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Holm, J., Cederholm, I., Alehagen, U., Lindahl, T. & Szabó, Z. (2020). Biomarker dynamics in cardiac surgery: a prospective observational study on MR-proADM, MR-proANP, hs-CRP and sP-selectin plasma levels in the perioperative period. Biomarkers, 25(3), 296-304
Open this publication in new window or tab >>Biomarker dynamics in cardiac surgery: a prospective observational study on MR-proADM, MR-proANP, hs-CRP and sP-selectin plasma levels in the perioperative period
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2020 (English)In: Biomarkers, ISSN 1354-750X, E-ISSN 1366-5804, Vol. 25, no 3, p. 296-304Article in journal (Refereed) Published
Abstract [en]

Background: For many biomarkers in cardiac surgery, there is a lack of knowledge regarding the normal dynamics of plasma levels during the perioperative course. The aim of this study was to investigate the perioperative dynamics of MR-proADM, MR-proANP, hs-CRP and sP-selectin in cardiac surgery. Method: A prospective observational pilot study with 20 patients scheduled for open cardiac surgery procedures with cardiopulmonary bypass (CPB). Plasma samples were taken for each patient and biomarker during the pre-, per- and postoperative period until Day 6 postoperatively. Results: MR-proADM increased significantly from 0.62 [IQR; 0.54-0.93] nmol/L preoperatively to 1.20 [1.04-1.80] nmol/L postoperative Day 1. MR-proANP increased significantly from 125 [77-152] pmol/L preoperatively to 198 [168-307] pmol/L on weaning from CPB. hs-CRP increased significantly from 2.5 mg/L [0.4-12] preoperatively to peak at 208 mg/L [186-239] postoperative Day 3. The preoperative level of sP-selectin at 23.0 [21.3-26.3] ng/mL initially fell at weaning from CPB, followed by a significant peak of 25.5 [22.7-27.7] ng/mL 8 h postoperatively. Conclusions: The findings in this study may help to understand the physiology of the biomarkers analysed and their response to cardiac surgical trauma including CPB. Furthermore, these findings will guide us in further research on the clinical usefulness of these biomarkers.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2020
Keywords
MR-proADM; MR-proANP; hs-CRP; sP-selectin; cardiac surgery
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-165575 (URN)10.1080/1354750X.2020.1748716 (DOI)000527265900001 ()32301345 (PubMedID)
Note

Funding Agencies|ALF Grants, Region Ostergotland

Available from: 2020-05-06 Created: 2020-05-06 Last updated: 2025-02-18
Karason, K., Lund, L. H., Dalen, M., Bjorklund, E., Grinnemo, K., Braun, O., . . . Dellgren, G. (2020). Randomized trial of a left ventricular assist device as destination therapy versus guideline-directed medical therapy in patients with advanced heart failure. Rationale and design of the SWEdish evaluation of left Ventricular Assist Device (SweVAD) trial. European Journal of Heart Failure, 22(4), 739-750
Open this publication in new window or tab >>Randomized trial of a left ventricular assist device as destination therapy versus guideline-directed medical therapy in patients with advanced heart failure. Rationale and design of the SWEdish evaluation of left Ventricular Assist Device (SweVAD) trial
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2020 (English)In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 22, no 4, p. 739-750Article in journal (Refereed) Published
Abstract [en]

Aims Patients with advanced heart failure (AdHF) who are ineligible for heart transplantation (HTx) can become candidates for treatment with a left ventricular assist device (LVAD) in some countries, but not others. This reflects the lack of a systematic analysis of the usefulness of LVAD systems in this context, and of their benefits, limitations and cost-effectiveness. The SWEdish evaluation of left Ventricular Assist Device (SweVAD) study is a Phase IV, prospective, 1:1 randomized, non-blinded, multicentre trial that will examine the impact of assignment to mechanical circulatory support with guideline-directed LVAD destination therapy (GD-LVAD-DT) using the HeartMate 3 (HM3) continuous flow pump vs. guideline-directed medical therapy (GDMT) on survival in a population of AdHF patients ineligible for HTx. Methods A total of 80 patients will be recruited to SweVAD at the seven university hospitals in Sweden. The study population will comprise patients with AdHF (New York Heart Association class IIIB-IV, INTERMACS profile 2-6) who display signs of poor prognosis despite GDMT and who are not considered eligible for HTx. Participants will be followed for 2 years or until death occurs. Other endpoints will be determined by blinded adjudication. Patients who remain on study-assigned interventions beyond 2 years will be asked to continue follow-up for outcomes and adverse events for up to 5 years. Conclusion The SweVAD study will compare survival, medium-term benefits, costs and potential hazards between GD-LVAD-DT and GDMT and will provide a valuable reference point to guide destination therapy strategies for patients with AdHF ineligible for HTx.

