32 results on '"Harjola, Veli-Pekka"'
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2. Low body temperature and mortality in older patients with frailty in the emergency department
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Alakare, Janne, Kemp, Kirsi, Strandberg, Timo, Castrén, Maaret, Tolonen, Jukka, and Harjola, Veli-Pekka
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- 2022
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3. Short-term outcomes of heart failure patients with reduced and preserved ejection fraction after acute decompensation according to the final destination after emergency department care
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Miró, Òscar, Gil, V.íctor, Martín-Sánchez, Francisco Javier, Jacob, Javier, Herrero, Pablo, Alquézar, Aitor, Llauger, Lluís, Aguiló, Sira, Martínez, Gemma, Ríos, José, Domínguez-Rodríguez, Alberto, Harjola, Veli-Pekka, Müller, Christian, Parissis, John, Peacock, W. Frank, Llorens, Pere, and The Research Group on Acute Heart Failure of the Spanish Society of Emergency Medicine (ICA-SEMES Research Group) Researchers
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- 2018
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4. Effects of the intensity of prehospital treatment on short-term outcomes in patients with acute heart failure: the SEMICA-2 study
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Miró, Òscar, Hazlitt, Melissa, Escalada, Xavier, Llorens, Pere, Gil, Víctor, Martín-Sánchez, Francisco Javier, Harjola, Pia, Rico, Verónica, Herrero-Puente, Pablo, Jacob, Javier, Cone, David C., Möckel, Martin, Christ, Michael, Freund, Yonathan, di Somma, Salvatore, Laribi, Said, Mebazaa, Alexandre, Harjola, Veli-Pekka, and On behalf of the ICA-SEMES Research Group
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- 2018
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5. Association between hypo- and hyperkalemia and outcome in acute heart failure patients: the role of medications
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Legrand, Matthieu, Ludes, Pierre-Olivier, Massy, Ziad, Rossignol, Patrick, Parenica, Jiri, Park, Jin-Joo, Ishihara, Shiro, AlHabib, Khalid F., Maggioni, Aldo, Miró, Òscar, Sato, Naoki, Cohen-Solal, Alain, Fairman, Enrique, Lassus, Johan, Harjola, Veli-Pekka, Mueller, Christian, Peacock, Franck W., Choi, Dong-Ju, Plaisance, Patrick, Spinar, Jindřich, Kosiborod, Mikhail, Mebazaa, Alexandre, Gayat, Etienne, and GREAT (Global Research on Acute Conditions Team) Network and INI-CRCT (Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists) network
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- 2018
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6. 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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7. 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
8. 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
9. 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
10. 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
11. Serum Lactate and A Relative Change in Lactate as Predictors of Mortality in Patients With Cardiogenic Shock - Results from the Cardshock Study
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John Parissis, Jindrich Spinar, Johan Lassus, Marek Banaszewski, José Silva-Cardoso, Lars Køber, Valentina Carubelli, Harjola Veli-Pekka, Alexandre Mebazaa, Matias Greve Lindholm, Mari Hongisto, diSomma Salvatore, and Alessandro Sionis
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Adult ,Male ,medicine.medical_specialty ,acute heart failure ,medicine.medical_treatment ,A relative change in lactate ,Shock, Cardiogenic ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,In patient ,Myocardial infarction ,Lactic Acid ,Aged ,Proportional Hazards Models ,Aged, 80 and over ,lactate ,business.industry ,Cardiogenic shock ,cardiogenic shock ,Hazard ratio ,Hemodynamics ,Percutaneous coronary intervention ,030208 emergency & critical care medicine ,prediction ,Middle Aged ,medicine.disease ,mortality ,Confidence interval ,3. Good health ,lactate clearance ,Multivariate Analysis ,Emergency Medicine ,Cardiology ,Population study ,Female ,business ,Anaerobic exercise - Abstract
Introduction: Cardiogenic shock complicating acute myocardial infarction has a very high mortality. Our present study focuses on serial measurement of lactate during admission due to cardiogenic shock and the prognostic effect of lactate and a relative change in lactate in patients after admission and the institution of intensive care treatment. Methods and Results: This is a secondary analysis of the CardShock study. Data on lactate at baseline were available on 217 of 219 patients. In the study population, the median baseline lactate was 2.8 mmol/L (min-max range, 0.5-23.1 mmol/L). At admission, lactate was predictive of 30-day mortality with an adjusted Hazard ratio (HR) of 1.20 mmol/L (95% confidence interval, CI 1.14-1.27). Within the first 24 h of admission, baseline lactate remained predictive of 30-day mortality. Lactate at 6 h had a HR of 1.14 (95% CI 1.06-1.24) and corresponding values at 12 and 24 h had a HR of 1.10 (1.04-1.17), and of HR 1.19 (95% CI 1.07-1.32), respectively. A 50% reduction in lactate within 6 h resulted in a HR of 0.82 (95% CI 0.72-0.94). Corresponding hazard ratios at 12 and 24 h, were 0.87 (95% CI 0.76-0.98) and 0.74 (95% CI 0.60-0.91), respectively. Conclusion: The main findings of the present study are that baseline lactate is a powerful predictor of 30-day mortality, lactate at 6, 12, and 24 h after admission are predictors of 30-day mortality, and a relative change in lactate is a significant predictor of survival within the first 24 h after instituting intensive care treatment adding information beyond the information from baseline values.
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- 2019
12. Circulating levels of 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, Bayés-Genís, Antoni, Tikkanen, Ilkka, Lakkisto, Päivi, Harjola, Veli-Pekka, and Universitat Autònoma de Barcelona. Departament de Medicina
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Mir-423-5p ,Acute coronary syndrome ,Mortality ,Prognosis ,Cardiogenic shock ,Microrna - Abstract
Ajuts: This work was supported by grants from the Finnish Foundation for Cardiovascular Research, Aarne Koskelo Foundation, Finnish Foundation for Laboratory Medicine, FinskaLäkaresällskapet, the Liv och Hälsa Foundation, and Finnish state funding for university-level research. 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. 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 < 0.001) as well as lower cardiac index (1.8 vs. 2.4, P = 0.04) and estimated glomerular filtration rate (56 vs. 70 mL/min/1.73 m 2, P = 0.002). In Cox regression analysis, miR-423-5p level above median was associated with 90 day all-cause mortality independently of established risk factors of cardiogenic shock [adjusted hazard ratio 1.9 (95% confidence interval 1.2-3.2), P = 0.01]. In cardiogenic shock patients, above median level of miR-423-5p at baseline is associated with markers of hypoperfusion and seems to independently predict 90 day all-cause mortality.
