emanuele, additional, Coats, Andrew J.S., additional, and Rosano, Giuseppe M.C., additional
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- 2023
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13. Epinephrine Versus Norepinephrine for Cardiogenic Shock After Acute Myocardial Infarction
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Mattei, Mathieu, Thivilier, Carine, Perez, Pierre, Auchet, Thomas, Fritz, Caroline, Boisrame-Helme, Julie, Mercier, Emmanuelle, Garot, Denis, Perny, Jessica, Gette, Sebastien, Hammad, Emmanuelle, Vigne, Coralie, Dargent, Auguste, Andreu, Pascal, Guiot, Philippe, Levy, Bruno, Clere-Jehl, Raphael, Legras, Annick, Morichau-Beauchant, Tristan, Leone, Marc, Frederique, Ganster, Quenot, Jean-Pierre, Kimmoun, Antoine, Cariou, Alain, Lassus, Johan, Harjola, Veli-Pekka, Meziani, Ferhat, Louis, Guillaume, Rossignol, Patrick, Duarte, Kevin, Girerd, Nicolas, Mebazaa, Alexandre, and Vignon, Philippe
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- 2018
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14. National Early Warning Score 2 (NEWS2) and 3-level triage scale as risk predictors in frail older adults in the emergency department
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Kemp, Kirsi, Alakare, Janne, Harjola, Veli-Pekka, Strandberg, Timo, Tolonen, Jukka, Lehtonen, Lasse, and Castrén, Maaret
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- 2020
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15. Triage quality control is missing tools—a new observation technique for ED quality improvement
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MALMSTRÖM, TOMI, HARJOLA, VELI-PEKKA, TORKKI, PAULUS, KUMPULAINEN, SALLA, and MALMSTRÖM, RAIJA
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- 2017
16. PROGNOSTIC VALUE OF CIRCULATING SECRETONEURIN CONCENTRATIONS IN PATIENTS WITH CARDIOGENIC SHOCK: THE CARDSHOCK STUDY
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Omland, Torbjorn, primary, Azibani, Feriel, additional, Kimmmoun, Antoine, additional, Harjola, Veli-Pekka, additional, Lassus, Johan P.E., additional, and Mebazaa, Alexandre, additional
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- 2023
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17. Adrenomedullin: a marker of impaired hemodynamics, organ dysfunction, and poor prognosis in cardiogenic shock
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Tolppanen, Heli, Rivas-Lasarte, Mercedes, Lassus, Johan, Sans-Roselló, Jordi, Hartmann, Oliver, Lindholm, Matias, Arrigo, Mattia, Tarvasmäki, Tuukka, Köber, Lars, Thiele, Holger, Pulkki, Kari, Spinar, Jindrich, Parissis, John, Banaszewski, Marek, Silva-Cardoso, Jose, Carubelli, Valentina, Sionis, Alessandro, Harjola, Veli-Pekka, and Mebazaa, Alexandre
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- 2017
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18. Cost-Effectiveness of Empagliflozin in Combination with Standard Care versus Standard Care Only in the Treatment of Heart Failure Patients in Finland
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Hallinen, Taru, primary, Kivelä, Santtu, additional, Soini, Erkki, additional, Harjola, Veli-Pekka, additional, and Pesonen, Mari, additional
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- 2023
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19. Comparison of the use of comprehensive point-of-care test panel to conventional laboratory process in emergency department
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Kankaanpää, Meri, Holma-Eriksson, Marika, Kapanen, Sami, Heitto, Merja, Bergström, Sari, Muukkonen, Leila, and Harjola, Veli-Pekka
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- 2018
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20. Performance of Early Capillary Refill Time Measurement on Outcomes in Cardiogenic Shock: An Observational, Prospective Multicentric Study
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Merdji, Hamid, primary, Curtiaud, Anais, additional, Aheto, Antoine, additional, Studer, Antoine, additional, Harjola, Veli-Pekka, additional, Monnier, Alexandra, additional, Duarte, Kevin, additional, Girerd, Nicolas, additional, Kibler, Marion, additional, Ait-Oufella, Hafid, additional, Helms, Julie, additional, Mebazaa, Alexandre, additional, Levy, Bruno, additional, Kimmoun, Antoine, additional, and Meziani, Ferhat, additional
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- 2022
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21. Soluble urokinase-type plasminogen activator receptor improves early risk stratification in cardiogenic shock
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Hongisto, Mari, Lassus, Johan, Tarvasmäki, Tuukka, Sans-Roselló, Jordi, Tolppanen, Heli, Kataja, Anu, Jäntti, Toni, Sabell, Tuija, Banaszewski, Marek, Silva-Cardoso, Jose, Parissis, John, Jurkko, Raija, Spinar, Jindrich, Castrén, Maaret, Mebazaa, Alexandre, Masip, Josep, Harjola, Veli-Pekka, Universitat Autònoma de Barcelona, HUS Emergency Medicine and Services, Department of Diagnostics and Therapeutics, University of Helsinki, HUS Heart and Lung Center, Department of Medicine, Kardiologian yksikkö, and Clinicum
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Supar ,MYOCARDIAL-INFARCTION ,PREDICTION ,MORTALITY ,Biomarker ,General Medicine ,3126 Surgery, anesthesiology, intensive care, radiology ,Cardiology and Cardiovascular Medicine ,Critical Care and Intensive Care Medicine ,Cardiogenic shock ,Risk stratification ,suPAR - Abstract
Aims Soluble urokinase–type plasminogen activator receptor (suPAR) is a biomarker reflecting the level of immune activation. It has been shown to have prognostic value in acute coronary syndrome and heart failure as well as in critical illness. Considering the complex pathophysiology of cardiogenic shock (CS), we hypothesized suPAR might have prognostic properties in CS as well. The aim of this study was to assess the kinetics and prognostic utility of suPAR in CS. Methods and results SuPAR levels were determined in serial plasma samples (0–96 h) from 161 CS patients in the prospective, observational, multicentre CardShock study. Kinetics of suPAR, its association with 90-day mortality, and additional value in risk-stratification were investigated. The median suPAR-level at baseline was 4.4 [interquartile range (IQR) 3.2–6.6)] ng/mL. SuPAR levels above median were associated with underlying comorbidities, biomarkers reflecting renal and cardiac dysfunction, and higher 90-day mortality (49% vs. 31%; P = 0.02). Serial measurements showed that survivors had significantly lower suPAR levels at all time points compared with nonsurvivors. For risk stratification, suPAR at 12 h (suPAR12h) with a cut-off of 4.4 ng/mL was strongly associated with mortality independently of established risk factors in CS: OR 5.6 (95% CI 2.0–15.5); P = 0.001) for death by 90 days. Adding suPAR12h > 4.4 ng/mL to the CardShock risk score improved discrimination identifying high-risk patients originally categorized in the intermediate-risk category. Conclusion SuPAR associates with mortality and improves risk stratification independently of other previously known risk factors in CS patients.
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- 2022
22. High-Sensitivity Troponin T and Risk Stratification in Patients With Atrial Fibrillation During Treatment With Apixaban or Warfarin
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Hijazi, Ziad, Wallentin, Lars, Siegbahn, Agneta, Andersson, Ulrika, Alexander, John H., Atar, Dan, Gersh, Bernard J., Hanna, Michael, Harjola, Veli Pekka, Horowitz, John D., Husted, Steen, Hylek, Elaine M., Lopes, Renato D., McMurray, John J.V., and Granger, Christopher B.
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- 2014
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23. Heart failure oral therapies at discharge are associated with better outcome in acute heart failure: a propensity‐score matched study
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Gayat, Etienne, Arrigo, Mattia, Littnerova, Simona, Sato, Naoki, Parenica, Jiri, Ishihara, Shiro, Spinar, Jindrich, Müller, Christian, Harjola, Veli‐Pekka, Lassus, Johan, Miró, Òscar, Maggioni, Aldo P., AlHabib, Khalid F., Choi, Dong‐Ju, Park, Jin Joo, Zhang, Yuhui, Zhang, Jian, Januzzi, James L., Jr, Kajimoto, Katsuya, Cohen‐Solal, Alain, and Mebazaa, Alexandre
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- 2018
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24. Long‐term safety of intravenous cardiovascular agents in acute heart failure: results from the European Society of Cardiology Heart Failure Long‐Term Registry
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Mebazaa, Alexandre, Motiejunaite, Justina, Gayat, Etienne, Crespo‐Leiro, Maria G., Lund, Lars H., Maggioni, Aldo P., Chioncel, Ovidiu, Akiyama, Eiichi, Harjola, Veli‐Pekka, Seferovic, Petar, Laroche, Cecile, Julve, Marisa Sanz, Roig, Eulalia, Ruschitzka, Frank, and Filippatos, Gerasimos
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- 2018
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25. Right heart dysfunction and failure in heart failure with preserved ejection fraction: mechanisms and management. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology
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Gorter, Thomas M., van Veldhuisen, Dirk J., Bauersachs, Johann, Borlaug, Barry A., Celutkiene, Jelena, Coats, Andrew J.S., Crespo‐Leiro, Marisa G., Guazzi, Marco, Harjola, Veli‐Pekka, Heymans, Stephane, Hill, Loreena, Lainscak, Mitja, Lam, Carolyn S.P., Lund, Lars H., Lyon, Alexander R., Mebazaa, Alexandre, Mueller, Christian, Paulus, Walter J., Pieske, Burkert, Piepoli, Massimo F., Ruschitzka, Frank, Rutten, Frans H., Seferovic, Petar M., Solomon, Scott D., Shah, Sanjiv J., Triposkiadis, Filippos, Wachter, Rolf, Tschöpe, Carsten, and de Boer, Rudolf A.
