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Vedin, Ola
Publications (10 of 18) Show all publications
Savarese, G., Vedin, O., D'Amario, D., Uijl, A., Dahlström, U., Rosano, G., . . . Lund, L. H. (2019). Prevalence and Prognostic Implications of Longitudinal Ejection Fraction Change in Heart Failure. JACC. Heart failure, 7(4), 306-317
Open this publication in new window or tab >>Prevalence and Prognostic Implications of Longitudinal Ejection Fraction Change in Heart Failure
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2019 (English)In: JACC. Heart failure, ISSN 2213-1779, E-ISSN 2213-1787, Vol. 7, no 4, p. 306-317Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: This study sought to evaluate the incidence, the predictors, and the associations with outcomes of changes in ejection fraction (EF) in heart failure (HF) patients.

BACKGROUND: EF determines therapy in HF, but information is scarce about incidence, determinants, and prognostic implications of EF change over time.

METHODS: Patients with >= 2 EF measurements were made in the Swedish Heart Failure Registry were categorized as heart failure with preserved ejection fraction (HFpEF) (EF >= 50%), heart failure with midrange ejection fraction (HFmrEF) (EF 40% to 49%), or heart failure with reduced ejection fraction (HFrEF) (EF <40%). Changes among categories were recorded, and associations among EF changes, predictors, and all-cause mortality and/or HF hospitalizations were analyzed using logistic and Cox regressions.

RESULTS: Of 4,942 patients at baseline, 18% had HFpEF, 19% had HFmrEF, and 63% had HFrEF. During follow-up, 21% and 18% of HFpEF patients transitioned to HFmrEF and HFrEF, respectively; 37% and 25% of HFmrEF patients transitioned to HFrEF and HFpEF, respectively; and 16% and 10% of HFrEF patients transitioned to HFmrEF and HFpEF, respectively. Predictors of increased EF included use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, female sex, cases of less severe HF, and comorbidities. Predictors of decreased EF included diabetes, ischemic heart disease, and cases of more severe HF. Increased EF was associated with a lower risk (hazard ratio [HR]: 0.62; 95% confidence interval [CI]: 0.55 to 0.69) and decreased EF with a higher risk (HR: 1.15; 95% CI: 1.01 to 1.30) of mortality and/or HF hospitalizations. Prognostic implications were most evident for transitions to and from HFrEF.

CONCLUSIONS: Increases in EF occurred in one-fourth of HFrEF and HFmrEF patients, and decreases occurred in more than one-third of patients with HFpEF and HFmrEF. EF change was associated with a wide range of important clinical, treatment, and organizational factors as well as with outcomes, particularly transitions to and from HFrEF.