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- 2018
13. Effects of the intensity of prehospital treatment on short-term outcomes in patients with acute heart failure: the SEMICA-2 study
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Mirã³, Ã’Scar, Hazlitt, Melissa, Escalada, Xavier, Llorens, Pere, Gil, Vãctor, MartÃn-Sánchez, Francisco Javier, Harjola, Pia, Rico, Verã³nica, Herrero-Puente, Pablo, Jacob, Javier, Cone, David C., Mã¶ckel, Martin, Christ, Michael, Freund, Yonathan, Di Somma, Salvatore, Laribi, Said, Mebazaa, Alexandre, Harjola, Veli-Pekka, Fuentes, Marta, Gil, Cristina, Alonso, Hã©ctor, Garmila, Pablo, Adrada, Esther RodrÃguez, Escoda, Rosa, Xipell, Carolina, Sã¡nchez, Carolina, Gaytan, Josep Mª, Salvo, Eva, Pérez-Durá, MarÃa José, Noval, Antonio, Torres, José M., Juan-Gómez, Maria Ãngeles, López-Grima, MarÃa Luisa, Valero, Amparo, Aguirre, Alfons, Pedragosa, Maria Àngels, Alonso, Maria Isabel, Ruiz, Francisco, Franco, José Miguel, DIAZ DELGADO, ELENA LOPEZ, Mecina, Ana Belén, Tost, Josep, Sã¡nchez, Susana, Piã±era, Pascual, Torres-Garate, Raquel, Alquezar, Aitor, Rizzi, Miguel Alberto, Herrera, Sergio, Cabello, Irene, Ãlvarez-Pérez, José MarÃa, López-Diez, Maria Pilar, Vázquez-Alvarez, Joaquin, Sánchez-Gonzalez, Marta, Gil-Román, Jose Juan, Carratalã¡, José Manuel, Brouzet, Benjamin, Marquina, Vãctor, Jimã©nez, Inmaculada, Hernã¡ndez, Nã©stor, Romã¡n, Francisco, Antonio Andueza, Juan, Romero, Rodolfo, Calvache, Roberto, Lorca, Maria Teresa, Calderã³n, Luis, Arriaga, Beatriz Amores, Sierra, Beatriz, MartÃn-Mojarro, Enrique, TraverÃa-Bécquer, Lisette, Llauger-Garcia, Lluãs, Corominas-LaSalle, Gerard, Agüera-Urbano, Carmen, Soy-Ferrer, Ester, Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], Université Pierre et Marie Curie - Paris 6 (UPMC), Biomarqueurs CArdioNeuroVASCulaires (BioCANVAS), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département d'Anesthésie Réanimation SMUR [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and University of Helsinki
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Male ,Emergency Medical Services ,Time Factors ,[SDV]Life Sciences [q-bio] ,030204 cardiovascular system & hematology ,0302 clinical medicine ,Risk Factors ,Positive airway pressure ,Clinical endpoint ,Odds Ratio ,030212 general & internal medicine ,Hospital Mortality ,Registries ,ComputingMilieux_MISCELLANEOUS ,Aged, 80 and over ,Furosemide ,General Medicine ,Combined Modality Therapy ,3. Good health ,prehospital care ,Treatment Outcome ,Acute Disease ,advanced life support ,outcome ,Cardiology ,Breathing ,Female ,Cardiology and Cardiovascular Medicine ,medicine.drug ,medicine.medical_specialty ,acute heart failure ,mortality ,cardiology and cardiovascular medicine ,Advanced Cardiac Life Support ,03 medical and health sciences ,Internal medicine ,Statistical significance ,medicine ,Humans ,Aged ,Heart Failure ,Chi-Square Distribution ,business.industry ,Odds ratio ,Length of Stay ,medicine.disease ,Advanced life support ,Logistic Models ,Spain ,Heart failure ,Emergency medicine ,business - Abstract
Little is known about treatments provided by advanced life support (ALS) ambulance teams to patients with acute heart failure (AHF) during the prehospital phase, and their influence on short-term outcome. We evaluated the effect of prehospital care in consecutive patients diagnosed with AHF in Spanish emergency departments (EDs). We selected patients from the EAHFE registry arriving at the ED by ALS ambulances with available follow-up data. We recorded specific prehospital ALS treatments (supplemental oxygen, diuretics, nitroglycerin, non-invasive ventilation) and patients were grouped according to whether they received low- (LIPHT; 0/1 treatments) or high-intensity prehospital therapy (HIPHT; > 1 treatment) for AHF. We also recorded 46 covariates. The primary endpoint was all-cause 7-day mortality, and secondary endpoints were prolonged hospitalisation (> 10 days) and in-hospital and 30-day mortality. Unadjusted and adjusted odds ratios were calculated to compare the groups. We included 1493 patients [mean age 80.7 (10) years; women 54.8%]. Prehospital treatment included supplemental oxygen in 71.2%, diuretics in 27.9%, nitroglycerin in 13.5%, and non-invasive ventilation in 5.3%. The LIPHT group included 1041 patients (70.0%) with an unadjusted OR for 7-day mortality of 1.770 (95% CI 1.115–2.811; p = 0.016), and 1.939 (95% CI 1.114–3.287, p = 0.014) after adjustment for 16 discordant covariables. The adjusted ORs for all secondary endpoints were always > 1 in the LIPHT group, but none reached statistical significance. Patients finally diagnosed with AHF at then ED that have received LIPHT by the ALS ambulance teams have a poorer short-term outcome, especially during the first 7 days.
- Published
- 2017
14. Current Use and Impact on 30-Day Mortality of Pulmonary Artery Catheter in Cardiogenic Shock Patients: Results From the CardShock Study.
