35 results on '"Harjola, Veli-Pekka"'
Search Results
2. Epinephrine and short-term survival in cardiogenic shock: an individual data meta-analysis of 2583 patients
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Léopold, Valentine, Gayat, Etienne, Pirracchio, Romain, Spinar, Jindrich, Parenica, Jiri, Tarvasmäki, Tuukka, Lassus, Johan, Harjola, Veli-Pekka, Champion, Sébastien, Zannad, Faiez, Valente, Serafina, Urban, Philip, Chua, Horng-Ruey, Bellomo, Rinaldo, Popovic, Batric, Ouweneel, Dagmar M., Henriques, José P. S., Simonis, Gregor, Lévy, Bruno, Kimmoun, Antoine, Gaudard, Philippe, Basir, Mir Babar, Markota, Andrej, Adler, Christoph, Reuter, Hannes, Mebazaa, Alexandre, and Chouihed, Tahar
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- 2018
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3. 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
4. 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
5. 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
6. Cystatin C: a step forward in assessing kidney function and cardiovascular risk
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Lassus, Johan and Harjola, Veli-Pekka
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- 2012
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7. Focused echocardiography and lung ultrasound protocol for guiding treatment in acute heart failure
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Öhman, J., Harjola, Veli-Pekka, Karjalainen, P., Lassus, Johan, HUS Emergency Medicine and Services, Clinicum, University of Helsinki, Anestesiologian yksikkö, Department of Diagnostics and Therapeutics, HUS Heart and Lung Center, Department of Medicine, and Kardiologian yksikkö
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OUTCOMES ,RENAL-FUNCTION ,Cardiac filling pressures ,Lung ultrasound ,Acute heart failure ,ASSOCIATION ,Prognosis ,3126 Surgery, anesthesiology, intensive care, radiology ,CONGESTION ,Pulmonary congestion ,SCIENTIFIC STATEMENT ,Treatment ,KIDNEY ,Echocardiography ,3121 General medicine, internal medicine and other clinical medicine ,TRIAL - Abstract
Aims There is little evidence-based therapy existing for acute heart failure (AHF), hospitalizations are lengthy and expensive, and optimal monitoring of AHF patients during in-hospital treatment is poorly defined. We evaluated a rapid cardiothoracic ultrasound (CaTUS) protocol, combining focused echocardiographic evaluation of cardiac filling pressures, that is, medial E/e' and inferior vena cava index, with lung ultrasound (LUS) for guiding treatment in hospitalized AHF patients. Methods and results We enrolled 20 consecutive patients hospitalized for AHF, whose in-hospital treatment was guided using the CaTUS protocol according to a pre-specified treatment protocol targeting resolution of pulmonary congestion on LUS and lowering cardiac filling pressures. Treatment results of these 20 patients were compared with those of a standard care sample of 100 patients, enrolled previously for follow-up purposes. The standard care sample had CaTUS performed daily for follow-up and received standard in-hospital treatment without ultrasound guidance. All CaTUS exams were performed by a single experienced sonographer. The CaTUS-guided therapy resulted in significantly larger decongestion as defined by reduction in symptoms, cardiac filling pressures, natriuretic peptides, cumulative fluid loss, and resolution of pulmonary congestion (P
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- 2018
8. 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
9. 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, Filippatos, Gerasimos, ESC Heart Failure Long-Term Registry Investigators, University of Zurich, and Mebazaa, Alexandre
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Vasopressor ,Inotrope ,10209 Clinic for Cardiology ,Vasodilator ,Acute heart failure ,610 Medicine & health ,Cardiology and Cardiovascular Medicine ,Prognosis ,Long-term outcome ,2705 Cardiology and Cardiovascular Medicine - Abstract
Aims The aim of this study was to assess long-term safety of intravenous cardiovascular agents-vasodilators, inotropes and/or vasopressors -in acute heart failure (AHF). Methods and results The European Society of Cardiology Heart Failure Long-Term (ESC-HF-LT) registry was a prospective, observational registry conducted in 21 countries. Patients with unscheduled hospitalizations for AHF (n = 6926) were included: 1304 (18.8%) patients received a combination of intravenous (i.v.) vasodilators and diuretics, 833 (12%) patients received i.v. inotropes and/or vasopressors. Primary endpoint was long-term all-cause mortality. Main secondary endpoints were in-hospital and post-discharge mortality. Adjusted hazard ratio (HR) showed no association between the use of i.v. vasodilator and diuretic and long-term mortality [HR 0.784, 95% confidence interval (CI) 0.596-1.032] nor in-hospital mortality (HR 1.049, 95% CI 0.592-1.857) in the matched cohort (n = 976 paired patients). By contrast, adjusted HR demonstrated a detrimental association between the use of i.v. inotrope and/or vasopressor and long-term all-cause mortality (HR 1.434, 95% CI 1.128-1.823), as well as in-hospital mortality (HR 1.873, 95% CI 1.151-3.048) in the matched cohort (n = 606 paired patients). No association was found between the use of i.v. inotropes and/or vasopressors and long-term mortality in patients discharged alive (HR 1.078, 95% CI 0.769-1.512). A detrimental association with inotropes and/or vasopressors was seen in all geographic regions and, among catecholamines, dopamine was associated with the highest risk of death (HR 1.628, 95% CI 1.031-2.572 vs. no inotropes). Conclusions Vasodilators did not demonstrate any association with long-term clinical outcomes, while inotropes and/or vasopressors were associated with increased risk of all-cause death, mostly related to excess of in-hospital mortality in AHF.
