Julie K.K. Vishram‐Nielsen

Capital Region of Denmark

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Michael Hecht Olsen

University of Southern Denmark

Kari Kuulasmaa

Finnish Institute for Health and Welfare

Ana Carolina Alba

University Health Network

Stefan Söderberg

Umeå University

Manan Pareek

Rigshospitalet

Veikko Salomaa

Finnish Institute for Health and Welfare

Allan Linneberg

Copenhagen University Hospital

Filio Billia

University Health Network

Finn Gustafsson

Copenhagen University Hospital

Teemu Niiranen

University of Turku

Cooperative Institutions

University of Toronto

University Health Network

Toronto General Hospital

Ted Rogers Centre for Heart Research

Toronto Public Health

University Medical Center Hamburg-Eppendorf

Inserm

University of British Columbia

University of Copenhagen

Copenhagen University Hospital

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Estimated Arterial Stiffness

Elsevier eBooks (2024)

Julie K.K. Vishram‐Nielsen Dimitrios Terentes‐Printzios Michael Hecht Olsen Charalambos Vlachopoulos

10.1016/b978-0-443-15512-3.00046-5

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Citations (0)

Predicting the Risk of Right Ventricular Failure in Patients Undergoing Left Ventricular Assist Device Implantation

Circulation Heart Failure (2020)

Claudia Frankfurter Micaela Molinero Julie K.K. Vishram‐Nielsen Farid Foroutan Susanna Mak

Right ventricular failure (RVF) is a cause of major morbidity and mortality after left ventricular assist device (LVAD) implantation. It is, therefore, integral to identify patients who may benefit from biventricular support early post-LVAD implantation. Our objective was to explore the performance of risk prediction models for RVF in adult patients undergoing LVAD implantation.A systematic search was performed on Medline, Embase, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews from inception until August 2019 for all relevant studies. Performance was assessed by discrimination (via C statistic) and calibration if reported. Study quality was assessed using the Prediction Model Risk of Bias Assessment Tool criteria.After reviewing 3878 citations, 25 studies were included, featuring 20 distinctly derived models. Five models were derived from large multicenter cohorts: the European Registry for Patients With Mechanical Circulatory Support, Interagency Registry for Mechanically Assisted Circulatory Support, Kormos, Pittsburgh Bayesian, and Mechanical Circulatory Support Research Network RVF models. Seventeen studies (68%) were conducted in cohorts implanted with continuous-flow LVADs exclusively. The definition of RVF as an outcome was heterogenous among models. Seven derived models (28%) were validated in at least 2 cohorts, reporting limited discrimination (C-statistic range, 0.53-0.65). Calibration was reported in only 3 studies and was variable.Existing RVF prediction models exhibit heterogeneous derivation and validation methodologies, varying definitions of RVF, and are mostly derived from single centers. Validation studies of these prediction models demonstrate poor-to-modest discrimination. Newer models are derived in cohorts implanted with continuous-flow LVADs exclusively and exhibit modest discrimination. Derivation of enhanced discriminatory models and their validations in multicenter cohorts is needed.

Statistic

10.1161/circheartfailure.120.006994

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Citations (107)

Advanced heart failure: guideline‐directed medical therapy, diuretics, inotropes, and palliative care

ESC Heart Failure (2022)

Daniela Tomasoni Julie K.K. Vishram‐Nielsen Matteo Pagnesi Marianna Adamo Carlo Lombardi

Heart failure (HF) is a major cause of mortality, hospitalizations, and reduced quality of life and a major burden for the healthcare system. The number of patients that progress to an advanced stage of HF is growing. Only a limited proportion of these patients can undergo heart transplantation or mechanical circulatory support. The purpose of this review is to summarize medical management of patients with advanced HF. First, evidence-based oral treatment must be implemented although it is often not tolerated. New therapeutic options may soon become possible for these patients. The second goal is to lessen the symptomatic burden through both decongestion and haemodynamic improvement. Some new treatments acting on cardiac function may fulfil both these needs. Inotropic agents acting through an increase in intracellular calcium have often increased risk of death. However, in the recent Global Approach to Lowering Adverse Cardiac Outcomes Through Improving Contractility in Heart Failure (GALACTIC-HF) trial, omecamtiv mecarbil was safe and effective in the reduction of the primary outcome of cardiovascular death or HF event compared with placebo (hazard ratio, 0.92; 95% confidence interval, 0.86-0.99; P = 0.03) and its effects were larger in those patients with more severe left ventricular dysfunction. Patients with severe HF who received omecamtiv mecarbil experienced a significant treatment benefit, whereas patients without severe HF did not (P = 0.005 for interaction). Lastly, clinicians should take care of the end of life with an appropriate multidisciplinary approach. Medical treatment of advanced HF therefore remains a major challenge and a wide open area for further research.