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Sionis, Alessandro, Rivas-Lasarte, Mercedes, Mebazaa, Alexandre, Tarvasmäki, Tuukka, Sans-Roselló, Jordi, Tolppanen, Heli, Varpula, Marjut, Jurkko, Raija, Banaszewski, Marek, Silva-Cardoso, Jose, Carubelli, Valentina, Lindholm, Matias Greve, Parissis, John, Spinar, Jindrich, Lassus, Johan, Harjola, Veli-Pekka, and Masip, Josep
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CARDIOGENIC shock ,PULMONARY artery catheters ,HOSPITAL mortality ,HEMODYNAMICS ,ARTIFICIAL respiration - Abstract
Background: Cardiogenic shock (CS) is the most life-threatening manifestation of acute heart failure. Its complexity and high inhospital mortality may justify the need for invasive monitoring with a pulmonary artery catheter (PAC). Methods: Patients with CS included in the CardShock Study, an observational, prospective, multicenter, European registry, were analyzed, aiming to describe the real-world use of PAC, evaluate its impact on 30-day mortality, and the ability of different hemodynamic parameters to predict outcomes. Results: Pulmonary artery catheter was used in 82 (37.4%) of the 219 patients. Cardiogenic shock patients who managed with a PAC received more frequently treatment with inotropes and vasopressors, mechanical ventilation, renal replacement therapy, and mechanical assist devices (P < .01). Overall 30-day mortality was 36.5%. Pulmonary artery catheter use did not affect mortality even after propensity score matching analysis (hazard ratio = 1.17 [0.59-2.32], P = .66). Cardiac index, cardiac power index (CPI), and stroke volume index (SVI) showed the highest areas under the curve for 30-day mortality (ranging from 0.752-0.803) and allowed for a significant net reclassification improvement of 0.467 (0.083-1.180), 0.700 (0.185-1.282), 0.683 (0.168-1.141), respectively, when added to the CardShock risk score. Conclusions: In our contemporary cohort of CS, over one-third of patients were managed with a PAC. Pulmonary artery catheter use was associated with a more aggressive treatment strategy. Nevertheless, PAC use was not associated with 30-day mortality. Cardiac index, CPI, and SVI were the strongest 30-day mortality predictors on top of the previously validated CardShock risk score. [ABSTRACT FROM AUTHOR]
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- 2020
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15. Seasonal variations of patients presenting dyspnea to emergency departments in Europe: Results from the EURODEM Study.
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KARAMERCAN, Mehmet Akif, DÜNDAR, Zerrin Defne, ERGİN, Mehmet, VAN MEER, Oene, BODY, Richard, HARJOLA, Veli-Pekka, VERSCHUREN, Franck, CHRIST, Michael, GOLEA, Adela, CAPSEC, Jean, BARLETTA, Cinzia, GARCIA-CASTRILLO, Luis, ALTUNCI, Yusuf Ali, KATIRCI, Yavuz, KELLY, Anne-Maree, and LARIBI, Said
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HOSPITAL emergency services ,AMBULANCES ,RESPIRATORY infections ,DYSPNEA ,MORTALITY ,ACQUISITION of data - 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. [ABSTRACT FROM AUTHOR]
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- 2020
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16. Acute kidney injury in cardiogenic shock: definitions, incidence, haemodynamic alterations, and mortality.
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Tarvasmäki, Tuukka, Haapio, Mikko, Mebazaa, Alexandre, Sionis, Alessandro, Silva‐Cardoso, José, Tolppanen, Heli, Lindholm, Matias Greve, Pulkki, Kari, Parissis, John, Harjola, Veli‐Pekka, Lassus, Johan, on behalf of the CardShock Study Investigators, Silva-Cardoso, José, Harjola, Veli-Pekka, and CardShock Study Investigators
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CARDIOGENIC shock ,HEMODYNAMIC monitoring ,KIDNEY injuries ,CREATININE ,MORTALITY - Abstract
Copyright of European Journal of Heart Failure is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2018
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17. Current real-life use of vasopressors and inotropes in cardiogenic shock - adrenaline use is associated with excess organ injury and mortality
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Tarvasmäki, Tuukka, Lassus, Johan, Varpula, Marjut, Sionis, Alessandro, Sund, Reijo, Kober, Lars, Spinar, Jindrich, Parissis, John, Banaszewski, Marek, Cardoso, Jose Silva, Carubelli, Valentina, Di Somma, Salvatore, Mebazaa, Alexandre, Harjola, Veli-Pekka, CardShock Study Investigators, Clinicum, Department of Diagnostics and Therapeutics, Department of Medicine, Kardiologian yksikkö, and Department of Social Research (2010-2017)
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Male ,Letter ,Survival ,Propensity score ,ILL PATIENTS ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,0302 clinical medicine ,Inotropes ,SUPPORT ,Vasoconstrictor Agents ,Myocardial infarction ,Hospital Mortality ,Cardiogenic shock ,Middle Aged ,3. Good health ,NOREPINEPHRINE ,Shock (circulatory) ,Cardiology ,adrenaline ,cardiogenic shock ,inotropes ,mortality ,propensity score ,survival ,vasoactive medication ,vasopressors ,HEART-FAILURE ,Female ,medicine.symptom ,medicine.drug ,Vasoactive medication ,Adult ,Mean arterial pressure ,medicine.medical_specialty ,ACUTE MYOCARDIAL-INFARCTION ,Cardiotonic Agents ,Vasopressors ,Epinephrine ,Shock, Cardiogenic ,RENAL DYSFUNCTION ,Adrenaline ,03 medical and health sciences ,Internal medicine ,LOW-DOSE DOPAMINE ,medicine ,MANAGEMENT ,Humans ,Mortality ,Aged ,Tissue Survival ,business.industry ,Hemodynamics ,030208 emergency & critical care medicine ,Levosimendan ,medicine.disease ,3126 Surgery, anesthesiology, intensive care, radiology ,TRENDS ,RANDOMIZED-TRIAL ,Blood pressure ,Heart failure ,3121 General medicine, internal medicine and other clinical medicine ,Dobutamine ,business - Abstract
Background: Vasopressors and inotropes remain a cornerstone in stabilization of the severely impaired hemodynamics and cardiac output in cardiogenic shock (CS). The aim of this study was to analyze current real-life use of these medications, and their impact on outcome and on changes in cardiac and renal biomarkers over time in CS. Methods: The multinational CardShock study prospectively enrolled 219 patients with CS. The use of vasopressors and inotropes was analyzed in relation to the primary outcome, i.e., 90-day mortality, with propensity score methods in 216 patients with follow-up data available. Changes in cardiac and renal biomarkers over time until 96 hours from baseline were analyzed with linear mixed modeling. Results: Patients were 67 (SD 12) years old, 26 % were women, and 28 % had been resuscitated from cardiac arrest prior to inclusion. On average, systolic blood pressure was 78 (14) and mean arterial pressure 57 (11) mmHg at detection of shock. 90-day mortality was 41 %. Vasopressors and/or inotropes were administered to 94 % of patients and initiated principally within the first 24 hours. Noradrenaline and adrenaline were given to 75 % and 21 % of patients, and 30 % received several vasopressors. In multivariable logistic regression, only adrenaline (21 %) was independently associated with increased 90-day mortality (OR 5.2, 95 % CI 1.88, 14.7, p = 0.002). The result was independent of prior cardiac arrest (39 % of patients treated with adrenaline), and the association remained in propensity-score-adjusted analysis among vasopressor-treated patients (OR 3.0, 95 % CI 1.3, 7.2, p = 0.013); this was further confirmed by propensity-score-matched analysis. Adrenaline was also associated, independent of prior cardiac arrest, with marked worsening of cardiac and renal biomarkers during the first days. Dobutamine and levosimendan were the most commonly used inotropes (49 % and 24 %). There were no differences in mortality, whether noradrenaline was combined with dobutamine or levosimendan. Conclusion: Among vasopressors and inotropes, adrenaline was independently associated with 90-day mortality in CS. Moreover, adrenaline use was associated with marked worsening in cardiac and renal biomarkers. The combined use of noradrenaline with either dobutamine or levosimendan appeared prognostically similar.