Place, publisher, year, edition, pages
ELSEVIER SCI LTD, 2019
Keywords
ejection fraction, heart failure, predictors, prognosis
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-381568 (URN)10.1016/j.jchf.2018.11.019 (DOI)000462357600004 ()30852236 (PubMedID)
Funder
Swedish Research Council, 2013-23897-104604-23Swedish Research Council, 523-2014-2336Swedish Heart Lung Foundation, 20120321Swedish Heart Lung Foundation, 20150557Stockholm County Council, 20110120
Available from: 2019-04-16 Created: 2019-04-16 Last updated: 2019-04-16Bibliographically approved
Stolfo, D., Uijl, A., Vedin, O., Stromberg, A., Faxen, U. L., Rosano, G. M. G., . . . Savarese, G. (2019). Sex-Based Differences in Heart Failure Across the Ejection Fraction Spectrum Phenotyping, and Prognostic and Therapeutic Implications. JACC. Heart failure, 7(6), 505-515
Open this publication in new window or tab >>Sex-Based Differences in Heart Failure Across the Ejection Fraction Spectrum Phenotyping, and Prognostic and Therapeutic Implications
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2019 (English)In: JACC. Heart failure, ISSN 2213-1779, E-ISSN 2213-1787, Vol. 7, no 6, p. 505-515Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES This study assessed sex-related differences in a large cohort of unselected patients with heart failure (HF) across the ejection fraction (EF) spectrum. BACKGROUND Females are under-represented in randomized clinical trials. Potential sex-related differences in HF may question the generalizability of trials. METHODS In the Swedish Heart Failure Registry population multivariate Cox and logistic regression models were fitted to investigate differences in prognosis, prognostic predictors, and treatments across mates and females. RESULTS Of 42,987 patients, 37% were females (55% with HF with preserved EF [HFpEF], 39% with HF with mid-range EF [HFmrEF], and 29% with HF with reduced EF [HFrEF]). Females were older and more symptomatic and more likely to have hypertension and kidney disease but less likely to have diabetes and ischemic heart disease. After adjustments, females were more likely to use beta-blockers and digoxin but less likely to receive HF device therapy. Crude mortality/HF hospitalization rates for HFpEF (hazard ratio [HR]: 1.16) and HFmrEF (HR: 1.14) were significantly higher in females but lower in females with HFrEF (HR: 0.95). After adjustments, the risk was significantly tower in females regardless of EF (HR: 0.80 in HFrEF, HR: 0.91 in HFmrEF, and HR: 0.93 in HFpEF). The main sex-related differences in prognostic predictors concerned diabetes in HFrEF and anemia in HFmrEF. CONCLUSIONS Mates and females with HF showed different characteristics across the EF spectrum. Mates reported a lower crude risk of mortality/morbidity in HFpEF and HFmrEF but higher risk of HFrEF, although after adjustments, prognosis was better in females regardless of EF. The observed sex-related differences highlight the need for an adequate representation of females in HF randomized controlled trials to improve generatizabitity.

Place, publisher, year, edition, pages
ELSEVIER SCI LTD, 2019
Keywords
gender, heart failure with mid-range ejection fraction, heart failure with preserved ejection fraction, heart failure with reduced ejection fraction, heart failure, outcome, registry, sex
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-386435 (URN)10.1016/j.jchf.2019.03.011 (DOI)000469047100010 ()31146874 (PubMedID)
Available from: 2019-06-26 Created: 2019-06-26 Last updated: 2019-06-26Bibliographically approved
Savarese, G., Orsini, N., Hage, C., Dahlstrom, U., Vedin, O., Rosano, G. M. C. & Lund, L. H. (2018). Associations With and Prognostic and Discriminatory Role of N-Terminal Pro-B-Type Natriuretic Peptide in Heart Failure With Preserved Versus Mid-range Versus Reduced Ejection Fraction. Journal of Cardiac Failure, 24(6), 365-374
Open this publication in new window or tab >>Associations With and Prognostic and Discriminatory Role of N-Terminal Pro-B-Type Natriuretic Peptide in Heart Failure With Preserved Versus Mid-range Versus Reduced Ejection Fraction
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2018 (English)In: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 24, no 6, p. 365-374Article in journal (Refereed) Published
Abstract [en]

Background: The aim of this study was to characterize N-terminal pro-B-type natriuretic peptide (NT-proBNP) in terms of determinants of levels and of its prognostic and discriminatory role in heart failure with mid-range (HFmrEF) versus preserved (HFpEF) and reduced (HFrEF) ejection fraction.

Methods and Results: In 9847 outpatients with HFpEF (n = 1811; 18%), HFmrEF (n = 2122; 22%) and HFrEF (n = 5914; 60%) enrolled in the Swedish Heart Failure Registry, median NT-proBNP levels were 1428, 1540, and 2288 pg/mL, respectively. Many determinants of NT-proBNP differed by ejection fraction, with atrial fibrillation (AF) more important in HFmrEF and HFpEF, diabetes and hypertension in HFmrEF, and age and body mass index in HFrEF and HFmrEF, whereas renal function, New York Heart Association functional class, heart rate, and anemia were similar. Hazard ratios for death and death/HF hospitalization for NT-proBNP above the median ranged from 1.48 to 2.00 and were greatest for HFmrEF and HFpEF. Areas under the receiver operating characteristic curve for death and death/HF hospitalization were greater in HFmrEF than in HFpEF and HFrEF and were reduced by AF in HFpEF and HFmrEF but not in HFrEF.