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- 2018
10. 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, María Generosa, Lund, Lars H., Maggioni, Aldo P., Chioncel, Ovidiu, Akiyama, Eiichi, Harjola, Veli-Pekka, Seferovic, Petar M., Laroche, Cécile, Sanz Julve, Marisa, Roig, Eulàlia, Ruschitzka, Frank, and Filippatos, Gerasimos
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Vasopressor ,Inotrope ,Vasodilator ,Acute heart failure ,Prognosis ,Long-term outcome - Abstract
[Abstract] Aims. The aim of this study was to assess long‐term safety of intravenous cardiovascular agents—vasodilators, inotropes and/or vasopressors—in acute heart failure (AHF). Methods and results. The European Society of Cardiology Heart Failure Long‐Term (ESC‐HF‐LT) registry was a prospective, observational registry conducted in 21 countries. Patients with unscheduled hospitalizations for AHF (n = 6926) were included: 1304 (18.8%) patients received a combination of intravenous (i.v.) vasodilators and diuretics, 833 (12%) patients received i.v. inotropes and/or vasopressors. Primary endpoint was long‐term all‐cause mortality. Main secondary endpoints were in‐hospital and post‐discharge mortality. Adjusted hazard ratio (HR) showed no association between the use of i.v. vasodilator and diuretic and long‐term mortality [HR 0.784, 95% confidence interval (CI) 0.596–1.032] nor in‐hospital mortality (HR 1.049, 95% CI 0.592–1.857) in the matched cohort (n = 976 paired patients). By contrast, adjusted HR demonstrated a detrimental association between the use of i.v. inotrope and/or vasopressor and long‐term all‐cause mortality (HR 1.434, 95% CI 1.128–1.823), as well as in‐hospital mortality (HR 1.873, 95% CI 1.151–3.048) in the matched cohort (n = 606 paired patients). No association was found between the use of i.v. inotropes and/or vasopressors and long‐term mortality in patients discharged alive (HR 1.078, 95% CI 0.769–1.512). A detrimental association with inotropes and/or vasopressors was seen in all geographic regions and, among catecholamines, dopamine was associated with the highest risk of death (HR 1.628, 95% CI 1.031–2.572 vs. no inotropes). Conclusions. Vasodilators did not demonstrate any association with long‐term clinical outcomes, while inotropes and/or vasopressors were associated with increased risk of all‐cause death, mostly related to excess of in‐hospital mortality in AHF.
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- 2017
11. Predictive value of the baseline electrocardiogram ST-segment pattern in cardiogenic shock: Results from the CardShock Study.
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Javanainen, Tuija, Tolppanen, Heli, Lassus, Johan, Nieminen, Markku S., Sionis, Alessandro, Spinar, Jindrich, Silva‐Cardoso, José, Greve Lindholm, Matias, Banaszewski, Marek, Harjola, Veli‐Pekka, Jurkko, Raija, Silva-Cardoso, José, and Harjola, Veli-Pekka
- Abstract
Background: The most common aetiology of cardiogenic shock (CS) is acute coronary syndrome (ACS), but even up to 20%-50% of CS is caused by other disorders. ST-segment deviations in the electrocardiogram (ECG) have been investigated in patients with ACS-related CS, but not in those with other CS aetiologies. We set out to explore the prevalence of different ST-segment patterns and their associations with the CS aetiology, clinical findings and 90-day mortality.Methods: We analysed the baseline ECG of 196 patients who were included in a multinational prospective study of CS. The patients were divided into 3 groups: (a) ST-segment elevation (STE). (b) ST-segment depression (STDEP). (c) No ST-segment deviation or ST-segment impossible to analyse (NSTD). A subgroup analysis of the ACS patients was conducted.Results: ST-segment deviations were present in 80% of the patients: 52% had STE and 29% had STDEP. STE was associated with the ACS aetiology, but one-fourth of the STDEP patients had aetiology other than ACS. The overall 90-day mortality was 41%: in STE 47%, STDEP 36% and NSTD 33%. In the multivariate mortality analysis, only STE predicted mortality (HR 1.74, CI95 1.07-2.84). In the ACS subgroup, the patients were equally effectively revascularized, and no differences in the survival were noted between the study groups.Conclusion: ST-segment elevation is associated with the ACS aetiology and high mortality in the unselected CS population. If STE is not present, other aetiologies must be considered. When effectively revascularized, the prognosis is similar regardless of the ST-segment pattern in ACS-related CS. [ABSTRACT FROM AUTHOR]- Published
- 2018
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12. Levels of Growth Differentiation Factor 15 and Early Mortality Risk Stratification in Cardiogenic Shock.