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- 2018
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26. Epidemiology and one‐year outcomes in patients with chronic heart failure and preserved, mid‐range and reduced ejection fraction: an analysis of the ESC Heart Failure Long‐Term Registry
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Chioncel, Ovidiu, Lainscak, Mitja, Seferovic, Petar M., Anker, Stefan D., Crespo‐Leiro, Maria G., Harjola, Veli‐Pekka, Parissis, John, Laroche, Cecile, Piepoli, Massimo Francesco, Fonseca, Candida, Mebazaa, Alexandre, Lund, Lars, Ambrosio, Giuseppe A., Coats, Andrew J., Ferrari, Roberto, Ruschitzka, Frank, Maggioni, Aldo P., and Filippatos, Gerasimos
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- 2017
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27. Clinical phenotypes and outcome of patients hospitalized for acute heart failure: the ESC Heart Failure Long‐Term Registry
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Chioncel, Ovidiu, Mebazaa, Alexandre, Harjola, Veli‐Pekka, Coats, Andrew J., Piepoli, Massimo Francesco, Crespo‐Leiro, Maria G., Laroche, Cecile, Seferovic, Petar M., Anker, Stefan D., Ferrari, Roberto, Ruschitzka, Frank, Lopez‐Fernandez, Silvia, Miani, Daniela, Filippatos, Gerasimos, and Maggioni, Aldo P.
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- 2017
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28. Soluble triggering receptor expressed on myeloid cells-1 is a marker of organ injuries in cardiogenic shock: results from the CardShock Study
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GREAT-Network, CardShock Investigators, Kimmoun, Antoine, Duarte, Kevin, Harjola, Veli-Pekka, Tarvasmäki, Tuukka, Lassus, Johan, Jurkko, Raija, Tolppanen, Heli, Nieminen, Markku S., Järvinen, Kristiina, Nieminen, Tuomo, Pulkki, Kari, Soininen, Leena, Sund, Reijo, Tierala, Ilkka, Tolonen, Jukka, Varpula, Marjut, BOZEC, Erwan, Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Service de Réanimation Médicale [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy] (INI-CRCT), Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy], French-Clinical Research Infrastructure Network - F-CRIN [Paris] (Cardiovascular & Renal Clinical Trialists - CRCT ), Marqueurs cardiovasculaires en situation de stress (MASCOT (UMR_S_942 / U942)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Centre d'investigation clinique plurithématique Pierre Drouin [Nancy] (CIC-P), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Helsingin yliopisto = Helsingfors universitet = University of Helsinki, Helsinki University Hospital [Finland] (HUS), Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), The CardShock study was supported by grants from Aarne Koskelo Foundation, the Finnish Cardiac Foundation, and the Finnish State funding for university-level health research., CardShock Investigators and the GREAT network: Katerina Koniari, Astrinos Voumvourakis, Apostolos Karavidas, John Parissis, Jordi Sans-Rosello, Montserrat Vila, Albert Duran-Cambra, Alessandro Sionis, Jiri Parenica, Roman Stipal, Ondrej Ludka, Marie Palsuva, Eva Ganovska, Petr Kubena, Jindrich Spinar, Matias G Lindholm, Christian Hassager, Lars Køber, Tom Bäcklund, Johan Lassus, Raija Jurkko, Heli Tolppanen, Markku S Nieminen, Kristiina Järvinen, Tuomo Nieminen, Kari Pulkki, Leena Soininen, Reijo Sund, Ilkka Tierala, Jukka Tolonen, Marjut Varpula, Tuomas Korva, Mervi Pietilä, Anne Pitkälä, Rossella Marino, Salvatore Di Somma, Marco Metra, Michela Bulgari, Valentina Lazzarini, Valentina Carubelli, Alexandra Sousa, Jose Silva-Cardoso, Carla Sousa, Mariana Paiva, Inês Rangel, Rui Almeida, Teresa Pinho, Maria Júlia Maciel, Marek Banaszewski, Janina Stepinska, Anna Skrobisz, Piotr Góral, Uwe Zeymer, Holger Thiele, HUS Emergency Medicine and Services, Department of Diagnostics and Therapeutics, Helsinki University Hospital Area, University of Helsinki, HUS Heart and Lung Center, Clinicum, Kardiologian yksikkö, HUS Internal Medicine and Rehabilitation, Department of Medicine, Päijät-Häme Welfare Consortium, Department of Clinical Chemistry and Hematology, HUSLAB, and Department of Social Research (2010-2017)
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Inotrope ,medicine.medical_specialty ,Myeloid ,Shock, Cardiogenic ,Renal function ,Hemodynamics ,Inflammation ,PHARMACOLOGICAL INHIBITION ,030204 cardiovascular system & hematology ,03 medical and health sciences ,LIMITS ,0302 clinical medicine ,INFLAMMATION ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Internal medicine ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,Myocardial infarction ,Outcome ,Cardiogenic Shock ,business.industry ,Cardiogenic shock ,General Medicine ,medicine.disease ,Triggering Receptor Expressed on Myeloid Cells-1 ,[SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Blood pressure ,medicine.anatomical_structure ,3121 General medicine, internal medicine and other clinical medicine ,Cardiology ,STREM ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers - Abstract
Aims Optimal outcome after cardiogenic shock (CS) depends on a coordinated healing response in which both debris removal and extracellular matrix tissue repair play a crucial role. Excessive inflammation can perpetuate a vicious circle, positioning leucocytes as central protagonists and potential therapeutic targets. High levels of circulating Triggering Receptor Expressed on Myeloid cells-1 (TREM-1), were associated with death in acute myocardial infarction confirming excessive inflammation as determinant of bad outcome. The present study aims to describe the association of soluble TREM-1 with 90-day mortality and with various organ injuries in patients with CS. Methods and results This is a post-hoc study of CardShock, a prospective, multicenter study assessing the clinical presentation and management in patients with CS. At the time of this study, 87 patients had available plasma samples at either baseline, and/or 48 h and/or 96-120 h for soluble TREM-1 (sTREM-1) measurements. Plasma concentration of sTREM-1 was higher in 90-day non-survivors than survivors at baseline [median: 1392 IQR: (724-2128) vs. 621 (525-1233) pg/mL, p = 0.008), 48 h (p = 0.019) and 96-120 h (p = 0.029). The highest tertile of sTREM-1 at baseline (threshold: 1347 pg/mL) was associated with 90-day mortality with an unadjusted HR 3.08 CI 95% (1.48-6.42). sTREM-1 at baseline was not associated to hemodynamic parameters (heart rate, blood pressure, use of vasopressors or inotropes) but rather with organ injury markers: renal (estimated glomerular filtration rate, p = 0.0002), endothelial (bio-adrenomedullin, p = 0.018), myocardial (Suppression of Tumourigenicity 2, p = 0.002) or hepatic (bilirubin, p = 0.008). Conclusion In CS patients TREM-1 pathway is highly activated and gives an early prediction of vital organ injuries and outcome. [GRAPHICS] .