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- 2016
18. Protein-based cardiogenic shock patient classifier.
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Rueda, Ferran, Borràs, Eva, García-García, Cosme, Iborra-Egea, Oriol, Revuelta-López, Elena, Harjola, Veli-Pekka, Cediel, Germán, Lassus, Johan, Tarvasmäki, Tuukka, Mebazaa, Alexandre, Sabidó, Eduard, and Bayés-Genís, Antoni
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Aims Cardiogenic shock (CS) is associated with high short-term mortality and a precise CS risk stratification could guide interventions to improve patient outcome. Here, we developed a circulating protein-based score to predict short-term mortality risk among patients with CS. Methods and results Mass spectrometry analysis of 2654 proteins was used for screening in the Barcelona discovery cohort (n = 48). Targeted quantitative proteomics analyses (n = 51 proteins) were used in the independent CardShock cohort (n = 97) to derive and cross-validate the protein classifier. The combination of four circulating proteins (Cardiogenic Shock 4 proteins—CS4P), discriminated patients with low and high 90-day risk of mortality. CS4P comprises the abundances of liver-type fatty acid-binding protein, beta-2-microglobulin, fructose-bisphosphate aldolase B, and SerpinG1. Within the CardShock cohort used for internal validation, the C-statistic was 0.78 for the CardShock risk score, 0.83 for the CS4P model, and 0.84 (P = 0.033 vs. CardShock risk score) for the combination of CardShock risk score with the CS4P model. The CardShock risk score with the CS4P model showed a marked benefit in patient reclassification, with a net reclassification improvement (NRI) of 0.49 (P = 0.020) compared with CardShock risk score. Similar reclassification metrics were observed in the IABP-SHOCK II risk score combined with CS4P (NRI =0.57; P = 0.032). The CS4P patient classification power was confirmed by enzyme-linked immunosorbent assay (ELISA). Conclusion A new protein-based CS patient classifier, the CS4P, was developed for short-term mortality risk stratification. CS4P improved predictive metrics in combination with contemporary risk scores, which may guide clinicians in selecting patients for advanced therapies. Download slide Download slide [ABSTRACT FROM AUTHOR]
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- 2019
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19. Hypoalbuminemia is a frequent marker of increased mortality in cardiogenic shock.
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Jäntti, Toni, Tarvasmäki, Tuukka, Harjola, Veli-Pekka, Parissis, John, Pulkki, Kari, Javanainen, Tuija, Tolppanen, Heli, Jurkko, Raija, Hongisto, Mari, Kataja, Anu, Sionis, Alessandro, Silva-Cardoso, Jose, Banaszewski, Marek, Spinar, Jindrich, Mebazaa, Alexandre, Lassus, Johan, and null, null
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CARDIOGENIC shock ,INTRA-aortic balloon counterpulsation ,SERUM albumin ,MORTALITY ,THERAPEUTICS ,ODDS ratio - Abstract
Introduction: The prevalence of hypoalbuminemia, early changes of plasma albumin (P-Alb) levels, and their effects on mortality in cardiogenic shock are unknown. Materials and methods: P-Alb was measured from serial blood samples in 178 patients from a prospective multinational study on cardiogenic shock. The association of hypoalbuminemia with clinical characteristics and course of hospital stay including treatment and procedures was assessed. The primary outcome was all-cause 90-day mortality. Results: Hypoalbuminemia (P-Alb < 34g/L) was very frequent (75%) at baseline in patients with cardiogenic shock. Patients with hypoalbuminemia had higher mortality than patients with normal albumin levels (48% vs. 23%, p = 0.004). Odds ratio for death at 90 days was 2.4 [95% CI 1.5–4.1] per 10 g/L decrease in baseline P-Alb. The association with increased mortality remained independent in regression models adjusted for clinical risk scores developed for cardiogenic shock (CardShock score adjusted odds ratio 2.0 [95% CI 1.1–3.8], IABP-SHOCK II score adjusted odds ratio 2.5 [95%CI 1.2–5.0]) and variables associated with hypoalbuminemia at baseline (adjusted odds ratio 2.9 [95%CI 1.2–7.1]). In serial measurements, albumin levels decreased at a similar rate between 0h and 72h in both survivors and nonsurvivors (ΔP-Alb -4.6 g/L vs. 5.4 g/L, p = 0.5). While the decrease was higher for patients with normal P-Alb at baseline (p<0.001 compared to patients with hypoalbuminemia at baseline), the rate of albumin decrease was not associated with outcome. Conclusions: Hypoalbuminemia was a frequent finding early in cardiogenic shock, and P-Alb levels decreased during hospital stay. Low P-Alb at baseline was associated with mortality independently of other previously described risk factors. Thus, plasma albumin measurement should be part of the initial evaluation in patients with cardiogenic shock. Trial registration: at ClinicalTrials.gov. [ABSTRACT FROM AUTHOR]
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- 2019
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20. 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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MICRORNA ,CARDIOGENIC shock ,ACUTE coronary syndrome - 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 < 0.001) as well as lower cardiac index (1.8 vs. 2.4, P = 0.04) and estimated glomerular filtration rate (56 vs. 70 mL/min/1.73 m2, P = 0.002). In Cox regression analysis, miR‐423‐5p level above median was associated with 90 day all‐cause mortality independently of established risk factors of cardiogenic shock [adjusted hazard ratio 1.9 (95% confidence interval 1.2–3.2), P = 0.01]. Conclusions: In cardiogenic shock patients, above median level of miR‐423‐5p at baseline is associated with markers of hypoperfusion and seems to independently predict 90 day all‐cause mortality. [ABSTRACT FROM AUTHOR]
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- 2019
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21. 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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ACUTE kidney failure , *BIOMARKERS , *MORTALITY , *RENAL replacement therapy , *PROGNOSIS - Abstract
In our study the time of onset of RRT was recorded in 17/22 patients and only 7 patients (5% of all patients included in our study) had RRT performed within 24 h of study baseline. Abbreviations P-PENK: Plasma proenkephalin P-NGAL: Plasma neutrophil gelatinase-associated lipocalin RRT: Renal replacement therapy Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 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!. [Extracted from the article]
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- 2021
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22. The COACH risk engine: a multistate model for predicting survival and hospitalization in patients with heart failure.
