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  1. Article ; Online: Poor adherence to beta-blockers is associated with increased long-term mortality even beyond the first year after an acute coronary syndrome event.

    Allonen, Jaakko / Nieminen, Markku S / Sinisalo, Juha

    Annals of medicine

    2020  Volume 52, Issue 3-4, Page(s) 74–84

    Abstract: ... ...

    Abstract Background
    MeSH term(s) Acute Coronary Syndrome/drug therapy ; Acute Coronary Syndrome/mortality ; Adrenergic beta-Antagonists/therapeutic use ; Aged ; Aged, 80 and over ; Comorbidity ; Female ; Humans ; Longitudinal Studies ; Male ; Medication Adherence/statistics & numerical data ; Middle Aged ; Proportional Hazards Models ; Secondary Prevention/methods ; Time Factors
    Chemical Substances Adrenergic beta-Antagonists
    Language English
    Publishing date 2020-03-17
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1004226-x
    ISSN 1365-2060 ; 1651-2219 ; 0785-3890 ; 1743-1387
    ISSN (online) 1365-2060 ; 1651-2219
    ISSN 0785-3890 ; 1743-1387
    DOI 10.1080/07853890.2020.1740938
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  2. Article ; Online: Repeated or intermittent levosimendan treatment in advanced heart failure: An updated meta-analysis.

    Silvetti, Simona / Nieminen, Markku S

    International journal of cardiology

    2016  Volume 202, Page(s) 138–143

    Abstract: Introduction: Advanced heart failure is a malignant disease characterized by a debilitating late course, with increasingly frequent hospitalisations and high rate of mortality. Levosimendan, an inodilator developed for the treatment of acutely ... ...

    Abstract Introduction: Advanced heart failure is a malignant disease characterized by a debilitating late course, with increasingly frequent hospitalisations and high rate of mortality. Levosimendan, an inodilator developed for the treatment of acutely decompensated chronic heart failure, has been recently proposed also as a repetitive treatment of advanced heart failure. Several studies on the use of levosimendan in this settings report mortality data. Independent meta-analyses on the effect on mortality of repetitive or intermittent levosimendan administration in advanced heart failure has been published but were criticized in regard to the selection of the studies. Meanwhile new data became available. We therefore updated the selection of studies and re-analyzed all the available data.
    Methods & results: Data from seven randomized trial and a total of 438 adult patients using intermittent levosimendan in a cardiological setting were included in the present analysis. The average follow-up period was 8±3.8 months. The use of levosimendan was associated with a significant reduction in mortality at the longest follow-up available [41 of 257 (16%) in the levosimendan group vs. 39 of 181 (21.5%) in the control arm, OR=0.54 (95% CI 0.32-0.91), p for effect=0.02, p for heterogeneity=0.64, I2=0%].
    Conclusions: The updated results suggest that repetitive or intermittent levosimendan administration in advanced heart failure is associated with a significant reduction in mortality at the longest follow-up available. There is therefore a strong rationale for a randomized clinical trial with adequate power on mortality.
    MeSH term(s) Cardiotonic Agents/administration & dosage ; Drug Administration Schedule ; Heart Failure/diagnosis ; Heart Failure/drug therapy ; Humans ; Hydrazones/administration & dosage ; Pyridazines/administration & dosage ; Randomized Controlled Trials as Topic/methods ; Treatment Outcome
    Chemical Substances Cardiotonic Agents ; Hydrazones ; Pyridazines ; simendan (349552KRHK)
    Language English
    Publishing date 2016-01-01
    Publishing country Netherlands
    Document type Journal Article ; Meta-Analysis
    ZDB-ID 779519-1
    ISSN 1874-1754 ; 0167-5273
    ISSN (online) 1874-1754
    ISSN 0167-5273
    DOI 10.1016/j.ijcard.2015.08.188
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  3. Book ; Thesis: Applications of multidirectional echocardiography in myocardial infarction

    Nieminen, Markku S.