Place, publisher, year, edition, pages
WILEY, 2020
Keywords
Advanced heart failure; Destination therapy; Mechanical circulatory support; Left ventricular assist device; HeartMate 3; Guideline-directed medical therapy; Randomized controlled trial
National Category
Cardiology and Cardiovascular Disease
Identifiers
urn:nbn:se:liu:diva-164621 (URN)10.1002/ejhf.1773 (DOI)000515900500001 ()32100946 (PubMedID)
Note

Funding Agencies|Sahlgrenska University Hospital; Swedish Research CouncilSwedish Research Council; Swedish Heart-Lung FoundationSwedish Heart-Lung Foundation; Swedish Federal Government under the ALF agreement [ALFGBG-775351, 447561, 726481]

Available from: 2020-03-27 Created: 2020-03-27 Last updated: 2025-02-10
Jiang, H., Holm, J., Vidlund, M., Vánky, F., Friberg, O., Yang, Y. & Svedjeholm, R. (2020). The impact of glutamate infusion on postoperative NT-proBNP in patients undergoing coronary artery bypass surgery: a randomized study. Journal of Translational Medicine, 18(1), Article ID 193.
Open this publication in new window or tab >>The impact of glutamate infusion on postoperative NT-proBNP in patients undergoing coronary artery bypass surgery: a randomized study
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2020 (English)In: Journal of Translational Medicine, E-ISSN 1479-5876, JOURNAL OF TRANSLATIONAL MEDICINE, Vol. 18, no 1, article id 193Article in journal (Refereed) Published
Abstract [en]

Background

Glutamate, a key intermediate in myocardial metabolism, may enhance myocardial recovery after ischemia and possibly reduce the incidence and severity of postoperative heart failure in coronary artery bypass surgery (CABG). N-terminal pro-B-type natriuretic peptide (NT-proBNP) can be used to assess postoperative heart failure (PHF) after CABG. Our hypothesis was that glutamate enhances myocardial recovery in post-ischemic heart failure and, therefore, will be accompanied by a mitigated postoperative increase of NT-proBNP.

Methods

Substudy of the GLUTAmate for Metabolic Intervention in Coronary Surgery (GLUTAMICS) trial (ClinicalTrials.gov Identifier: NCT00489827) a prospective triple-center double-blind randomized clinical trial on 399 patients undergoing CABG with or without concomitant procedure for acute coronary syndrome at three Swedish Cardiac Surgery centres (Linköping, Örebro, and Karlskrona) from May 30, 2007 to November 12, 2009. Patients were randomly assigned to intravenous infusion of 0.125 M L-glutamic acid or saline (1.65 mL/kg of body weight per hour) intraoperatively and postoperatively. Plasma NT-proBNP was measured preoperatively, the first (POD1) and third postoperative morning (POD3). A Clinical Endpoints Committee, blinded to both intervention and NT-proBNP used prespecified criteria to diagnose PHF. The primary endpoints were the absolute levels of postoperative NT-proBNP and the difference between preoperative and postoperative levels of NT-proBNP.

Results

Overall no significant difference was detected in postoperative NT-proBNP levels between groups. However, in high-risk patients (upper quartile of EuroSCORE II ≥ 4.15; glutamate group n = 56; control group n = 45) glutamate was associated with significantly lower postoperative increase of NT-proBNP (POD3-Pre: 3900 [2995–6260] vs. 6745 [3455–12,687] ng•L−1, p = 0.012) and lower NT-proBNP POD3 (POD3: 4845 [3426–7423] vs. 8430 [5370–14,100] ng•L−1, p = 0.001). After adjusting for significant differences in preoperative demographics, NT-proBNP POD3 in the glutamate group was 0.62 times of that in the control group (p = 0.002). Patients in the glutamate group also had shorter ICU stay (21 [19–26] vs. 25 [22–46] h, p = 0.025) and less signs of myocardial injury (Troponin T POD3 (300 [170–500] vs. 560 [210–910] ng•L−1, p = 0.025).

Conclusions

Post hoc analysis of postoperative NT-proBNP suggests that intravenous infusion of glutamate may prevent or mitigate myocardial dysfunction in high-risk patients undergoing CABG. Further studies are necessary to confirm these findings.

