Arne Hoiseth - Academia.edu (original) (raw)

Papers by Arne Hoiseth

A variety of methods exist for determining femoral neck anteversion. There is, however, no consis... more A variety of methods exist for determining femoral neck anteversion. There is, however, no consistent definition or reference method by which the correctness of the measurements can be determined. In this report the precision of a specific definition of femoral neck anteversion is estimated by means of a reference method. Three different radiologic measuring methods based on fundamentally different principles are evaluated by comparison with this reference. It is concluded that: 1) The Dunlap/Rippstein method can be recommended as the standard method. 2) Computed tomography may have substantial sources of error. 3) Methods based on arbitrary projections have poor precision.

Skeletal Radiology, Feb 1, 1990

The normal relationships of the patellofemoral joint with the knee in extension were measured wit... more The normal relationships of the patellofemoral joint with the knee in extension were measured with computed tomography (CT) in 43 normal adults. The upper and lower halves of the joint were examined. The range in measurement of the sulcus angle was 115 degrees - 172 degrees, of the congruence angle 43 degrees - 27 degrees, and of the lateral patellofemoral angle 26 degrees - 11 degrees. No significant differences were found between men and women or between the right and left sides. There were some differences between the measurements of the upper and lower halves of the joint. These data may serve as a basis for the evaluation of patients with abnormalities of the patellofemoral joint.

Acta Orthopaedica Scandinavica, Nov 1, 1982

Femoral neck angles were determined in 44 patients with unilateral or bilateral idiopathic osteoa... more Femoral neck angles were determined in 44 patients with unilateral or bilateral idiopathic osteoarthritis of the hip. The mean anteversion angle was 20 degrees +/- 9 degrees and the neck-shaft angle 131 degrees +/- 7 degrees. In comparison with a normal material the anteversion was significantly larger in the patients (P less than 0.001), but no difference was found in the neck-shaft angle. A positive correlation between the size of the anteversion and the severity of the disease was observed. It is concluded that increased anteversion of the femoral neck may contribute to the development of osteoarthritis of the hip.

The British Journal of Radiology, Jan 28, 2014

Femoral neck anteversion is determined by the neck, shaft and knee axes. It is commonly assumed t... more Femoral neck anteversion is determined by the neck, shaft and knee axes. It is commonly assumed that the neck axis is a straight line connecting the centre of the femoral head, the centre of the femoral neck and the axis of the femoral shaft. However, the line through the centre of the femoral head and neck crosses anterior to the axis of the femoral shaft. A distinction has therefore to be made between two principal different definitions of anteversion, denoted ANTEV 1 and ANTEV 2 in this paper, depending on the precise definition of the neck axis. Previous studies have indicated substantial differences between these definitions. The present study, using precise measuring methods, shows that the definitions have a systematic but small spread of differences. The large individual variation previously found between the two definitions is therefore caused mainly by the measuring methods and to a lesser extent by real anatomical variations.

European Respiratory Journal, Sep 1, 2011

Acta Radiologica, 1988

Although the general definition of femoral neck anteversion seems to be accepted, the details var... more Although the general definition of femoral neck anteversion seems to be accepted, the details vary substantially and some measuring methods are based on anatomic prerequisites that are lacking. This may be a cause of inconsistent and incorrect determinations. An anatomic study was therefore performed. Only small differences were found between two neck axes and different methods for delineating the axes. Inconsistent use of the shaft axis gave substantial variations. The long axis of the femoral shaft was, however, not shown to be a source of substantial error. The variation between three different knee axes was substantial. The cross section of the femoral neck was found to be radially asymmetric. Therefore, a precise and unequivocal neck centre cannot be made by any combination of bi-plane projections of the neck.

