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3. Frailty and Cognitive Function in Middle-Aged and Older Adults With Congenital Heart Disease

Author

Sasikumar, Navaneetha, Enomoto, Junko, Mizuno, Yoshiko, Leong, Ming Chern, Binto Sabran, Izzatun Nafsi, Ladak, Laila Akbar, Hasan, Babar, Siddiqui, Ayat, Moon, Ju Ryoung, Huh, June, Yang, Hsiao-Ling, Wang, Jou-Kou, Lu, Chun-Wei, Demir, Fatma, Öden, Tuğba, Tefera, Endale, Mwita, Julius, Ambassa, Jean-Claude, Mvondo, Charles, Fanka, Marcel, Yadeta, Dejuma, Alemayehu, Mulualem, Leye, Mohamed, Gueye, Khadija, Gabriel, Harald, Svhneider, Matthias, Seeliger, Selina, Budts, Werner, Van De Bruaene, Alexander, Moons, Philip, Goossens, Eva, Van Bulck, Liesbet, Rassart, Jessica, Luyckx, Koen, De Hosson, Michele, De Backer, Julie, Kaneva, Anna, Markova, Mila, Lykkeberg, Birgitte, Biyai, Miriam, Ladouceur, Magalie, Boubrit, Anissa, Thambo, Jean-Benoît, Ruissel, Amandine, Jore, Cecile, Amedro, Pascal, Abassi, Hamouda, Soltani, Sonia, Bredy, Charlene, Giannakoulas, George, Kosmidis, Diamantis, Ntiloudi, Despina, Callus, Edward, Pagliuca, Silvana, Bertoldo, Enrico Giuseppe, Fiolo, Valentina, Caruana, Maryanne, Swain, Justine, Grech, Neil, Xuereb, Rachel, Craus, Sarah, Bonello, Maria, Borg, Darren, Farrugia, Paul, Cardona, Joanne, Estensen, Mette-Elise, Andresen, Brith, Eriksen, Katrine, Areias, Maria Emília, Miranda, Joana, Areias, José Carlos, Cruz, Cristina, Macedo, Filipe, Ribeiro Nunes, Filipa Manuela, Barbosa de Bessa, Ana Maria, Espírito Santo, Sara Mafalda, Brito, Paula, Pereira, Marisa, Teixeira, Sofia, Marques, Brenda, Marques, Ana Raquel, Johansson, Bengt, Sandberg, Camilla, Cronesten, Helena, Dellborg, Mikael, Mandalenakis, Zacharias, Mattson, Eva, Christersson, Christina, Robertsson, Louise, Hlebowicz, Joanna, Ternrud, Linda, Thomet, Corina, Ruperti, Javier, Bouchardy, Judith, Brand, Fanny, Rutz, Tobias, Blanche, Coralie, van Melle, Joost P., Boer, Anna, Constantine, Andrew, Gatzoulis, Michael A., Dimopoulos, Konstantinos, Coats, Louise, McParlin, Debbie, Khairy, Paul, Proietti, Anna, Roy, Veronique, Windram, Jonathan, Jandura, Deborah, Jameson, Susan, Major, Melissa, Mahadevan, Vaikom Subremanian, Nguyen, Thomas, Sarwary, Shabir, Saidi, Arwa, Breault, Leah, Colon, Dalia Lopez, Cedars, Ari, Kutty, Shelby, Ko, Jong, Valente, Anne Marie, Brainard, Sarah, Reichman, Jeffrey, Zaidi, Ali, Amlani, Amrin, Jackson, Jamie, Swenski, Taylor, Neville, Steven, Kovacs, Adrienne, McGrath, Lidija, Taunton, Marshall, Kim, Yuli, Carducci, Jessica, Bashey, Saffy, Alday, Luis, Lousararian, Marina, Maisuls, Héctor, Quinteros, Marisa, Lucero, Mónica, Ortiz, Lucia, Amaral, Fernando, Schmidt, Andre, Manso, Paulo Henrique, Pavão, Rafael Brolio, Reyes, Fernando Baraona, Arancibia, M. Francisca, Araujo, John Jairo, Súarez, Alberto Hernadez, Menahem, Samuel, Wijayarathne, Pasangi Madhuka, Daelman, Bo, Kovacs, Adrienne H., Schmidt, André, and de Hosson, Michèle

