J B Johansen

Importance of beta-blocker dose in prevention of ventricular tachyarrhythmias, heart failure hospitalizations, and death in primary prevention implantable cardioverter-defibrillator recipients: a Danish nationwide cohort study

Aims There is a paucity of studies investigating a dose-dependent association between beta-blocker therapy and risk of outcome. In a nationwide cohort of primary prevention implantable cardioverter-defibrillator (ICD) patients, we aimed to investigate the dose-dependent association between beta-blocker therapy and risk of ventricular tachyarrhythmias (VT/VF), heart failure (HF) hospitalizations, and death. Methods and results Information on ICD implantation, endpoints, comorbidities, beta-blocker usage, type, and dose were obtained through Danish nationwide registers. The two major beta-blockers carvedilol and metoprolol were examined in three dose levels; low (metoprolol ≤ 25 mg; carvedilol ≤ 12.5 mg), intermediate (metoprolol 26-199 mg; carvedilol 12.6-49.9 mg), and high (metoprolol ≥ 200 mg; carvedilol ≥ 50 mg). Time to events was investigated utilizing multivariate Cox models with beta-blocker as a time-dependent variable. From 2007 to 2012, 2935 first-time ICD devices were implanted. During follow-up, 399 patients experienced VT/VF, 728 HF hospitalizations and 361 died. As compared with patients not on beta-blockers, low, intermediate, and high dose had significantly reduced risk of HF hospitalizations {hazard ratio (HR) = 0.68 [0.54-0.87], P = 0.002; HR = 0.53 [0.42-0.66], P < 0.001; HR = 0.43 [0.34-0.54], P < 0.001} and death (HR = 0.47 [0.35-0.64], P < 0.001; HR = 0.29 [0.22-0.39], P = 0.001; HR = 0.24 [0.18-0.33], P < 0.001). For the endpoint of VT/VF, only intermediate and high dose beta-blocker was associated with significantly reduced risk (HR = 0.58 [0.43-0.79], P < 0.001; HR = 0.53 [0.39-0.72], P < 0.001). No significant difference was found between comparable doses of carvedilol and metoprolol on any endpoint (P = 0.06-0.94). Conclusion In primary prevention ICD patients, beta-blocker therapy was associated with significantly reduced risk of all endpoints, as compared with patients not on beta-blocker, with the suggestion of a dose-dependent effect. No detectable difference was found between comparable doses of carvedilol and metoprolol.

Risk of motor vehicle accidents in patients with an implantable cardioverter defibrillator: A Danish nationwide study

cells; they establish 3D vascular structures in vitro and quantifiable vascular networks in vivo Authors: E. Gara1, S.Z. Kiraly1, G. Kiszler2, J. Skopal1, M. Polos1, B. Merkely1, S.E. Harding3, G. Foldes3, 1Semmelweis University, Heart Center -Budapest Hungary, 2Semmelweis University, Department of Pathology and Experimental Cancer Research Budapest Hungary, 3Imperial College London, National Heart and Lung Institute London United Kingdom,Published on behalf of the European Society of Cardiology. All rights reserved.

The use of Guideline recommended betablocker therapy in primary prevention ICD patients: Insight from Danish nationwide registries