Biomarkers, 2016

Troponin (hs-TnT) levels predict mortality after acute exacerbation of COPD (AECOPD). Whether thi... more Troponin (hs-TnT) levels predict mortality after acute exacerbation of COPD (AECOPD). Whether this is independent of heart failure (HF) is not established. Prospectively included AECOPD patients adjudicated for acute HF categorized into three groups: (A) AECOPD, but acute HF the primary cause for hospitalization; (B) AECOPD the primary cause, but co-existing myocardial dysfunction and (C) AECOPD without myocardial dysfunction. About 103 AECOPD patients; 18% A, 27% B and 54% C. Hs-TnT level differed between the groups: (ng/l, median) A: 41, B: 25 and C: 15, p = 0.03 for A versus B and p = 0.005 for B versus C. During a median 826 days, 47% died. In Cox analysis, hs-TnT levels remained associated with mortality (hazard ratio per 10 ng/l 1.3, p < 0.0001). hs-TnT levels are influenced by myocardial dysfunction/HF in AECOPD, but provide independent prognostic information. The prognostic merit of hs-TnT cannot be attributed to HF alone.

Acta Radiologica, Dec 1, 1990

The incidence of deep vein thrombosis (DVT) in 62 consecutive patients under dextran thromboproph... more The incidence of deep vein thrombosis (DVT) in 62 consecutive patients under dextran thromboprophylaxis after total hip replacement, was examined by venography of the legs on the second postoperative day. The venography was repeated on day 9 after the operation in 43 patients to study the development of thrombi. Twenty-one patients were found to have venographically deep vein thrombosis on the second postoperative day, but had no clinical signs of DVT. All thrombi were located distally in the leg and equally distributed between the operated and the non-operated leg. Distally located asymptomatic DVT were not given specific treatment. Thrombolysis between postoperative day 2 and day 9 seemed to dominate over thrombus formation and propagation. Even large thrombi in the legs may dissolve during the first postoperative week. Thus, the timing is essential for the screening of DVT.

Acta Orthop, 1982

The femoral neck angles were determined in 48 pairs of normal specimens from cadavers of elderly ... more The femoral neck angles were determined in 48 pairs of normal specimens from cadavers of elderly Norwegians, 24 males and 24 females. The anteversion angle was found to average 10.4 degrees +/- 6.7 degrees and the neck-shaft 127.7 degrees +/- 7.6 degrees. There were no significant differences between the sexes. The bilateral differences were analysed. The 95 per cent confidence limits of the anteversion and head-neck-shaft angles were calculated to be 11.8 and 13.8 degrees, respectively.

Radiography and computed tomography measurements were made of femoral neck anteversion, femoral h... more Radiography and computed tomography measurements were made of femoral neck anteversion, femoral head cartilage distribution, and the orientation of the acetabulum. The measurements were made in elderly cadaver femurs and in patients. They failed to establish any correlation between the femoral neck anteversion and the orientation of the articulating surface of the femoral head, nor between the femoral neck anteversion and the angles of the acetabulum.

Torsion of the leg was measured in 50 adults by computed tomography. The tangent to the dorsal as... more Torsion of the leg was measured in 50 adults by computed tomography. The tangent to the dorsal aspect of the femoral condyles gave the proximal reference line. The distal reference line joined the centers of the medial and lateral malleoli. Tibial torsion was measured as the inclination between the dorsal tangent to the tibial condyles and the distal reference line, and torsion of the leg was measured as the inclination between the proximal and the distal reference lines. The anatomy of the dorsal aspects of the tibial condyles was more inconsistent than the anatomy of the dorsal aspects of the femoral condyles. In the females the external torsion of the leg was 38 +/- 9 degrees on the right side and 37 +/- 11 degrees on the left side. In the males the values were 41 +/- 6 degrees and 40 +/- 10 degrees, respectively.