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- 2022
29. The role of pre‐hospital management in acute heart failure
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Harjola, Pia, Tolonen, Jukka, Boyd, James, Mattila, Juho, Koski, Reijo, Palomäki, Ari, Kuisma, Markku, and Harjola, Veli‐Pekka
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- 2017
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30. Prognostic impact of angiographic findings, procedural success, and timing of percutaneous coronary intervention in cardiogenic shock
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Sabell, Tuija, Banaszewski, Marek, Lassus, Johan, Nieminen, Markku S., Tolppanen, Heli, Jäntti, Toni, Kataja, Anu, Hongisto, Mari, Køber, Lars, Sionis, Alessandro, Parissis, John, Tarvasmäki, Tuukka, Harjola, Veli-Pekka, Jurkko, Raija, Universitat Autònoma de Barcelona, HUS Heart and Lung Center, Department of Medicine, Helsinki University Hospital Area, University of Helsinki, Kardiologian yksikkö, Clinicum, HUS Emergency Medicine and Services, and Department of Diagnostics and Therapeutics
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Male ,medicine.medical_specialty ,Acute coronary syndrome ,OCCLUSION ,medicine.medical_treatment ,Short Communication ,Short Communications ,Shock, Cardiogenic ,030204 cardiovascular system & hematology ,Revascularization ,Coronary Angiography ,Percutaneous coronary intervention ,03 medical and health sciences ,0302 clinical medicine ,TERM MORTALITY ,Internal medicine ,Medicine ,Diseases of the circulatory (Cardiovascular) system ,Humans ,030212 general & internal medicine ,Myocardial infarction ,cardiovascular diseases ,PREDICTORS ,Cardiogenic shock ,ARTERY ,Aged ,business.industry ,ELEVATION MYOCARDIAL-INFARCTION ,PCI ,Thrombolysis ,Middle Aged ,medicine.disease ,Prognosis ,3. Good health ,3121 General medicine, internal medicine and other clinical medicine ,RC666-701 ,Conventional PCI ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,TIMI - Abstract
Altres ajuts: This study was supported by grants from the Finnish Foundation for Cardiovascular Research, and Aarne Koskelo Foundation, Helsinki, Finland. Roche Diagnostics provided kits for the analysis of NT-proBNP and TnT. The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. Tuija Sabell (néeJavanainen) received following personal research grants: Acute Coronary Syndromes and secondary prevention grant from the Finnish Cardiac Society, grant supported by Astra Zeneca and grants from Paavo Nurmi Foundation and Paavo Ilmari Ahvenaisen säätiö. Dr Lassus has served on an advisory board for Boehringer Ingelheim, Medix Biochemica, Novartis, Servier, and Vifor Pharma and received lecture fees from Bayer, Boehringer Ingelheim, Pfizer, Novartis, Orion Pharma, and Vifor Pharma. Dr Parissis has received honoraria from Novartis and Orion Pharma. Urgent revascularization is the mainstay of treatment in acute coronary syndrome (ACS) related cardiogenic shock (CS). The aim was to investigate the association of angiographic results with 90-day mortality. Procedural complications of percutaneous coronary intervention (PCI) were also examined. This CardShock (NCT01374867) substudy included 158 patients with ACS aetiology and data on coronary angiography and complications during PCI procedure. Survival analysis was conducted with Kaplan-Meier curves and Cox regression analysis. Median age was 67 ± 11 years, and 77% were men. During 90-day follow-up, 66 (42%) patients died. Patients with one-vessel disease (n = 49) had lower mortality than patients with two-vessel (n = 59) or three-vessel (n = 50) disease (25% vs. 48% vs. 52%, P = 0.011). Successful revascularization [Thrombolysis in Myocardial Infarction (TIMI) Flow 3 post-PCI) was achieved more often in survivors than non-survivors (81% vs. 60%, P = 0.019). The median symptom-to-balloon time was 340 (196-660) minutes, with no difference between survivors and non-survivors. In multivariable mortality analysis, multivessel disease (HR 2.59, CI 1.29-5.18) and TIMI flow
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- 2020
31. Contemporary management of acute right ventricular failure: a statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the European Society of Cardiology
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Harjola, Veli-Pekka, Mebazaa, Alexandre, Čelutkienė, Jelena, Bettex, Dominique, Bueno, Hector, Chioncel, Ovidiu, Crespo-Leiro, Maria G., Falk, Volkmar, Filippatos, Gerasimos, Gibbs, Simon, Leite-Moreira, Adelino, Lassus, Johan, Masip, Josep, Mueller, Christian, Mullens, Wilfried, Naeije, Robert, Nordegraaf, Anton Vonk, Parissis, John, Riley, Jillian P., Ristic, Arsen, Rosano, Giuseppe, Rudiger, Alain, Ruschitzka, Frank, Seferovic, Petar, Sztrymf, Benjamin, Vieillard-Baron, Antoine, Yilmaz, Mehmet Birhan, and Konstantinides, Stavros
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- 2016
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32. Recommendations on pre-hospital and early hospital management of acute heart failure: a consensus paper from the Heart Failure Association of the European Society of Cardiology, the European Society of Emergency Medicine and the Society of Academic Emergency Medicine – short version
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Mebazaa, Alexandre, Yilmaz, M. Birhan, Levy, Phillip, Ponikowski, Piotr, Peacock, W. Frank, Laribi, Said, Ristic, Arsen D., Lambrinou, Ekaterini, Masip, Josep, Riley, Jillian P., McDonagh, Theresa, Mueller, Christian, deFilippi, Christopher, Harjola, Veli-Pekka, Thiele, Holger, Piepoli, Massimo F., Metra, Marco, Maggioni, Aldo, McMurray, John J.V., Dickstein, Kenneth, Damman, Kevin, Seferovic, Petar M., Ruschitzka, Frank, Leite-Moreira, Adelino F., Bellou, Abdelouahab, Anker, Stefan D., and Filippatos, Gerasimos
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- 2015
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33. Clinical picture and risk prediction of short-term mortality in cardiogenic shock
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Harjola, Veli-Pekka, Lassus, Johan, Sionis, Alessandro, Kber, Lars, Tarvasmäki, Tuukka, Spinar, Jindrich, Parissis, John, Banaszewski, Marek, Silva-Cardoso, Jose, Carubelli, Valentina, Di Somma, Salvatore, Tolppanen, Heli, Zeymer, Uwe, Thiele, Holger, Nieminen, Markku S, and Mebazaa, Alexandre
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- 2015
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34. Circulating levels of microRNA 423‐5p are associated with 90 day mortality in cardiogenic shock
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Jäntti, Toni, Segersvärd, Heli, Tolppanen, Heli, Tarvasmäki, Tuukka, Lassus, Johan, Devaux, Yvan, Vausort, Mélanie, Pulkki, Kari, Sionis, Alessandro, Bayes‐Genis, Antoni, Tikkanen, Ilkka, Lakkisto, Päivi, and Harjola, Veli‐Pekka
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Male ,Time Factors ,microRNA ,Short Communication ,Shock, Cardiogenic ,Prognosis ,Risk Assessment ,Survival Rate ,MicroRNAs ,miR‐423‐5p ,Risk Factors ,Cause of Death ,Humans ,Female ,Acute coronary syndrome ,Prospective Studies ,Mortality ,Cardiogenic shock ,Biomarkers ,Finland ,Aged ,Follow-Up Studies - Abstract
Aims The role of microRNAs has not been studied in cardiogenic shock. We examined the potential role of miR‐423‐5p level to predict mortality and associations of miR‐423‐5p with prognostic markers in cardiogenic shock. Methods and results We conducted a prospective multinational observational study enrolling consecutive cardiogenic shock patients. Blood samples were available for 179 patients at baseline to determine levels of miR‐423‐5p and other biomarkers. Patients were treated according to local practice. Main outcome was 90 day all‐cause mortality. Median miR‐423‐5p level was significantly higher in 90 day non‐survivors [median 0.008 arbitrary units (AU) (interquartile range 0.003–0.017) vs. 0.004 AU (0.002–0.009), P = 0.003]. miR‐423‐5p level above median was associated with higher lactate (median 3.7 vs. 2.4 mmol/L, P = 0.001) and alanine aminotransferase levels (median 68 vs. 35 IU/L, P
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- 2018
35. Halálozásikockázat-becslő pontrendszerek alkalmazhatóságának előzetes vizsgálata újraélesztett betegek körében
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Gábor Dér, Harjola Veli-Pekka, Zoltán Ruzsa, Endre Zima, Levente Molnár, Dávid Becker, Zsigmond Jenei, Boldizsár Kiss, Anna Párkányi, László Gellér, Dávid Pilecky, Enikő Kovács, Béla Merkely, Alexandra Fekete-Győr, Péter Nyéki, Zsófia Szakál-Tóth, HUS Akuten, and Diagnostisk-terapeutiska avdelningen
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medicine.medical_specialty ,post-resuscitation care ,PREDICTION ,medicine.medical_treatment ,resuscitation ,Sudden cardiac death ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,Intensive care ,COUNCIL GUIDELINES ,medicine ,Cardiopulmonary resuscitation ,risk ,CARDIOLOGY ,Gynecology ,Framingham Risk Score ,business.industry ,Neurological status ,DEATH ,HOSPITAL CARDIAC-ARREST ,EPINEPHRINE ,General Medicine ,ASSOCIATION ,CARE ,medicine.disease ,Intensive care unit ,mortality ,EUROPEAN-SOCIETY ,Mortality data ,3121 General medicine, internal medicine and other clinical medicine ,SURVIVAL ,030211 gastroenterology & hepatology ,Serum lactate level ,business - Abstract
Összefoglaló. Bevezetés: A cardiovascularis halálokok közül világszerte nagy jelentőségű a hirtelen szívhalál. Annak ellenére, hogy a cardiopulmonalis resuscitatio és a postresuscitatiós intenzív osztályos kezelés is komoly metodikai és technikai fejlődésen ment keresztül az elmúlt időszakban, kevés az olyan validált pontrendszer, amely jól becsülné a beteg intenzív osztályra kerülésekor a mortalitási rizikót. Célkitűzés: A sikeres újraélesztést követő intenzív osztályos kezelés kezdetekor felmért, a cardiogen shock rizikóstratifikációjára alkalmazott CardShock Risk Score (CSRS) és az általunk hozzáadott, specifikus súlyozófaktorokkal (iniciális ritmus, inotropigény) módosított CardShock Risk Score (mCSRS) összevetése a mortalitás előrejelzésében post-cardiac arrest szindrómás betegeknél. Módszerek: Retrospektív vizsgálatunk során 172, kórházon kívül sikeresen újraélesztett és klinikánkon ellátott consecutiv betegből a CSRS- és mCSRS-pontrendszerek segítségével végül 123 beteg adatait elemeztük. A CSRS- és mCSRS-változók és a korai/késői mortalitás közötti összefüggést Cox-regressziós analízissel vizsgáltuk. A pontszámok alapján 3 csoportba (1–3, 4–6, 7+) soroltuk a betegeket. Az összevont csoportok túlélését log-rank teszttel hasonlítottuk össze. Eredmények: A betegpopuláció átlagéletkora 63,6 év volt (69% férfi), és a hirtelen szívhalál hátterében 80%-ban akut coronaria szindróma állt. A korai/késői mortalitást leginkább a felvétel utáni neurológiai állapot, a szérumlaktátszint, a vesefunkció, az iniciális ritmus és a beteg katecholaminigénye határozta meg. A mCSRS alkalmazását követően mind az „1–3” és a „4–6” (p≤0,001), mind a „4–6” és a „7+” (p = 0,006) csoportok között szignifikáns különbséget találtunk a túlélésben. Következtetés: A felvételkori pontok alapján a mCSRS pontosabban definiálja és differenciálja egymástól az általunk beválasztott két extra súlyozófaktorral az enyhe, a közepes és a magas mortalitási rizikóval bíró betegpopulációkat, mint a CSRS. Orv Hetil. 2021; 162(2): 52–60. Summary. Introduction: Sudden cardiac death is one of the most significant cardiovascular causes of death worldwide. Although there have been immense methodological and technical advances in the field of cardiopulmonary resuscitation and following intensive care in the last decade, currently there are only a few validated risk-stratification scoring systems for the quick and reliable estimation of the mortality risk of these patients at the time of admission to the intensive care unit. Objective: Our aim was to correlate the mortality prediction risk points calculated by CardShock Risk Score (CSRS) and modified (m) CSRS based on the admission data of the post-cardiac arrest syndrome (PCAS) patients. Methods: The medical records of 172 out-of-hospital resuscitated cardiac arrest patients, who were admitted at the Heart and Vascular Centre of Semmelweis University, were screened retrospectively. Out of the 172 selected patients, 123 were eligible for inclusion to calculate CSRS and mCSRS. Based on CSRS score, we generated three different groups of patients, with scores 1 to 3, 4 to 6, and 7+, respectively. Mortality data of the groups were compared by log-rank test. Results: Mean age of the patients was 63.6 years (69% male), the cause of sudden cardiac death was acut coronary syndrome in 80% of the cases. The early and late mortality was predicted by neurological status, serum lactate level, renal function, initial rhythm, and the need of catecholamines. Using mCSRS, a significant survival difference was proven in between the groups “1–3” vs “4–6” (p≤0.001), “4–6” vs “7+” (p = 0.006). Conclusion: Compared to the CSRS, the mCSRS expanded with the 2 additional weighting points differentiates more specifically the low-moderate and high survival groups in the PCAS patient population treated in our institute. Orv Hetil. 2021; 162(2): 52–60.