Published
2024
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4. Anxiety and Depression in Adults With Congenital Heart Disease

Author

Kovacs, Adrienne H., Luyckx, Koen, Thomet, Corina, Budts, Werner, Enomoto, Junko, Sluman, Maayke A., Lu, Chun-Wei, Jackson, Jamie L., Khairy, Paul, Cook, Stephen C., Chidambarathanu, Shanthi, Alday, Luis, Estensen, Mette-Elise, Dellborg, Mikael, Berghammer, Malin, Johansson, Bengt, Mackie, Andrew S., Menahem, Samuel, Caruana, Maryanne, Veldtman, Gruschen, Soufi, Alexandra, Jameson, Susan M., Callus, Edward, Kutty, Shelby, Oechslin, Erwin, Van Bulck, Liesbet, and Moons, Philip

Published
2024
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6. Adult congenital heart disease training in Europe: current status, disparities and potential solutions

Author

McMahon, Colin J, primary, Voges, Inga, additional, Jenkins, Petra, additional, Brida, Margarita, additional, van der Bosch, Annemien E, additional, Dellborg, Mikael, additional, Heying, Ruth, additional, Stein, Jörg I, additional, Georgiev, Borislav, additional, Mesihovic-Dinarevic, Senka, additional, Prokšelj, Katja, additional, Oskarsson, Gylfi, additional, Frogoudaki, Alexandra, additional, Karagöz, Tevfik, additional, Jossif, Antonis, additional, Doros, Gabriela, additional, Nielsen, Dorte, additional, Jalanko, Mikko, additional, Sanchez Perez, Inmaculada, additional, Alvares, Sílvia, additional, Estensen, Mette-Elise, additional, Petropoulos, Andreas, additional, Tagen, Raili, additional, Gumbienė, Lina, additional, Michel-Behnke, Ina, additional, Olejnik, Peter, additional, Clift, Paul F, additional, Sendzikaite, Skaiste, additional, Albert-Brotons, Dimpna C, additional, Rhodes, Mark, additional, Pitkänen, Olli, additional, Bassareo, Pier Paolo, additional, Gatzoulis, Michael A, additional, Walsh, Kevin, additional, Milanesi, Ornella, additional, Ladouceur, Magalie, additional, Chessa, Massimo, additional, and Budts, Werner, additional

Published
2023
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7. Increased ferroptosis in leukocytes from preeclamptic women involving the long non‐coding taurine upregulated gene 1 (TUG1).

Author

Lekva, Tove, Michelsen, Annika Elisabet, Roland, Marie Cecilie Paasche, Norwitz, Errol R., Estensen, Mette‐Elise, Olstad, Ole Kristoffer, Akkouh, Ibrahim A, Henriksen, Tore, Bollerslev, Jens, Aukrust, Pål, and Ueland, Thor

Subjects
LEUCOCYTES, IRON in the body, VASCULAR endothelial cells, PREECLAMPSIA, TAURINE
Abstract

Background: Ferroptosis plays a key role in placental development and physiology, and abnormal ferroptosis has been implicated in trophoblast injury leading to preeclampsia (PE). We hypothesize that leukocytes isolated from PE exhibit increased ferroptosis and that extracellular vesicles contain long non‐coding (lnc) RNA/mRNAs that modulate oxidative stress and iron toxicity in vascular endothelial cells. Methods: We measured the expression of key regulators of ferroptosis in leukocytes and extracellular vesicles as well as circulating biomarkers of iron homeostasis and oxidative stress in plasma from women with/without PE at different timepoints during pregnancy. For markers that were dysregulated, we assessed their temporal correlation with established markers of disease activity and marker of endothelial activation. For markers dysregulated in early pregnancy, we assessed their ability to predict the development of PE. Results: We found decreased lncRNA/mRNAs in leukocytes, but not extracellular vesicles, in PE that may modulate oxidative stress and iron toxicity. This decrease in anti‐ferroptotic markers does not appear to be related to maternal disease activity or plasma oxidative stress status but rather to attenuated anti‐inflammatory expression in these cells. Circulating ferritin was elevated in PE, supporting the hypothesis that PE represents a disbalance in iron homeostasis. Low lncRNA taurine upregulated gene 1 RNA levels in leukocytes at 22–24 weeks were strongly associated with the development of PE. Conclusions: Our findings suggest that maternal leukocytes in PE show decreased anti‐ferroptotic activity that correlates with anti‐inflammatory expression. Moreover, some of these changes in ferroptotic activity appear to precede the development of PE. [ABSTRACT FROM AUTHOR]