Conclusions: In HFpEF and especially HFmrEF, NT-proBNP was more prognostic and discriminatory, but also more affected by confounders such as AF. These data support the use of NT-proBNP for eligibility, enrichment, and surrogate end points in HFpEF and HFmrEF trials, and suggest that cutoff levels for eligibility should be carefully tailored to comorbidity.

Place, publisher, year, edition, pages
CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS, 2018
Keywords
N-Terminal pro-B-type natriuretic peptide, heart failure with preserved ejection fraction, heart failure with mid-range ejection fraction, heart failure with reduced ejection fraction
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-360487 (URN)10.1016/j.cardfail.2018.03.010 (DOI)000437389100006 ()29597053 (PubMedID)
Funder
Swedish Research CouncilStockholm County CouncilSwedish Heart Lung Foundation
Available from: 2018-09-17 Created: 2018-09-17 Last updated: 2018-09-17Bibliographically approved
Vedin, O., Vasko, P., Bachus, E., Dahlstrom, U., Fu, M., Lindmark, K., . . . Lund, L. H. (2018). Early real-world implementation of sacubitril/valsartan in Sweden. European Journal of Heart Failure, 20(S1), 266-266
Open this publication in new window or tab >>Early real-world implementation of sacubitril/valsartan in Sweden
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2018 (English)In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 20, no S1, p. 266-266Article in journal, Meeting abstract (Other academic) Published
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-365134 (URN)000434123901192 ()
Available from: 2018-11-09 Created: 2018-11-09 Last updated: 2018-11-09Bibliographically approved
Lund, L. H., Vedin, O. & Savarese, G. (2018). Is ejection fraction in heart failure a limitation or an opportunity?. European Journal of Heart Failure, 20(3), 431-432
Open this publication in new window or tab >>Is ejection fraction in heart failure a limitation or an opportunity?
2018 (English)In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 20, no 3, p. 431-432Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
WILEY, 2018
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-356895 (URN)10.1002/ejhf.1106 (DOI)000428392800006 ()29333631 (PubMedID)
Available from: 2018-08-09 Created: 2018-08-09 Last updated: 2018-08-09Bibliographically approved
Savarese, G., Orsini, N., Hage, C., Vedin, O., Cosentino, F., Rosano, G., . . . Lund, L. H. (2018). Optimizing criteria for N-terminal pro-B-type natriuretic peptide for eligibility and enrichment in trials in heart failure with preserved, mid-range and reduced ejection fraction. European Journal of Heart Failure, 20(S1), 284-285
Open this publication in new window or tab >>Optimizing criteria for N-terminal pro-B-type natriuretic peptide for eligibility and enrichment in trials in heart failure with preserved, mid-range and reduced ejection fraction
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2018 (English)In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 20, no S1, p. 284-285Article in journal, Meeting abstract (Other academic) Published
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-365135 (URN)000434123901247 ()
Funder
Swedish Research Council, 2013-23897-104604-23Swedish Research Council, 523-2014-2336
Available from: 2018-11-12 Created: 2018-11-12 Last updated: 2018-11-12Bibliographically approved
Vedin, O., Savarese, G., Dahlstrom, U., Lam, C. S. & Lund, L. H. (2018). Prevalence and prognostic implications of longitudinal ejection fraction change in heart failure. European Journal of Heart Failure, 20(S1), 32-32
Open this publication in new window or tab >>Prevalence and prognostic implications of longitudinal ejection fraction change in heart failure
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2018 (English)In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 20, no S1, p. 32-32Article in journal, Meeting abstract (Other academic) Published
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-365132 (URN)000434123900065 ()
Funder
Swedish Heart Lung Foundation, 20120321Swedish Heart Lung Foundation, 20150557Swedish Research Council, 523-2014-2336Swedish Research Council, 2013-23897-104604-23
Available from: 2018-11-09 Created: 2018-11-09 Last updated: 2018-11-09Bibliographically approved
Kero, T., Sorensen, J., Antoni, G., Wilking, H., Carlson, K., Vedin, O., . . . Lubberink, M. (2018). Quantification of (11)C-PIB kinetics in cardiac amyloidosis. Journal of Nuclear Cardiology, ISSN 1071-3581, EISSN 1532-6551
Open this publication in new window or tab >>Quantification of (11)C-PIB kinetics in cardiac amyloidosis
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2018 (English)In: Journal of Nuclear Cardiology, ISSN 1071-3581, EISSN 1532-6551Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: The purpose of this work was to determine the optimal tracer kinetic model of (11)C-PIB and to validate the use of the simplified methods retention index (RI) and standardized uptake value (SUV) for quantification of cardiac (11)C-PIB uptake in amyloidosis. METHODS AND RESULTS: Single-tissue, reversible and irreversible two-tissue models were fitted to data from seven cardiac amyloidosis patients who underwent (11)C-PIB PET scans and arterial blood sampling for measurement of blood radioactivity and metabolites. The irreversible two-tissue model (2Tirr) best described cardiac (11)C-PIB uptake. RI and SUV showed high correlation with the rate of irreversible binding (Ki) from the 2Tirr model (r(2 )=0.95 and r(2 )=0.94). Retrospective data from 10 amyloidosis patients and 5 healthy controls were analyzed using RI, SUV, as well as compartment modelling with a population-average metabolite correction. All measures were higher in amyloidosis patients than in healthy controls (p=.001), but with an overlap between groups for Ki. CONCLUSION: An irreversible two-tissue model best describes the (11)C-PIB uptake in cardiac amyloidosis. RI and SUV correlate well with Ki from the 2Tirr model. RI and SUV discriminate better between amyloidosis patients and controls than Ki based on population-average metabolite correction.