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- 2021
36. Predictive value of plasma proenkephalin and neutrophil gelatinase-associated lipocalin in acute kidney injury and mortality in cardiogenic shock
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Jäntti, Toni, Tarvasmäki, Tuukka, Harjola, Veli-Pekka, Pulkki, Kari, Turkia, Heidi, Sabell, Tuija, Tolppanen, Heli, Jurkko, Raija, Hongisto, Mari, Kataja, Anu, Sionis, Alessandro, Silva-Cardoso, Jose, Banaszewski, Marek, DiSomma, Salvatore, Mebazaa, Alexandre, Haapio, Mikko, Lassus, Johan, Universitat Autònoma de Barcelona, Kardiologian yksikkö, HUS Heart and Lung Center, Helsinki University Hospital Area, University of Helsinki, Clinicum, HUS Emergency Medicine and Services, Department of Medicine, Department of Clinical Chemistry and Hematology, HUSLAB, Department of Diagnostics and Therapeutics, HUS Internal Medicine and Rehabilitation, HUS Abdominal Center, and Nefrologian yksikkö
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BIOMARKER ,medicine.medical_specialty ,PROGNOSIS ,030204 cardiovascular system & hematology ,Lipocalin ,Critical Care and Intensive Care Medicine ,PENK ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,AKI ,Interquartile range ,Oliguria ,Anesthesiology ,Internal medicine ,medicine ,MANAGEMENT ,030212 general & internal medicine ,Mortality ,NGAL ,Cardiogenic shock ,Creatinine ,OUTCOMES ,business.industry ,STATEMENT ,Research ,Hazard ratio ,Acute kidney injury ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,lcsh:RC86-88.9 ,medicine.disease ,3126 Surgery, anesthesiology, intensive care, radiology ,Prognosis ,chemistry ,3121 General medicine, internal medicine and other clinical medicine ,Cardiology ,medicine.symptom ,business ,Proenkephalin - Abstract
BackgroundAcute kidney injury (AKI) is a frequent form of organ injury in cardiogenic shock. However, data on AKI markers such as plasma proenkephalin (P-PENK) and neutrophil gelatinase-associated lipocalin (P-NGAL) in cardiogenic shock populations are lacking. The objective of this study was to assess the ability of P-PENK and P-NGAL to predict acute kidney injury and mortality in cardiogenic shock.ResultsP-PENK and P-NGAL were measured at different time points between baseline and 48 h in 154 patients from the prospective CardShock study. The outcomes assessed were AKI defined by an increase in creatinine within 48 h and all-cause 90-day mortality. Mean age was 66 years and 26% were women. Baseline levels of P-PENK and P-NGAL (median [interquartile range]) were 99 (71–150) pmol/mL and 138 (84–214) ng/mL. P-PENK > 84.8 pmol/mL and P-NGAL > 104 ng/mL at baseline were identified as optimal cut-offs for AKI prediction and independently associated with AKI (adjusted HRs 2.2 [95% CI 1.1–4.4,p = 0.03] and 2.8 [95% CI 1.2–6.5,p = 0.01], respectively). P-PENK and P-NGAL levels at baseline were also associated with 90-day mortality. For patients with oliguria 6 h before study enrollment, 90-day mortality differed significantly between patients with low and high P-PENK/P-NGAL at baseline (5% vs. 68%,p 24h > 105.7 pmol/L and P-NGAL24h > 151 ng/mL had unadjusted hazard ratios of 5.6 (95% CI 3.1–10.7,p p ConclusionsHigh levels of P-PENK and P-NGAL at baseline were independently associated with AKI in cardiogenic shock patients. Furthermore, oliguria before study inclusion was associated with worse outcomes only if combined with high baseline levels of P-PENK or P-NGAL. High levels of both P-PENK and P-NGAL at 24 h were found to be strong and independent predictors of 90-day mortality.Trial registration: NCT01374867 atwww.clinicaltrials.gov, registered 16 Jun 2011—retrospectively registered
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- 2021
37. Kinetics of procalcitonin, C-reactive protein and interleukin-6 in cardiogenic shock – Insights from the CardShock study
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Kataja, Anu Tarvasmaki, Tuukka Lassus, Johan Sionis, Alessandro Mebazaa, Alexandre Pulkki, Kari Banaszewski, Marek Carubelli, Valentina Hongisto, Mari Jankowska, Ewa and Jurkko, Raija Jantti, Toni Kasztura, Monika Parissis, John and Sabell, Tuija Silva-Cardoso, Jose Spinar, Jindrich and Tolppanen, Heli Harjola, Veli-Pekka CardShock Investigators
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Background: Inflammatory responses play an important role in the pathophysiology of cardiogenic shock (CS). The aim of this study was to investigate the kinetics of procalcitonin (PCT), C-reactive protein (CRP), and interleukin-6 (IL-6) in CS and to assess their relation to clinical presentation, other biochemical variables, and prognosis. Methods: Levels of PCT, CRP and IL-6 were analyzed in serial plasma samples (0-120h) from 183 patients in the CardShock study. The study population was dichotomized by PCTmax >= and < 0.5 mu g/L, and IL-6 and CRPmax above/below median. Results: PCT peaked already at 24 h [median PCTmax 0.71 mu g/L (IQR 0.24-3.4)], whereas CRP peaked later between 48 and 72 h [median CRPmax 137mg/L (59-247)]. PCT levels were significantly higher among non-survivors compared with survivors from 12 h on, as were CRP levels from 24 h on (p < 0.001). PCTmax >= 0.5 mu g/L (60% of patients) was associated with clinical signs of systemic hypoperfusion, cardiac and renal dysfunction, acidosis, and higher levels of blood lactate, IL-6, growth-differentiation factor 15 (GDF-15), and CRPmax. Similarly, IL-6 > median was associated with clinical signs and biochemical findings of systemic hypoperfusion. PCTmax >= 0.5 mu g/L and IL-6 > median were associated with increased 90-day mortality (50% vs. 30% and 57% vs. 22%, respectively; p < 0.01 for both), while CRPmax showed no prognostic significance. The association of inflammatory markers with clinical infections was modest. Conclusions: Inflammatory markers are highly related to signs of systemic hypoperfusion in CS. Moreover, high PCT and IL-6 levels are associated with poor prognosis. (C) 2020 Elsevier B.V. All rights reserved.