Published
2024
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11. Reduced left ventricular function and sustained hypertension in women seven years after severe preeclampsia

Author

Grønningsæter, Lasse, Skulstad, Helge, Quattrone, Alessia, Langesæter, Eldrid, and Estensen, Mette-Elise

Subjects
Adult, Ventricular Dysfunction, Left, Cross-Sectional Studies, Pre-Eclampsia, Pregnancy, Hypertension, Humans, Female, Cardiology and Cardiovascular Medicine, Ventricular Function, Left
Abstract

Objective. To study left ventricular (LV) function and blood pressure (BP) at a long-term follow-up in women after severe pre-eclampsia. Design. In this single-centre, cross-sectional study, 96 patients were eligible for inclusion. LV function was examined by transthoracic echocardiography including tissue Doppler echocardiography and speckle tracking. BP was measured at rest using repeated non-invasive techniques. Results. We compared 36 patients with early-onset and 33 patients with late-onset pre-eclampsia with 28 healthy controls. Mean age (40 ± 3 years) and median time since delivery (7 ± 2 years) were similar across the study groups. The patients had 18% higher systolic BP (139 ± 15 mmHg) and 24% higher diastolic BP (87 ± 19 mmHg) than controls (p

Published
2022

13. Red Flags for Maltese Adults with Congenital Heart Disease: Poorer Dental Care and Less Sports Participation Compared to Other European Patients—An APPROACH-IS Substudy

Author

Caruana, Maryanne, Apers, Silke, Kovacs, Adrienne H., Luyckx, Koen, Thomet, Corina, Budts, Werner, Sluman, Maayke, Eriksen, Katrine, Dellborg, Mikael, Berghammer, Malin, Johansson, Bengt, Soufi, Alexandra, Callus, Edward, Moons, Philip, Grech, Victor, Alday, Luis, Maisuls, Héctor, Vega, Betina, Menahem, Samuel, Eaton, Sarah, Larion, Ruth, Wang, Qi Feng, Budts, Werner, Van Deyk, Kristien, Apers, Silke, Goossens, Eva, Rassart, Jessica, Luyckx, Koen, Moons, Philip, Rempel, Gwen, Mackie, Andrew, Ballantyne, Ross, Rankin, Kathryn, Norris, Colleen, Taylor, Dylan, Vondermuhll, Isabelle, Windram, Jonathan, Heggie, Pamela, Lasiuk, Gerri, Khairy, Paul, Proietti, Anna, Dore, Annie, Mercier, Lise-Andrée, Mongeon, François-Pierre, Marcotte, François, Ibrahim, Reda, Mondésert, Blandine, Côté, Marie-Claude, Kovacs, Adrienne, Oechslin, Erwin, Bandyopadhyay, Mimi, Soufi, Alexandra, Filippo, Sylvie Di, Sassolas, François, Bozio, André, Chidambarathanu, Shanthi, Farzana, Farida, Lakshmi, Nitya, Callus, Edward, Quadri, Emilia, Chessa, Massimo, Campioni, Giovanna, Giamberti, Alessandro, Enomoto, Junko, Mizuno, Yoshiko, Caruana, Maryanne, Grech, Victor, Vella, Sheena, Mifsud, Anabel, Borg, Neville, Chircop, Daniel, Mercieca Balbi, Matthew, Vella Critien, Rachel, Farrugia, James, Gatt, Yanika, Muscat, Darlene, Eriksen, Katrine, Estensen, Mette-Elise, Dellborg, Mikael, Berghammer, Malin, Mattson, Eva, Strandberg, Anita, Karlström-Hallberg, Pia, Johansson, Bengt, Kronhamn, Anna-Karin, Schwerzmann, Markus, Thomet, Corina, Huber, Margrit, Wang, Jou-Kou, Lu, Chun-Wei, Yang, Hsiao-Ling, Hua, Yu Chuan, Mulder, Barbara, Sluman, Maayke, Post, Marco, Pieper, Els, Peels, Kathinka, Waskowsky, Marc, Veldtman, Gruschen, Faust, Michelle, Lozier, Colin, Reed, Christy, Hilfer, Jamie, Daniels, Curt, Jackson, Jamie, Kutty, Shelby, Chamberlain, Carolyn, Cook, Stephen, Hindes, Morgan, Cedars, Ari, White, Kamila, Rompfh, Anitra, Fernandes, Susan, MacMillen, Kirstie, and On behalf of the APPROACH-IS consortium and the International Society for Adult Congenital Heart Disease (ISACHD)