C57. CARDIOPULMONARY INTERACTIONS IN THE INTENSIVE CARE UNIT, 2012

D45. CHRONIC OBSTRUCTIVE PULMONARY DISEASE COMORBIDITY, 2010

Acta Medica Scandinavica, 1982

In a previous study on 42 patients with acute deep vein thrombosis, randomly allocated to treatme... more In a previous study on 42 patients with acute deep vein thrombosis, randomly allocated to treatment with streptokinase or heparin, we found that 71.4 % of the streptokinase-treated patients achieved phlebographically significant thrombolysis as compared to 23.8% in the heparin group. These patients have been reevaluated after a mean observation period of 64 years. Seven patients had died and there were no other drop-outs. Thus, 35 patients were subjected to the follow-up study consisting of phlebography and clinical examination. The evaluations were performed without knowledge of the initial therapy. Seven patients had phlebographically normal veins, and all belonged to the streptokinase group. This difference between the treatment groups is statistically highly significant (p cO.01). At clinical examination, 13 of the 17 patients in the streptokinase group had normal legs and 4 exhibited moderate postthrombotic changes. In contrast, 3 of the heparin-treated patients showed serious postthrombotic changes with open leg ulcers, and only 6 of 18 patients in this group had normal legs. The present results strongly support the assumption that streptokinase therapy is the best treatment at present in patients with acute deep vein thrombosis. This has been shown for the initial thrombolysis, and now also for the avoidance of late postthrombotic changes.

Journal of internal medicine, Jan 11, 2014

The objective of this study was to examine whether statin therapy is associated with enhanced end... more The objective of this study was to examine whether statin therapy is associated with enhanced endothelium-dependent vascular function, improved pulmonary function and reduced systemic inflammation in patients with chronic obstructive pulmonary disease (COPD). This randomized, placebo-controlled, double-blind, parallel trial including patients with COPD was performed at two University hospitals in Norway. Patients with stable COPD (n = 99) were assigned randomly to receive rosuvastatin 10 mg (n = 49) or matching placebo (n = 50) once daily for 12 weeks. The primary outcome measure was change in endothelium-dependent vascular function measured using peripheral arterial tonometry and expressed as the reactive hyperaemia index. Secondary end-points were change in pulmonary function, as assessed by forced expiratory volume in 1 s (FEV1) and FEV1/forced vital capacity (FVC), and change in the circulating levels of the inflammatory markers interleukin-6 (IL6) and high-sensitivity C-reactiv...

Open heart, 2014

To assess the prevalence and long-term prognostic value of a dynamic (rise/fall) pattern of cardi... more To assess the prevalence and long-term prognostic value of a dynamic (rise/fall) pattern of cardiac troponin T (hs-cTnT) elevation during acute exacerbation of chronic obstructive pulmonary disease (AECOPD) compared with a stable hs-cTnT elevation. Prospective cohort study of unselected patients admitted with AECOPD to the emergency room of a university hospital. Serial hs-cTnT measurements were made during admission. Survival after a median of 1.8 years was recorded. 83 patients with a mean age of 72 years and a mean forced expiratory volume in 1 s (FEV1) of 0.9 L. The mortality rate was 62%. The median hs-cTnT at admission was 27 ng/L (IQR 13.4-51)). 65 patients (78%) had at least one hs-cTnT measurement ≥14 ng/L, and among these the median change in hs-cTnT was 50.7% (IQR 25.2-89.4). Of the patients with serial hs-cTnT measurements, 53 (82%) had a dynamic pattern (ie, ΔTnT ≥20%). In multivariate analysis, stable hs-cTnT elevation was associated with increasing age (OR per 5 years...

International Journal of Chronic Obstructive Pulmonary Disease, 2013

Congestive heart failure is underdiagnosed in patients with chronic obstructive pulmonary disease... more Congestive heart failure is underdiagnosed in patients with chronic obstructive pulmonary disease (COPD). Pulmonary congestion on chest radiograph at admission for acute exacerbation of COPD (AECOPD) is associated with an increased risk of mortality. A standardized evaluation of chest radiographs may enhance prognostic accuracy. We aimed to evaluate whether a standardized, liberal assessment of pulmonary congestion is superior to the routine assessment in identifying patients at increased risk of long-term mortality, and to investigate the association of heart failure with N-terminal prohormone of brain natriuretic peptide (NT-proBNP) concentrations. This was a prospective cohort study of 99 patients admitted for AECOPD. Chest radiographs obtained on admission were routinely evaluated and then later evaluated by blinded investigators using a standardized protocol looking for Kerley B lines, enlarged vessels in the lung apex, perihilar cuffing, peribronchial haze, and interstitial or alveolar edema, defining the presence of pulmonary congestion. Adjusted associations with long-term mortality and NT-proBNP concentration were calculated. The standardized assessment was positive for pulmonary congestion in 32 of the 195 radiographs (16%) ruled negative in the routine assessment. The standardized assessment was superior in predicting death during a median follow up of 1.9 years (P=0.022), and in multivariable analysis, only the standardized assessment showed a significant association with mortality (hazard ratio 2.4, 95% confidence interval [CI] 1.2-4.7) (P=0.016) and NT-proBNP (relative concentration 1.8, CI 1.2-2.6) (P=0.003). By applying a standardized approach when evaluating pulmonary congestion on chest radiographs during AECOPD, a group of patients with increased risk of dying, possibly due to heart failure, is identified.