Trial registration Swedish Medical Products Agency 151:2003/70403 (prospectively registered with amendment about this substudy filed March 17, 2007). ClinicalTrials.gov Identifier: NCT00489827 (retrospectively registered) https://clinicaltrials.gov/ct2/show/NCT00489827?term=glutamics&draw=1&rank=1

Place, publisher, year, edition, pages
BioMed Central, 2020
Keywords
Glutamic acid; Natriuretic peptide; Heart failure; Coronary artery bypass surgery; Postoperative care
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-166100 (URN)10.1186/s12967-020-02351-7 (DOI)000534291800002 ()32393387 (PubMedID)2-s2.0-85084541718 (Scopus ID)
Note

Funding Agencies|Linkoping University; Swedish Heart-Lung FoundationSwedish Heart-Lung Foundation [20030595, 20140633]; Region Ostergotland [LIO-443891, LIO-693091]

Available from: 2020-06-08 Created: 2020-06-08 Last updated: 2024-07-04Bibliographically approved
Ahn, H. C., Holm, J., Najar, A., Hellers, G. & Szabó, Z. (2018). A New Total Artificial Heart Concept Allowing Replacement or Support of the Native Heart. Journal of Clinical & Experimental Cardiology, 9(2), Article ID 1000569.
Open this publication in new window or tab >>A New Total Artificial Heart Concept Allowing Replacement or Support of the Native Heart
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2018 (English)In: Journal of Clinical & Experimental Cardiology, E-ISSN 2155-9880, Vol. 9, no 2, article id 1000569Article in journal (Refereed) Published
Abstract [en]

A total artificial heart (TAH) is typically used to bridge the time to heart transplantation. A device designed by Robert Jarvik has been improved through the years and under the name of Syncardia™ this has been the most successful commercially available TAH so far. Since 2008 the Carmat™ heart has been under development in Europe. The Scandinavian Real Heart™ is based on a unique physiological concept where the atrio-ventricular valve plane is of utmost importance in the pumping function of the heart. It consists of two identical parts driven separately by independent motors and in this first animal study we have used one part as a left ventricular assist device. This new concept makes the device flexible as it may be used not only as a TAH but also as a separate pump for left or right ventricular assist.

Place, publisher, year, edition, pages
Los Angeles, United States: Omics Publishing Group, 2018
Keywords
Heart assist; Total artificial heart; Ventricular assist device; Left ventricular assist device
National Category
Cardiology and Cardiovascular Disease
Identifiers
urn:nbn:se:liu:diva-146044 (URN)10.4172/2155-9880.1000569 (DOI)
Available from: 2018-03-23 Created: 2018-03-23 Last updated: 2025-02-10Bibliographically approved
Holm, J., Szabó, Z., Alehagen, U., Lindahl, T. & Cederholm, I. (2018). Copeptin Release in Cardiac Surgery: A New Biomarker to Identify Risk Patients?. Journal of Cardiothoracic and Vascular Anesthesia, 32(1), 245-250
Open this publication in new window or tab >>Copeptin Release in Cardiac Surgery: A New Biomarker to Identify Risk Patients?
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2018 (English)In: Journal of Cardiothoracic and Vascular Anesthesia, ISSN 1053-0770, E-ISSN 1532-8422, Vol. 32, no 1, p. 245-250Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To describe the dynamics of copeptin in open cardiac surgery during the perioperative course.

DESIGN: Prospective cohort study.

SETTING: Single tertiary hospital.

PARTICIPANTS: Twenty patients scheduled for open cardiac surgery procedures with cardiopulmonary bypass (CPB).

INTERVENTIONS: No intervention.

MEASUREMENTS AND MAIN RESULTS: Copeptin concentrations were measured pre-, peri-, and postoperatively until day 6 after surgery. Patients were analyzed as a whole cohort (n = 20) and in a restricted "normal cohort" consisting of patients with normal preoperative copeptin concentration (<10 pmol/L) and perioperative uneventful course (n = 11). In the whole cohort, preoperative copeptin concentration was 7.0 pmol/L (interquartile range: 3.1-11 pmol/L). All patients had an early rise of copeptin, with 80% having peak copeptin concentration at weaning from CPB or upon arrival in the intensive care unit. Patients in the "normal cohort" had copeptin concentration at weaning from CPB of 194 pmol/L (98-275), postoperative day 1, 27 pmol/L (18-31); and day 3, 8.9 pmol/L (6.3-12).