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Hongisto, Mari, Kataja, Anu, Tarvasmäki, Tuukka, Holopainen, Anu, Javanainen, Tuija, Jurkko, Raija, Jäntti, Toni, Kimmoun, Antoine, Levy, Bruno, Mebazaa, Alexandre, Pulkki, Kari, Sionis, Alessandro, Tolppanen, Heli, Wollert, Kai C., Harjola, Veli-pekka, Lassus, Johan, and CardShock investigators
- Abstract
Background: The aim of this study was to assess the levels, kinetics, and prognostic value of growth differentiation factor 15 (GDF-15) in cardiogenic shock (CS).Methods and Results: Levels of GDF-15 were determined in serial plasma samples (0-120 h) from 177 CS patients in the CardShock study. Kinetics of GDF-15, its association with 90-day mortality, and incremental value for risk stratification were assessed. The median GDF-150h level was 9647 ng/L (IQR 4500-19,270 ng/L) and levels above median were significantly associated with acidosis, hyperlactatemia, renal dysfunction, and higher 90-day mortality (56% vs 28%, P < .001). Serial sampling showed that non-survivors had significantly higher GDF-15 levels at all time points (P < .001 for all). Furthermore, non-survivors displayed increasing and survivors declining GDF-15 levels during the first days in CS. Higher levels of GDF-15 were independently associated with mortality. A GDF-1512h cutoff >7000 ng/L was identified as a strong predictor of death (OR 5.0; 95% CI 1.9-3.8, P = .002). Adding GDF-1512h >7000 ng/L to the CardShock risk score improved discrimination and risk stratification for 90-day mortality.Conclusions: GDF-15 levels are highly elevated in CS and associated with markers of systemic hypoperfusion and end-organ dysfunction. GDF-15 helps to discriminate survivors from non-survivors very early in CS. [ABSTRACT FROM AUTHOR]- Published
- 2019
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13. 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., Filippatos, Gerasimos, Crespo-Leiro, Maria G, and Harjola, Veli-Pekka
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HEART failure treatment ,VENTRICULAR ejection fraction ,EPIDEMIOLOGY ,HEALTH outcome assessment ,HEART disease related mortality ,LEFT heart ventricle ,HEART physiology ,CARDIOLOGY ,COMPARATIVE studies ,CAUSES of death ,HEART failure ,HOSPITAL care ,LONGITUDINAL method ,RESEARCH methodology ,MEDICAL cooperation ,MEDICAL societies ,PROGNOSIS ,RESEARCH ,TIME ,EVALUATION research ,DISEASE incidence ,ACQUISITION of data ,SEVERITY of illness index ,STROKE volume (Cardiac output) - Abstract
Aims: The objectives of the present study were to describe epidemiology and outcomes in ambulatory heart failure (HF) patients stratified by left ventricular ejection fraction (LVEF) and to identify predictors for mortality at 1 year in each group.Methods and Results: The European Society of Cardiology Heart Failure Long-Term Registry is a prospective, observational study collecting epidemiological information and 1-year follow-up data in 9134 HF patients. Patients were classified according to baseline LVEF into HF with reduced EF [EF <40% (HFrEF)], mid-range EF [EF 40-50% (HFmrEF)] and preserved EF [EF >50% (HFpEF)]. In comparison with HFpEF subjects, patients with HFrEF were younger (64 years vs. 69 years), more commonly male (78% vs. 52%), more likely to have an ischaemic aetiology (49% vs. 24%) and left bundle branch block (24% vs. 9%), but less likely to have hypertension (56% vs. 67%) or atrial fibrillation (18% vs. 32%). The HFmrEF group resembled the HFrEF group in some features, including age, gender and ischaemic aetiology, but had less left ventricular and atrial dilation. Mortality at 1 year differed significantly between HFrEF and HFpEF (8.8% vs. 6.3%); HFmrEF patients experienced intermediate rates (7.6%). Age, New York Heart Association (NYHA) class III/IV status and chronic kidney disease predicted mortality in all LVEF groups. Low systolic blood pressure and high heart rate were predictors for mortality in HFrEF and HFmrEF. A lower body mass index was independently associated with mortality in HFrEF and HFpEF patients. Atrial fibrillation predicted mortality in HFpEF patients.Conclusions: Heart failure patients stratified according to different categories of LVEF represent diverse phenotypes of demography, clinical presentation, aetiology and outcomes at 1 year. Differences in predictors for mortality might improve risk stratification and management goals. [ABSTRACT FROM AUTHOR]- Published
- 2017
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14. 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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15. Association between elevated blood glucose and outcome in acute heart failure: results from an international observational cohort
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Mebazaa, Alexandre, Gayat, Etienne, Lassus, Johan, Meas, Taly, Mueller, Christian, Maggioni, Aldo, Peacock, Frank, Spinar, Jindrich, Harjola, Veli-Pekka, van Kimmenade, Roland, Pathak, Atul, Mueller, Thomas, Tavazzi, Luigi, Disomma, Salvatore, Metra, Marco, Pascual-Figal, Domingo, Laribi, Said, Logeart, Damien, Nouira, Semir, Sato, Naoki, Parenica, Jiri, Deye, Nicolas, Boukef, Riadh, Collet, Corinne, Van den Berghe, Greet, Cohen-Solal, Alain, Januzzi, James L, and GREAT Network