Journal of Clinical Densitometry, 2013

FREEDOM was a phase 3 trial in 7808 women aged 60-90yr with postmenopausal osteoporosis. Subjects... more FREEDOM was a phase 3 trial in 7808 women aged 60-90yr with postmenopausal osteoporosis. Subjects received placebo or 60 mg denosumab subcutaneously every 6mo for 3yr in addition to daily calcium and vitamin D. Denosumab significantly decreased bone turnover; increased dual-energy X-ray absorptiometry (DXA) areal bone mineral density (aBMD); and significantly reduced new vertebral, nonvertebral, and hip fractures. In a subset of women (N=209), lumbar spine, total hip, and femoral neck volumetric BMD (vBMD) were assessed by quantitative computed tomography at baseline and months 12, 24, and 36. Significant improvement from placebo and baseline was observed in aBMD and vBMD in the denosumab-treated subjects at all sites and time points measured. The vBMD difference from placebo reached 21.8%, 7.8%, and 5.9%, respectively, for the lumbar spine, total hip, and femoral neck at 36mo (all p≤0.0001). Compared with placebo and baseline, significant increases were also observed in bone mineral content (BMC) at the total hip (p<0.0001) largely related to significant BMC improvement in the cortical compartment (p<0.0001). These results supplement the data from DXA on the positive effect of denosumab on BMD in both the cortical and trabecular compartments.

Heart, 2013

To investigate if acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is associa... more To investigate if acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is associated with myocardial injury, expressed as elevated high sensitive cardiac troponin T (hs-cTnT), and to identify determinants of hs-cTnT in chronic obstructive pulmonary disease (COPD) patients. In a cross-sectional study, hs-cTnT in patients hospitalised for AECOPD was compared with hs-cTnT in COPD patients in their stable state. The study was conducted at a teaching and a pulmonary rehabilitation clinic. Consecutive admissions to participating units for the years 2010-2011 meeting objective, standardised criteria for AECOPD and stable COPD. Ratio of hs-cTnT in hospitalised AECOPD patients compared with stable COPD patients. Change in the ratio of hs-cTnT per unit increase of relevant covariables. The geometric mean of hs-cTnT in the index group was 25.8 ng/l (95% CI 21.1 to 31.7) compared with 4.55 ng/l (95% CI 3.72 to 5.67) in the reference group. After inclusion of relevant covariables, multiple linear regression analyses showed that the ratio between hs-cTnT in AECOPD patients and the references was 4.26 (95% CI 3.02 to 6.00) and that hs-cTnT increased 1.41-fold (95% CI 1.20 to 1.68), for each quartile increase in leucocyte count in stable COPD but not in AECOPD. Higher hs-cTnT levels were also associated with the presence of pathological q-waves (p=0.012) and electrocardiographic left ventricular hypertrophy (p=0.039), long-term oxygen treatment (p=0.002) and decreasing forced expiratory volume in 1 s (p=0.014). A significant univariable association between cTnT and arterial hypoxaemia was also found but this association was attenuated almost to a zero effect after inclusion of relevant covariates. AECOPD is associated with higher hs-cTnT as compared with stable COPD. In stable COPD, hs-cTnT appears to be positively associated with indices of COPD severity, whereas we were unable to identify significant determinants of hs-cTnT in AECOPD.

