Publikasjoner
-
-
Holt, Margrethe Flesvig; Michelsen, Annika Elisabet; Flø, August Magnus Stensrød; Russell, Kristoffer; Beitnes, Jan Otto & Kløve, Sophie Foss
[Vis alle 12 forfattere av denne artikkelen]
(2025).
Increased dipeptidyl peptidase 4 in patients with concomitant transthyretin cardiac amyloidosis and severe aortic stenosis.
International journal of cardiology: Heart and Vasculature (IJCHA).
61.
doi:
10.1016/j.ijcha.2025.101820.
Fulltekst i vitenarkiv
Vis sammendrag
Background
Due to overlapping symptoms and signs, it can be challenging to diagnose transthyretin amyloid cardiomyopathy (ATTR-CM) in the setting of concomitant aortic stenosis. Biomarkers may discriminate between heart failure with ATTR-CM and heart failure without ATTR-CM, but it is not known if these markers can differentiate between AS with and AS without concomitant ATTR-CM.
Methods
In 9 patients with ATTR-CM and AS, 161 patients with lone AS, and 23 healthy controls, we measured 8 plasma proteins previously identified by proteomic analysis as potential candidates for diagnosing ATTR-CM. We assessed differences between groups and association with indices of heart failure and AS severity.
Results
Plasma levels of dipeptidyl peptidase 4 (DPP4) were significantly higher in patients with AS and ATTR-CM than in patients with lone AS and in healthy controls. Lower levels of DPP4 were also associated with worse left ventricular function, higher New York Heart Association functional class, and low-flow, low-gradient aortic stenosis.
Conclusions
Our findings suggest that DPP4 may be a marker of ATTR-CM in patients with severe AS. In all AS patients, those with and without coexisting ATTR-CM, high DPP4 levels were asociated with better cardiac function.
-
-
Holt, Margrethe Flesvig; Flø, August Magnus Stensrød; Kaya, Esra; Kløve, Sophie Foss; Martinsen, Hege & Amlie, Kristine
[Vis alle 16 forfattere av denne artikkelen]
(2025).
Transthyretin amyloid cardiomyopathy in aortic stenosis patients scheduled for transcatheter aortic valve implantation.
ESC Heart Failure.
12(4),
s. 2467–2476.
doi:
10.1002/ehf2.15258.
Fulltekst i vitenarkiv
Vis sammendrag
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. We aimed to assess the co-occurrence of ATTR-CM in patients scheduled for TAVI.
Methods
In patients accepted for TAVI for severe AS, we used bone scintigraphy to screen for ATTR-CM. We defined ATTR-CM as a cardiac tracer uptake ≥ Perugini Grade 2 in the absence of abnormal monoclonal protein or abnormal free light chain ratio. We offered bioptic verification to patients with Grade 1 or ambiguous DPD uptake.
Results
We included 171 consecutive patients aged 79 ± 7 years, 57% were male. Six patients (3.5%) had cardiac bone tracer uptake ≥ Perugini Grade 2 and no abnormal monoclonal protein/free light chains. Endomyocardial biopsies confirmed the diagnosis in two additional patients (1.2%), whereas five patients with low-grade uptake did not have ATTR-CM. In total, 8/171 patients (4.7%) were diagnosed with concomitant AS and ATTR-CM. Most of the patients with concomitant ATTR-CM had low-flow low-gradient (LFLG) AS, and 25% had a history of carpal tunnel syndrome.
Conclusions
We found concomitant AS and ATTR-CM in 5% of our TAVI patients. Carpal tunnel syndrome and LFLG AS suggest concomitant ATTR.
-
Holt, Margrethe Flesvig; Flø, August Magnus Stensrød; Ravnestad, Håvard; Bjørnø, Vilde; Gullestad, Lars & Andreassen, Arne K.
[Vis alle 8 forfattere av denne artikkelen]
(2023).
Invasive haemodynamics at rest and exercise in cardiac amyloidosis.
ESC Heart Failure.
doi:
10.1002/ehf2.14621.
Fulltekst i vitenarkiv
Vis sammendrag
Aims Our aim was to investigate haemodynamics at rest and during exercise in patients with transthyretin cardiomyopathy (ATTR-CM) in light of the 2022 European Society of Cardiology (ESC) and European Respiratory Society (ERS) guidelines on pulmonary hypertension (PH). Methods and results We performed right heart catheterization (RHC) in 57 subjects with ATTR-CM. The proportion of patients with PH was 77% according to the 2022 guidelines versus 47% when applying the 2015 guidelines. Isolated post-capillary PH and combined pre- and post-capillary PH were most prevalent. Thirty-six patients underwent a supine bicycle cardiopulmonary exercise test during RHC. Exercise-induced PH was defined as an increase in mean pulmonary arterial pressure from rest to exercise per increase in cardiac output (ΔmPAP/ΔCO) of > 3 mmHg/L/min. An increase in pulmonary arterial wedge pressure per change in cardiac output (ΔPAWP/ΔCO) from rest to exercise >2 mmHg/L/min was considered suggestive of post-capillary exercise-induced PH. All but two patients who exercised during RHC developed exercise-induced PH. The median ΔmPAP/ΔCO was 7.2 mmHg/L/min and ΔPAWP/ΔCO was 5.1 mmHg/L/min. The median ΔRAP/ΔCO was 3.6 mmHg/L/min and ΔRAP/ΔPAWP was 0.6 mmHg/L/min. Conclusions Most patients with ATTR-CM have isolated post-capillary or combined pre- and post-capillary PH at rest, and almost all patients develop exercise-induced PH with a large post-capillary component. There was a pronounced, but balanced increase in atrial pressures on exercise.
Se alle arbeider i NVA
-
Holt, Margrethe Flesvig; Flø, August Magnus Stensrød; Bjørnø, Vilde; Husebye, Trygve Guttorm; Knudsen, Eva Cecilie & Hodt, Anders
[Vis alle 12 forfattere av denne artikkelen]
(2023).
En mann i 70-årene med utmattelse og nyresvikt.
Tidsskrift for Den norske legeforening (Tidsskriftet).
ISSN 0029-2001.
143(9).
doi:
10.4045/tidsskr.22.0679.
Fulltekst i vitenarkiv
Vis sammendrag
En mann i 70-årene ble henvist til regionssykehus for ekkokardiografi og invasiv koronarutredning som ledd i en nyreresipientutredning. Pasienten hadde kronisk nyresvikt i stadium 5 og fikk peritonealdialyse. Han hadde hverken diabetes eller hypertensjon. Gjennom 20 år hadde han hatt stabil monoklonal gammopati av usikker klinisk signifikans (MGUS). Nyrebiopsi tatt ti år tidligere viste nefrosklerose, men ikke avleiringssykdom. To år før den aktuelle innleggelsen gjennomgikk pasienten et cerebralt insult med sekvele i form av dysartri. Ekkokardiografi på daværende tidspunkt avdekket lett hypertrofi av venstre ventrikkel og diastolisk dysfunksjon. Han fikk antikoagulasjonsbehandling med apiksaban grunnet permanent atrieflimmer. Ved fysisk aktivitet fikk han generell utmattelse, men ikke funksjonsdyspné eller brystsmerter.
Se alle arbeider i NVA
Publisert
14. des. 2022 14:12
- Sist endret
21. apr. 2023 13:11