Publications by authors named "Einar Gude"
Aims: The prevalences of aortic stenosis (AS) and transthyretin amyloid cardiomyopathy (ATTR-CM) increase with age. Identification of occult ATTR-CM in patients with AS can help explain out-of-proportion myocardial dysfunction, aid in prognostication and prompt initiation of disease-modifying treatment. Studies have suggested that many patients referred for transcatheter aortic valve implantation (TAVI) have concomitant ATTR-CM, but some have included unverified ATTR-CM in patients with ambiguous scintigrams.
View Article and Find Full Text PDFBackground: Calcineurin inhibitors (CNIs) are associated with long-term complications after heart transplantation (HTx). Everolimus (EVR)-based immunosuppression allows for CNI withdrawal. We used data from The Scandinavian heart transplant everolimus de novo study with early CNI avoidance (SCHEDULE) trial to assess whether health-related quality of life (HRQoL) differed between patients on long-term treatment with EVR versus a CNI-based regimen.
View Article and Find Full Text PDFBackground: Pulmonary endarterectomy (PEA) is the treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH), while balloon pulmonary angioplasty (BPA) is an alternative for inoperable patients. We aimed to compare right ventricular (RV) remodelling and late survival after PEA and BPA.
Methods: In this prospective observational cohort study, we performed echocardiography at baseline and follow-up in patients with CTEPH treated with PEA (n=54) or BPA (n=44) between 2011 and 2022.
Article Synopsis
- Early substitution of calcineurin inhibitors (CNI) with everolimus in heart transplant patients showed improved long-term kidney function compared to standard CNI therapy.
- In a study involving 115 heart transplant recipients, those on everolimus maintained significantly better kidney health over 10-12 years, with an estimated glomerular filtration rate (eGFR) of 82.7 ml/min/1.73 m² versus 61.0 ml/min/1.73 m² for the standard CNI group.
- Despite the differences in kidney function, survival rates and overall graft performance were similar between both treatment groups, indicating that both approaches are viable long-term.
Introduction: Pre-transplant obesity and weight gain after heart transplantation are both associated with increased risk of poor clinical outcomes. We aimed to assess the association between overweight or obesity, exercise capacity, and health-related quality of life in heart transplant recipients.
Methods: This study is based on baseline data from the IronIC trial, in which we randomized 102 heart transplant recipients with iron deficiency to ferric derisomaltose or placebo.
Article Synopsis
- Cardiac allograft vasculopathy is a serious condition affecting heart transplant patients, characterized by increased thickness of coronary arteries, and despite using statins, it remains a top cause of death.
- A clinical trial was conducted to investigate whether the cholesterol-lowering drug evolocumab could reduce this condition's severity in heart transplant recipients.
- Though evolocumab significantly lowered LDL cholesterol levels in participants, it did not lead to a reduction in the thickness of coronary arteries after 12 months, and safety was not compromised during the study.
Background: Echocardiography is widely used to evaluate left ventricular (LV) diastolic function in patients suspected of heart failure. For patients in sinus rhythm, a combination of several echocardiographic parameters can differentiate between normal and elevated LV filling pressure with good accuracy. However, there is no established echocardiographic approach for the evaluation of LV filling pressure in patients with atrial fibrillation.
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- Ventricular septal rupture (VSR) is a rare but serious complication after heart attacks, and its symptoms can vary widely, highlighting the need for careful clinical evaluation.
- A middle-aged man with no prior heart issues experienced heart failure symptoms while abroad; tests revealed a small area of heart damage, but it wasn't initially linked to a major heart condition.
- Ultimately, he was diagnosed with a large VSR after further investigations showed a significant defect, leading to successful surgical repair, emphasizing that VSR can occur even after minor heart events and that new heart murmurs should not be overlooked.
Background: Evidence-based guidelines for cardiac sarcoidosis (CS) regarding use of second- and third-line agents, treatment duration, surveillance and prognostic factors are lacking.
Objective: To analyze the clinical presentation, diagnostics, treatment, monitoring and clinical outcomes in a Norwegian cohort.
Methods: Using discharge diagnoses between 2017 through 2020 from a large tertiary center, we identified 52 patients with CS.
Article Synopsis
- Giant cell myocarditis (GCM) is a rare and serious heart condition primarily affecting younger adults, often leading to rapid progression, life-threatening complications, and the need for an endomyocardial biopsy (EMB) for accurate diagnosis.
- A case study of a 50-year-old man with fulminant GCM demonstrated the critical need for early EMB and the effectiveness of starting treatment with methylprednisolone, along with sustained immunosuppressive therapy and heart failure medications, which resulted in full recovery.
- Accurate early diagnosis and rapid treatment are essential for improving outcomes in GCM patients, highlighting the importance of utilizing EMB, immunosuppressive therapy, and mechanical support when
Article Synopsis
- The study investigated blood flow dynamics in patients with transthyretin cardiomyopathy (ATTR-CM) during rest and exercise, focusing on pulmonary hypertension based on recent guidelines.
- It found that a significant 77% of patients had pulmonary hypertension according to the 2022 standards, compared to 47% with older guidelines, highlighting a rise in cases.