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- 2021
38. 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC)Endorsed by the European Respiratory Society (ERS)
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Konstantinides, Stavros V., Torbicki, Adam, Agnelli, Giancarlo, Danchin, Nicolas, Fitzmaurice, David, Galiè, Nazzareno, Gibbs, J. Simon R., Huisman, Menno V., Humbert, Marc, Kucher, Nils, Lang, Irene, Lankeit, Mareike, Lekakis, John, Maack, Christoph, Mayer, Eckhard, Meneveau, Nicolas, Perrier, Arnaud, Pruszczyk, Piotr, Rasmussen, Lars H., Schindler, Thomas H., Svitil, Pavel, Vonk Noordegraaf, Anton, Zamorano, Jose Luis, Zompatori, Maurizio, Zamorano, Jose Luis, Achenbach, Stephan, Baumgartner, Helmut, Bax, Jeroen J., Bueno, Hector, Dean, Veronica, Deaton, Christi, Erol, Çetin, Fagard, Robert, Ferrari, Roberto, Hasdai, David, Hoes, Arno, Kirchhof, Paulus, Knuuti, Juhani, Kolh, Philippe, Lancellotti, Patrizio, Linhart, Ales, Nihoyannopoulos, Petros, Piepoli, Massimo F., Ponikowski, Piotr, Sirnes, Per Anton, Tamargo, Juan Luis, Tendera, Michal, Torbicki, Adam, Wijns, William, Windecker, Stephan, Erol, Çetin, Jimenez, David, Ageno, Walter, Agewall, Stefan, Asteggiano, Riccardo, Bauersachs, Rupert, Becattini, Cecilia, Bounameaux, Henri, Büller, Harry R., Davos, Constantinos H., Deaton, Christi, Geersing, Geert-Jan, Sanchez, Miguel Angel Gómez, Hendriks, Jeroen, Hoes, Arno, Kilickap, Mustafa, Mareev, Viacheslav, Monreal, Manuel, Morais, Joao, Nihoyannopoulos, Petros, Popescu, Bogdan A., Sanchez, Olivier, Spyropoulos, Alex C., Skoro-Sajer, Nika, Najafov, Ruslan, Sudzhaeva, Svetlana, De Pauw, Michel, Baraković, Fahir, Tokmakova, Mariya, Skoric, Bosko, Rokyta, Richard, Hansen, Morten Lock, Elmet, Märt, Harjola, Veli-Pekka, Meyer, Guy, Chukhrukidze, Archil, Rosenkranz, Stephan, Androulakis, Aristides, Forster, Tamás, Fedele, Francesco, Sooronbaev, Talant, Maca, Aija, Ereminiene, Egle, Micallef, Josef, Andreasen, Arne, Kurzyna, Marcin, Ferreira, Daniel, Petris, Antoniu Octavian, Dzemeshkevich, Sergey, Asanin, Milika, Šimkova, Iveta, Anguita, Manuel, Christersson, Christina, Kostova, Nela, Baccar, Hedi, Sade, Leyla Elif, Parkhomenko, Alexander, and Pepke-Zaba, Joanna
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- 2014
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39. Seasonal variations of patients presenting dyspnea to emergency departments in Europe:Results from the EURODEM Study
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Rangé, Gregoire, Saint Etienne, Christophe, Marcollet, Pierre, Chassaing, Stephan, Dequenne, Philippe, Hakim, Radwan, Capsec, Jean, Laure, Christophe, Gautier, Sandra, Albert, Franck, Godillon, Lucile, Stolt, Pelle, Motreff, Pascal, Grammatico-Guillon, Leslie, Karamercan, Mehmet Akif, Dündar, Zerrin Defne, van Meer, Oene, Body, Richard, Harjola, Veli-Pekka, Verschuren, Franck, Christ, Michael, Golea, Adela, Barletta, Cinzia, Garcia-Castrillo, Luis, Altunci, Yusuf Ali, Katirci, Yavuz, Kelly, Anne-Maree, Laribi, Said, Hôpital Louis Pasteur [Chartres], CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre Hospitalier Jacques Coeur, Clinique Saint Gatien, Hôpitaux de Chartres [Chartres], Éducation Éthique Santé EA 7505 (EES), Université de Tours (UT), Maglia Rotta, Institut Pascal (IP), SIGMA Clermont (SIGMA Clermont)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Centre National de la Recherche Scientifique (CNRS), Unité d'Épidémiologie des données cliniques [Tours] (EpiDcliC), Helsingin yliopisto = Helsingfors universitet = University of Helsinki, Emergency Department (FV - ED), Saint Luc University Hospital, HUS Emergency Medicine and Services, University of Helsinki, and Faculty of Medicine
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Male ,Ambulances ,Comorbidity ,030204 cardiovascular system & hematology ,[SHS]Humanities and Social Sciences ,Cohort Studies ,0302 clinical medicine ,Epidemiology ,Risk-Factors ,Prospective Studies ,Diuretics ,Prospective cohort study ,ComputingMilieux_MISCELLANEOUS ,Aged, 80 and over ,0303 health sciences ,COPD ,education.field_of_study ,Age Factors ,General Medicine ,Middle Aged ,humanities ,ED diagnosis ,Anti-Bacterial Agents ,Bronchodilator Agents ,3. Good health ,Europe ,Hospitalization ,Female ,Seasons ,Emergency Service, Hospital ,medicine.medical_specialty ,emergency department ,Population ,Outcomes ,Article ,Exacerbations ,03 medical and health sciences ,older patient ,Lower respiratory tract infection ,medicine ,Humans ,education ,Aged ,030306 microbiology ,business.industry ,seasonal variations ,Oxygen Inhalation Therapy ,Emergency department ,Pneumonia ,3126 Surgery, anesthesiology, intensive care, radiology ,medicine.disease ,Dyspnea ,Emergency medicine ,Copd ,business - Abstract
Background/aim: To describe seasonal variations in epidemiology, management, and short-term outcomes of patients in Europe presenting to an emergency department (ED) with a main complaint of dyspnea. Materials and methods: An observational prospective cohort study was performed in 66 European EDs which included consecutive patients presenting to EDs with dyspnea as the main complaint during 3 72-h study periods. Data were collected on demographics, comorbidities, chronic treatment, prehospital treatment, mode of arrival of patient to ED, clinical signs at admission, treatment in the ED, ED diagnosis, discharge from ED, and in-hospital outcome. Results: The study included 2524 patients with a median age of 69 (53–80) years old. Of the patients presented, 991 (39.3%) were in autumn, 849 (33.6%) were in spring, and 48 (27.1%) were in winter. The winter population was significantly older (P < 0.001) and had a lower rate of ambulance arrival to ED (P < 0.001). In the winter period, there was a higher rate for lower respiratory tract infection (35.1%), and patients were more hypertensive, more hypoxic, and more hyper/hypothermic compared to other seasons. The ED mortality was about 1% and, in hospital, mortality for admitted patients was 7.4%. Conclusion: The analytic method and the outcome of this study may help to guide the allocation of ED resources more efficiently and to recommend seasonal ED management protocols based on the seasonal trend of dyspneic patients. © TÜBİTAK., Lietuvos Mokslo Taryba: MIP-049/2015, We would like to thank Toine van den Ende and Ans Kluivers for their assistance in collecting data in Europe. The work of Justina Motiejunaite was supported by the Research Council of Lithuania (Grant No. MIP-049/2015), as well as by training grants from the French government, the Embassy of France in Lithuania, and the Erasmus Program. The EuroDEM study protocol and informed consent was received and reviewed by the institutional review board and ethical committee for each country (and/ or institution), and all participants provided informed consent. The EuroDEM study was done under the supervision of the EUSEM Research Committee. Data management in Europe was facilitated by the Jeroen Bosch Hospital., The work of Justina Motiejunaite was supported by the Research Council of Lithuania (Grant No. MIP-049/2015), as well as by training grants from the French government, the Embassy of France in Lithuania, and the Erasmus Program.
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- 2020
40. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation
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Ibanez, Borja, James, Stefan, Agewall, Stefan, Antunes, Manuel J., Bucciarelli-Ducci, Chiara, Bueno, Hector, Caforio, Alida L. P., Crea, Filippo, Goudevenos, John A., Halvorsen, Sigrun, Hindricks, Gerhard, Kastrati, Adnan, Lenzen, Mattie J., Prescott, Eva, Roffi, Marco, Valgimigli, Marco, Varenhorst, Christoph, Vranckx, Pascal, Widimský, Petr, Baumbach, Andreas, Bugiardini, Raffaele, Coman, Ioan Mircea, Delgado, Victoria, Fitzsimons, Donna, Gaemperli, Oliver, Gershlick, Anthony H., Gielen, Stephan, Harjola, Veli-Pekka, Katus, Hugo A., Knuuti, Juhani, Kolh, Philippe, Leclercq, Christophe, Lip, Gregory Y. H., Morais, Joao, Neskovic, Aleksandar N., Neumann, Franz-Josef, Niessner, Alexander, Piepoli, Massimo Francesco, Richter, Dimitrios J., Shlyakhto, Evgeny, Simpson, Iain A, Steg, Ph Gabriel, Terkelsen, Christian Juhl, Thygesen, Kristian, Windecker, Stephan, Zamorano, Jose Luis, Zeymer, Uwe, Ibanez, Borja, James, Stefan, Agewall, Stefan, Antunes, Manuel J., Bucciarelli-Ducci, Chiara, Bueno, Hector, Caforio, Alida L. P., Crea, Filippo, Goudevenos, John A., Halvorsen, Sigrun, Hindricks, Gerhard, Kastrati, Adnan, Lenzen, Mattie J., Prescott, Eva, Roffi, Marco, Valgimigli, Marco, Varenhorst, Christoph, Vranckx, Pascal, Widimskã½, Petr, Baumbach, Andrea, Bugiardini, Raffaele, Coman, Ioan Mircea, Delgado, Victoria, Fitzsimons, Donna, Gaemperli, Oliver, Gershlick, Anthony H., Gielen, Stephan, Harjola, Veli-Pekka, Katus, Hugo A., Knuuti, Juhani, Kolh, Philippe, Leclercq, Christophe, Lip, Gregory Y. H., Morais, Joao, Neskovic, Aleksandar N., Neumann, Franz-Josef, Niessner, Alexander, Piepoli, Massimo Francesco, Richter, Dimitrios J., Shlyakhto, Evgeny, Simpson, Iain A, Steg, Ph Gabriel, Terkelsen, Christian Juhl, Thygesen, Kristian, Windecker, Stephan, Zamorano, Jose Lui, and Zeymer, Uwe
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Quality indicator ,medicine.medical_treatment ,Quality indicators ,Guideline ,ST-segment elevation ,030204 cardiovascular system & hematology ,0302 clinical medicine ,ST segment ,030212 general & internal medicine ,Myocardial infarction ,reproductive and urinary physiology ,Emergency medical system ,Evidence ,Risk assessment ,MINOCA ,Ischaemic heart disease ,Fibrinolysis ,Secondary prevention ,Primary percutaneous coronary intervention ,Reperfusion therapy ,Antithrombotics ,embryonic structures ,Cardiology ,Acute coronary syndrome ,biological phenomena, cell phenomena, and immunity ,Cardiology and Cardiovascular Medicine ,medicine.medical_specialty ,Acute myocardial infarction ,Acute coronary syndromes ,Guidelines ,Antithrombotic therapy ,03 medical and health sciences ,Antithrombotic ,Internal medicine ,medicine ,Fibrinolysi ,In patient ,cardiovascular diseases ,urogenital system ,Task force ,business.industry ,medicine.disease ,Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE ,business - Abstract
The ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their publication. The ESC is not responsible in the event of any contradiction, discrepancy and/or ambiguity between the ESC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the ESC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic or therapeutic medical strategies; however, the ESC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient's health condition and in consultation with that patient and, where appropriate and/or necessary, the patient's caregiver. Nor do the ESC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient's case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional's responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.
