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Det kræver en indsats fra forskere, institutioner og forskningsfonde i både at forske i bæredygtige løsninger i sundhedsvæsenet og sørge for, at forskningsaktiviteten bliver mere bæredygtig. Bæredygtig udvikling blev første gang defineret i FN’s rapport »Our common future« i 1987: »Bæredygtig udvikling er en udvikling, som opfylder de nuværende generationers behov uden at bringe fremtidige generationers muligheder for at opfylde deres behov i fare« [1]. I de seneste år har der været et stadig stigende fokus på, hvordan bæredygtig udvikling – og det senere mere anvendte udtryk »bæredygtighed« – kan være rammesættende i sundhedsvæsenet. Lægeforeningen har i 2022 understreget vigtigheden af videnskabelig forskning i bæredygtige løsninger i sundhedsvæsenet [2], og internationalt ses der en stigende interesse for og fokus på bæredygtig sundhedsforskning med konkrete tiltag som forskningsguidelines for CO2-reduktion [3-6] og et internationalt netværk som Low Carbon Clinical Trials Consortium. Erfaringer fra udlandet viser desuden, at bæredygtighed kan inkluderes som et sundhedsfagligt kvalitetsaspekt hos lægefaglige selskaber [3, 4]. Formålet med denne statusartikel er at give et overblik over den nuværende evidens om bæredygtig forskning og inspirere forskere, læger og sundhedspersonale til refleksion og diskussion for at fremme bæredygtige forskningsaktiviteter.

Varmt vejr og hedebølger er den største klimarelaterede årsag til død i højindkomstlande, og det er ofte muligt at forebygge disse dødsfald [1]. Over 85% af de klimarelaterede dødsfald i Europa er relateret til hedebølger og varmt vejr [2]. Den hidtil varmeste dokumenterede sommer i Europe i 2022 resulterede i overdødelighed på 61.672 dødsfald, heraf 252 i Danmark [3]. Klimaforandringer interagerer med andre globale trends som befolkningsvækst, aldring, urbanisering og socioøkonomisk udvikling, som enten kan forværre eller forbedre varmerelaterede hændelser [1]. Hedebølge og tørke kom i 2022 for første gang med i Beredskabsstyrelsens nationale risikobillede blandt i alt 14 særlige hændelsestyper i Danmark [4]. Der mangler en national strategi og handleplan tilsvarende til heat-health warning system og heat-health action plan, som flere europæiske lande, inklusive Sverige, Tyskland og Holland, benytter til information og forebyggelse af alvorlige hændelser ved hedebølger

Hvordan bæredygtighed kan inkluderes i undervisning bliver nu debatteret på de sundhedsvidenskabelige, videregående uddannelser. Både studerende og studieledere interesserer sig for sammenhængen mellem klima og sundhed og implementering af bæredygtige løsninger. Bæredygtighedsbegrebet har fokus på miljø og klima og på sociale og økonomiske aspekter samt sammenspillet mellem de tre. Det repræsenterer et nyt perspektiv, en ny måde at tænke, beslutte og handle på i sundhedsvæsenet. Bæredygtighed indebærer at tænke langsigtet og i netværk af forbindelser, som i sidste ende har global effekt. Når klimakrisen bliver udråbt som vores århundredes sundhedskrise, bør vi som profession og uddannelsesinstitutioner gå forrest med viden, forskning og forandringer mod at skabe et mere bæredygtigt sundhedsvæsen.

Background: Cardiac troponins (cTns) are the cornerstone of diagnosing acute myocardial infarction. There is limited knowledge on the duration of ischemia necessary to induce a measurable release of cTns or the very-early-release kinetics of cTns after an ischemic event. Copeptin may have a supplementary role in ruling out myocardial infarction early. We investigated the release of cTns and copeptin in the first hours after experimental balloon-induced ischemia in humans. Methods: Thirty-four patients (median age, 60 years [interquartile range, 51-64]; 15 men, 43%) with angiographically normal coronary arteries were randomly assigned into 4 groups with different durations of induced myocardial ischemia (0, 30, 60, 90 s). Ischemia was induced by inflating a balloon in the left anterior descending artery between the first and second diagonal branch. Blood was collected before balloon inflation (baseline) every 15 minutes for the first 3 hours, and every 30 minutes for the next 3 hours. The cTns were analyzed by 3 high-sensitivity (hs) cTn assays: hs-cTnT (Roche), hs-cTnI (Siemens), and hs-cTnI (Abbott). Copeptin was analyzed by a sandwich immunoluminometric assay. Results: None of the patients had any complications. Increased cTn concentrations were detected by all 3 assays, and the magnitude of the increase was associated with the duration of ischemia. Increased hs-cTnI (Siemens) concentrations were first detectable 15 minutes after 90-s ischemia (median 43.7% increase) and increased more steeply and had a higher peak than the other assays. Copeptin levels did not significantly change. Using the cTnT, hs-cTnI (Siemens), and hs-cTnI (Abbott) concentrations at 0 and 180 minutes, 1 (11%), 0, and 0 patients from the 60-s ischemia group and 5 (63%), 2 (25%), and 1 (11%) from the 90-s ischemia group, respectively, fulfilled criteria for a biochemical myocardial infarction. Conclusions: This study is the first to report the early-release kinetics of cTn concentrations af