Nesiritide

10.1002/ehf2.13859

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Citations (50)

Association between continuous‐flow left ventricular assist device infections requiring long‐term antibiotic use and post‐heart transplant morbidity and mortality

Journal of Cardiac Surgery (2021)

Maria Lambadaris Julie K.K. Vishram‐Nielsen Jennifer M. Amadio Shahid Husain Vivek Rao

There exists controversy regarding the impact of infection in patients with a left ventricular assist device (LVAD) on post-heart transplant outcomes. This study evaluated the association between infections during LVAD support and the risk of early and late post-heart transplant infection, rejection, and mortality in transplant recipients bridged with an LVAD.This is a single-center retrospective observational cohort study of consecutive adults supported with a continuous flow LVAD undergoing heart transplant between 2006 and 2019 at the Toronto General Hospital. The grade of LVAD infection was classified as per International Society of Heart and Lung Transplantation guidelines. Patients were divided into three groups: (1) patients with LVAD-specific infection confirmed with positive cultures requiring long-term antibiotic use until the time of transplant; (2) patients with any type of infection in whom antibiotics were stopped at least 1 month before transplant; (3) patients without any infections between LVAD implant and transplant. Logistic regression and Cox proportional hazard models were used to evaluate early- and late-post transplant outcomes, respectively.We included 75 LVAD recipients: 16 (21%) patients had a chronic LVAD-related infection on suppressive antibiotics, 30 (40%) had a resolved infection, and 29 (39%) had no infections. During a median post-transplant follow-up time of 4 (2 to 7) years, 65 (87%) patients developed infections, 43 (64%) rejections, and 17 (23%) deaths. Both short- and long-term risks of infection, rejection, and mortality did not differ significantly among the groups.LVAD patients with infections did not have a significantly higher risk of infection, rejection, or mortality at any time point after transplant.

Single Center

Destination therapy

10.1111/jocs.16073

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Association between antecedent blood pressure, hypertension-mediated organ damage and cardiovascular outcome

Blood Pressure (2020)

Thomas Bastholm Olesen Manan Pareek Jacob V. Stidsen Marie K. Blicher Susanne Rasmussen

Purpose: The objective of this study was to test if combining antecedent systolic blood pressure (SBP) with traditional risk factors and hypertension-mediated organ damage (HMOD) improves risk stratification for subsequent cardiovascular disease.Materials and methods: 1910 subjects participated in this study. Antecedent SBP was defined as the average of measurements obtained in 1982 and in 1987. Current SBP was obtained in 1993. HMOD were examined in 1993. HMOD was defined as either atherosclerotic plaque(s), increased pulse wave velocity, increased urine albumin creatinine ratio (above the 90th percentile) or left ventricular hypertrophy. Major adverse cardiovascular events (MACE) including myocardial infarction, cerebrovascular disease, heart failure and arrhythmia were obtained from national registries.Results: Subjects were divided into two age categories: a middle-aged group (aged 41 or 51) and an older group (aged 61 or 71). From 1993 to 2010, 425 events were observed. In multivariable analysis with both current and antecedent SBP adjusted for traditional risk factors, current SBP was associated with each measure of HMOD whilst antecedent SBP was not significantly associated with urine albumin creatinine ratio in the older group, LVMI in the middle-aged group, or the presence of plaque in any of the age groups (all p > 0.15). When current and antecedent SBP were evaluated together, current SBP was not associated with MACE in the middle-aged subgroup [HR = 1.09 (0.96–1.22), p = 0.18] but remained associated with MACE in the older subgroup [HR = 1.21 (1.10–1.34), p < 0.01]. Contrariwise, antecedent SBP was only associated with MACE in the middle-aged subgroup [HR = 1.24 (1.04–1.48), p = 0.02]. Adding antecedent SBP to traditional risk factors did not improve the predictive accuracy of the survival model.Conclusion: In healthy non-medicated middle-aged subjects, antecedent SBP is associated with cardiovascular outcome independently of current BP, traditional risk factors and HMOD. However, improvement in risk stratification seems to be limited.

End organ damage

Association (psychology)

10.1080/08037051.2020.1735930

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Citations (7)

Better Respiratory Function in Heart Failure Patients With Use of Central-Acting Therapeutics

CJC Open (2024)

Julie K.K. Vishram‐Nielsen Fernando Luís Scolari Chun‐Po Steve Fan Yasbanoo Moayedi Heather J. Ross

