Göran Rådegran

Göran Rådegran
Lund University | LU · Department of Cardiology

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186
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Publications (186)
Article
Funding Acknowledgements Type of funding sources: None. Background Orthotopic heart transplantation (OHT) is a standard treatment option for end-stage heart failure (HF). Although post-transplant diabetes (PTDM) is a main complication due to immunosuppressive corticosteroid treatment, its impact on left ventricular (LV) function following OHT has...
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Background Patients with pulmonary arterial hypertension (PAH) exhibit high mortality, partially related to right heart failure. Right ventricular (RV) volumes and ejection fraction (EF) can be measured accurately with cardiac magnetic resonance (CMR), but EF is a crude measure of cardiac function. Additional methods for risk assessment and prognos...
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To improve outcome in pulmonary arterial hypertension, earlier diagnosis and better prognostic assessments are required. We aimed to investigate the diagnostic and prognostic potential of plasma proteins related to pathways recognized in pulmonary arterial hypertension including coagulation, inflammation, and metabolism. Forty-two proteins were ana...
Article
The PAH and CTEPH care in Sweden is since 2007 structured in collaboration with the Swedish Society of Pulmonary Hypertension (SveFPH) and centralized to pulmonary hypertension (PH) centers at the university hospitals. At biannual SveFPH meetings, ideas are exchanged to spread new knowledge on diagnostics and treatment in Sweden. The PAH-CTEPH cent...
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Despite systematic screening and improved treatment strategies, the prognosis remains worse in patients with connective tissue disease-associated pulmonary arterial hypertension (CTD-PAH) compared to patients with idiopathic/hereditary pulmonary arterial hypertension (IPAH). We aimed to investigate differences in clinical characteristics, outcome a...
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To evaluate the association between impaired left ventricular (LV) longitudinal function and LV underfilling in patients with pulmonary arterial hypertension (PAH). Thirty-nine patients with PAH and 18 age and sex-matched healthy controls were included. LV volume and left atrial volume (LAV) were delineated in short-axis cardiac magnetic resonance...
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Background: In adult patients with pulmonary arterial hypertension (PAH), right ventricular (RV) failure may worsen rapidly, resulting in a poor prognosis. In this population, non-invasive assessment of RV function is challenging. RV stroke work index (RVSWI) measured by right heart catheterization (RHC) represents a promising index for RV functio...
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Aims Detecting changes in ventricular function after orthotopic heart transplantation (OHT) using transthoracic echocardiography (TTE) is important but interpretation of findings is complicated by lack of data on early graft adaptation. We sought to evaluate echocardiographic measures of ventricular size and function the first year following OHT in...
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Objectives: Systemic sclerosis-associated pulmonary arterial hypertension (SSc-APAH) is a late but devastating complication of systemic sclerosis (SSc). Early identification of SSc-APAH may improve survival. We examined the role of circulating micro-RNAs (miRNAs) in SSc-APAH. Methods: Using quantitative RT-PCR the abundance of mature miRNAs in p...
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Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Swedish Society of Pulmonary Hypertension Background In adult patients with pulmonary arterial hypertension (PAH), right ventricular (RV) failure may worsen rapidly, constituting a negative prognostic factor. In this population, non-invas...
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The European Society of Cardiology (ESC) and European Respiratory Society (ERS) guideline recommendation of comprehensive risk assessments, which classify patients with pulmonary arterial hypertension (PAH) as having low, intermediate or high mortality risk, has not been evaluated during long-term follow-up in a “real-life” clinical setting. We the...
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Aims: Right ventricular dysfunction may arise because of pulmonary arterial hypertension (PAH). Development of new diagnostic methods able to identify PAH and allow for earlier treatment initiation, before the development of vascular remodelling and manifest right heart failure (HF), could potentially improve prognosis. Proteoglycans and inflammat...
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Aims Low‐risk status in pulmonary arterial hypertension (PAH) predicts better survival. The present study aimed to describe changes in risk status and treatment approaches over multiple clinical assessments in PAH, taking age and comorbidity burden into consideration. Methods and results The study included incident patients from the Swedish PAH re...
Article
Chronic thromboembolic pulmonary hypertension is a subtype of pulmonary hypertension that affects 0,5-4% of patients who have had a pulmonary embolism. Emboli in the pulmonary arteries lead to fibrosis, obstruction and remodeling of the pulmonary arteries which causes increased pulmonary arterial blood pressure and increased pulmonary vascular resi...
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Heart transplantation is the ultimate treatment for patients with end-stage heart failure (HF). Patients with severe HF have pulmonary congestion, which affects the pulmonary perfusion distribution. Invasive right heart catheterization (RHC) and echocardiography are routinely used to follow-up patients after heart transplantation. Furthermore, meas...