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Aged, 80 and over ,Blood Glucose ,Heart Failure ,Male ,Diagnostic Tests, Routine ,Coronary Artery Disease ,Prognosis ,Risk Assessment ,Survival Analysis ,Ventricular Function, Left ,Cohort Studies ,Outcome Assessment (Health Care) ,Predictive Value of Tests ,Risk Factors ,Hyperglycemia ,Acute Disease ,Confidence Intervals ,Odds Ratio ,Humans ,Female ,Aged - Abstract
The aim of this analysis was to assess the association between elevated blood glucose level and mortality in acute heart failure (AHF). ispartof: Journal of the American College of Cardiology vol:61 issue:8 pages:820-9 ispartof: location:United States status: published
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- 2013
16. Management of cardiogenic shock complicating myocardial infarction.
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Mebazaa, Alexandre, Combes, Alain, van Diepen, Sean, Hollinger, Alexa, Katz, Jaon N., Landoni, Giovanni, Hajjar, Ludhmila Abrahao, Lassus, Johan, Lebreton, Guillaume, Montalescot, Gilles, Park, Jin Joo, Price, Susanna, Sionis, Alessandro, Yannopolos, Demetris, Harjola, Veli-Pekka, Levy, Bruno, and Thiele, Holger
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CARDIOGENIC shock ,TREATMENT of acute coronary syndrome ,ACUTE coronary syndrome ,PATHOLOGICAL physiology ,PROGNOSIS ,DIAGNOSIS ,THERAPEUTICS - Abstract
Up to 10% of acute coronary syndromes are complicated by cardiogenic shock (CS) with contemporary mortality rates of 40-50%. The extent of ischemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis in this patient population. Individualized patient risk assessment plays an important role in determining appropriate revascularization, drug treatment with inotropes and vasopressors, mechanical circulatory support, intensive care support of other organ systems, hospital level of care triage, and allocation of clinical resources. This review will outline the underlying causes and diagnostic criteria, pathophysiology, and treatment of CS complicating acute coronary syndromes with a focus on (a) potential therapeutic issues from the perspective an interventional cardiologist, an emergency physician, and an intensive care physician, (b) the type of revascularization, and (c) new therapeutic advancements in pharmacologic and mechanical percutaneous circulatory support. [ABSTRACT FROM AUTHOR]
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- 2018
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17. 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, Naoki Sato, Parenica, Jiri, Shiro Ishihara, Spinar, Jindrich, Müller, Christian, Harjola, Veli-Pekka, Lassus, Johan, Miró, Òscar, Maggioni, Aldo P., AlHabib, Khalid F., Dong-Ju Choi, Jin Joo Park, Yuhui Zhang, Jian Zhang, Januzzi Jr, James L., Katsuya Kajimoto, and Cohen-Solal, Alain
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HEART failure treatment ,CONFIDENCE intervals ,HEART failure ,PROBABILITY theory ,STATISTICS ,SURVIVAL ,DISCHARGE planning ,TREATMENT effectiveness ,PROPORTIONAL hazards models ,ODDS ratio ,PROGNOSIS - Abstract
Aims Heart failure oral therapies (HFOTs), including beta-blockers (BB), renin-angiotensin system inhibitors (RASi) and mineralocorticoid receptor antagonists, administered before hospital discharge after acute heart failure (AHF) might improve outcome. However, concerns have been raised because early administration of HFOTs may worsen patient's condition. We hypothesized that HFOTs at hospital discharge might be associated with better post-discharge survival. Methods and results The study population was composed of 19 980 AHF patients from the GREAT registry. The primary and secondary outcomes were 90-day and 1-year all-cause mortality, respectively. Survival was estimated with univariate and covariate-adjusted Cox proportional hazards regression models for the whole population and after propensity-score matching. HFOTs at discharge were consistently associated with no excess mortality in the unadjusted and adjusted analyses of the whole and matched cohorts. In the matched cohort, BB and RASi at discharge were associated with lower 90-day mortality risks compared to the respective untreated groups [hazard ratio (HR) 0.56, 95% confidence interval (CI) 0.46-0.69; and HR 0.53, 95% CI 0.42-0.66, respectively]. The favourable associations of BB and RASi at discharge with 90-day mortality were present in many subgroups including patients with reduced or preserved left ventricular ejection fraction and persisted up to 1 year after discharge. The combination of RASi and BB was associated with an even lower risk of death than RASi or BB alone. Conclusions Administration of HFOTs at hospital discharge is associated with better survival of AHF patients. [ABSTRACT FROM AUTHOR]
- Published
- 2018
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18. Role of cardiopulmonary exercise testing in clinical stratification in heart failure. A position paper from the Committee on Exercise Physiology and Training of the Heart Failure Association of the European Society of Cardiology.