A variety of methods exist for determining femoral neck anteversion. There is, however, no consis... more A variety of methods exist for determining femoral neck anteversion. There is, however, no consistent definition or reference method by which the correctness of the measurements can be determined. In this report the precision of a specific definition of femoral neck anteversion is estimated by means of a reference method. Three different radiologic measuring methods based on fundamentally different principles are evaluated by comparison with this reference. It is concluded that: 1) The Dunlap/Rippstein method can be recommended as the standard method. 2) Computed tomography may have substantial sources of error. 3) Methods based on arbitrary projections have poor precision.

Skeletal Radiology, Feb 1, 1990

The normal relationships of the patellofemoral joint with the knee in extension were measured wit... more The normal relationships of the patellofemoral joint with the knee in extension were measured with computed tomography (CT) in 43 normal adults. The upper and lower halves of the joint were examined. The range in measurement of the sulcus angle was 115 degrees - 172 degrees, of the congruence angle 43 degrees - 27 degrees, and of the lateral patellofemoral angle 26 degrees - 11 degrees. No significant differences were found between men and women or between the right and left sides. There were some differences between the measurements of the upper and lower halves of the joint. These data may serve as a basis for the evaluation of patients with abnormalities of the patellofemoral joint.

Acta Orthopaedica Scandinavica, Nov 1, 1982

Femoral neck angles were determined in 44 patients with unilateral or bilateral idiopathic osteoa... more Femoral neck angles were determined in 44 patients with unilateral or bilateral idiopathic osteoarthritis of the hip. The mean anteversion angle was 20 degrees +/- 9 degrees and the neck-shaft angle 131 degrees +/- 7 degrees. In comparison with a normal material the anteversion was significantly larger in the patients (P less than 0.001), but no difference was found in the neck-shaft angle. A positive correlation between the size of the anteversion and the severity of the disease was observed. It is concluded that increased anteversion of the femoral neck may contribute to the development of osteoarthritis of the hip.

The British Journal of Radiology, Jan 28, 2014

Femoral neck anteversion is determined by the neck, shaft and knee axes. It is commonly assumed t... more Femoral neck anteversion is determined by the neck, shaft and knee axes. It is commonly assumed that the neck axis is a straight line connecting the centre of the femoral head, the centre of the femoral neck and the axis of the femoral shaft. However, the line through the centre of the femoral head and neck crosses anterior to the axis of the femoral shaft. A distinction has therefore to be made between two principal different definitions of anteversion, denoted ANTEV 1 and ANTEV 2 in this paper, depending on the precise definition of the neck axis. Previous studies have indicated substantial differences between these definitions. The present study, using precise measuring methods, shows that the definitions have a systematic but small spread of differences. The large individual variation previously found between the two definitions is therefore caused mainly by the measuring methods and to a lesser extent by real anatomical variations.

European Respiratory Journal, Sep 1, 2011

Acta Radiologica, 1988

Although the general definition of femoral neck anteversion seems to be accepted, the details var... more Although the general definition of femoral neck anteversion seems to be accepted, the details vary substantially and some measuring methods are based on anatomic prerequisites that are lacking. This may be a cause of inconsistent and incorrect determinations. An anatomic study was therefore performed. Only small differences were found between two neck axes and different methods for delineating the axes. Inconsistent use of the shaft axis gave substantial variations. The long axis of the femoral shaft was, however, not shown to be a source of substantial error. The variation between three different knee axes was substantial. The cross section of the femoral neck was found to be radially asymmetric. Therefore, a precise and unequivocal neck centre cannot be made by any combination of bi-plane projections of the neck.