Successful reperfusion is associated with lower levels of markers of myocardial damage and dysfunction in ST-elevation but not in non-ST-elevation myocardial infarction : insights from the PLATO trialBackground: Carbohydrate antigen 125 (CA125) is a mucin produced by serosal cells in response to mechanical and inflammatory stimuli. CA125 has emerged as prognostic biomarker in heart failure (HF) and correlates with markers of fluid overload, echocardiographic parameters and prognosis in HF patients. In patients with acute coronary syndrome (ACS), elevated CA125 is correlated with a higher risk of in-hospital HF. The relationship between CA125 and long-term prognosis in ACS patients has not previously been assessed. Purpose: The purpose of our study was to investigate if CA125 measured at the time of an acute coronary event is related to cardiac remodeling during the first year of follow-up and long-term risk for HF and death Methods: We measured CA125 in plasma within 24 hours of the acute event in 523 patients with acute myocardial infarction or unstable angina admitted to the Coronary Care Unit. Routine echocardiograms were performed in all participants. The primary outcomes were hospitalization with a diagnosis of heart failure or death during follow-up, identified through data from the Swedish Hospital Discharge Register and the Swedish Cause of Death Register. In a subgroup of 109 patients aged 75 years or above we assessed the relationships between baseline CA125 and echocardiographical parameters of cardiac structure and function at 1 year after the index ACS. Results: The median follow-up period was 27.3 months for incident HF and 39.5 months for mortality. In Cox proportional hazards models we found an adjusted hazard ratio of 1.51 (95% CI 1.08-2.12; p (Less)

Dosage-dependent association between betablocker therapy with Carvedilol or Metoprolol and the risk of appropriate ICD therapy in primary prevention ICD patients

Published on behalf of the European Society of Cardiology. All rights reserved.

A one-size fits all approach to ICD therapy

Purpose: Approximately 10 000 people in Sweden suffer from sudden cardiac arrest outside the hospital each year. Cardiopulmonary resuscitation (CPR) is started in about half of the cases. Treatment ...Background: Chest pain is one of the most common reasons for hospital admissions and more than 50 % of the patients admitted are diagnosed as non-cardiac and discharged without a clear explanation ...The purpose was to investigate how a negative life event (NLE) affects perceived psychosocial stress, recovery and running economy (RE). Competitive runners were monitored in a prospective non-experimental cohort study over one full training season in which they experienced the same unplanned severe NLE. Sixteen runners recorded stress and recovery scores (RESTQ-Sport) every week. The average scores over 3 weeks before the NLE were used as a baseline and were compared to scores during the week of the NLE (week 0), week 1and week 2. Seven runners completed a submaximal treadmill test before and after the NLE. Repeated measures ANOVA’s revealed that most scores on general stress scales were increased in week 0 and 1. Of the general recovery scales, “general well-being” was decreased in week 0 and 1, “social” and “physical recovery” were decreased in week 0. No changes in the sport-specific stress scales were found. However, two of the sport-specific recovery scales were decreased in week 0. An impaired RE was shown 3 weeks after the NLE. Therefore, it is important to know what is going on in an athlete’s life, because stressful life events alter RE after the stress and recovery already returned to normal levels.

A one-size fits all approach to ICD therapy: Is what is good for the gander also good for the goose?

Purpose: Approximately 10 000 people in Sweden suffer from sudden cardiac arrest outside the hospital each year. Cardiopulmonary resuscitation (CPR) is started in about half of the cases. Treatment ...Background: Chest pain is one of the most common reasons for hospital admissions and more than 50 % of the patients admitted are diagnosed as non-cardiac and discharged without a clear explanation ...The purpose was to investigate how a negative life event (NLE) affects perceived psychosocial stress, recovery and running economy (RE). Competitive runners were monitored in a prospective non-experimental cohort study over one full training season in which they experienced the same unplanned severe NLE. Sixteen runners recorded stress and recovery scores (RESTQ-Sport) every week. The average scores over 3 weeks before the NLE were used as a baseline and were compared to scores during the week of the NLE (week 0), week 1and week 2. Seven runners completed a submaximal treadmill test before and after the NLE. Repeated measures ANOVA’s revealed that most scores on general stress scales were increased in week 0 and 1. Of the general recovery scales, “general well-being” was decreased in week 0 and 1, “social” and “physical recovery” were decreased in week 0. No changes in the sport-specific stress scales were found. However, two of the sport-specific recovery scales were decreased in week 0. An impaired RE was shown 3 weeks after the NLE. Therefore, it is important to know what is going on in an athlete’s life, because stressful life events alter RE after the stress and recovery already returned to normal levels.