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Corrà, Ugo, Agostoni, Pier Giuseppe, Anker, Stefan D., Coats, Andrew J. S., Leiro, Maria G. Crespo, de Boer, Rudolph A., Harjola, Veli-Pekka, Hill, Loreena, Lainscak, Mitja, Lund, Lars H., Metra, Marco, Ponikowski, Piotr, Riley, Jillian, Seferović, Petar M., and Piepoli, Massimo F.
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HEART failure ,HEART failure treatment ,CARDIOPULMONARY system ,EXERCISE tests ,RISK assessment ,COMORBIDITY ,VENTRICULAR ejection fraction ,DIAGNOSIS ,PROGNOSIS - Abstract
Traditionally, the main indication for cardiopulmonary exercise testing (CPET) in heart failure (HF) was for the selection of candidates to heart transplantation: CPET was mainly performed in middle-aged male patients with HF and reduced left ventricular ejection fraction. Today, CPET is used in broader patients' populations, including women, elderly, patients with co-morbidities, those with preserved ejection fraction, or left ventricular assistance device recipients, i.e. individuals with different responses to incremental exercise and markedly different prognosis. Moreover, the diagnostic and prognostic utility of symptom-limited CPET parameters derived from submaximal tests is more and more considered, since many patients are unable to achieve maximal aerobic power. Repeated tests are also being used for risk stratification and evaluation of intervention, so that these data are now available. Finally, patients, physicians and healthcare decision makers are increasingly considering how treatments might impact morbidity and quality of life rather than focusing more exclusively on hard endpoints (such as mortality) as was often the case in the past. Innovative prognostic flowcharts, with CPET at their core, that help optimize risk stratification and the selection of management options in HF patients, have been developed. [ABSTRACT FROM AUTHOR]
- Published
- 2018
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19. Morphine Use in the ED and Outcomes of Patients With Acute Heart Failure: A Propensity Score-Matching Analysis Based on the EAHFE Registry.
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Miró, Òscar, Gil, Víctor, Martín-Sánchez, Francisco J., Herrero-Puente, Pablo, Jacob, Javier, Mebazaa, Alexandre, Harjola, Veli-Pekka, Ríos, José, Hollander, Judd E., Peacock, W. Frank, Llorens, Pere, Herrero, Pablo, ICA-SEMES Research Group, and ICA-SEMES Research Group(∗)
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HEART failure patients ,MORPHINE abuse ,HEART failure ,DEATH rate ,HEART failure treatment ,DIAGNOSIS ,COMPARATIVE studies ,HEMODYNAMICS ,LENGTH of stay in hospitals ,HOSPITAL emergency services ,INTRAVENOUS injections ,RESEARCH methodology ,MEDICAL cooperation ,MORPHINE ,NARCOTICS ,PROBABILITY theory ,PROGNOSIS ,RESEARCH ,RISK assessment ,SURVIVAL ,EVALUATION research ,ACQUISITION of data ,RETROSPECTIVE studies ,ACUTE diseases ,HOSPITAL mortality - Abstract
Objective: The objective was to determine the relationship between short-term mortality and intravenous morphine use in ED patients who received a diagnosis of acute heart failure (AHF).Methods: Consecutive patients with AHF presenting to 34 Spanish EDs from 2011 to 2014 were eligible for inclusion. The subjects were divided into those with (M) or without IV morphine treatment (WOM) groups during ED stay. The primary outcome was 30-day all-cause mortality, and secondary outcomes were mortality at different intermediate time points, in-hospital mortality, and length of hospital stay. We generated a propensity score to match the M and WOM groups that were 1:1 according to 46 different epidemiological, baseline, clinical, and therapeutic factors. We investigated independent risk factors for 30-day mortality in patients receiving morphine.Results: We included 6,516 patients (mean age, 81 [SD, 10] years; 56% women): 416 (6.4%) in the M and 6,100 (93.6%) in the WOM group. Overall, 635 (9.7%; M, 26.7%; WOM, 8.6%) died by day 30. After propensity score matching, 275 paired patients constituted each group. Patients receiving morphine had a higher 30-day mortality (55 [20.0%] vs 35 [12.7%] deaths; hazard ratio, 1.66; 95% CI, 1.09-2.54; P = .017). In patients receiving morphine, death was directly related to glycemia (P = .013) and inversely related to the baseline Barthel index and systolic BP (P = .021) at ED arrival (P = .021). Mortality was increased at every intermediate time point, although the greatest risk was at the shortest time (at 3 days: 22 [8.0%] vs 7 [2.5%] deaths; OR, 3.33; 95% CI, 1.40-7.93; P = .014). In-hospital mortality did not increase (39 [14.2%] vs 26 [9.1%] deaths; OR, 1.65; 95% CI, 0.97-2.82; P = .083) and LOS did not differ between groups (median [interquartile range] in M, 8 [7]; WOM, 8 [6]; P = .79).Conclusions: This propensity score-matched analysis suggests that the use of IV morphine in AHF could be associated with increased 30-day mortality. [ABSTRACT FROM AUTHOR]- Published
- 2017
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20. Clinical picture and risk prediction of short-term mortality in cardiogenic shock.