Diaphragm atrophy can contribute to dyspnea in patients with heart failure (HF) with its link to central neurohormonal overactivation. HF medications that cross the blood-brain barrier could act centrally and improve respiratory function, potentially alleviating diaphragmatic atrophy. Therefore, we compared the benefit of central- vs peripheral-acting HF drugs on respiratory function, as assessed by a single cardiopulmonary exercise test (CPET) and outcomes in HF patients. A retrospective study was conducted of 624 ambulatory adult HF patients (80% male) with reduced left ventricular ejection fraction ≤ 40% and a complete CPET, followed at a single institution between 2001 and 2017. CPET parameters, and the outcomes all-cause death, a composite endpoint (all-cause death, need for left ventricular assist device, heart transplantation), and all-cause and/or HF hospitalizations, were compared in patients receiving central-acting (n = 550) vs peripheral-acting (n = 74) drugs. Compared to patients who receive peripheral-acting drugs, patients who receive central-acting drugs had better respiratory function (peak breath-by breath oxygen uptake [VO2], P = 0.020; forced expiratory volume in 1 second [FEV1], P = 0.007), and ventilatory efficiency (minute ventilation / carbon dioxide production [VE/VCO2], P < 0.001; end-tidal carbon dioxide tension [PETCO2], P = 0.015; and trend for forced vital capacity [FVC], P = 0.056). Many of the associations between the CPET parameters and drug type remained significant after multivariate adjustment. Moreover, patients receiving central-acting drugs had fewer composite events (P = 0.023), and HF hospitalizations (P = 0.044), although significance after multivariant correction was not achieved, despite the hazard ratio being 0.664 and 0.757, respectively. Central-acting drugs were associated with better respiratory function as measured by CPET parameters in HF patients. This could extend to clinically meaningful composite outcomes and hospitalizations but required more power to be definitive in linking to drug effect. Central-acting HF drugs show a role in mitigating diaphragm weakness.

10.1016/j.cjco.2024.01.003

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RIGHT VENTRICULAR - PULMONARY ARTERIAL UNCOUPLING PREDICTS MORTALITY IN CANDIDATES FOR ADVANCED HEART FAILURE THERAPIES

Canadian Journal of Cardiology (2019)

Shane D. Wright Leah Groves Julie K.K. Vishram‐Nielsen Elizabeth Karvasarski A. Alba

Interquartile range

Afterload

10.1016/j.cjca.2019.07.592

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Cardiac troponin I and incident stroke in European cohorts - insights from the BiomarCaRE project

WOS (2020)

Stephan Camen Tarja Palosaari Jaakko Reinikainen Ngoc Anh Spruenker Teemu Niiranen

Stroke

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IMPACT OF AGE ON THE ASSOCIATIONS BETWEEN TARGET ORGAN DAMAGE AND HEMODYNAMIC COMPONENTS DERIVED FROM 24-HOUR AMBULATORY BLOOD PRESSURE MEASUREMENT

Journal of Hypertension (2018)

Thomas Bastholm Olesen Manan Pareek Jacob V. Stidsen M. Blicher S. Rasmussen

Objective: Hemodynamic parameters obtained from 24-hour ambulatory blood pressure (BP) measurements (24hABPM) are more closely associated with markers of target organ damage than conventional office BP. The aim of this study was to evaluate the impact of age on the associations between hemodynamic components derived from 24hABPM and target organ damage, in apparently healthy, non-medicated subjects. Design and method: 24hABPM and target organ damage (left ventricular mass index, pulse wave velocity, urine albumin:creatinine ratio and carotid atherosclerotic plaques) were evaluated in 1408 subjects. Associations were examined in regression models, stratified for age [middle-aged (41 or 51 years) or elderly (61 or 71 years)], and adjusted for sex, smoking status, and total-cholesterol. Results: In middle-aged subjects, an increase of 10 mmHg in 24-hour systolic blood pressure was independently associated with an increase of 3.8 (2.7–4.8) g/m2 in LVMI. The effect was nearly doubled in the elderly subgroup, where the same increase resulted in an increase in LVMI of 6.3 (5.0–7.6) g/m2 (P for interaction < 0.01). An increase of 10 mmHg of 24-hour systolic blood pressure was associated with a 6.5% increase in pulse wave velocity in middle-aged subjects and with an 8.9% increase in elderly subjects (P for interaction < 0.01). An independent association between 24hABPM and urine albumin:creatinine ratio was only observed in the elderly subgroup. Associations between the presence of atherosclerotic plaques and components from 24hABPM, except that for 24hDBP, were not modified by age (P for all interactions > 0.26). Conclusions: Age enhances the associations between hemodynamic components obtained from 24hABPM and measures of arterial stiffness, microvascular damage, and cardiac structure, but not atherosclerosis.

Pulse pressure

10.1097/01.hjh.0000539433.80857.69

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Hemodynamic reserve predicts early right heart failure after LVAD implantation

The Journal of Heart and Lung Transplantation (2022)

Jacob M. Read Nnamdi I. Azih Carli J. Peters Vikram Gurtu Julie K.K. Vishram‐Nielsen

Afterload

10.1016/j.healun.2022.07.003

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Citations (15)