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- 2017
41. Seasonal variations of patients presenting dyspnea to emergency departments in Europe: Results from the EURODEM Study
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KARAMERCAN, Mehmet Akif, primary, DÜNDAR, Zerrin Defne, additional, ERGİN, Mehmet, additional, VAN MEER, Oene, additional, BODY, Richard, additional, HARJOLA, Veli-Pekka, additional, VERSCHUREN, Franck, additional, CHRIST, Michael, additional, GOLEA, Adela, additional, CAPSEC, Jean, additional, BARLETTA, Cinzia, additional, GARCIA-CASTRILLO, Luis, additional, ALTUNCI, Yusuf Ali, additional, KATIRCI, Yavuz, additional, KELLY, Anne-Maree, additional, and LARIBI, Said, additional
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- 2020
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42. Levosimendan Efficacy and Safety : 20 Years of SIMDAX in Clinical Use
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Papp, Zoltán, Álvarez, Julián, Bettex, Dominique, Bouchez, Stefan, Brito, Dulce, Černý, Vladimir, Comin-Colet, Comin-Colet, Josep, Crespo-Leiro, María Generosa, Delgado-Jiménez, Juan F., Édes, István, Eremenko, Alexander, Farmakis, Dimitrios, Fedele, Francesco, Fonseca, Candida, Fruhwald, Sonja, Girardis, Massimo, Guarracino, Fabio, Harjola, Veli-Pekka, Heringlake, Matthias, Herpain, Antoine, Heunks, Leo, Husebye, Tryggve, Ivancan, Višnja, Karason, Kristjan, Kaul, Sundeep, Kivikko, Matti, Kubica, Janek, Masip, Josep, Matskeplishvili, Simon, Mebazaa, Alexandre, Nieminen, Markku S., Oliva, Fabrizio, Papp, Julius G., Parissis, John, Parkhomenko, Alexander, Põder, Pentti, Pölzl, Gerhard, Reinecke, Alexander, Ricksten, Sven-Erik, Riha, Hynek, Rudiger, Alain, Sarapohja, Toni, Schwinger, Robert H. G., Toller, Wolfgang, Tritapepe, Luigi, Tschöpe, Carsten, Wikström, Gerhard, Lewinski, Dirk von, Vrtovec, Bojan, Pollesello, Piero, Agostoni, Piergiuseppe, HUS Emergency Medicine and Services, Helsinki University Hospital Area, University of Helsinki, HUS Heart and Lung Center, and Repositório da Universidade de Lisboa
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0301 basic medicine ,Inotrope ,lcsh:Diseases of the circulatory (Cardiovascular) system ,CALCIUM SENSITIZING DRUG ,Advanced heart failure ,Vasodilator Agents ,RIGHT-VENTRICULAR FUNCTION ,Cardiomyopathy ,TROPONIN-C ,Insuficiència cardíaca ,030204 cardiovascular system & hematology ,hemodynamics ,GLOMERULAR-FILTRATION-RATE ,AMYOTROPHIC-LATERAL-SCLEROSIS ,ARTERY-BYPASS GRAFT ,0302 clinical medicine ,CARDIAC TROPONIN-C ,Medicine and Health Sciences ,Neurohormone ,Cardiac and Cardiovascular Systems ,Myocardial infarction ,media_common ,Regulatory clinical trial ,0303 health sciences ,Kardiologi ,Cardiogenic shock ,Inodilator ,Cardiac surgery ,3. Good health ,Vasodilation ,Treatment Outcome ,317 Pharmacy ,inotrope ,Patient Safety ,Cardiology and Cardiovascular Medicine ,medicine.drug ,medicine.medical_specialty ,Pharmacological Therapy ,Cardiotonic Agents ,acute heart failure ,neurohormone ,Heart failure ,CARDIAC ,EXTRACORPOREAL MEMBRANE-OXYGENATION ,03 medical and health sciences ,DECOMPENSATED HEART-FAILURE ,medicine ,media_common.cataloged_instance ,Diseases of the circulatory (Cardiovascular) system ,Humans ,regulatory clinical trial ,European union ,Intensive care medicine ,inodilator ,Simendan ,030304 developmental biology ,Pharmacology ,Heart Failure ,haemodynamics ,BLOOD-FLOW ,business.industry ,advanced heart failure ,Hemodynamics ,CORONARY BLOOD-FLOW ,Acute heart failure ,Levosimendan ,medicine.disease ,Hemodinàmica ,Myocardial Contraction ,IMPROVES RENAL-FUNCTION ,030104 developmental biology ,lcsh:RC666-701 ,RC666-701 ,3121 General medicine, internal medicine and other clinical medicine ,CORONARY ,business - Abstract
Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc., Levosimendan was first approved for clinical use in 2000, when authorization was granted by Swedish regulatory authorities for the hemodynamic stabilization of patients with acutely decompensated chronic heart failure (HF). In the ensuing 20 years, this distinctive inodilator, which enhances cardiac contractility through calcium sensitization and promotes vasodilatation through the opening of adenosine triphosphate–dependent potassium channels on vascular smooth muscle cells, has been approved in more than 60 jurisdictions, including most of the countries of the European Union and Latin America. Areas of clinical application have expanded considerably and now include cardiogenic shock, takotsubo cardiomyopathy, advanced HF, right ventricular failure, pulmonary hypertension, cardiac surgery, critical care, and emergency medicine. Levosimendan is currently in active clinical evaluation in the United States. Levosimendan in IV formulation is being used as a research tool in the exploration of a wide range of cardiac and noncardiac disease states. A levosimendan oral form is at present under evaluation in the management of amyotrophic lateral sclerosis. To mark the 20 years since the advent of levosimendan in clinical use, 51 experts from 23 European countries (Austria, Belgium, Croatia, Cyprus, Czech Republic, Estonia, Finland, France, Germany, Greece, Hungary, Italy, the Netherlands, Norway, Poland, Portugal, Russia, Slovenia, Spain, Sweden, Switzerland, the United Kingdom, and Ukraine) contributed to this essay, which evaluates one of the relatively few drugs to have been successfully introduced into the acute HF arena in recent times and charts a possible development trajectory for the next 20 years.