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Harjola, Veli‐Pekka, Lassus, Johan, Sionis, Alessandro, Køber, 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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CARDIOGENIC shock , *ACUTE coronary syndrome , *PREDICTION models , *CORONARY angiography , *ETIOLOGY of diseases - Abstract
Aims The aim of this study was to investigate the clinical picture and outcome of cardiogenic shock and to develop a risk prediction score for short-term mortality. Methods and results The CardShock study was a multicentre, prospective, observational study conducted between 2010 and 2012. Patients with either acute coronary syndrome ( ACS) or non- ACS aetiologies were enrolled within 6 h from detection of cardiogenic shock defined as severe hypotension with clinical signs of hypoperfusion and/or serum lactate >2 mmol/L despite fluid resuscitation ( n = 219, mean age 67, 74% men). Data on clinical presentation, management, and biochemical variables were compared between different aetiologies of shock. Systolic blood pressure was on average 78 mmHg (standard deviation 14 mmHg) and mean arterial pressure 57 (11) mmHg. The most common cause (81%) was ACS (68% ST-elevation myocardial infarction and 8% mechanical complications); 94% underwent coronary angiography, of which 89% PCI. Main non- ACS aetiologies were severe chronic heart failure and valvular causes. In-hospital mortality was 37% ( n = 80). ACS aetiology, age, previous myocardial infarction, prior coronary artery bypass, confusion, low LVEF, and blood lactate levels were independently associated with increased mortality. The CardShock risk Score including these variables and estimated glomerular filtration rate predicted in-hospital mortality well (area under the curve 0.85). Conclusion Although most commonly due to ACS, other causes account for one-fifth of cases with shock. ACS is independently associated with in-hospital mortality. The CardShock risk Score, consisting of seven common variables, easily stratifies risk of short-term mortality. It might facilitate early decision-making in intensive care or guide patient selection in clinical trials. Trial registration NCT01374867. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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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]
- Published
- 2012
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23. Markers of renal function and acute kidney injury in acute heart failure: definitions and impact on outcomes of the cardiorenal syndrome.
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Lassus, Johan P.E., Nieminen, Markku S., Peuhkurinen, Keijo, Pulkki, Kari, Siirilä-Waris, Krista, Sund, Reijo, and Harjola, Veli-Pekka
- Abstract
Aims Acute kidney injury (AKI) in patients hospitalized for acute heart failure (AHF) is part of the cardiorenal syndrome and has been associated with increased morbidity and mortality. However, definitions and prognostic impact of AKI in AHF have been variable. Cystatin C is a prospective new marker of AKI. The objective of this study was to investigate the use of cystatin C as a marker of early AKI in AHF. Methods and results Patients (n = 292) hospitalized for AHF had measurements of cystatin C on admission and at 48 h. We assessed the incidence of a rise in cystatin C between the two measurements and evaluated the effect of an increase in cystatin C on outcomes up to 12 months. The population was on average 75 years old and 49% were female. On admission, median cystatin C was 1.25 mg/L (interquartile range 0.99–1.61 mg/L). A rise in cystatin C by >0.3 mg/L within 48 h after hospitalization (AKIcysC) occurred in 16% of patients and resulted in 3 days (P = 0.01) longer hospital stay and was associated with significantly higher in-hospital mortality, odds ratio 4.0 [95% confidence intervals (CI) 1.3–11.7, P = 0.01]. During follow-up, AKIcysC was an independent predictor of 90 days mortality, adjusted odds ratio 2.8 (95% CI 1.2–6.7, P = 0.02). Conclusion Cystatin C appears to be a useful marker of early AKI in patients hospitalized for AHF. A decline in renal function detected by cystatin C during the first 48 h after hospitalization occurs frequently in AHF and has a detrimental impact on prognosis. [ABSTRACT FROM PUBLISHER]
- Published
- 2010
24. 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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25. Clinical significance of cardiac troponins I and T in acute heart failure
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Ilva, Tuomo, Lassus, Johan, Siirilä-Waris, Krista, Melin, John, Peuhkurinen, Keijo, Pulkki, Kari, Nieminen, Markku S., Mustonen, Harri, Porela, Pekka, and Harjola, Veli-Pekka
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HEART failure ,PROTEINS ,CYSTATINS ,HOSPITAL admission & discharge ,MULTIVARIATE analysis - Abstract