Published
2017
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15. Heart Failure and Patient‐Reported Outcomes in Adults With Congenital Heart Disease from 15 Countries

Author

Lu, Chun‐Wei, primary, Wang, Jou‐Kou, additional, Yang, Hsiao‐Ling, additional, Kovacs, Adrienne H., additional, Luyckx, Koen, additional, Ruperti‐Repilado, Francisco Javier, additional, Van De Bruaene, Alexander, additional, Enomoto, Junko, additional, Sluman, Maayke A., additional, Jackson, Jamie L., additional, Khairy, Paul, additional, Cook, Stephen C., additional, Chidambarathanu, Shanthi, additional, Alday, Luis, additional, Oechslin, Erwin, additional, Eriksen, Katrine, additional, Dellborg, Mikael, additional, Berghammer, Malin, additional, Johansson, Bengt, additional, Mackie, Andrew S., additional, Menahem, Samuel, additional, Caruana, Maryanne, additional, Veldtman, Gruschen, additional, Soufi, Alexandra, additional, Fernandes, Susan M., additional, White, Kamila, additional, Callus, Edward, additional, Kutty, Shelby, additional, Apers, Silke, additional, Moons, Philip, additional, Maisuls, Héctor, additional, Vega, Betina, additional, Eaton, Sarah, additional, Wang, Qi Feng, additional, Larion, Ruth, additional, Budts, Werner, additional, Van Deyk, Kristien, additional, Goossens, Eva, additional, Rassart, Jessica, additional, Rempel, Gwen, additional, Mackie, Andrew, additional, Ballantyne, Ross, additional, Rankin, Kathryn, additional, Norris, Colleen, additional, Taylor, Dylan, additional, Vondermuhll, Isabelle, additional, Windram, Jonathan, additional, Heggie, Pamela, additional, Lasiuk, Gerri, additional, Proietti, Anna, additional, Dore, Annie, additional, Mercier, Lise‐Andrée, additional, Mongeon, François‐Pierre, additional, Marcotte, François, additional, Ibrahim, Reda, additional, Mondésert, Blandine, additional, Côté, Marie‐Claude, additional, Kovacs, Adrienne, additional, Bandyopadhyay, Mimi, additional, Di Filippo, Sylvie, additional, Sassolas, François, additional, Bozio, André, additional, Chareyras, Cécile, additional, Farzana, Farida, additional, Lakshmi, Nitya, additional, Quadri, Emilia, additional, Chessa, Massimo, additional, Campioni, Giovanna, additional, Giamberti, Alessandro, additional, Mizuno, Yoshiko, additional, Grech, Victor, additional, Vella, Sheena, additional, Mifsud, Anabel, additional, Borg, Neville, additional, Chircop, Daniel, additional, Balbi, Matthew Mercieca, additional, Critien, Rachel Vella, additional, Farrugia, James, additional, Gatt, Yanika, additional, Muscat, Darlene, additional, Estensen, Mette‐Elise, additional, Mattsson, Eva, additional, Strandberg, Anita, additional, Karlström‐Hallberg, Pia, additional, Kronhamn, Anna‐Karin, additional, Schwerzman, Markus, additional, Thomet, Corina, additional, Huber, Margrit, additional, Lu, Chun‐Wei, additional, Hua, Yu Chuan, additional, Mulder, Barbara, additional, Sluman, Maayke, additional, Post, Marco, additional, Pieper, Els, additional, Peels, Kathinka, additional, Waskowsky, Marc, additional, Faust, Michelle, additional, Lozier, Colin, additional, Reed, Christy, additional, Hilfer, Jamie, additional, Daniels, Curt, additional, Jackson, Jamie, additional, Chamberlain, Carolyn, additional, Warta, Sara, additional, Cook, Stephen, additional, Hindes, Morgan, additional, Cedars, Ari, additional, Fernandes, Susan, additional, Romfh, Anitra, additional, and MacMillen, Kirstie, additional