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Background The prevalence of heart failure (HF) is rising with ageing population and constitutes a major health problem globally. A common complication of HF is pulmonary hypertension (PH) which negatively impacts survival. A pathophysiological association between HF and PH with tumorigenic processes has been suggested. We aimed to identify the pla...
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Background: Beside the pulmonary vasoconstriction observed in pulmonary arterial hypertension (PAH), severe proliferative and antiapoptotic cellular phenotypes result in vascular remodelling. Many recent findings indicate similarities between PAH and tumour pathology. For instance, insulin-like growth factor (IGF)-1 signalling, which is known to pr...
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Objectives. To investigate if the pulmonary arterial hypertension (PAH) risk assessment tool presented in the 2015 ESC/ERS guidelines is valid for patients with chronic thromboembolic pulmonary hypertension (CTEPH) when taking pulmonary endarterectomy (PEA) into account. Design. Incident CTEPH patients registered in the Swedish PAH Registry (SPAHR)...
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Aims Metabolic derangement is implicated in the pathophysiology of heart failure (HF) and pulmonary hypertension (PH). We aimed to identify the dynamics of metabolic plasma proteins linked to end‐stage HF and associated PH in relation to haemodynamics, before and after heart transplantation (HT). Methods and results Twenty‐one metabolic plasma pro...
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Background: Right ventricular (RV) function is a major determinant of outcome in patients with pulmonary hypertension. Cardiac magnetic resonance (CMR) is gold standard to assess RV ejection fraction (RVEFCMR), however this is a crude measure. New CMR measures of RV function beyond RVEFCMR have emerged, such as RV lateral atrio-ventricular plane d...
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Adrenomedullin is a potent vasodilatory peptide, linked to pulmonary arterial hypertension pathology. Proximity extension assays were utilized to study plasma biomarkers related to vasoregulation, with focus on adrenomedullin peptides and precursor levels, collectively referred to as ADM. ADM was measured in 48 treatment-naïve pulmonary arterial hy...
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Aims Improved risk stratification is of value for decision making in pulmonary arterial hypertension (PAH). Right heart catheterization combined with quantitative tricuspid regurgitation (TR) by cardiovascular magnetic resonance (CMR) may provide this. The aims were to study: (i) to what extent quantitative TR is associated with event‐free survival...
Article
Background Cardiac allograft vasculopathy (CAV) is characterized by diffuse thickening of the arterial intima. Statins reduce the incidence of CAV, but despite the use of statins, CAV remains one of the leading causes of long‐term death after heart transplant. Inhibitors of proprotein convertase subtilisin–kexin type 9 (PCSK9) substantially reduce...
Article
Purpose To investigate the survival of heart transplant (HTx) recipients during different time periods in Sweden. We hypothesized that the survival for HTx recipients has improved following advancements in the management of these patients. Methods Data was obtained through the database of the organ exchange organization Scandiatransplant. All pati...
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Background: Our aim was to investigate the bone mineral density (BMD) evolution and incidence of osteoporosis in relation to chronic kidney disease (CKD) up to 10 years after heart transplantation (HT). Methods: A retrospective analysis was performed on 159 HT patients at Skåne University Hospital in Lund 1988-2016. Results: The median follow-...
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Aims: Invasive haemodynamic profiles at rest and during exercise after heart transplantation (HTx) have never been described in a randomized trial where de novo everolimus (EVR)-based therapy with early calcineurin inhibitor (CNI) withdrawal has been compared with conventional CNI treatment. We report central invasive haemodynamic parameters at re...
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Receptor tyrosine kinases (RTKs) are implicated in cardiovascular growth and remodelling. We aimed to identify the plasma levels of RTKs and related proteins and their association with haemodynamic alterations in heart failure (HF) and related pulmonary hypertension (PH) following heart transplantation (HT). Using proximity extension assay, 28 RTKs...
Article
Purpose: To evaluate the association between mild acute cellular rejection (ACR) and the development of cardiac allograft vasculopathy (CAV) after heart transplantation (HTx). Methods: Substudy of the SCHEDULE trial (n=115), where de novo HTx recipients were randomized to (i) everolimus with early CNI elimination or (ii) CNI-based immunosuppress...
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Variation of the blood content of the pulmonary vascular bed during a heartbeat can be quantified by pulmonary blood volume variation (PBVV) using magnetic resonance imaging (MRI). The aim was to evaluate if PBVV differs in patients with heart failure compared to healthy controls and investigate the mechanisms behind the PBVV. Forty-six patients an...
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Heart failure (HF) is a major public health problem characterized by inability of the heart to maintain sufficient output of blood. The systematic characterization of circulating proteins across different stages of HF may provide pathophysiological insights and identify therapeutic targets. Here we report application of aptamer-based proteomics to...