Abstract: Background: Elevated cardiac troponin (cTn) levels are relatively common in acute heart failure (AHF). Aims: To evaluate the prevalence and prognostic significance of elevated cTnI and cTnT in AHF. Methods: FINN-AKVA is a prospective, multicenter study in AHF. In this analysis, 364 non-ACS patients with measurements of cTnI and cTnT taken on admission and 48 h thereafter were analyzed. Results: Of the 364 AHF patients, 51.1% had cTnI and 29.7% cTnT levels above the cut-off value. Six-month all-cause mortality was 18.7%. Both cTnI (OR 2.0, 95% CI 1.2–3.5, p =0.01) and cTnT (OR 2.6, 95% CI 1.5–4.4, p =0.0006) were associated with adverse outcome. The mortality risk was proportional to the magnitude of cTn release. On multivariable analysis, Cystatin C (OR 6.3, 95% CI 3.2–13, p <0.0001), logNT-proBNP (OR 1.4, 95% CI 1.0–1.8, p =0.03) and systolic blood pressure on admission (/10 mm Hg increase, OR 0.9, 95% CI 0.8–0.9, p =0.0004) were independent risk markers, whereas the troponins were not significantly associated with increased mortality. Conclusions: cTn elevations are frequent in AHF patients without ACS. cTnI is more often elevated than cTnT. Both cTnI and cTnT elevations are associated with increased mortality proportional to the degree elevation but they do not act as independent risk markers. [Copyright &y& Elsevier]
- Published
- 2008
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26. Prognostic role of pro- and anti-inflammatory cytokines and their polymorphisms in acute decompensated heart failure
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Miettinen, Kati H., Lassus, Johan, Harjola, Veli-Pekka, Siirilä-Waris, Krista, Melin, John, Punnonen, Kari R., Nieminen, Markku S., Laakso, Markku, and Peuhkurinen, Keijo J.
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CYTOKINES ,HEART failure ,INTERLEUKIN-6 ,TUMOR necrosis factors ,ATRIAL natriuretic peptides ,PROGNOSIS ,GENETIC polymorphisms - Abstract
Abstract: Background: Cytokines play an important role in chronic heart failure (HF), but little is known about their involvement in acute decompensated heart failure (ADHF). Aim: To evaluate the prognostic role of inflammatory cytokines in patients with ADHF. Methods: Levels of interleukin (IL)-6, tumour necrosis factor alpha (TNF-α), IL-10 and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured in 423 patients with ADHF. In addition, appropriate cytokine gene polymorphisms were determined. Survival was followed up to 12 months, and prognostic factors were evaluated. Results: Elevated levels of IL-6 and TNF-α were strongly associated with increased 12-month mortality (P <0.001 for both), whereas the level of IL-10 was predictive only of 6-month mortality (P <0.01). In multivariate analysis IL-6, chronic renal insufficiency, NT-proBNP, age/10 years'' increase and TNF-α were identified as the most powerful predictors of 12-month mortality. Furthermore, high levels of both IL-6 and NT-proBNP were associated with >7-fold mortality. Cytokine gene polymorphisms were not associated with outcome. Conclusions: Circulating levels of pro-inflammatory cytokines IL-6 and TNF-α, and the level of an anti-inflammatory cytokine IL-10, but not their gene polymorphisms, provide novel and important prognostic information in patients with ADHF. Combining measurements of pro-inflammatory cytokines and NT-proBNP seems a promising tool in the prognostic assessment of these patients. [Copyright &y& Elsevier]
- Published
- 2008
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27. Gender related differences in patients presenting with acute heart failure. Results from EuroHeart Failure Survey II
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Nieminen, Markku S., Harjola, Veli-Pekka, Hochadel, Matthias, Drexler, Helmut, Komajda, Michel, Brutsaert, Dirk, Dickstein, Kenneth, Ponikowski, Piotr, Tavazzi, Luigi, Follath, Ferenc, and Lopez-Sendon, Jose Luis
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HEART diseases in women , *WOMEN'S health , *HEART diseases , *CARDIOMYOPATHIES , *MYOCARDIAL infarction , *CORONARY disease - Abstract
Abstract: Aims: This analysis evaluates the gender differences in patients hospitalised for acute heart failure (AHF) in the EuroHeart Failure Survey II (EHFS). Results: Of the 3580 patients included in EHFS II, 1384 (39%) were women, mean age 73 years. 2196 (61%) were men, mean age 68 years. Women more frequently had new-onset AHF, hypertension and valvular disease and less frequently coronary heart disease or dilated cardiomyopathy compared with men. Smoking, chronic obstructive pulmonary disease, peripheral arterial disease and renal failure were less common, but diabetes and anaemia significantly more frequent in women. Atrial fibrillation and preserved left ventricular function were more common in women. Men were more often non-compliant with medication. After adjustment for indications and age, there were no significant gender differences in prescription of HF medication. All-cause readmission rate during the one-year follow-up was lower in women. However, the proportion of HF hospitalisation and one-year mortality after discharge (20%) were similar in both genders. Conclusion: Women frequently present with new-onset AHF. A significant gender difference exists in aetiology, ventricular function and co-morbidities. Women''s use of HF medication has improved. These findings emphasize the importance of individualised management and need for more comprehensive recruitment of women in clinical trials. [Copyright &y& Elsevier]
- Published
- 2008
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28. 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]
- Published
- 2020
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29. Venous lactate improves the prediction of in-hospital adverse outcomes in normotensive pulmonary embolism.