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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.
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HEART failure ,RANDOMIZED controlled trials ,MEDICAL statistics ,CONFIDENCE intervals ,EPIDEMIOLOGY ,MORTALITY ,COHORT analysis ,PROGNOSIS - Abstract
Aims Several models for predicting the prognosis of heart failure (HF) patients have been developed, but all of them focus on a single outcome variable, such as all-cause mortality. The purpose of this study was to develop a multistate model for simultaneously predicting survival and HF-related hospitalization in patients discharged alive from hospital after recovery from acute HF. Methods and results The model was derived in the COACH (Coordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure) cohort, a multicentre, randomized controlled trial in which 1023 patients were enrolled after hospitalization because of HF. External validation was attained with the FINN-AKVA (Finish Acute Heart Failure Study) cohort, a prospective, multicentre study with 620 patients hospitalized due to acute HF. The observed vs. predicted 18-month survival was 72.1% vs. 72.3% in the derivation cohort and 71.4% vs. 71.2% in the validation cohort. The corresponding values of the c statistic were 0.733 [95% confidence interval (CI) 0.705–0.761] and 0.702 (95% CI 0.663–0.744), respectively. The model's accuracy in predicting HF hospitalization was excellent, with predicted values that closely resembled the values observed in the derivation cohort. Conclusion The COACH risk engine accurately predicted survival and various measures of recurrent hospitalization in (acute) HF patients. It may therefore become a valuable tool in improving and personalizing patient care and optimizing the use of scarce healthcare resources. [ABSTRACT FROM PUBLISHER]
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- 2012
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23. Characteristics, outcomes, and predictors of mortality at 3 months and 1 year in patients hospitalized for acute heart failure.
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Harjola, Veli-Pekka, Follath, Ferenc, Nieminen, Markku S., Brutsaert, Dirk, Dickstein, Kenneth, Drexler, Helmut, Hochadel, Matthias, Komajda, Michel, Lopez-Sendon, Jose L., Ponikowski, Piotr, and Tavazzi, Luigi
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HEART failure , *MORTALITY , *PROGNOSIS , *SURVEYS , *PATIENTS - Abstract
Aims: Acute heart failure (AHF) has a poor prognosis. We evaluated 3- and 12-month mortality in different clinical classes of AHF patients from 30 European countries who were included in the EuroHeart Failure Survey (EHFS) II. [ABSTRACT FROM PUBLISHER]
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- 2010
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24. Acute heart failure: Clinical presentation, one-year mortality and prognostic factors
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Rudiger, Alain, Harjola, Veli-Pekka, Müller, Andreas, Mattila, Eero, Säila, Petrus, Nieminen, Markku, and Follath, Ferenc
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HEART failure , *CARDIAC patients , *MORTALITY , *DISEASE risk factors , *SYMPTOMS - Abstract
Abstract: Aims: Acute heart failure (HF) is a common but ill-defined clinical entity. We describe patients hospitalised with acute HF in regard of clinical presentation, mortality, and risk factors for an unfavourable outcome. Methods and results: We conducted a prospective study including 312 consecutive patients from two European centers hospitalised with acute HF, defined as new onset or worsening of symptoms and signs of HF within 7 days. The mean age was 73 years and 56% were men. Twenty-eight percent had de-novo acute HF and 72% a decompensation of chronic HF. Coronary heart disease (CHD) was the most frequent underlying heart disease, elevated blood pressure >150 mmHg and acute ischemia being the most important triggers. Four percent of the patients had cardiogenic shock, 13% presented with pulmonary edema. LV-EF was <35%, 35–50% and >50% in 35%, 32% and 33% of the patients, respectively. ICU-treatment was necessary in 39% of the patients. Thirty-day mortality (11%) was increased in the presence of shock or elevated troponin T levels. Twelve-month all-cause mortality (29%) increased in the presence of shock, left ventricular dysfunction, renal insufficiency, CHD, and age. Conclusions: This prospective study shows that despite modern treatment, morbidity and mortality of patients hospitalised with acute HF remain high. [Copyright &y& Elsevier]
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- 2005
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25. Association of miR-21-5p, miR-122-5p, and miR-320a-3p with 90-Day Mortality in Cardiogenic Shock.
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Hänninen, Mikko, Jäntti, Toni, Tolppanen, Heli, Segersvärd, Heli, Tarvasmäki, Tuukka, Lassus, Johan, Vausort, Mélanie, Devaux, Yvan, Sionis, Alessandro, Tikkanen, Ilkka, Harjola, Veli-Pekka, and Lakkisto, Päivi
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CARDIOGENIC shock ,INTRA-aortic balloon counterpulsation ,ACUTE coronary syndrome ,GLOMERULAR filtration rate ,ALANINE aminotransferase ,MORTALITY - Abstract
Cardiogenic shock (CS) is a life-threatening emergency. New biomarkers are needed in order to detect patients at greater risk of adverse outcome. Our aim was to assess the characteristics of miR-21-5p, miR-122-5p, and miR-320a-3p in CS and evaluate the value of their expression levels in risk prediction. Circulating levels of miR-21-5p, miR-122-5p, and miR-320a-3p were measured from serial plasma samples of 179 patients during the first 5–10 days after detection of CS, derived from the CardShock study. Acute coronary syndrome was the most common cause (80%) of CS. Baseline (0 h) levels of miR-21-5p, miR-122-5p, and miR-320a-3p were all significantly elevated in nonsurvivors compared to survivors (p < 0.05 for all). Above median levels at 0h of each miRNA were each significantly associated with higher lactate and alanine aminotransferase levels and decreased glomerular filtration rates. After adjusting the multivariate regression analysis with established CS risk factors, miR-21-5p and miR-320a-3p levels above median at 0 h were independently associated with 90-day all-cause mortality (adjusted hazard ratio 1.8 (95% confidence interval 1.1–3.0), p = 0.018; adjusted hazard ratio 1.9 (95% confidence interval 1.2–3.2), p = 0.009, respectively). In conclusion, circulating plasma levels of miR-21-5p, miR-122-5p, and miR-320a-3p at baseline were all elevated in nonsurvivors of CS and associated with markers of hypoperfusion. Above median levels of miR-21-5p and miR-320a-3p at baseline appear to independently predict 90-day all-cause mortality. This indicates the potential of miRNAs as biomarkers for risk assessment in cardiogenic shock. [ABSTRACT FROM AUTHOR]
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- 2020
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26. Combined Measurement of Soluble ST2 and Amino-Terminal Pro-B-Type Natriuretic Peptide Provides Early Assessment of Severity in Cardiogenic Shock Complicating Acute Coronary Syndrome.