Published
2022
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19. Vascular function in adults with cyanotic congenital heart disease

Author

Tarp, Julie Bjerre, primary, Clausen, Peter, additional, Celermajer, David, additional, Christoffersen, Christina, additional, Jensen, Annette Schophuus, additional, Sørensen, Keld, additional, Sillesen, Henrik, additional, Estensen, Mette-Elise, additional, Nagy, Edit, additional, Holstein-Rathlou, Niels-Henrik, additional, Engstrøm, Thomas, additional, Feldt-Rasmussen, Bo, additional, and Søndergaard, Lars, additional

Published
2020
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20. Patient-reported outcomes of adults with congenital heart disease from eight European countries: scrutinising the association with healthcare system performance

Author

Van Bulck, Liesbet, Luyckx, Koen, Goossens, Eva, Apers, SiIke, Kovacs, Adrienne H., Thomet, Corina, Budts, Werner, Sluman, Maayke A., Eriksen, Katrine, Dellborg, Mikael, Berghammer, Malin, Johansson, Bengt, Caruana, Maryanne, Soufi, Alexandra, Callus, Edward, Moons, Philip, Alday, Luis, Maisuls, Hector, Vega, Betina, Menahem, Samuel, Eaton, Sarah, Wang, Qi Feng, Larion, Ruth, Van Deyk, Kristien, Apers, Silke, Rassart, Jessica, Rempel, Gwen, Mackie, Andrew, Ballantyne, Ross, Rankin, Kathryn, Norris, Colleen, Taylor, Dylan, Vondermuhll, Isabelle, Windram, Jonathan, Heggie, Pamela, Lasiuk, Gerri, Khairy, Paul, Proietti, Anna, Dore, Annie, Mercier, Lise-Andree, Mongeon, Francois-Pierre, Marcotte, Francois, Ibrahim, Reda, Mondesert, Blandine, Cote, Marie-Claude, Kovacs, Adrienne, Oechslin, Erwin, Bandyopadhyay, Mimi, Di Filippo, Sylvie, Sassolas, Francois, Bozio, Andre, Chareyras, Cecile, Chidambarathanu, Shanthi, Farzana, Farida, Lakshmi, Nitya, Quadri, Emilia, Chessa, Massimo, Campioni, Giovanna, Giamberti, Alessandro, Enomoto, Junko, Mizuno, Yoshiko, Grech, Victor, Vella, Sheena, Mifsud, Anabel, Borg, Neville, Chircop, Daniel, Balbi, Matthew Mercieca, Critien, Rachel Vella, Farrugia, James, Gatt, Yanika, Muscat, Darlene, Estensen, Mette-Elise, Mattsson, Eva, Strandberg, Anita, Karlstrom-Hallberg, Pia, Kronhamn, Anna-Karin, Schwerzman, Markus, Huber, Margrit, Wang, Jou-Kou, Lu, Chun-Wei, Yang, Hsiao-Ling, Hua, Yu Chuan, Mulder, Barbara, Sluman, Maayke, Post, Marco, Pieper, Els, Peels, Kathinka, Waskowsky, Marc, Veldtman, Gruschen, Faust, Michelle, Lozier, Colin, Reed, Christy, Hilfer, Jamie, Daniels, Curt, Jackson, Jamie, Kutty, Shelby, Chamberlain, Carolyn, Warta, Sara, Cook, Stephen, Hindes, Morgan, Cedars, Ari, White, Kamila, Fernandes, Susan, Romfh, Anitra, MacMillen, Kirstie, Cardiovascular Centre (CVC), APH - Societal Participation & Health, Coronel Institute of Occupational Health, APPROACH-IS Consortium, and ISACHD

Subjects
Adult, Heart Defects, Congenital, Male, Pediatrics, medicine.medical_specialty, Heart disease, Cross-sectional study, 030204 cardiovascular system & hematology, ACTIVATION, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Quality of life (healthcare), Patient Self-Report, Humans, Medicine, QUALITY, Nursing science, 030212 general & internal medicine, Young adult, Advanced and Specialized Nursing, business.industry, STATEMENT, Editorials, congenital, medicine.disease, Mental health, Healthcare system performance, heart defect, Europe, Medical–Surgical Nursing, Cross-Sectional Studies, Mental Health, patient reported outcome measures, Quality of Life, PATTERNS, Female, health services accessibility, Human medicine, Cardiology and Cardiovascular Medicine, business, Delivery of Health Care, Healthcare system
Abstract