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- 2020
43. Get with the guidelines: management of chronic obstructive pulmonary disease in emergency departments in Europe and Australasia is sub-optimal
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Van Meer, Oene, Keijzers, Gerben, Motiejunaite, Justina, Klim, Sharon, Capsec, Jean, Kuan, Win, McNulty, Richard, Tan, Clifford, Cowell, David Lord, Holdgate, Anna, Jain, Nitin, Devillecourt, Tracey, Forrester, Alan, Lee, Kendall, Chalkley, Dane, Gillett, Mark, Lozzi, Lydia, Asha, Stephen, Duffy, Martin, Watkins, Gina, Stone, Richard, Rosengren, David, Thone, Jae, Martin, Shane, Orda, Ulrich, Thom, Ogilvie, Kinnear, Frances, Eley, Rob, Ryan, Alison, Morel, Douglas, May, Christopher, Furyk, Jeremy, Thomson, Graeme, Smith, Simon, Smith, Richard, Maclean, Andrew, Grummisch, Michelle, Meyer, Alistair, Meek, Robert, Rosengarten, Pamela, Chan, Barry, Haythorne, Helen, Archer, Peter, Craig, Simon, Wilson, Kathryn, Knott, Jonathan, Ritchie, Peter, Bryant, Michael, MacDonald, Stephen, Lee, Tom, Mahlangu, Mlungisi, Mountain, David, Rogers, Ian, Otto, Tobias, Stuart, Peter, Bament, Jason, Brown, Michelle, Jones, Peter, Greven‐Garcia, Renee, Scott, Michael, Cheri, Thomas, Nguyen, Mai, Graham, Colin, Wong, Chi‐Pang, Wong, Tai Wai, Leung, Ling‐Pong, Man, Chan Ka, Saiboon, Ismail Mohd, Rahman, Nik Hisamuddin, Lee, Wee Yee, Lee, Francis Chun Yue, Kuan, Win Sen, Russell, SharonKerrie, Kelly, Anne‐Maree, Laribi, Gerbenand Said, Lawoko, Charles, Laribi, Said, Meer, Oene, Harjola, Veli‐Pekka, Golea, Adela, Christ, Michael, Garcia‐Castrillo, Luis, Al Dandachi, Ghanima, Maignan, Maxime, Hermand, DominiqueChristelle, Tessier, Cindy, Roy, Pierre‐Marie, Bucco, Lucie, Barletta, Cinzia, Carbone, Giorgio, Cosentini, Roberto, Truță, Sorana, Hrihorișan, Natalia, Cimpoeșu, Diana, Rotaru, Luciana, Petrică, Alina, Cojocaru, Mariana, Nica, Silvia, Tudoran, Rodica, Vecerdi, Cristina, Puticiu, Monica, Schönberger, Titus, Coolsma, Constant, Baggelaar, Maarten, Fransen, Noortje, Brand, Crispijn, Idzenga, Doutsje, Maas, Maaike, Franssen, Myriam, Mackaij‐Staal, Charlotte, Schutte, Lot, Kubber, Marije, Mignot‐Evers, Lisette, Penninga‐Puister, Ursula, Jansen, Joyce, Kuijten, Jeroen, Bouwhuis, Marna, Body, Richard, Reuben, Adam, Smith, Jason, Ramlakhan, Shammi, Darwent, Melanie, Gagg, James, Keating, Liza, Bongale, Santosh, Hardy, Elaine, Keep, Jeff, Jarman, Heather, Crane, Steven, Lawal, Olakunle, Hassan, Taj, Corfield, Alasdair, Reed, Matthew, Smolarsky, Yvonne, Blaschke, Sabine, Jerrentrup, ClemensAndreas, Hohenstein, Christian, Brünnler, FelixTanja, Ghuysen, Alexandre, Vranckx, Marc, Verschuren, Franck, Karamercan, Mehmet, Ergin, Mehmet, Dundar, Zerrin, Altuncu, Yusuf, Arziman, Ibrahim, Avcil, Mucahit, Katirci, Yavuz, Kokkonen, Liisa, Valli, JukkaJuha, Kiljunen, Minna, Tolonen, Jukka, Kaye, Sanna, Mäkelä, JukkaMikko, Metsäniitty, JukkaJuhani, Vaula, Eija, Duytsche, Nicolas, Garmilla, Pablo, HUS Emergency Medicine and Services, Department of Diagnostics and Therapeutics, University of Helsinki, Biomarqueurs CArdioNeuroVASCulaires (BioCANVAS), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Indian Institute of Technology Kharagpur (IIT Kharagpur), University of Leicester, Smith Watkins Trumpets, Institute for Fiscal Studies, Leibniz Institute for Tropospheric Research (TROPOS), University of California [Santa Barbara] (UCSB), University of California, iThemba Laboratory for Accelerator Based Science, Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Centre Hospitalier Universitaire [Grenoble] (CHU), Emergency Department (FV - ED), and Saint Luc University Hospital
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Male ,medicine.medical_specialty ,emergency department ,[SDV]Life Sciences [q-bio] ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,ACUTE EXACERBATIONS ,Pulmonary Disease, Chronic Obstructive ,03 medical and health sciences ,0302 clinical medicine ,Dyspnoea ,Internal Medicine ,medicine ,COPD ,Humans ,Prospective Studies ,030212 general & internal medicine ,PREDICTORS ,Prospective cohort study ,Emergency Treatment ,ComputingMilieux_MISCELLANEOUS ,Aged ,Aged, 80 and over ,Mechanical ventilation ,ASIA ,Australasia ,business.industry ,NEW-ZEALAND DYSPNEA ,Emergency department ,Guideline ,Middle Aged ,medicine.disease ,3. Good health ,Europe ,Respiratory acidosis ,3121 General medicine, internal medicine and other clinical medicine ,Practice Guidelines as Topic ,Emergency medicine ,outcome ,Breathing ,Female ,Observational study ,Emergency Service, Hospital ,business ,management - Abstract
OBJECTIVES: Exacerbations of chronic obstructive pulmonary disease (COPD) are common in emergency departments (ED). Guidelines recommend administration of inhaled bronchodilators, systemic corticosteroids and antibiotics along with non-invasive ventilation (NIV) for patients with respiratory acidosis. We aimed to determine compliance with guideline recommendations for patients with treated for COPD in ED in Europe (EUR) and South East Asia/Australasia (SEA) and to compare management and outcomes. METHODS: In each region, an observational prospective cohort study was performed that included patients presenting to EDs with the main complaint of dyspnoea during three 72-hour periods. This planned sub-study included those with an ED primary discharge diagnosis of COPD. Data were collected on demographics, clinical features, treatment, disposition and in-hospital mortality. We determined overall compliance with guideline recommendations and compared treatments and outcome between regions. RESULTS: 801 patients were included from 122 EDs (66 EUR and 46 SEA). Inhaled bronchodilators were administered to 80.3% of patients, systemic corticosteroids to 59.5%, antibiotics to 44% and 60.6% of patients with pH
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- 2020
44. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European respiratory society (ERS) : The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC)
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Konstantinides, Stavros V., Meyer, Guy, Bueno, Hector, Galié, Nazzareno, Gibbs, J. Simon R., Ageno, Walter, Agewall, Stefan, Almeida, Ana G., Andreotti, Felicita, Barbato, Emanuele, Baumbach, Andreas, Beygui, Farzin, Carlsen, Jørn, De Carlo, Marco, Delcroix, Marion, Subias, Pilar Escribano, Gaine, Sean, Goldhaber, Samuel Z., Gopalan, Deepa, Habib, Gilbert, Jenkins, David, Kjellström, Barbro, Lainscak, Mitja, Lee, Geraldine, Le Gal, Grégoire, Messas, Emmanuel, Morais, Joao, Piepoli, Massimo Francesco, Price, Susanna, Salvi, Aldo, Sanchez, Olivier, Stortecky, Stefan, Thielmann, Matthias, Noordegraaf, Anton Vonk, Becattini, Cecilia, Bueno, Héctor, Geersing, Geert Jan, Harjola, Veli Pekka, Huisman, Menno V., Humbert, Marc, Jennings, Catriona Sian, Jiménez, David, Kucher, Nils, Lang, Irene Marthe, Lankeit, Mareike, Lorusso, Roberto, Mazzolai, Lucia, Meneveau, Nicolas, Áinle, Fionnuala Ní, Prandoni, Paolo, Pruszczyk, Piotr, Righini, Marc, Torbicki, Adam, Van Belle, Eric, Zamorano, José Luis, Windecker, Stephan, Aboyans, Victor, Baigent, Colin, Collet, Jean Philippe, Dean, Veronica, Delgado, Victoria, Fitzsimons, Donna, Gale, Chris P., Grobbee, Diederick E., Hindricks, Gerhard, Iung, Bernard, Jüni, Peter, Katus, Hugo A., Landmesser, Ulf, Leclercq, Christophe, Lettino, Maddalena, Lewis, Basil S., Merkely, Bela, Mueller, Christian, Petersen, Steffen E., Petronio, Anna Sonia, Richter, Dimitrios J., Roffi, Marco, Shlyakhto, Evgeny, Simpson, Iain A., Sousa-Uva, Miguel, Touyz, Rhian M., Hammoudi, Naima, Hayrapetyan, Hamlet, Mascherbauer, Julia, Ibrahimov, Firdovsi, Polonetsky, Oleg, Lancellotti, Patrizio, Tokmakova, Mariya, Skoric, Bosko, Michaloliakos, Ioannis, Hutyra, Martin, Mellemkjaer, Søren, Mansour, Mostafa, Reinmets, Julia, Jääskeläinen, Pertti, Angoulvant, Denis, Bauersachs, Johann, Giannakoulas, George, Zima, Endre, Vizza, Carmine Dario, Sugraliyev, Akhmetzhan, Bytyçi, Ibadete, Maca, Aija, Ereminiene, Egle, Huijnen, Steve, Xuereb, Robert, Diaconu, Nadejda, Bulatovic, Nebojsa, Asfalou, Ilyasse, Bosevski, Marijan, Halvorsen, Sigrun, Sobkowicz, Bozena, Ferreira, Daniel, Petris, Antoniu Octavian, Moiseeva, Olga, Zavatta, Marco, Obradovic, Slobodan, Šimkova, Iveta, Radsel, Peter, Ibanez, Borja, Wikström, Gerhard, Aujesky, Drahomir, Kaymaz, Cihangir, Parkhomenko, Alexander, and Pepke-Zaba, Joanna
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thrombolysis ,pulmonary embolism ,treatment ,diagnosis ,education ,venous thromboembolism ,biomarkers ,heart failure ,shock ,Embolectomy ,Guidelines ,dyspnoea ,right ventricle ,humanities ,Anticoagulation ,Pregnancy ,Venous thrombosis ,Journal Article ,echocardiography ,Cardiology and Cardiovascular Medicine ,health care economics and organizations ,Risk assessment - Abstract
Guidelines summarize and evaluate available evidence with the aim of assisting health professionals in proposing the best management strategies for an individual patient with a given condition. Guidelines and their recommendations should facilitate decision making of health professionals in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate.