- Most subjects developed exercise-induced pulmonary hypertension, with increases in key pressure metrics indicating a major post-capillary component during physical activity.
Article Synopsis
- Cutaneous squamous cell carcinoma (cSCC) can lead to multiple tumors and is dangerous for both immunocompetent and immunosuppressed patients, including organ transplant recipients.
- This study analyzed data from nearly 48,000 cSCC patients in Norway to compare the rates of second cSCC, metastasis, and mortality between those who received organ transplants and those who didn't.
- Findings revealed that organ transplant recipients had significantly higher rates of second cSCC (4.3 times more) and metastasis (1.5 times more), with a small percentage of deaths from cSCC, especially in the transplant group.
A man in his seventies underwent routine heart examinations as part of workup for kidney transplantation. Unexpected findings led to more extensive investigations and revealed two rare systemic diseases as causes of his heart failure.
View Article and Find Full Text PDFPericarditis is an important differential diagnosis in patients with chest pain. The two most common causes in the developed world are idiopathic pericarditis and inflammation following cardiac surgery or myocardial infarction. Recurrence of pericarditis affects up to 30 % of patients, half of whom experience multiple episodes, and approximately 10 % develop steroid-dependent and colchicine-refractory pericarditis.
View Article and Find Full Text PDFAims: Transthyretin amyloid cardiomyopathy (ATTR CM) is a progressive and severe heart disease with physical and psychological implications. The Nordic PROACT study was conducted to investigate the health-related quality of life (HRQoL) in ATTR CM patients.
Methods And Results: The Nordic PROACT study was a cross-sectional non-interventional study conducted in 12 cardiology hospital clinics across Norway, Sweden, Finland and Denmark.
The treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH) is pulmonary endarterectomy (PEA). Balloon pulmonary angioplasty (BPA) is an emerging option for inoperable patients. Comparisons of the hemodynamic and functional outcome between these treatments are scarce.
View Article and Find Full Text PDFAn earlier healthy 64-year-old man with previous surgery for bilateral carpal tunnel syndrome (CTS) in his 50s, presented with dyspnoea on exertion. Cardiac amyloidosis was suspected due to "red flag" signs and symptoms. Further investigations with scintigraphy and genetic testing confirmed the diagnosis of hereditary ATTR variant (ATTRv) amyloidosis.
View Article and Find Full Text PDFIntroduction: Systemic sclerosis (SSc) is a heterogenous disorder that appears to result from interplay between vascular pathologies, tissue fibrosis and immune processes, with evidence for deregulation of chemokines, which normally control immune trafficking. We recently identified altered levels of chemokine CCL21 in SSc associated pulmonary arterial hypertension (PAH). Here, we aimed to define target organ expression and biomarker characteristics of CCL21.
View Article and Find Full Text PDFAims: Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive condition caused by deposition of transthyretin amyloid fibrils in the heart and is associated with poor quality of life and a shortened lifespan. This study aimed to describe the prevalence, clinical characteristics, and mortality of patients with ATTR-CM, using multiple national health registers in Denmark, Finland, Norway, and Sweden.
Methods And Results: Transthyretin amyloid cardiomyopathy patients were identified during 2008-2018 using a combination of diagnosis codes for amyloidosis and heart disease and were matched to patients with non-ATTR heart failure (HF).
Introduction: The randomized IronIC trial evaluated the effect of intravenous ferric derisomaltose on physical capacity in iron-deficient, maintenance heart transplant (HTx) recipients. Iron deficiency was defined as in heart failure with high cut-points for ferritin to compensate for inflammation. However, intravenous iron did not improve physical capacity except in patients with ferritin <30 μg/L.
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- - The study aims to compare healthcare resource use for patients with transthyretin amyloid cardiomyopathy (ATTR-CM) to those with heart failure (HF) in Denmark, Finland, Norway, and Sweden between 2008 and 2018.
- - Researchers analyzed data from nationwide health registers, finding that ATTR-CM patients had significantly higher hospital visits and admissions both before and after diagnosis compared to HF patients.
- - Results indicate that ATTR-CM results in a greater healthcare burden, with about double the outpatient visits and 50% more hospitalizations in the year following diagnosis compared to HF patients, highlighting the need for studies on earlier diagnosis and treatment to potentially reduce these healthcare demands.
Background: Optimal timing of aortic valve replacement remains difficult in patients with asymptomatic, severe aortic stenosis (AS). More accurate diagnostic methods are warranted for the detection of subtle ventricular impairment. We aimed to evaluate diastolic function in asymptomatic patients with severe AS.
View Article and Find Full Text PDFObjective: Transthyretin amyloid cardiomyopathy (ATTR-CM) is a rare, progressive and fatal condition caused by deposition of transthyretin amyloid fibrils in the heart. This study aims to identify all patients diagnosed with ATTR-CM in Sweden, estimate the prevalence of ATTR-CM, describe patient characteristics and mortality, assess the importance of early symptoms (red flags) for identification of ATTR-CM, and compare with patients with heart failure (HF).
Methods: This retrospective study combined multiple national health registers covering all specialist visits and prescriptions for the entire population of Sweden.