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Sadoune, Malha, Tolppanen, Heli, Rivas-Lasarte, Mercedes, Gayat, Etienne, Mebazaa, Alexandre, Arrigo, Mattia, Krastinova, Evguenia, Parissis, John, Spinar, Jindrich, Januzzi, James, Harjola, Veli-Pekka, Lassus, Johan, Sionis, Alessandro, Pulkki, Kari, and CardShock Investigators
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ACUTE coronary syndrome , *CARDIOGENIC shock , *SEVERITY of illness index , *NATRIURETIC peptides , *MORTALITY , *BIOMARKERS , *PATIENTS , *THERAPEUTICS , *ACADEMIC medical centers , *COMPARATIVE studies , *INTENSIVE care units , *LONGITUDINAL method , *RESEARCH methodology , *MEDICAL cooperation , *PEPTIDE hormones , *PEPTIDES , *PROGNOSIS , *RESEARCH , *RISK assessment , *EVALUATION research , *DISEASE complications - Abstract
Objectives: Mortality in cardiogenic shock complicating acute coronary syndrome is high, and objective risk stratification is needed for rational use of advanced therapies such as mechanical circulatory support. Traditionally, clinical variables have been used to judge risk in cardiogenic shock. The aim of this study was to assess the added value of serial measurement of soluble ST2 and amino-terminal pro-B-type natriuretic peptide to clinical parameters for risk stratification in cardiogenic shock.Design: CardShock (www.clinicaltrials.gov NCT01374867) is a prospective European multinational study of cardiogenic shock. The main study introduced CardShock risk score, which is calculated from seven clinical variables at baseline, and was associated with short-term mortality.Setting: Nine tertiary care university hospitals.Patients: Patients with cardiogenic shock caused by acute coronary syndrome (n=145).Interventions: In this substudy, plasma samples from the study patients were analyzed at eight time points during the ICU or cardiac care unit stay. Additional prognostic value of the biomarkers was assessed with incremental discrimination improvement.Measurements and Main Results: The combination of soluble ST2 and amino-terminal pro-B-type natriuretic peptide showed excellent discrimination for 30-day mortality (area under the curve, 0.77 at 12 hr up to 0.93 at 5-10 d after cardiogenic shock onset). At 12 hours, patients with both biomarkers elevated (soluble ST2, ≥ 500 ng/mL and amino-terminal pro-B-type natriuretic peptide, ≥ 4,500 ng/L) had higher 30-day mortality (79%) compared to those with one or neither biomarkers elevated (31% or 10%, respectively; p < 0.001). Combined measurement of soluble ST2 and amino-terminal pro-B-type natriuretic peptide at 12 hours added value to CardShock risk score, correctly reclassifying 11% of patients.Conclusions: The combination of results for soluble ST2 and amino-terminal pro-B-type natriuretic peptide provides early risk assessment beyond clinical variables in patients with acute coronary syndrome-related cardiogenic shock and may help therapeutic decision making in these patients. [ABSTRACT FROM AUTHOR]- Published
- 2017
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27. Risk Stratification for Patients in Cardiogenic Shock After Acute Myocardial Infarction.
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Pöss, Janine, Köster, Jelena, Fuernau, Georg, Eitel, Ingo, de Waha, Suzanne, Thiele, Holger, Desch, Steffen, Ouarrak, Taoufik, Zeymer, Uwe, Lassus, Johan, and Harjola, Veli-Pekka
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CARDIOGENIC shock , *MYOCARDIAL infarction complications , *MYOCARDIAL infarction risk factors , *PATIENTS , *CARDIOVASCULAR system , *COMPARATIVE studies , *EXPERIMENTAL design , *INTRA-aortic balloon counterpulsation , *RESEARCH methodology , *MEDICAL care , *EVALUATION of medical care , *MEDICAL cooperation , *MORTALITY , *RESEARCH , *RISK assessment , *THROMBOLYTIC therapy , *EVALUATION research , *RANDOMIZED controlled trials , *KAPLAN-Meier estimator , *THERAPEUTICS ,MYOCARDIAL infarction-related mortality - Abstract
Background: Mortality in cardiogenic shock (CS) remains high. Early risk stratification is crucial to make adequate treatment decisions.Objectives: This study sought to develop an easy-to-use, readily available risk prediction score for short-term mortality in patients with CS, derived from the IABP-SHOCK II (Intraaortic Balloon Pump in Cardiogenic Shock) trial.Methods: The score was developed using a stepwise multivariable regression analysis.Results: Six variables emerged as independent predictors for 30-day mortality and were used as score parameters: age >73 years, prior stroke, glucose at admission >10.6 mmol/l (191 mg/dl), creatinine at admission >132.6 μmol/l (1.5 mg/dl), Thrombolysis In Myocardial Infarction flow grade <3 after percutaneous coronary intervention, and arterial blood lactate at admission >5 mmol/l. Either 1 or 2 points were attributed to each variable, leading to a score in 3 risk categories: low (0 to 2), intermediate (3 or 4), and high (5 to 9). The observed 30-day mortality rates were 23.8%, 49.2%, and 76.6%, respectively (p < 0.0001). Validation in the IABP-SHOCK II registry population showed good discrimination with an area under the curve of 0.79. External validation in the CardShock trial population (n = 137) showed short-term mortality rates of 28.0% (score 0 to 2), 42.9% (score 3 to 4), and 77.3% (score 5 to 9; p < 0.001) and an area under the curve of 0.73. Kaplan-Meier analysis revealed a stepwise increase in mortality between the different score categories (0 to 2 vs. 3 to 4: p = 0.04; 0 to 2 vs. 5 to 9: p = 0.008).Conclusions: The IABP-SHOCK II risk score can be easily calculated in daily clinical practice and strongly correlated with mortality in patients with infarct-related CS. It may help stratify patient risk for short-term mortality and might, thus, facilitate clinical decision making. (Intraaortic Balloon Pump in Cardiogenic Shock II [IABP-SHOCK II]; NCT00491036). [ABSTRACT FROM AUTHOR]- Published
- 2017
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28. The association of admission blood glucose level with the clinical picture and prognosis in cardiogenic shock – Results from the CardShock Study.