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Aims: Remodelling of the extracellular matrix (ECM) is a key mechanism involved in the development and progression of heart failure (HF) but also functional in associated pulmonary hypertension (PH). Our aim was to identify plasma ECM proteins associated to end-stage HF and secondary PH in relation to haemodynamics, before and after heart transpla...
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Metabolic abnormalities are proposed to contribute to pulmonary arterial as well as right ventricular remodelling in pulmonary arterial hypertension. Among the proposed abnormalities are altered glucose and lipid processing, mitochondrial malfunction, oxidative stress as well as vitamin D and iron abnormalities. In the present study, we investigate...
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Pulmonary arterial hypertension is a severe disease for which diagnosis often is delayed. Matrix metalloproteinases have been suggested to play a role in vascular remodeling and pulmonary hypertension development. Our aim was therefore to investigate the potential role of matrix metalloproteinases as biomarkers in diagnosis and differentiation of p...
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Background Patients with CTD-APAH have a worse prognosis than those with IPAH, despite having lower pulmonary vascular resistance at diagnosis. Purpose To compare the effect of baseline hemodynamics on one-year survival in incident CTD-APAH patients and IPAH patients. Methods Patients with IPAH and CTD-APAH reported to the SPAHR between January 2...
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Background/Introduction Echocardiography is commonly used in evaluation patients after heart transplantation (HTx). Detecting discrete changes in ventricular function is important but challenging using standard echocardiographic parameters. Furthermore, interpretation of findings are complicated by the fact that data on early possible adaptation is...
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Background Pulmonary arterial hypertension (PAH) is a serious disease exhibiting unspecific symptoms, as a result of which diagnosis is often delayed and prognosis is poor. The underlying pathophysiology includes vasoconstriction and remodelling of small pulmonary arteries. As receptor tyrosine kinases (RTKs) and their ligands have been shown to pr...
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Atrial natriuretic peptide (ANP) represents an attractive therapeutic target in hypertension and heart failure. The biologically active form of ANP is produced by the cardiac serine protease CORIN, and modulation of its activity might therefore represent a novel approach for ANP augmentation. microRNAs (miRNAs) are pervasive regulators of gene expr...
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Background Women with idiopathic pulmonary arterial hypertension (IPAH) have been found to have a worse haemodynamic status at diagnosis, but better survival than men. Over the past decade, demographics have changed and new treatments have become available. The objective of this study was to investigate sex differences in an incident IPAH populatio...
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For patients living with chronic conditions, the daily life will change due to symptoms, drug treatment, and psychosocial factors caused by the disease. Our studies show that Swedish patients with PAH or CTEPH are satisfied with the information they have received, but still have a wish for more. Therefore, it is important to repeat the information...
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Purpose Cardiac allograft vasculopathy (CAV) is a unique form of accelerated atherosclerosis that is characterized by a diffuse, progressive thickening of the arterial intima of the allograft coronaries. CAV accounts for 30% of deaths occurring beyond the first year after heart transplantation. It is partly caused by immunological factors, partly b...
Article
Purpose The impact of mild (1R) acute cellular rejection (ACR) on the development of cardiac allograft vasculopathy (CAV) after heart transplantation (HTx) remains unclear. We aimed to investigate the association between mild ACR within 1 year of HTx and development of CAV at 3 years post HTx. Methods This is a substudy of the SCHEDULE trial (n=11...
Article
Pulmonary hypertension is a common consequence of left heart disease, associated with poor prognosis. The pulmonary hypertension in left heart disease is initially caused by a passive congestion of the pulmonary circuit but may, if longstanding, result in endothelial dysfunction and excessive vasoconstriction. In some cases pulmonary vascular remod...
Article
Background: A calcineurin inhibitor (CNI)-free immunosuppressive regimen has been demonstrated to improve renal function early after heart transplantation, but long-term outcome of such a strategy has not been well described. Methods: In the randomized SCHEDULE trial, de novo heart transplant recipients received (1) everolimus with reduced-expos...
Article
Aims Assessment following heart transplantation (HTx) is routinely performed using transthoracic echocardiography. Differences in long‐term mortality following HTx related to donor‐recipient matching have been reported, but effects of gender on cardiac size and function are not well studied. The aims of this study were to evaluate differences in ec...
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Introduction Spouses play a crucial role, both physically and psychologically, for patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). Our aim was to investigate the spouse's experiences when living with a partner diagnosed with PAH or CTEPH. Methods We used a qualitative interview study d...