Primary and secondary prophylactic implantable cardioverter defibrillator implantation in patients with a diagnosis of cancer: Insight from a nationwide Danish registry

Background: Galectin 3 and ST2 are mediators and biomarkers of myocardial fibrosis and remodeling that have recently entered the clinical practice guidelines as prognostic factors in heart failure patients. Elevated galectin 3 and ST2 levels in acute myocardial infarction patients have also been associated with increased incidence of adverse events during follow-up. Purpose: We aimed to assess the comparative ability of Galectin 3 and ST2 to offer additional prognostic information for risk stratification in acute coronary syndrome (ACS) patients, on top of traditional cardiovascular risk factors and other established prognostic biomarkers. Methods: We measured the levels of galectin 3, ST2, N-terminal pro-B type natriuretic peptide (NTproBNP), high-sensitivity C-reactive protein (hsCRP), highsensitivity troponin T (TnT), cystatin C, and lipids in plasma collected from 524 ACS patients (STEMI, non-STEMI and unstable angina) on day 1 following the acute event. Biomarker levels were correlated with the risk to develop recurrent coronary events, in linear regression models adjusted for age, sex and traditional risk factors (smoking, diabetes mellitus, hypertension, LDL, HDL and triglycerides). Results: During a mean follow-up period of 2.13 years, 63 (12%) of the patients suffered a new coronary event. Baseline galectin 3, ST2, hsCRP, NTproBNP and cystatin C were significantly higher in these patients compared to the event-free controls. In a Cox proportional hazards model with forward step selection that included all biomarkers alongside traditional risk factors, age (HR per year of age 1.06, 95% CI 1.03-1.09), galectin 3 (HR per SD log increase 1.88, 95% CI 1.41- 2.51) and cystatin C (HR per SD log increase 1.39, 95% CI 1.12-1.74) were selected as the only independent predictors of recurrent events in the population. In receiver operating curve (ROC) analyses, addition of galectin 3 significantly improved the c-statistic of the model based on traditional risk factors alone (0.81 vs. 0.76, P (Less)

The impact of chronic renal disease on short- and long-term survival and risk of appropriate ICD therapy in primary prevention ICD/CRT-D patients

Background: Galectin 3 and ST2 are mediators and biomarkers of myocardial fibrosis and remodeling that have recently entered the clinical practice guidelines as prognostic factors in heart failure patients. Elevated galectin 3 and ST2 levels in acute myocardial infarction patients have also been associated with increased incidence of adverse events during follow-up. Purpose: We aimed to assess the comparative ability of Galectin 3 and ST2 to offer additional prognostic information for risk stratification in acute coronary syndrome (ACS) patients, on top of traditional cardiovascular risk factors and other established prognostic biomarkers. Methods: We measured the levels of galectin 3, ST2, N-terminal pro-B type natriuretic peptide (NTproBNP), high-sensitivity C-reactive protein (hsCRP), highsensitivity troponin T (TnT), cystatin C, and lipids in plasma collected from 524 ACS patients (STEMI, non-STEMI and unstable angina) on day 1 following the acute event. Biomarker levels were correlated with the risk to develop recurrent coronary events, in linear regression models adjusted for age, sex and traditional risk factors (smoking, diabetes mellitus, hypertension, LDL, HDL and triglycerides). Results: During a mean follow-up period of 2.13 years, 63 (12%) of the patients suffered a new coronary event. Baseline galectin 3, ST2, hsCRP, NTproBNP and cystatin C were significantly higher in these patients compared to the event-free controls. In a Cox proportional hazards model with forward step selection that included all biomarkers alongside traditional risk factors, age (HR per year of age 1.06, 95% CI 1.03-1.09), galectin 3 (HR per SD log increase 1.88, 95% CI 1.41- 2.51) and cystatin C (HR per SD log increase 1.39, 95% CI 1.12-1.74) were selected as the only independent predictors of recurrent events in the population. In receiver operating curve (ROC) analyses, addition of galectin 3 significantly improved the c-statistic of the model based on traditional risk factors alone (0.81 vs. 0.76, P (Less)