Biomarkers, 2016

Troponin (hs-TnT) levels predict mortality after acute exacerbation of COPD (AECOPD). Whether thi... more Troponin (hs-TnT) levels predict mortality after acute exacerbation of COPD (AECOPD). Whether this is independent of heart failure (HF) is not established. Prospectively included AECOPD patients adjudicated for acute HF categorized into three groups: (A) AECOPD, but acute HF the primary cause for hospitalization; (B) AECOPD the primary cause, but co-existing myocardial dysfunction and (C) AECOPD without myocardial dysfunction. About 103 AECOPD patients; 18% A, 27% B and 54% C. Hs-TnT level differed between the groups: (ng/l, median) A: 41, B: 25 and C: 15, p = 0.03 for A versus B and p = 0.005 for B versus C. During a median 826 days, 47% died. In Cox analysis, hs-TnT levels remained associated with mortality (hazard ratio per 10 ng/l 1.3, p < 0.0001). hs-TnT levels are influenced by myocardial dysfunction/HF in AECOPD, but provide independent prognostic information. The prognostic merit of hs-TnT cannot be attributed to HF alone.

Acta Radiologica, Dec 1, 1990

The incidence of deep vein thrombosis (DVT) in 62 consecutive patients under dextran thromboproph... more The incidence of deep vein thrombosis (DVT) in 62 consecutive patients under dextran thromboprophylaxis after total hip replacement, was examined by venography of the legs on the second postoperative day. The venography was repeated on day 9 after the operation in 43 patients to study the development of thrombi. Twenty-one patients were found to have venographically deep vein thrombosis on the second postoperative day, but had no clinical signs of DVT. All thrombi were located distally in the leg and equally distributed between the operated and the non-operated leg. Distally located asymptomatic DVT were not given specific treatment. Thrombolysis between postoperative day 2 and day 9 seemed to dominate over thrombus formation and propagation. Even large thrombi in the legs may dissolve during the first postoperative week. Thus, the timing is essential for the screening of DVT.

Acta Orthop, 1982

The femoral neck angles were determined in 48 pairs of normal specimens from cadavers of elderly ... more The femoral neck angles were determined in 48 pairs of normal specimens from cadavers of elderly Norwegians, 24 males and 24 females. The anteversion angle was found to average 10.4 degrees +/- 6.7 degrees and the neck-shaft 127.7 degrees +/- 7.6 degrees. There were no significant differences between the sexes. The bilateral differences were analysed. The 95 per cent confidence limits of the anteversion and head-neck-shaft angles were calculated to be 11.8 and 13.8 degrees, respectively.

Radiography and computed tomography measurements were made of femoral neck anteversion, femoral h... more Radiography and computed tomography measurements were made of femoral neck anteversion, femoral head cartilage distribution, and the orientation of the acetabulum. The measurements were made in elderly cadaver femurs and in patients. They failed to establish any correlation between the femoral neck anteversion and the orientation of the articulating surface of the femoral head, nor between the femoral neck anteversion and the angles of the acetabulum.

Torsion of the leg was measured in 50 adults by computed tomography. The tangent to the dorsal as... more Torsion of the leg was measured in 50 adults by computed tomography. The tangent to the dorsal aspect of the femoral condyles gave the proximal reference line. The distal reference line joined the centers of the medial and lateral malleoli. Tibial torsion was measured as the inclination between the dorsal tangent to the tibial condyles and the distal reference line, and torsion of the leg was measured as the inclination between the proximal and the distal reference lines. The anatomy of the dorsal aspects of the tibial condyles was more inconsistent than the anatomy of the dorsal aspects of the femoral condyles. In the females the external torsion of the leg was 38 +/- 9 degrees on the right side and 37 +/- 11 degrees on the left side. In the males the values were 41 +/- 6 degrees and 40 +/- 10 degrees, respectively.