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Kataja, Anu, Tarvasmäki, Tuukka, Lassus, Johan, Cardoso, Jose, Mebazaa, Alexandre, Køber, Lars, Sionis, Alessandro, Spinar, Jindrich, Carubelli, Valentina, Banaszewski, Marek, Marino, Rossella, Parissis, John, Nieminen, Markku S., and Harjola, Veli-Pekka
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CARDIOGENIC shock , *BLOOD sugar measurement , *HYPERGLYCEMIA , *BIOMARKERS , *MORTALITY , *PATIENTS , *THERAPEUTICS - Abstract
Background Critically ill patients often present with hyperglycemia, regardless of previous history of diabetes mellitus (DM). Hyperglycemia has been associated with adverse outcome in acute myocardial infarction and acute heart failure. We investigated the association of admission blood glucose level with the clinical picture and short-term mortality in cardiogenic shock (CS). Methods Consecutively enrolled CS patients were divided into five categories according to plasma glucose level at the time of enrolment: hypoglycemia (glucose < 4.0 mmol/L), normoglycemia (4.0–7.9 mmol/L), mild (8.0–11.9 mmol/L), moderate (12.0–15.9 mmol/L), and severe (≥ 16.0 mmol/L) hyperglycemia. Clinical presentation, biochemistry, and short-term mortality were compared between the groups. Results Plasma glucose level of 211 CS patients was recorded. Glucose levels were distributed equally between normoglycemia (26% of patients), mild (27%), moderate (19%) and severe (25%) hyperglycemia, while hypoglycemia (2%) was rare. Severe hyperglycemia was associated with higher blood leukocyte count (17.3 (5.8) E9/L), higher lactate level (4.4 (3.3–8.4) mmol/L) and lower arterial pH (7.23 (0.14)) compared with normoglycemia or mild to moderate hyperglycemia (p < 0.001 for all). In-hospital mortality was highest among hypoglycemic (60%) and severely hyperglycemic (56%) patients, compared with 22% in normoglycemic group (p < 0.01). Severe hyperglycemia was an independent predictor of in-hospital mortality (OR 3.7, 95% CI 1.19–11.7, p = 0.02), when adjusted for age, gender, LVEF, lactate, and DM. Conclusions Admission blood glucose level has prognostic significance in CS. Mortality is highest among patients with severe hyperglycemia or hypoglycemia. Severe hyperglycemia is independently associated with high in-hospital mortality in CS. It is also associated with biomarkers of systemic hypoperfusion and stress response. [ABSTRACT FROM AUTHOR]
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- 2017
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29. Effect of baseline characteristics on mortality in the SURVIVE trial on the effect of levosimendan vs dobutamine in acute heart failure: Sub-analysis of the Finnish patients.
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Kivikko, Matti, Pollesello, Piero, Tarvasmäki, Tuukka, Sarapohja, Toni, Nieminen, Markku S., and Harjola, Veli-Pekka
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HEART disease related mortality , *LEVOSIMENDAN , *DOBUTAMINE , *HEART failure , *CAUSES of death - Abstract
Background In the SURVIVE trial, including 1327 acute heart failure patients, no statistically significant difference between levosimendan and dobutamine in the 180-day all-cause mortality was seen. Country-specific differences in outcome were, however, present. In the Finnish sub-population in fact, mortality was significantly lower in levosimendan treated patients. We aim to understand the reasons for this disparity. Methods The risk factors for all-cause mortality were identified in the whole study population using multivariate Cox proportional hazards regression analysis. Those factors were evaluated in the 95 patients of the Finnish sub-population. Results The treatment by country interaction for mortality in Finland vs. other countries was significant, p = 0.029. Levosimendan treated patients had a lower 180-day mortality compared to dobutamine treated (17% vs. 40%, p = 0.023) in the Finnish sub-population. Baseline variables predicting survival in the whole SURVIVE trial population included age, systolic blood pressure, heart rate, myocardial infarction during admission, levels of NT-pro-BNP, glucose, creatinine, and alanine transferase, use of ACE inhibitors and β-blockers, oliguria, time from hospital admission to randomization, history of cardiac arrest, and left ventricular ejection fraction. Finnish patients were more frequently treated with β-blockers (88% vs. 52%, p < 0.0001), their study treatment was started earlier (mean ± SD 41 ± 40 h vs. 81 ± 154; p < 0.0001), and they had more often acute myocardial infarction at admission (39% vs. 16%, p < 0.0001). Conclusion The lower mortality in the Finnish patients treated with levosimendan was associated with higher use of β-blockers, higher frequency of myocardial infarction at admission, and shorter delay between randomization and start of treatment. [ABSTRACT FROM AUTHOR]
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- 2016
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30. Amiodarone, Anticoagulation, and Clinical Events in Patients With Atrial Fibrillation: Insights From the ARISTOTLE Trial.
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Flaker, Greg, Lopes, Renato D., Hylek, Elaine, Wojdyla, Daniel M., Thomas, Laine, Al-Khatib, Sana M., Sullivan, Renee M., Hohnloser, Stefan H., Garcia, David, Hanna, Michael, Amerena, John, Harjola, Veli-Pekka, Dorian, Paul, Avezum, Alvaro, Keltai, Matyas, Wallentin, Lars, and Granger, Christopher B.