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- 2020
45. an international multicentre single-arm clinical trial
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Barco, Stefano, Schmidtmann, Irene, Ageno, Walter, Bauersachs, Rupert M., Becattini, Cecilia, Bernardi, Enrico, Beyer-Westendorf, Jan, Bonacchini, Luca, Brachmann, Johannes, Christ, Michael, Czihal, Michael, Duerschmied, Daniel, Empen, Klaus, Espinola-Klein, Christine, Ficker, Joachim H., Fonseca, Cândida, Genth-Zotz, Sabine, Jiménez, David, Harjola, Veli Pekka, Held, Matthias, Iogna Prat, Lorenzo, Lange, Tobias J., Manolis, Athanasios, Meyer, Andreas, Mustonen, Pirjo, Rauch-Kroehnert, Ursula, Ruiz-Artacho, Pedro, Schellong, Sebastian, Schwaiblmair, Martin, Stahrenberg, Raoul, Westerweel, Peter E., Wild, Philipp S., Konstantinides, Stavros V., Lankeit, Mareike, and NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)
- Subjects
Rivaroxaban ,SDG 3 - Good Health and Well-being ,Pulmonary embolism ,Home treatment ,Management trial ,Right ventricular dysfunction ,Cardiology and Cardiovascular Medicine ,Risk stratification - Abstract
Funding: HoT-PE is an independent, investigator-initiated trial with an academic sponsor (Centre for Thrombosis and Haemostasis, University Medical Centre Mainz, Germany). The work of Stefano Barco, Philipp S. Wild, Stavros V. Konstantinides, and Mareike Lankeit was supported by the German Federal Ministry of Education and Research [BMBF 01EO1003 and 01EO1503]. In addition, the sponsor has obtained the study drug (rivaroxaban) and a grant from the market authorization holder of rivaroxaban, Bayer AG. AIMS: To investigate the efficacy and safety of early transition from hospital to ambulatory treatment in low-risk acute PE, using the oral factor Xa inhibitor rivaroxaban. METHODS AND RESULTS: We conducted a prospective multicentre single-arm investigator initiated and academically sponsored management trial in patients with acute low-risk PE (EudraCT Identifier 2013-001657-28). Eligibility criteria included absence of (i) haemodynamic instability, (ii) right ventricular dysfunction or intracardiac thrombi, and (iii) serious comorbidities. Up to two nights of hospital stay were permitted. Rivaroxaban was given at the approved dose for PE for ≥3 months. The primary outcome was symptomatic recurrent venous thromboembolism (VTE) or PE-related death within 3 months of enrolment. An interim analysis was planned after the first 525 patients, with prespecified early termination of the study if the null hypothesis could be rejected at the level of α = 0.004 (
- Published
- 2020
46. Levosimendan Efficacy and Safety: 20 years of SIMDAX in Clinical Use
- Author
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Papp, Zoltán Agostoni, Piergiuseppe Alvarez, Julian Bettex, Dominique Bouchez, Stefan Brito, Dulce Černý, Vladimir Comin-Colet, Josep Crespo-Leiro, Marisa G. Delgado, Juan F. Édes, Istvan Eremenko, Alexander A. Farmakis, Dimitrios Fedele, Francesco Fonseca, Cândida Fruhwald, Sonja Girardis, Massimo Guarracino, Fabio Harjola, Veli-Pekka Heringlake, Matthias Herpain, Antoine Heunks, Leo Ma Husebye, Tryggve Ivancan, Višnja Karason, Kristjan Kaul, Sundeep Kivikko, Matti Kubica, Janek Masip, Josep Matskeplishvili, Simon Mebazaa, Alexandre Nieminen, Markku S. Oliva, Fabrizio Papp, Julius-Gyula Parissis, John Parkhomenko, Alexander Põder, Pentti Pölzl, Gerhard Reinecke, Alexander Ricksten, Sven-Erik Riha, Hynek Rudiger, Alain Sarapohja, Toni Schwinger, Robert Hg Toller, Wolfgang Tritapepe, Luigi Tschöpe, Carsten Wikström, Gerhard von Lewinski, Dirk Vrtovec, Bojan Pollesello, Piero
- Abstract
Levosimendan was first approved for clinic use in 2000, when authorisation was granted by Swedish regulatory authorities for the haemodynamic stabilisation of patients with acutely decompensated chronic heart failure. In the ensuing 20 years, this distinctive inodilator, which enhances cardiac contractility through calcium sensitisation and promotes vasodilatation through the opening of adenosine triphosphate-dependent potassium channels on vascular smooth muscle cells, has been approved in more than 60 jurisdictions, including most of the countries of the European Union and Latin America. Areas of clinical application have expanded considerably and now include cardiogenic shock, takotsubo cardiomyopathy, advanced heart failure, right ventricular failure and pulmonary hypertension, cardiac surgery, critical care and emergency medicine. Levosimendan is currently in active clinical evaluation in the US. Levosimendan in IV formulation is being used as a research tool in the exploration of a wide range of cardiac and non-cardiac disease states. A levosimendan oral form is at present under evaluation in the management of amyotrophic lateral sclerosis. To mark the 20 years since the advent of levosimendan in clinical use, 51 experts from 23 European countries (Austria, Belgium, Croatia, Cyprus, Czech Republic, Estonia, Finland, France, Germany, Greece, Hungary, Italy, the Netherlands, Norway, Poland, Portugal, Russia, Slovenia, Spain, Sweden, Switzerland, UK and Ukraine) contributed to this essay, which evaluates one of the relatively few drugs to have been successfully introduced into the acute heart failure arena in recent times and charts a possible development trajectory for the next 20 years.
- Published
- 2020
47. Acute coronary syndromes and acute heart failure: a diagnostic dilemma and high-risk combination. A statement from the Acute Heart Failure Committee of the Heart Failure Association of the European Society of Cardiology
- Author
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Harjola, Veli-Pekka Parissis, John Bauersachs, Johann and Brunner-La Rocca, Hans-Peter Bueno, Hector Celutkiene, Jelena and Chioncel, Ovidiu Coats, Andrew J. S. Collins, Sean P. de Boer, Rudolf A. Filippatos, Gerasimos Gayat, Etienne Hill, Loreena Laine, Mika Lassus, Johan Lommi, Jyri Masip, Josep Mebazaa, Alexandre Metra, Marco Miro, Oscar and Mortara, Andrea Mueller, Christian Mullens, Wilfried and Peacock, W. Frank Pentikaeinen, Markku Piepoli, Massimo F. and Polyzogopoulou, Effie Rudiger, Alain Ruschitzka, Frank and Seferovic, Petar Sionis, Alessandro Teerlink, John R. Thum, Thomas Varpula, Marjut Weinstein, Jean Marc Yilmaz, Mehmet B.
- Abstract
Acute coronary syndrome is a precipitant of acute heart failure in a substantial proportion of cases, and the presence of both conditions is associated with a higher risk of short-term mortality compared to acute coronary syndrome alone. The diagnosis of acute coronary syndrome in the setting of acute heart failure can be challenging. Patients may present with atypical or absent chest pain, electrocardiograms can be confounded by pre-existing abnormalities, and cardiac biomarkers are frequently elevated in patients with chronic or acute heart failure, independently of acute coronary syndrome. It is important to distinguish transient or limited myocardial injury from primary myocardial infarction due to vascular events in patients presenting with acute heart failure. This paper outlines various clinical scenarios to help differentiate between these conditions and aims to provide clinicians with tools to aid in the recognition of acute coronary syndrome as a cause of acute heart failure. Interpretation of electrocardiogram and biomarker findings, and imaging techniques that may be helpful in the diagnostic work-up are described. Guidelines recommend an immediate invasive strategy for patients with acute heart failure and acute coronary syndrome, regardless of electrocardiographic or biomarker findings. Pharmacological management of patients with acute coronary syndrome and acute heart failure should follow guidelines for each of these syndromes, with priority given to time-sensitive therapies for both. Studies conducted specifically in patients with the combination of acute coronary syndrome and acute heart failure are needed to better define the management of these patients.
- Published
- 2020
48. Circulating MiRNA Dynamics in ST-Segment Elevation Myocardial Infarction-driven Cardiogenic Shock
- Author
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Iborra-Egea, Oriol, Rueda, Ferran, Lakkisto, Päivi, Harjola, Veli-Pekka, Garcia-Garcia, Cosme, Bayes-Genis, Antoni, HUSLAB, Department of Clinical Chemistry and Hematology, University of Helsinki, HUS Emergency Medicine and Services, and Department of Diagnostics and Therapeutics
- Subjects
3121 General medicine, internal medicine and other clinical medicine ,education ,HEART - Abstract
Non
- Published
- 2019
49. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)
- Author
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European Soc Cardiology ESC, Konstantinides, Stavros V., Meyer, Guy, Harjola, Veli-Pekka, Luis Zamorano, Jose, HUS Emergency Medicine and Services, Department of Diagnostics and Therapeutics, Helsinki University Hospital Area, and University of Helsinki
- Subjects
ORAL ANTICOAGULANT-THERAPY ,EXTRACORPOREAL MEMBRANE-OXYGENATION ,RIGHT-VENTRICULAR DYSFUNCTION ,INHALED NITRIC-OXIDE ,INFERIOR VENA-CAVA ,education ,RIGHT HEART THROMBI ,MOLECULAR-WEIGHT HEPARIN ,DEEP-VEIN THROMBOSIS ,VENTILATION-PERFUSION SCINTIGRAPHY ,3126 Surgery, anesthesiology, intensive care, radiology ,RECURRENT VENOUS THROMBOEMBOLISM - Published
- 2019
50. The COACH risk engine: a multistate model for predicting survival and hospitalization in patients with heart failure
- Author
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Postmus, Douwe, van Veldhuisen, Dirk J., Jaarsma, Tiny, Luttik, Marie Louise, Lassus, Johan, Mebazaa, Alexandre, Nieminen, Markku S., Harjola, Veli-Pekka, Lewsey, James, Buskens, Erik, and Hillege, Hans L.
- Published
- 2012
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