Background: Inter-country variation in patient-reported outcomes of adults with congenital heart disease has been observed. Country-specific characteristics may play a role. A previous study found an association between healthcare system performance and patient-reported outcomes. However, it remains unknown which specific components of the countries’ healthcare system performance are of importance for patient-reported outcomes. Aims: The aim of this study was to investigate the relationship between components of healthcare system performance and patient-reported outcomes in a large sample of adults with congenital heart disease. Methods: A total of 1591 adults with congenital heart disease (median age 34 years; 51% men; 32% simple, 48% moderate and 20% complex defects) from eight European countries were included in this cross-sectional study. The following patient-reported outcomes were measured: perceived physical and mental health, psychological distress, health behaviours and quality of life. The Euro Health Consumer Index 2015 and the Euro Heart Index 2016 were used as measures of healthcare system performance. General linear mixed models were conducted, adjusting for patient-specific variables and unmeasured country differences. Results: Health risk behaviours were associated with the Euro Health Consumer Index subdomains about patient rights and information, health outcomes and financing and access to pharmaceuticals. Perceived physical health was associated with the Euro Health Consumer Index subdomain about prevention of chronic diseases. Subscales of the Euro Heart Index were not associated with patient-reported outcomes. Conclusion: Several features of healthcare system performance are associated with perceived physical health and health risk behaviour in adults with congenital heart disease. Before recommendations for policy-makers and clinicians can be conducted, future research ought to investigate the impact of the healthcare system performance on outcomes further.

Published
2019

21. Subclinical atherosclerosis in patients with cyanotic congenital heart disease

Author

Tarp, Julie Bjerre, primary, Sørgaard, Mathias Holm, additional, Christoffersen, Christina, additional, Jensen, Annette Schophuus, additional, Sillesen, Henrik, additional, Celermajer, David, additional, Eriksson, Peter, additional, Estensen, Mette-Elise, additional, Nagy, Edit, additional, Holstein-Rathlou, Niels-Henrik, additional, Engstrøm, Thomas, additional, and Søndergaard, Lars, additional

Published
2019
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23. Past and current cause-specific mortality in Eisenmenger syndrome

Author

Hjortshøj, Cristel M. Sørensen, primary, Kempny, Aleksander, additional, Jensen, Annette Schophuus, additional, Sørensen, Keld, additional, Nagy, Edit, additional, Dellborg, Mikael, additional, Johansson, Bengt, additional, Rudiene, Virginija, additional, Hong, Gu, additional, Opotowsky, Alexander R., additional, Budts, Werner, additional, Mulder, Barbara J., additional, Tomkiewicz-Pająk, Lidia, additional, D’Alto, Michele, additional, Prokšelj, Katja, additional, Diller, Gerhard-Paul, additional, Dimopoulos, Konstantinos, additional, Estensen, Mette-Elise, additional, Holmstrøm, Henrik, additional, Turanlahti, Maila, additional, Thilén, Ulf, additional, Gatzoulis, Michael A., additional, and Søndergaard, Lars, additional

Published
2017
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24. Predictors of Death in Contemporary Adult Patients With Eisenmenger Syndrome

Author

Kempny, Aleksander, primary, Hjortshøj, Cristel Sørensen, additional, Gu, Hong, additional, Li, Wei, additional, Opotowsky, Alexander R., additional, Landzberg, Michael J., additional, Jensen, Annette Schophuus, additional, Søndergaard, Lars, additional, Estensen, Mette-Elise, additional, Thilén, Ulf, additional, Budts, Werner, additional, Mulder, Barbara J., additional, Blok, Ilja, additional, Tomkiewicz-Pająk, Lidia, additional, Szostek, Kamil, additional, D’Alto, Michele, additional, Scognamiglio, Giancarlo, additional, Prokšelj, Katja, additional, Diller, Gerhard-Paul, additional, Dimopoulos, Konstantinos, additional, Wort, Stephen J., additional, and Gatzoulis, Michael A., additional

Published
2017
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29. Increased Arterial Stiffness in Pre-eclamptic Pregnancy at Term and Early and Late Postpartum: A Combined Echocardiographic and Tonometric Study.