C57. CARDIOPULMONARY INTERACTIONS IN THE INTENSIVE CARE UNIT, 2012

D45. CHRONIC OBSTRUCTIVE PULMONARY DISEASE COMORBIDITY, 2010

Acta Medica Scandinavica, 1982

In a previous study on 42 patients with acute deep vein thrombosis, randomly allocated to treatme... more In a previous study on 42 patients with acute deep vein thrombosis, randomly allocated to treatment with streptokinase or heparin, we found that 71.4 % of the streptokinase-treated patients achieved phlebographically significant thrombolysis as compared to 23.8% in the heparin group. These patients have been reevaluated after a mean observation period of 64 years. Seven patients had died and there were no other drop-outs. Thus, 35 patients were subjected to the follow-up study consisting of phlebography and clinical examination. The evaluations were performed without knowledge of the initial therapy. Seven patients had phlebographically normal veins, and all belonged to the streptokinase group. This difference between the treatment groups is statistically highly significant (p cO.01). At clinical examination, 13 of the 17 patients in the streptokinase group had normal legs and 4 exhibited moderate postthrombotic changes. In contrast, 3 of the heparin-treated patients showed serious postthrombotic changes with open leg ulcers, and only 6 of 18 patients in this group had normal legs. The present results strongly support the assumption that streptokinase therapy is the best treatment at present in patients with acute deep vein thrombosis. This has been shown for the initial thrombolysis, and now also for the avoidance of late postthrombotic changes.

Journal of internal medicine, Jan 11, 2014

The objective of this study was to examine whether statin therapy is associated with enhanced end... more The objective of this study was to examine whether statin therapy is associated with enhanced endothelium-dependent vascular function, improved pulmonary function and reduced systemic inflammation in patients with chronic obstructive pulmonary disease (COPD). This randomized, placebo-controlled, double-blind, parallel trial including patients with COPD was performed at two University hospitals in Norway. Patients with stable COPD (n = 99) were assigned randomly to receive rosuvastatin 10 mg (n = 49) or matching placebo (n = 50) once daily for 12 weeks. The primary outcome measure was change in endothelium-dependent vascular function measured using peripheral arterial tonometry and expressed as the reactive hyperaemia index. Secondary end-points were change in pulmonary function, as assessed by forced expiratory volume in 1 s (FEV1) and FEV1/forced vital capacity (FVC), and change in the circulating levels of the inflammatory markers interleukin-6 (IL6) and high-sensitivity C-reactiv...

Open heart, 2014

To assess the prevalence and long-term prognostic value of a dynamic (rise/fall) pattern of cardi... more To assess the prevalence and long-term prognostic value of a dynamic (rise/fall) pattern of cardiac troponin T (hs-cTnT) elevation during acute exacerbation of chronic obstructive pulmonary disease (AECOPD) compared with a stable hs-cTnT elevation. Prospective cohort study of unselected patients admitted with AECOPD to the emergency room of a university hospital. Serial hs-cTnT measurements were made during admission. Survival after a median of 1.8 years was recorded. 83 patients with a mean age of 72 years and a mean forced expiratory volume in 1 s (FEV1) of 0.9 L. The mortality rate was 62%. The median hs-cTnT at admission was 27 ng/L (IQR 13.4-51)). 65 patients (78%) had at least one hs-cTnT measurement ≥14 ng/L, and among these the median change in hs-cTnT was 50.7% (IQR 25.2-89.4). Of the patients with serial hs-cTnT measurements, 53 (82%) had a dynamic pattern (ie, ΔTnT ≥20%). In multivariate analysis, stable hs-cTnT elevation was associated with increasing age (OR per 5 years...

International Journal of Chronic Obstructive Pulmonary Disease, 2013

Congestive heart failure is underdiagnosed in patients with chronic obstructive pulmonary disease... more Congestive heart failure is underdiagnosed in patients with chronic obstructive pulmonary disease (COPD). Pulmonary congestion on chest radiograph at admission for acute exacerbation of COPD (AECOPD) is associated with an increased risk of mortality. A standardized evaluation of chest radiographs may enhance prognostic accuracy. We aimed to evaluate whether a standardized, liberal assessment of pulmonary congestion is superior to the routine assessment in identifying patients at increased risk of long-term mortality, and to investigate the association of heart failure with N-terminal prohormone of brain natriuretic peptide (NT-proBNP) concentrations. This was a prospective cohort study of 99 patients admitted for AECOPD. Chest radiographs obtained on admission were routinely evaluated and then later evaluated by blinded investigators using a standardized protocol looking for Kerley B lines, enlarged vessels in the lung apex, perihilar cuffing, peribronchial haze, and interstitial or alveolar edema, defining the presence of pulmonary congestion. Adjusted associations with long-term mortality and NT-proBNP concentration were calculated. The standardized assessment was positive for pulmonary congestion in 32 of the 195 radiographs (16%) ruled negative in the routine assessment. The standardized assessment was superior in predicting death during a median follow up of 1.9 years (P=0.022), and in multivariable analysis, only the standardized assessment showed a significant association with mortality (hazard ratio 2.4, 95% confidence interval [CI] 1.2-4.7) (P=0.016) and NT-proBNP (relative concentration 1.8, CI 1.2-2.6) (P=0.003). By applying a standardized approach when evaluating pulmonary congestion on chest radiographs during AECOPD, a group of patients with increased risk of dying, possibly due to heart failure, is identified.