Article
Bone mineral density (BMD) in the lumbar spine and femoral neck, the incidence of osteoporosis, and survival up to 10 years after heart transplantation (HT) were investigated in 169 patients who underwent HT at Skåne University Hospital in Lund, Sweden, 1988‐2016. Within the first year post‐transplantation, mean (SD) BMD decreased by 3.9% (10.1) (P...
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Purpose Patients with pulmonary arterial hypertension (PAH) due to systemic sclerosis (SSc) have high mortality. Left ventricular (LV) peak global longitudinal strain (GLS) is decreased in SSc. It is unknown if low GLS is due to SSc or PAH. Therefore, our primary aim was to evaluate both LV and RV free wall GLS (RVRF GLS) in SSc, with and without P...
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Background Right ventricular (RV) systolic function is an important determinant of outcome in patients with pulmonary hypertension (PH). Conventional echocardiographic measures of RV are mainly based on longitudinal contractility. Recently, measurement of RV global longitudinal strain derived from multiple windows (RVGLS) has emerged as an option b...
Article
Pulmonary arterial hypertension (PAH) is a progressive vascular disease, due to vasoconstriction and remodelling of pulmonary arteries. Survival has from diagnosis, if untreated, been found to be 1 to 2.8 years, depending on whether related to rheumatic disease or not. The ESC/ERS risk stratification tool provides a new approach to evaluate the cli...
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In pulmonary arterial hypertension (PAH), severe vasoconstriction and remodelling of small pulmonary arteries result in high mortality. Receptor tyrosine kinases and their ligands, such as transforming growth factor (TGF)-α, modulate proliferation in PAH. Although the receptor tyrosine kinase c-Kit has been shown to be overexpressed in PAH, the exp...
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Background Cardiac allograft vasculopathy (CAV) limits survival after heart transplantation, and the effect of different immunosuppressive regimens on CAV is not fully understood. The randomized SCHEDULE trial (Scandinavian Heart Transplant Everolimus De Novo Study With Early Calcineurin Inhibitors Avoidance) evaluated whether initiation of the pro...
Data
Table S1. Hemodynamic data, pulmonary hypertension classification and results from CXR and V/P SPECT of the 46 included patients mean pulmonary artery pressure (mPAP), mean right atrial pressure (mRAP), mean pulmonary arterial wedge pressure (mPAWP), pulmonary vascular resistance (PVR), transpulmonary gradient (TPG), diastolic pulmonary vascular pr...
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Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) share similar quality of life impairment. The aim of the present study was to investigate health-related quality of life (HRQoL) and its relation to the perception of treatment and psychosocial support among PAH and CTEPH patients. All adult PAH or CTEPH...
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Aims Pulmonary congestion remains a diagnostic challenge in patients with heart failure (HF). The recommended method, chest X‐ray (CXR), lacks in accuracy, whereas quantitative tomographic lung scintigraphy [ventilation/perfusion single‐photon emission computed tomography (V/P SPECT)] has shown promising results but needs independent validation. Th...
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Aims Pre‐capillary pulmonary hypertension (PHpre‐cap) has a poor prognosis, especially when caused by pulmonary arterial hypertension (PAH) associated with systemic sclerosis (SSc‐PAH). Whether cardiac magnetic resonance (CMR)‐based quantification of atrial volumes in PHpre‐cap is beneficial in risk assessment is unknown. The aims were to investiga...
Article
Objective: Endothelial function, including the nitric oxide (NO)-pathway, has previously been extensively investigated in heart failure (HF). In contrast, studies are lacking on the NO pathway after heart transplantation (HT). We therefore investigated substances in the NO pathway prior to and after HT in relation to hemodynamic parameters. Desig...
Article
50 years have passed since the first human to human heart transplantation, performed by Christiaan Barnard in Cape Town December 3rd 1967. Over the years there has been a dramatic improvement in postoperative survival, mainly due to numerous diagnostic and therapeutic advances. Today, heart transplantation constitutes the treatment of choice among...
Article
Background. Recent reports from worldwide pulmonary hypertension registries show a new demographic picture of the idiopathic pulmonary arterial hypertension (IPAH) population, with an increasing prevalence among the elderly.AimTo investigate the effect of age and comorbidity on risk stratification and outcome of patients with incident IPAH.Methods...
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Objective: To identify circulating angiogenic and inflammatory biomarkers with potential in screening for pulmonary arterial hypertension (PAH) in systemic sclerosis (SSc), and in early diagnosis and determination of treatment response in PAH. Method: Plasma samples were taken at the time of PAH diagnosis and at treatment follow-up after a median (...
Article
Background: Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are rare diseases with a gradual decline in physical health. Adherence to treatment is crucial in these very symptomatic and life threatening diseases. Objective: To describe PAH and CTEPH patients experience of their self-reported medicat...