    1977  

    Size 35 S.
    Publishing country Finland
    Document type Book ; Thesis
    Thesis / German Habilitation thesis Helsinki, Univ., Diss., 1977
    HBZ-ID HT002287668
    ISBN 951-99113-8-3 ; 978-951-99113-8-0
    Database Catalogue ZB MED Medicine, Health

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  4. Article ; Online: Relation of Use of Red Blood Cell Transfusion After Acute Coronary Syndrome to Long-Term Mortality.

    Allonen, Jaakko / Nieminen, Markku S / Hiippala, Seppo / Sinisalo, Juha

    The American journal of cardiology

    2018  Volume 121, Issue 12, Page(s) 1496–1504

    Abstract: Registry studies have associated red blood cell (RBC) transfusion with increased in-hospital mortality in patients with acute coronary syndrome (ACS). The impact on long-term mortality after 1-year follow-up remains unknown. Consecutive patients with ACS ...

    Abstract Registry studies have associated red blood cell (RBC) transfusion with increased in-hospital mortality in patients with acute coronary syndrome (ACS). The impact on long-term mortality after 1-year follow-up remains unknown. Consecutive patients with ACS (n = 2,009) of a prospective Genetic Predisposition of Coronary Artery Disease cohort were followed for a median of 8.6 years (95% confidence interval [CI] 8.59 to 8.69). After discharge, 1,937 (96%) patients survived for over 30 days. Of those survivors, a subgroup of previously transfusion-naïve patients 85/1,937 (4.4%) who had received at least 1 RBC transfusion during hospitalization were compared with 1,278/1,937 patients (66.0%) who had not received any transfusion either during the hospitalization or the entire follow-up. Unadjusted long-term mortality was significantly higher in the patients transfused with RBC compared with their counterparts not transfused with RBC (58.8% vs 20.3%, p <0.001). The results remained significant for hazard ratio (HR) 1.91, 95% CI 1.39 to 2.63, p <0.001, after multivariate Cox proportional hazards model analysis and were similar after 1-year landmark analysis (HR 1.90, 95% CI 1.34 to 2.70, p <0.001). The higher all-cause mortality was largely explained by cancer mortality (15.3% vs 4.1%, p <0.001) and cardiovascular mortality (34.1% vs 12.1%, p <0.001). After 1:1 propensity score matching (n = 65 vs 65), the association of RBC transfusion with worse survival remained significant (HR 2.70, 95% CI 1.48 to 4.95, p = 0.001). Inverse probability weighted Cox analyses turned out similar results (HR 2.07, 95% CI 1.38 to 3.11, p <0.001). In conclusion, the strong association of need for RBC transfusion with increased mortality continued for patients with ACS even after a 1-year follow-up.
    MeSH term(s) Acute Coronary Syndrome/therapy ; Aged ; Aged, 80 and over ; Anemia/therapy ; Cohort Studies ; Erythrocyte Transfusion/statistics & numerical data ; Female ; Hemorrhage/therapy ; Hospital Mortality ; Hospitalization ; Humans ; Male ; Middle Aged ; Mortality ; Multivariate Analysis ; Postoperative Hemorrhage/therapy ; Propensity Score ; Proportional Hazards Models ; Retrospective Studies
    Language English
    Publishing date 2018-03-13
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 80014-4
    ISSN 1879-1913 ; 0002-9149
    ISSN (online) 1879-1913
    ISSN 0002-9149
    DOI 10.1016/j.amjcard.2018.02.035
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  5. Article: The potential of the inodilator levosimendan in maintaining quality of life in advanced heart failure.

    Nieminen, Markku S / Fonseca, Cândida / Brito, Dulce / Wikström, Gerhard

    European heart journal supplements : journal of the European Society of Cardiology

    2017  Volume 19, Issue Suppl C, Page(s) C15–C21

    Abstract: Maintaining adequate quality of life (QoL) is an important therapeutic objective for patients with advanced heart failure and, for some patients, may take precedence over prolonging life. Achieving good QoL in this context may involve aspects of patient ... ...