Background: High-sensitivity cardiac troponin T (hs-cTnT) is a good prognostic marker for mortality. However, it is uncertain if hs-cTnT can be used to detect sub-clinical cardiac disease. Method: Pilot study in patients without known heart disease and elevated hs-cTnT measured at presentation to the emergency department. Hs-cTnT was measure with Roche Diagnostics. Echocardiography was used to assess structural heart disease and the participants underwent computed tomography angiography for assessment of coronary artery disease and agatston score. Results: Ten patients were included in the final cohort. Median age was 68 years IQR (57-78) and 80% were female (n = 8). Six patients had a history of chronic obstructive lung disease and five patients had history of hypertension. The median level of hs-cTnT was 26 ng/L and values ranged from 19 ng/L to 495 ng/L. The median calcium score was 12. Three patients had signs of coronary artery disease. All patients had normal left ventricular ejection fraction with a median LVEF at 54.5%. Two patients were noted to have increased left ventricular mass index (LVMI). Conclusion: The majority of patients with hs-cTnT above the 99th percentile did not have structural heart disease or ischaemic coronary disease. However, 30% of the patient did have signs of coronary disease and might benefit from preventive medical treatment. Measuring hs-cTnT in the absence of acute illness might be a better approach for evaluation for sub-clinical cardiac disease.

BACKGROUND: Primary percutaneous coronary intervention (pPCI) is recommended in patients presenting with ST-elevation myocardial infarction (STEMI) within <12 h of symptom onset. However, patients-reported symptom duration is not always reliable. Cardiac specific troponin T (cTnT) and the endogenous stress marker copeptin have different temporal release patterns for myocardial infarction MI. We hypothesized that copeptin/troponin-ratio is associated to the duration of coronary occlusion and therefore inversely proportional to myocardial salvage.METHOD: Patients older than 18 years with first time STEMI referred to pPCI were eligible. cTnT and copeptin values were measured at admission. A cardiac magnetic resonance scanning (CMR) was done during the index admission for assessment of area at risk (AAR), and later 3 months to assess final infarct size (FIS). Myocardial salvage index (MSI) was calculated based on these measurements.RESULTS: A total of 468 patients were included. The median time from patient-reported onset of symptoms to pPCI was 192 min (IQR 150 min - 290 min). At presentation 416 (89%) patients had hs-cTnT values above the 99th percentile, median hs-cTnT was 53 ng/l (IQR 24 ng/l-146 ng/l) and 318 (68%) patients had copeptin values above the 99th percentile (18.9 pmol/l), median copeptin was 50 pmol/l (IQR 14 pmol/l-131 pmol/l). Symptom duration showed a weak but significant association with AAR (R2 = 0.02, p = .04), FIS (R2 = 0.03, p < .01) and MSI (R2 = 0.04, p < .01). Copeptin/troponin-ratio was significantly associated with symptom duration (R2 = 0.19, p < .01), but not AAR (R2 = 0.02, p = .19), FIS (R2 = 0.02, p = .12), or MSI (R2 = 0.01, p = .25).CONCLUSION: Copeptin/troponin-ratio is associated with patient-reported symptom duration, but there was no association with area at risk, final infarct size or myocardial salvage index.

BACKGROUND: Cardiac-specific troponin T (cTnT) and troponin I (cTnI) are considered diagnostically equal in patients with acute coronary syndrome (ACS). The aim of this systematic review was to compare the prevalence and prognostic strength of elevations of cTnT and cTnI in patients with other conditions than ACS.METHODS: A systemic review was conducted in concordance with the PRISMA guidelines. The studies were identified by searching PubMed, EMBASE and Cochrane Central Register, from May to August 2016. Studies measuring both cTnT and cTnI in populations without ACS were eligible.RESULTS: Twenty-nine studies were included (n = 25,859). Seventeen studies reported on prognostic information with follow-up time ranging for 30 d-5 years. Elevation above the 99th percentile (reference value for a healthy population) in non-ACS population was reported to be 0-39% for cTnI and 40-100% for cTnT. Elevation of cTnT tends to be a superior predictor for all-cause mortality and elevation of cTnI tends to be a superior predictor for cardiovascular related mortality.DISCUSSION: In the absence of ACS, elevation of cTnT is more frequent than elevation of cTnI.CONCLUSION: Both cTnT and cTnI elevations have important prognostic information regarding morbidity, cardiac mortality and all-cause mortality.