Arne Didrik Høiseth

Elevated high-sensitivity cardiac troponin T is associated with increased mortality after acute exacerbation of chronic obstructive pulmonary disease

Background Cardiovascular co-morbidities are common in chronic obstructive pulmonary disease (COPD). Retrospective studies on selected patients have indicated that cardiac troponin elevation is frequent during acute exacerbations of COPD (AECOPD), and that this is associated with poor survival. In the present prospective study the prevalence and prognostic value of elevated cardiac troponin T (cTnT) in unselected patients with AECOPD have been investigated, using a novel high-sensitivity assay (hs-cTnT assay). Methods and results 99 patients hospitalised for AECOPD were included. They were followed until death or study termination. During a median follow-up time of 1.9 years, 57 patients (58%) died. 97 patients (98%) had measurable levels of hs-cTnT and 73 (74%) had hs-cTnT above the normal range (≥14.0 ng/l). The crude mortality rates in patients having hs-cTnT <14.0, 14.0–39.9 and ≥40 ng/l were 4.6, 30.2 and 58.3 per 100 patient-years, respectively. Adjusting for relevant covariables using an extended Cox regression analysis, the HRs (95% CI) for death were 4.5 (1.2 to 16) and 8.9 (2.4 to 32) among patients having hs-cTnT 14.0–39.9 and ≥40 ng/l, respectively, compared with patients with hs-cTnT <14.0 ng/l. The association between mortality and hs-cTnT was strongly modified by heart rate at admission (p<0.001)—that is, the association between mortality and hs-cTnT was stronger among patients with tachycardia. Conclusion Elevated hs-cTnT during AECOPD is frequent, and it is associated with increased mortality. The effect is stronger among patients having tachycardia than among patients with normal heart rate.

Femoral Neck Angles in Osteoarthritis of the Hip

Femoral neck angles were determined in 44 patients with unilateral or bilateral idiopathic osteoarthritis of the hip. The mean anteversion angle was 20 degrees +/- 9 degrees and the neck-shaft angle 131 degrees +/- 7 degrees. In comparison with a normal material the anteversion was significantly larger in the patients (P less than 0.001), but no difference was found in the neck-shaft angle. A positive correlation between the size of the anteversion and the severity of the disease was observed. It is concluded that increased anteversion of the femoral neck may contribute to the development of osteoarthritis of the hip.

Femoral Neck Angles: A Specimen Study with Special Regard to Bilateral Differences

The femoral neck angles were determined in 48 pairs of normal specimens from cadavers of elderly Norwegians, 24 males and 24 females. The anteversion angle was found to average 10.4 degrees +/- 6.7 degrees and the neck-shaft 127.7 degrees +/- 7.6 degrees. There were no significant differences between the sexes. The bilateral differences were analysed. The 95 per cent confidence limits of the anteversion and head-neck-shaft angles were calculated to be 11.8 and 13.8 degrees, respectively.

Prediction of disturbed healing in femoral neck fracture : radiographic analysis of 149 cases

To determine factors predictive of early healing disturbances after fixation of femoral neck fracture, the radiographic and clinical data of 149 patients were subjected to a logistic regression analysis comparing them with the results 3 months postoperatively. As in previous studies, fracture reduction distinguished between fractures with or without healing disturbances. The following signs in the preoperative radiographs were predictive of unfavorable outcome: small head fragment, comminution of the calcar femorale, and varus angulation of the head. Fractures with negative predictive signs may be selected for primary arthroplasty.

Holding power of the 4.5 mm AO/ASIF cortex screw in cortical bone in relation to bone mineral

To obtain basic data about the holding power of a 4.5 mm AO/ASIF cortex screw in cortical bone in relation to bone mineral as expressed by densitometric methods, uniaxial pull-out tests were performed on 14 human cadaver femurs. The mechanical parameters were correlated with bone mineral which was assessed by quantitative computed tomography (QCT) and dual energy X-ray absorptiometry (DXA). High correlations were found between the QCT mass, the DXA density and content values and the holding power of the screw. The QCT density values, expressing the physical density of the bone, did not correlate similarly well.

Torsion of the leg determined by computed tomography

Torsion of the leg was measured in 50 adults by computed tomography. The tangent to the dorsal aspect of the femoral condyles gave the proximal reference line. The distal reference line joined the centers of the medial and lateral malleoli. Tibial torsion was measured as the inclination between the dorsal tangent to the tibial condyles and the distal reference line, and torsion of the leg was measured as the inclination between the proximal and the distal reference lines. The anatomy of the dorsal aspects of the tibial condyles was more inconsistent than the anatomy of the dorsal aspects of the femoral condyles. In the females the external torsion of the leg was 38 +/- 9 degrees on the right side and 37 +/- 11 degrees on the left side. In the males the values were 41 +/- 6 degrees and 40 +/- 10 degrees, respectively.