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Ebner, Matthias, Pagel, Charlotta F., Sentler, Carmen, Harjola, Veli-Pekka, Bueno, Héctor, Lerchbaumer, Markus H., Stangl, Karl, Pieske, Burkert, Hasenfuß, Gerd, Konstantinides, Stavros V., and Lankeit, Mareike
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PULMONARY embolism , *LACTATES , *ARTERIAL puncture , *PROGNOSIS , *ANAEROBIC threshold - Abstract
• Elevated venous lactate predicts adverse outcomes in normotensive pulmonary embolism. • Optimal prognostic performance was observed for venous lactate ≥3.3 mmol/l. • Adding venous lactate to the 2019 ESC algorithm may improve risk stratification. • The established threshold for arterial lactate has limited specificity in venous samples. Arterial lactate is an established risk marker in patients with pulmonary embolism (PE). However, its clinical applicability is limited by the need of an arterial puncture. In contrast, venous lactate can easily be measured from blood samples obtained via routine peripheral venepuncture. We investigated the prognostic value of venous lactate with regard to in-hospital adverse outcomes and mortality in 419 consecutive PE patients enrolled in a single-center registry between 09/2008 and 09/2017. An optimised venous lactate cut-off value of 3.3 mmol/l predicted both, in-hospital adverse outcome (OR 11.0 [95% CI 4.6–26.3]) and all-cause mortality (OR 3.8 [95%CI 1.3–11.3]). The established cut-off value for arterial lactate (2.0 mmol/l) and the upper limit of normal for venous lactate (2.3 mmol/l) had lower prognostic value for adverse outcomes (OR 3.6 [95% CI 1.5–8.7] and 5.7 [95% CI 2.4–13.6], respectively) and did not predict mortality. If added to the 2019 European Society of Cardiology (ESC) algorithm, venous lactate <2.3 mmol/l was associated with a high negative predictive value (0.99 [95% CI 0.97–1.00]) for adverse outcomes in intermediate-low-risk patients, whereas levels ≥3.3 mmol/l predicted adverse outcomes in the intermediate-high-risk group (OR 5.2 [95% CI 1.8–15.0]). Venous lactate above the upper limit of normal was associated with increased risk for adverse outcomes and an optimised cut-off value of 3.3 mmol/l predicted adverse outcome and mortality. Adding venous lactate to the 2019 ESC algorithm may improve risk stratification. Importantly, the established cut-off value for arterial lactate has limited specificity in venous samples and should not be used. [ABSTRACT FROM AUTHOR]
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- 2021
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30. PROGNOSTIC VALUE OF CIRCULATING SECRETONEURIN CONCENTRATIONS IN PATIENTS WITH CARDIOGENIC SHOCK: THE CARDSHOCK STUDY.
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Omland, Torbjorn, Azibani, Feriel, Kimmmoun, Antoine, Harjola, Veli-Pekka, Lassus, Johan P.E., and Mebazaa, Alexandre
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CARDIOGENIC shock , *PROGNOSIS - Published
- 2023
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31. 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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32. 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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33. 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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34. 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]
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- 2013
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35. BIOACTIVE ADRENOMEDULLIN: A NOVEL PROGNOSTIC MARKER IN CARDIOGENIC SHOCK.
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Lasarte, Mercedes Rivas, Tolppanen, Heli, Lassus, Johan, Green, Alessandro Sionis, Harjola, Veli-Pekka, and Mebazaa, Alexandre
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CARDIOGENIC shock , *BIOACTIVE compounds , *ADRENOMEDULLIN , *BIOMARKERS , *CARDIOLOGY , *PROGNOSIS , *THERAPEUTICS - Published
- 2016
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