CONCLUSIONS: Regardless of cardiac surgical procedure and perioperative course, all patients had an early significant rise of copeptin concentrations, generally peaking at weaning from CBP or upon arrival in the intensive care unit. Among patients with normal copeptin concentration preoperatively and uneventful course, the postoperative copeptin concentrations decreased to normal values within 3-to-4 days after cardiac surgery. Furthermore, the restricted "normal cohort" generally tended to display lower levels of copeptin concentration postoperatively. Further studies may evaluate whether copeptin can be a tool in identifying risk patients in cardiac surgery.

Place, publisher, year, edition, pages
Saunders Elsevier, 2018
Keywords
cardiac surgery, copeptin, kinetics, perioperative care
National Category
Cardiology and Cardiovascular Disease
Identifiers
urn:nbn:se:liu:diva-144019 (URN)10.1053/j.jvca.2017.06.011 (DOI)000424730300032 ()29102258 (PubMedID)2-s2.0-85033433737 (Scopus ID)
Available from: 2018-01-03 Created: 2018-01-03 Last updated: 2025-02-10Bibliographically approved
Hultkvist, H., Holm, J., Svedjeholm, R. & Vánky, F. (2018). Rise and fall of NT-proBNP in aortic valve intervention.. Open heart, 5(1), Article ID e000739.
Open this publication in new window or tab >>Rise and fall of NT-proBNP in aortic valve intervention.
2018 (English)In: Open heart, E-ISSN 2053-3624, Vol. 5, no 1, article id e000739Article in journal (Refereed) Published
Abstract [en]

Objectives: To describe the dynamics of N-terminal pro-B-type natriuretic peptide (NT-proBNP) from preoperative evaluation to 6-month follow-up in patients undergoing aortic valve intervention, and to evaluate NT-proBNP with regard to 1-year mortality.

Methods: At preoperative evaluation, we prospectively included 462 patients accepted for aortic valve intervention. The median time to surgical aortic valve replacement (SAVR; n=336) or transcatheter aortic valve implantation (TAVI; n=126) was 4 months. NT-proBNP was measured at enrolment for preoperative evaluation, on the day of surgery, postoperatively on day 1, day 3 and at the 6-month follow-up. Subgroups of patients undergoing SAVR with aortic regurgitation and aortic stenosis with and without coronary artery bypass were also analysed.

Results: NT-proBNP remained stable in all subgroups during the preoperative waiting period, but displayed a substantial transient early postoperative increase with a peak on day 3 except in the TAVI group, which peaked on day 1. At the 6-month follow-up, NT-proBNP had decreased to or below the preoperative level in all groups. In the SAVR group, NT-proBNP preoperatively and on postoperative days 1 and 3 revealed significant discriminatory power with regard to 1-year mortality (area under the curve (AUC)=0.79, P=0.0001; AUC=0.71, P=0.03; and AUC=0.79, P=0.002, respectively). This was not found in the TAVI group, which had higher levels of NT-proBNP both preoperatively and at the 6-month follow-up compared with the SAVR group.

Conclusions: The dynamic profile of NT-proBNP differed between patients undergoing TAVI and SAVR. NT-proBNP in the perioperative course was associated with increased risk of 1-year mortality in SAVR but not in TAVI.

Keywords
aortic valve disease, heart failure, surgery-valve
National Category
Cardiology and Cardiovascular Disease
Identifiers
urn:nbn:se:liu:diva-149013 (URN)10.1136/openhrt-2017-000739 (DOI)000438977000009 ()29632678 (PubMedID)
Available from: 2018-06-25 Created: 2018-06-25 Last updated: 2025-02-10
Holm, J., Vidlund, M., Vánky, F., Friberg, O., Håkanson, E., Walther, S. & Svedjeholm, R. (2014). EuroSCORE II and N-terminal pro-B-type natriuretic peptide for risk evaluation: an observational longitudinal study in patients undergoing coronary artery bypass graft surgery. British Journal of Anaesthesia, 113(1), 75-82
Open this publication in new window or tab >>EuroSCORE II and N-terminal pro-B-type natriuretic peptide for risk evaluation: an observational longitudinal study in patients undergoing coronary artery bypass graft surgery
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2014 (English)In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 113, no 1, p. 75-82Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Postoperative heart failure remains the major cause of death after cardiac surgery. As N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a predictor for postoperative heart failure, the aim was to evaluate if preoperative NT-proBNP could provide additional prognostic information to the recently launched EuroSCORE II.