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AMIODARONE , *ATRIAL fibrillation , *HEMORRHAGE , *DRUG abuse , *WARFARIN , *DRUG therapy , *MORTALITY , *CONFIDENCE intervals , *PATIENTS , *THERAPEUTICS - Abstract
Background Amiodarone is an effective medication in preventing atrial fibrillation (AF), but it interferes with the metabolism of warfarin. Objectives This study sought to examine the association of major thrombotic clinical events and bleeding with the use of amiodarone in the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial. Methods Baseline characteristics of patients who received amiodarone at randomization were compared with those who did not receive amiodarone. The interaction between randomized treatment and amiodarone was tested using a Cox model, with main effects for randomized treatment and amiodarone and their interaction. Matching on the basis of a propensity score was used to compare patients who received and who did not receive amiodarone at the time of randomization. Results In ARISTOTLE, 2,051 (11.4%) patients received amiodarone at randomization. Patients on warfarin and amiodarone had time in the therapeutic range that was lower than patients not on amiodarone (56.5% vs. 63.0%; p < 0.0001). More amiodarone-treated patients had a stroke or a systemic embolism (1.58%/year vs. 1.19%/year; adjusted hazard ratio [HR]: 1.47, 95% confidence interval [CI]: 1.03 to 2.10; p = 0.0322). Overall mortality and major bleeding rates were elevated, but were not significantly different in amiodarone-treated patients and patients not on amiodarone. When comparing apixaban with warfarin, patients who received amiodarone had a stroke or a systemic embolism rate of 1.24%/year versus 1.85%/year (HR: 0.68, 95% CI: 0.40 to 1.15), death of 4.15%/year versus 5.65%/year (HR: 0.74, 95% CI: 0.55 to 0.98), and major bleeding of 1.86%/year versus 3.06%/year (HR: 0.61, 95% CI: 0.39 to 0.96). In patients who did not receive amiodarone, the stroke or systemic embolism rate was 1.29%/year versus 1.57%/year (HR: 0.82, 95% CI: 0.68 to 1.00), death was 3.43%/year versus 3.68%/year (HR: 0.93, 95% CI: 0.83 to 1.05), and major bleeding was 2.18%/year versus 3.03%/year (HR: 0.72, 95% CI: 0.62 to 0.84). The interaction p values for amiodarone use by apixaban treatment effects were not significant. Conclusions Amiodarone use was associated with significantly increased stroke and systemic embolism risk and a lower time in the therapeutic range when used with warfarin. Apixaban consistently reduced the rate of stroke and systemic embolism, death, and major bleeding compared with warfarin in amiodarone-treated patients and patients who were not on amiodarone. [ABSTRACT FROM AUTHOR]
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- 2014
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31. Incremental value of biomarkers to clinical variables for mortality prediction in acutely decompensated heart failure: The Multinational Observational Cohort on Acute Heart Failure (MOCA) study.
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Lassus, Johan, Gayat, Etienne, Mueller, Christian, Peacock, W.Frank, Spinar, Jindrich, Harjola, Veli-Pekka, van Kimmenade, Roland, Pathak, Atul, Mueller, Thomas, diSomma, Salvatore, Metra, Marco, Pascual-Figal, Domingo, Laribi, Said, Logeart, Damien, Nouira, Semir, Sato, Naoki, Potocki, Michael, Parenica, Jiri, Collet, Corinne, and Cohen-Solal, Alain
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BIOMARKERS , *COHORT analysis , *SCIENTIFIC observation , *HEART failure , *MORTALITY , *DISEASE duration , *HEART failure patients - Abstract
Abstract: Aim: This study aims to evaluate the incremental value of plasma biomarkers to traditional clinical variables for risk stratification of 30-day and one-year mortality in acutely decompensated heart failure (ADHF). Methods and results: Through an international collaborative network, individual patient data on 5306 patients hospitalized for ADHF were collected. The all-cause mortality rate was 11.7% at 30days and 32.9% at one year. The clinical prediction model (age, gender, blood pressure on admission, estimated glomerular filtration rate <60mL/min/1.73m2, sodium and hemoglobin levels, and heart rate) had a c-statistic of 0.74 for 30-day mortality and 0.73 for one-year mortality. Several biomarkers measured at presentation improved risk stratification when added to the clinical model. At 30days, the net reclassification improvement (NRI) was 28.7% for mid-regional adrenomedullin (MR-proADM; p<0.001) and 25.5% for soluble (s)ST2 (p<0.001). At one year, sST2 (NRI 10.3%), MR-proADM (NRI 9.1%), amino-terminal pro-B-type natriuretic peptide (NT-proBNP; NRI 9.1%), mid-regional proatrial natriuretic peptide (MR-proANP; NRI 7.4%), B-type natriuretic peptide (NRI 5.5%) and C-reactive protein (CRP; NRI 5.3%) reclassified patients with ADHF (p<0.05 for all). CRP also markedly improved risk stratification of patients with ADHF as a dual biomarker combination with MR-proADM (NRI 36.8% [p<0.001] for death at 30days) or with sST2 (NRI 20.3%; [p<0.001] for one-year mortality). Conclusion: In this study, biomarkers provided incremental value for risk stratification of ADHF patients. Biomarkers such as sST2, MR-proADM, natriuretic peptides and CRP, reflecting different pathophysiologic pathways, add prognostic value to clinical risk factors for predicting both short-term and one-year mortality in ADHF. [Copyright &y& Elsevier]
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- 2013
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32. Long-term survival after hospitalization for acute heart failure — Differences in prognosis of acutely decompensated chronic and new-onset acute heart failure.
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Lassus, Johan P.E., Siirilä-Waris, Krista, Nieminen, Markku S., Tolonen, Jukka, Tarvasmäki, Tuukka, Peuhkurinen, Keijo, Melin, John, Pulkki, Kari, and Harjola, Veli-Pekka
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HEART failure patients , *HEART failure , *MORTALITY , *HOSPITAL care , *KIDNEY physiology , *FOLLOW-up studies (Medicine) , *LONGITUDINAL method , *PROGNOSIS - Abstract
Abstract: Aims: To analyze the five-year mortality after hospitalization for acute heart failure (AHF) and compare predictors of prognosis in patients with and without a previous history of heart failure. Methods: Patients with AHF (n=620) from the prospective multicenter FINN-AKVA study were classified as acutely decompensated chronic heart failure (ADCHF) or de-novo AHF if no previous history of heart failure was present. Both all-cause mortality during five years of follow-up and prognostic factors were determined. Results: The overall mortality was 60.3% (n=374) at five years. ADCHF was associated with significantly poorer outcome compared to de-novo AHF; five-year mortality rate 75.6% vs. 44.4% (p<0.001). Initially, mortality was high (33.5% in ADCHF and 21.7% in de-novo AHF after 12months), but in de-novo AHF the annual mortality declined markedly already after the first year. Compared to de-novo AHF, patients with ADCHF had an increased risk of death for several years after the index hospitalization. A previous history of heart failure was an independent predictor of five-year mortality (adjusted hazard ratio 1.8 (95% CI 1.4–2.2; p<0.001). Older age and impaired renal function were associated with adverse long-term prognosis in both ADCHF and de-novo AHF, while higher systolic blood pressure on admission predicted better outcome. Conclusion: The long-term prognosis after hospitalization for AHF is poor, with a significantly different survival observed in patients with de-novo AHF compared to ADCHF. A previous history of heart failure is an independent predictor of five-year mortality. Distinction between ADCHF and de-novo AHF may improve our understanding of patients with AHF. [Copyright &y& Elsevier]
- Published
- 2013
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