Journal of Clinical Densitometry, 2013

FREEDOM was a phase 3 trial in 7808 women aged 60-90yr with postmenopausal osteoporosis. Subjects... more FREEDOM was a phase 3 trial in 7808 women aged 60-90yr with postmenopausal osteoporosis. Subjects received placebo or 60 mg denosumab subcutaneously every 6mo for 3yr in addition to daily calcium and vitamin D. Denosumab significantly decreased bone turnover; increased dual-energy X-ray absorptiometry (DXA) areal bone mineral density (aBMD); and significantly reduced new vertebral, nonvertebral, and hip fractures. In a subset of women (N=209), lumbar spine, total hip, and femoral neck volumetric BMD (vBMD) were assessed by quantitative computed tomography at baseline and months 12, 24, and 36. Significant improvement from placebo and baseline was observed in aBMD and vBMD in the denosumab-treated subjects at all sites and time points measured. The vBMD difference from placebo reached 21.8%, 7.8%, and 5.9%, respectively, for the lumbar spine, total hip, and femoral neck at 36mo (all p≤0.0001). Compared with placebo and baseline, significant increases were also observed in bone mineral content (BMC) at the total hip (p<0.0001) largely related to significant BMC improvement in the cortical compartment (p<0.0001). These results supplement the data from DXA on the positive effect of denosumab on BMD in both the cortical and trabecular compartments.

Heart, 2013

To investigate if acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is associa... more To investigate if acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is associated with myocardial injury, expressed as elevated high sensitive cardiac troponin T (hs-cTnT), and to identify determinants of hs-cTnT in chronic obstructive pulmonary disease (COPD) patients. In a cross-sectional study, hs-cTnT in patients hospitalised for AECOPD was compared with hs-cTnT in COPD patients in their stable state. The study was conducted at a teaching and a pulmonary rehabilitation clinic. Consecutive admissions to participating units for the years 2010-2011 meeting objective, standardised criteria for AECOPD and stable COPD. Ratio of hs-cTnT in hospitalised AECOPD patients compared with stable COPD patients. Change in the ratio of hs-cTnT per unit increase of relevant covariables. The geometric mean of hs-cTnT in the index group was 25.8 ng/l (95% CI 21.1 to 31.7) compared with 4.55 ng/l (95% CI 3.72 to 5.67) in the reference group. After inclusion of relevant covariables, multiple linear regression analyses showed that the ratio between hs-cTnT in AECOPD patients and the references was 4.26 (95% CI 3.02 to 6.00) and that hs-cTnT increased 1.41-fold (95% CI 1.20 to 1.68), for each quartile increase in leucocyte count in stable COPD but not in AECOPD. Higher hs-cTnT levels were also associated with the presence of pathological q-waves (p=0.012) and electrocardiographic left ventricular hypertrophy (p=0.039), long-term oxygen treatment (p=0.002) and decreasing forced expiratory volume in 1 s (p=0.014). A significant univariable association between cTnT and arterial hypoxaemia was also found but this association was attenuated almost to a zero effect after inclusion of relevant covariates. AECOPD is associated with higher hs-cTnT as compared with stable COPD. In stable COPD, hs-cTnT appears to be positively associated with indices of COPD severity, whereas we were unable to identify significant determinants of hs-cTnT in AECOPD.