METHODS:

A total of 365 patients with acute coronary syndrome (ACS) undergoing isolated coronary artery bypass graft (CABG) surgery were studied prospectively. Preoperative NT-proBNP and EuroSCORE II were evaluated with regard to severe circulatory failure after operation according to prespecified criteria. To assess what clinical outcomes are indicated by NT-proBNP levels in different risk categories, the patients were stratified according to EuroSCORE II. Based on receiver operating characteristics analysis, these cohorts were assessed with regard to preoperative NT-proBNP below or above 1028 ng litre(-1). The follow-up time averaged 4.4 (0.7) yr.

RESULTS:

Preoperative NT-proBNP≥1028 ng litre(-1) [odds ratio (OR) 9.9, 95% confidence interval (CI) 1.01-98.9; P=0.049] and EuroSCORE II (OR 1.24, 95% CI 1.06-1.46; P=0.008) independently predicted severe circulatory failure after operation. In intermediate-risk patients (EuroSCORE II 2.0-10.0), NT-proBNP≥1028 ng litre(-1) was associated with a higher incidence of severe circulatory failure (6.6% vs 0%; P=0.007), renal failure (14.8% vs 5.4%; P=0.03), stroke (6.6% vs 0.7%; P=0.03), longer intensive care unit stay [37 (35) vs 27 (38) h; P=0.002], and worse long-term survival.

CONCLUSIONS:

Combining EuroSCORE II and preoperative NT-proBNP appears to improve risk prediction with regard to severe circulatory failure after isolated CABG for ACS. NT-proBNP may be particularly useful in patients at intermediate risk according to EuroSCORE II.

Place, publisher, year, edition, pages
Oxford University Press, 2014
Keywords
acute coronary syndrome; coronary artery bypass surgery; natriuretic peptides; risk assessment
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-109246 (URN)10.1093/bja/aeu088 (DOI)000338598700011 ()24727704 (PubMedID)
Available from: 2014-08-12 Created: 2014-08-11 Last updated: 2024-01-10Bibliographically approved
Svedjeholm, R., Tajik, B., Vidlund, M., Friberg, Ö., Holm, J., Vanky, F. & Håkansson, E. (2014). Intravenous glutamatereduces the need for inotropes in patients with heart failure after CABG foracute coronary syndrome?. In: : . Paper presented at 6th Joint Scandinavian conference in Cardiothoracic Surgery, Gothenburg, Sweden.
Open this publication in new window or tab >>Intravenous glutamatereduces the need for inotropes in patients with heart failure after CABG foracute coronary syndrome?
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2014 (English)Conference paper, Poster (with or without abstract) (Other academic)
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-114365 (URN)
Conference
6th Joint Scandinavian conference in Cardiothoracic Surgery, Gothenburg, Sweden
Available from: 2015-02-19 Created: 2015-02-19 Last updated: 2024-01-10
Tajik, B., Vidlund, M., Sundbom, P., Friberg, Ö., Holm, J., Vanky, F. & Svedjeholm, R. (2014). Intravenous glutamatereduces the need for inotropes in patients with heart failure after CABG foracute coronary syndrome?. In: : . Paper presented at 29th Annual meeting of the European Association of Cardiothoracic Anesthesiologists, Florence, Italy.
Open this publication in new window or tab >>Intravenous glutamatereduces the need for inotropes in patients with heart failure after CABG foracute coronary syndrome?
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2014 (English)Conference paper, Poster (with or without abstract) (Other academic)
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-114367 (URN)
Conference
29th Annual meeting of the European Association of Cardiothoracic Anesthesiologists, Florence, Italy
Available from: 2015-02-19 Created: 2015-02-19 Last updated: 2024-01-10
Holm, J., Vidlund, M., Vanky, F., Friberg, Ö., Håkanson, E. & Svedjeholm, R. (2013). Does preoperative NT-proBNP provide additional prognostic information to EuroSCORE II in patients undfergoing CABG?. In: : . Paper presented at 28th Annual meeting of the European Association of Cardiothoracic Anesthesiologists, Barcelona, Spain, June 6-8, 2013.
Open this publication in new window or tab >>Does preoperative NT-proBNP provide additional prognostic information to EuroSCORE II in patients undfergoing CABG?
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2013 (English)Conference paper, Poster (with or without abstract) (Other academic)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-103348 (URN)
Conference
28th Annual meeting of the European Association of Cardiothoracic Anesthesiologists, Barcelona, Spain, June 6-8, 2013
Available from: 2014-01-17 Created: 2014-01-17 Last updated: 2024-01-10
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-3443-3392

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