Keywords
11c-pib, Cardiac amyloidosis, absolute quantification, retention index, standardized uptake value
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-356695 (URN)10.1007/s12350-018-1349-x (DOI)1532-6551 (Electronic) 1071-3581 (Linking) (ISBN)
Note

Kero, Tanja Sorensen, Jens Antoni, Gunnar Wilking, Helena Carlson, Kristina Vedin, Ola Rosengren, Sara Wikstrom, Gerhard Lubberink, Mark eng J Nucl Cardiol. 2018 Jul 23. pii: 10.1007/s12350-018-1349-x. doi: 10.1007/s12350-018-1349-x.

Available from: 2018-08-03 Created: 2018-08-03 Last updated: 2018-10-25Bibliographically approved
Savarese, G., Orsini, N., Hage, C., Vedin, O., Cosentino, F., Rosano, G. M. C., . . . Lund, L. H. (2018). Utilizing NT-proBNP for Eligibility and Enrichment in Trials in HFpEF, HFmrEF, and HFrEF. JACC. Heart failure, 6(3), 246-256
Open this publication in new window or tab >>Utilizing NT-proBNP for Eligibility and Enrichment in Trials in HFpEF, HFmrEF, and HFrEF
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2018 (English)In: JACC. Heart failure, ISSN 2213-1779, E-ISSN 2213-1787, Vol. 6, no 3, p. 246-256Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES

The purpose of this study was to assess the association between N-terminal pro-B-type natriuretic peptide (NT-proBNP) and cardiovascular (CV) versus non-CV events and between NT-proBNP and potential treatment effects in heart failure (HF) with preserved, mid-range, and reduced ejection fraction (HFpEF, HFmrEF, and HFrEF, respectively) and clinically relevant subgroups.

BACKGROUND

Optimizing patient eligibility criteria in HF trials requires biomarkers that enrich for CV but not for non-CV events and select patients most likely to respond to the tested intervention.

METHODS

In the Swedish HF registry population stratified by EF category, we used Kaplan-Meier curves to estimate unadjusted CV and non-CV risks (mortality or hospitalization); Poisson regressions to calculate crude event rates of CV and non-CV events according to NT-proBNP levels; and Cox regressions to calculate the adjusted hazard ratios for HF therapies according to NT-proBNP <= or > median.