NT-proBNP independently predicts long term mortality after acute exacerbation of COPD - a prospective cohort study

BackgroundCardiovascular disease is prevalent and frequently unrecognized in patients with chronic obstructive pulmonary disease (COPD). NT-proBNP is an established risk factor in patients with heart failure. NT-proBNP may also be released from the right ventricle. Thus serum NT-proBNP may be elevated during acute exacerbations of COPD (AECOPD). The prognostic value of NT-proBNP in patients hospitalized with AECOPD is sparsely studied. Our objective was to test the hypothesis that NT-proBNP independently predicts long term mortality following AECOPD.MethodsA prospective cohort study of 99 patients with 217 admissions with AECOPD. Clinical, electrocardiographic, radiological and biochemical data were collected at index and repeat admissions and analyzed in an extended survival analysis with time-dependent covariables.ResultsMedian follow-up time was 1.9 years, and 57 patients died during follow-up. NT-proBNP tertile limits were 264.4 and 909 pg/mL, and NT-proBNP in tertiles 1 through 3 was associated with mortality rates of 8.6, 35 and 62 per 100 patient-years, respectively (age-adjusted log-rank p<0.0001). After adjustment for age, gender, peripheral edema, cephalization and cTnT in a multivariable survival model, the corresponding hazard ratios for dying were 2.4 (0.95-6.0) and 3.2 (1.3-8.1) (with 95% confidence intervals in parentheses, p-value for trend 0.013).ConclusionsNT-proBNP is a strong and independent determinant of mortality after AECOPD.

Cardiac troponin T levels and exercise stress testing in patients with suspected coronary artery disease: the Akershus Cardiac Examination (ACE) 1 study

Whether reversible ischaemia in patients referred for exercise stress testing and MPI (myocardial perfusion imaging) is associated with changes in circulating cTn (cardiac troponin) levels is controversial. We measured cTnT with a sensitive assay before, immediately after peak exercise and 1.5 and 4.5 h after exercise stress testing in 198 patients referred for MPI. In total, 19 patients were classified as having reversible myocardial ischaemia. cTnT levels were significantly higher in patients with reversible myocardial ischaemia on MPI at baseline, at peak exercise and after 1.5 h, but not at 4.5 h post-exercise. In patients with reversible ischaemia on MPI, cTnT levels did not change significantly after exercise stress testing [11.1 (5.2–14.9) ng/l at baseline compared with 10.5 (7.2–16.3) ng/l at 4.5 h post-exercise, P=0.27; values are medians (interquartile range)]. Conversely, cTnT levels increased significantly during testing in patients without reversible myocardial ischaemia [5.4 (3.0–9.0) ng/l at baseline compared with 7.5 (4.6–12.4) ng/l, P<0.001]. In conclusion, baseline cTnT levels are higher in patients with MPI evidence of reversible myocardial ischaemia than those without reversible ischaemia. However, although cTnT levels increase during exercise stress testing in patients without evidence of reversible ischaemia, this response appears to be blunted in patients with evidence of reversible ischaemia. Mechanisms other than reversible myocardial ischaemia may play a role for acute exercise-induced increases in circulating cTnT levels.

Radiographic prediction of early failure in femoral neck fracture

We studied the primary radiographs of 56 patients treated with osteosynthesis for a displaced femoral neck fracture. The radiographic findings were subjected to a multiple regression analysis together with the results 3 months postoperatively. A primary fracture displacement of more than 20 mm on the AP film and a defect of the calcar due to fracture comminution were associated with a failed osteosynthesis.

Acute exacerbation of COPD is associated with fourfold elevation of cardiac troponin T

Objective To investigate if acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is associated with myocardial injury, expressed as elevated high sensitive cardiac troponin T (hs-cTnT), and to identify determinants of hs-cTnT in chronic obstructive pulmonary disease (COPD) patients. Design In a cross-sectional study, hs-cTnT in patients hospitalised for AECOPD was compared with hs-cTnT in COPD patients in their stable state. Setting The study was conducted at a teaching and a pulmonary rehabilitation clinic. Participants Consecutive admissions to participating units for the years 2010–2011 meeting objective, standardised criteria for AECOPD and stable COPD. Main outcomes Ratio of hs-cTnT in hospitalised AECOPD patients compared with stable COPD patients. Change in the ratio of hs-cTnT per unit increase of relevant covariables. Results The geometric mean of hs-cTnT in the index group was 25.8 ng/l (95% CI 21.1 to 31.7) compared with 4.55 ng/l (95% CI 3.72 to 5.67) in the reference group. After inclusion of relevant covariables, multiple linear regression analyses showed that the ratio between hs-cTnT in AECOPD patients and the references was 4.26 (95% CI 3.02 to 6.00) and that hs-cTnT increased 1.41-fold (95% CI 1.20 to 1.68), for each quartile increase in leucocyte count in stable COPD but not in AECOPD. Higher hs-cTnT levels were also associated with the presence of pathological q-waves (p=0.012) and electrocardiographic left ventricular hypertrophy (p=0.039), long-term oxygen treatment (p=0.002) and decreasing forced expiratory volume in 1 s (p=0.014). A significant univariable association between cTnT and arterial hypoxaemia was also found but this association was attenuated almost to a zero effect after inclusion of relevant covariates. Conclusions AECOPD is associated with higher hs-cTnT as compared with stable COPD. In stable COPD, hs-cTnT appears to be positively associated with indices of COPD severity, whereas we were unable to identify significant determinants of hs-cTnT in AECOPD.