Author

Estensen, Mette-Elise, Remme, Espen W, Grindheim, Guro, Smiseth, Otto A., Segers, Patrick, Henriksen, Tore, and Aakhus, Svend

Subjects
ARTERIAL diseases, PREECLAMPSIA, PREGNANCY complications, POSTNATAL care, ECHOCARDIOGRAPHY, TONOMETRY, BLOOD flow
Abstract

BACKGROUND Pre-eclampsia (PE) is characterized by hypertension and proteinuria, and complicates from 3%–10% of all pregnancies. The hemodynamic pathophysiology of the heart and systemic arteries in pre-eclamptic patients has not been well described. We therefore performed a comprehensive comparison of the systemic arterial properties at term and at 6 months postpartum in women with PE and in women with normal pregnancy (NP) and in nonpregnant women with a previous pre-eclamptic pregnancy (PPEP). METHODS The comparison included 40 patients with PE, 40 others with a PPEP (at 3.5±1.0 years postpartum), and 65 women who had had an NP. Noninvasive estimates of blood flow and pressure in the aortic root were made with echocardiography and calibrated right subclavian artery pulse traces obtained through tonometry. Total arterial compliance (C), arterial elastance (Ea), characteristic impedance (Z0), and peripheral arterial resistance (R) were estimated both through the use of a three-element Windkessel model and Fourier analysis of pressure and flow data. RESULTS At term, Z0, Ea, and R were higher by 37%, 25%, and 23%, respectively (all P < 0.05) in women with PE than in those with an NP, and C was lower by 12% (P < 0.05). The values of Z0, Ea, and R remained elevated at 6 months postpartum in women who had had PE, and were also elevated in those with a PPEP, as compared to their values in NP. CONCLUSIONS Our results demonstrate that pre-eclamptic pregnancies are characterized by a higher resistance throughout the arterial system. The altered arterial properties (Ea, Z0, and R) persisted at 6 months after PE and were also elevated at 3 years postpartum in women with a PPEP, indicating that PE induces long-standing cardiovascular disturbances. [ABSTRACT FROM AUTHOR]

Published
2013
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30. Systemic Arterial Response and Ventriculo-Arterial Interaction During Normal Pregnancy.

Author

Estensen, Mette-Elise, Grindheim, Guro, Remme, Espen W., Swillens, Abigail, Smiseth, Otto A., Segers, Patrick, Henriksen, Tore, and Aakhus, Svend

Subjects
BLOOD pressure, PREGNANCY, CARDIAC output, LEFT heart ventricle, PUERPERIUM
Abstract

BackgroundDuring normal pregnancy (NP), cardiac output (CO) increases, and blood pressure and systemic vascular resistance are reduced. We wanted to evaluate systemic arterial properties and interaction between the left ventricle (LV) and systemic arteries during NP. The role of systemic arteries and their interaction with LV-function in this hemodynamic response, lack description.MethodsWe used noninvasive methods to study 65 healthy women (32 ± 5 years) with NP repeatedly at gestational weeks 14-16, 22-24, 36, and 6 months postpartum (PP). Aortic root pressure and flow were obtained by calibrated right subclavian artery pulse traces and aortic annular Doppler flow recordings. Arterial properties were described by estimates of total arterial compliance (C), proximal aortic stiffness (characteristic impedance (Z0)), arterial elastance (Ea), and peripheral arterial resistance (R). Ventriculo-arterial coupling (VAC) was characterized by the ratio between arterial (EaI) and LV (ELVI) elastance index.ResultsDuring NP, CO increased by 20% due to increased heart rate and stroke volume. Mean arterial pressure was reduced by 10% (P < 0.001) as compared to 6 months PP. R was reduced by 5% (P < 0.01), Z0 trended lower and C higher. EaI decreased (P < 0.01) and ELVI was reduced to a higher extent resulting in 29% increase of EaI/ELVI during NP (P < 0.01).ConclusionsDuring NP there is an increase in CO, and decrease in blood pressure and R whereas central aortic properties are less altered. The increased VAC index (EaI/ELVI) during NP indicates a decrease in LV-function not fully compensated for by vascular adaptation.American Journal of Hypertension 2012; doi:10.1038/ajh.2012.29 [ABSTRACT FROM AUTHOR]

Published
2012
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