RESULTS

In a cohort of 15,849 patients (23% HFpEF, 21% HFmrEF, 56% HFrEF), median NT-proBNP was 2,037, 2,192, and 3,141 pg/ml, respectively. With increasing NT-proBNP, CV event rates increased more steeply than non-CV rates (range 20 to 160 and 30 to 100 per 100 patient-years in HFpEF; 20 to 130 and 20 to 100 in HFmrEF; and 20 to 110 and 20 to 50 in HFrEF, respectively). The CV-to-non-CV ratio increased with increasing NT-proBNP in HFpEF and HFrEF, but only in the lower range in HFmrEF. The association between treatments (e.g., angiotensin-converting enzyme-inhibitor, angiotensin II receptor blockers, and beta-blockers) and outcomes was consistent in NT-proBNP <= and > median.

CONCLUSIONS

In HF trial design in different EF categories, NT-proBNP may be a useful tool for eligibility and enrichment for CV events, but its role in predicting a potential treatment response remains unclear.

Keywords
eligibility, heart failure, N-terminal pro-B-type natriuretic peptide, registry, trials
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-351266 (URN)10.1016/j.jchf.2017.12.014 (DOI)000426507700011 ()29428439 (PubMedID)
Funder
Swedish Research Council, 2013-23897-104604-23Swedish Research Council, 523-2014-2336AstraZenecaSwedish Research Council
Available from: 2018-06-11 Created: 2018-06-11 Last updated: 2018-06-11Bibliographically approved
Vedin, O., Hagström, E., Östlund, O., Avezum, A., Budaj, A., Flather, M. D., . . . Held, C. (2017). Associations between tooth loss and prognostic biomarkers and the risk for cardiovascular events in patients with stable coronary heart disease. International Journal of Cardiology, 245, 271-276
Open this publication in new window or tab >>Associations between tooth loss and prognostic biomarkers and the risk for cardiovascular events in patients with stable coronary heart disease
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2017 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 245, p. 271-276Article in journal (Refereed) Published
Abstract [en]

Background:

Underlying mechanisms behind the hypothesized relationship between periodontal disease (PD) and coronary heart disease (CHD) have been insufficiently explored. We evaluated associations between self-reported tooth loss-a marker of PD- and prognostic biomarkers in 15,456 (97%) patients with stable CHD in the global STABILITY trial.

Methods and results:

Baseline blood samples were obtained and patients reported their number of teeth according to the following tooth loss levels: "26-32 (All)" [lowest level], "20-25", "15-19", "1-14", and "No Teeth" [highest level]. Linear and Cox regression models assessed associations between tooth loss levels and biomarker levels, and the relationship between tooth loss levels and outcomes, respectively.

After multivariable adjustment, the relative biomarker increase between the highest and the lowest tooth loss level was: high-sensitivity C-reactive protein 1.21 (95% confidence interval, 1.14-1.29), interleukin 6 1.14 (1.10-1.18), lipoprotein-associated phospholipase A(2) activity 1.05 (1.03-1.06), growth differentiation factor 15 1.11 (1.08-1.14), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) 1.18 (1.11-1.25). No association was detected for high-sensitivity troponin T 1.02 (0.98-1.05). Some attenuation of the relationship between tooth loss and outcomes resulted from the addition of biomarkers to the multivariable analysis, of which NT-proBNP had the biggest impact.

Conclusions:

A graded and independent association between tooth loss and several prognostic biomarkers was observed, suggesting that tooth loss and its underlying mechanisms may be involved in multiple pathophysiological pathways also implicated in the development and prognosis of CHD. The association between tooth loss and cardiovascular death and stroke persisted despite comprehensive adjustment including prognostic biomarkers.

Keywords
Tooth loss, Periodontal disease, Stable coronary heart disease, Biomarkers, Risk factors
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-336290 (URN)10.1016/j.ijcard.2017.07.036 (DOI)000411288700055 ()28735759 (PubMedID)
Available from: 2018-01-23 Created: 2018-01-23 Last updated: 2018-01-23Bibliographically approved
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