    Abstract Maintaining adequate quality of life (QoL) is an important therapeutic objective for patients with advanced heart failure and, for some patients, may take precedence over prolonging life. Achieving good QoL in this context may involve aspects of patient care that lie outside the familiar limits of heart failure treatment. The inodilator levosimendan may be advantageous in this setting, not least because of its sustained duration of action, ascribed to a long-acting metabolite designated OR-1896. The possibility of using this drug in an outpatient setting is a notable practical advantage that avoids the need for patients to attend a clinic appointment. Intermittent therapy can be integrated into a wider system of outreach and patient monitoring. Practical considerations in the use of levosimendan as part of a palliative or end-of-life regimen focused on preserving QoL include the importance of starting therapy at low doses and avoiding bolus administration unless immediate effects are required and patients have adequate baseline arterial blood pressure.
    Language English
    Publishing date 2017-03
    Publishing country England
    Document type Journal Article
    ZDB-ID 1463769-8
    ISSN 1554-2815 ; 1520-765X
    ISSN (online) 1554-2815
    ISSN 1520-765X
    DOI 10.1093/eurheartj/sux003
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  6. Article ; Online: Risk of sudden cardiac death associated with QRS, QTc, and JTc intervals in the general population.

    Tikkanen, Jani T / Kentta, Tuomas / Porthan, Kimmo / Anttonen, Olli / Eranti, Antti / Aro, Aapo L / Kerola, Tuomas / Rissanen, Harri A / Knekt, Paul / Heliövaara, Markku / Holkeri, Arttu / Haukilahti, Anette / Niiranen, Teemu / Hernesniemi, Jussi / Jula, Antti / Nieminen, Markku S / Myerburg, Robert J / Albert, Christine M / Salomaa, Veikko /
    Huikuri, Heikki V / Junttila, M Juhani

    Heart rhythm

    2022  Volume 19, Issue 8, Page(s) 1297–1303

    Abstract: ... QT interval (Bazett's) were measured from standard 12-lead electrocardiograms at baseline. JTc ...

    Abstract Background: QRS duration and corrected QT (QTc) interval have been associated with sudden cardiac death (SCD), but no data are available on the significance of repolarization component (JTc interval) of the QTc interval as an independent risk marker in the general population.
    Objective: In this study, we sought to quantify the risk of SCD associated with QRS, QTc, and JTc intervals.
    Methods: This study was conducted using data from 3 population cohorts from different eras, comprising a total of 20,058 individuals. The follow-up period was limited to 10 years and age at baseline to 30-61 years. QRS duration and QT interval (Bazett's) were measured from standard 12-lead electrocardiograms at baseline. JTc interval was defined as QTc interval - QRS duration. Cox proportional hazards models that controlled for confounding clinical factors identified at baseline were used to estimate the relative risk of SCD.
    Results: During a mean period of 9.7 years, 207 SCDs occurred (1.1 per 1000 person-years). QRS duration was associated with a significantly increased risk of SCD in each cohort (pooled hazard ratio [HR] 1.030 per 1-ms increase; 95% confidence interval [CI] 1.017-1.043). The QTc interval had borderline to significant associations with SCD and varied among cohorts (pooled HR 1.007; 95% CI 1.001-1.012). JTc interval as a continuous variable was not associated with SCD (pooled HR 1.001; 95% CI 0.996-1.007).
    Conclusion: Prolonged QRS durations and QTc intervals are associated with an increased risk of SCD. However, when the QTc interval is deconstructed into QRS and JTc intervals, the repolarization component (JTc) appears to have no independent prognostic value.
    MeSH term(s) Death, Sudden, Cardiac/epidemiology ; Death, Sudden, Cardiac/etiology ; Electrocardiography ; Humans ; Prognosis ; Proportional Hazards Models ; Risk Factors
    Language English
    Publishing date 2022-04-25
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2229357-7
    ISSN 1556-3871 ; 1547-5271
    ISSN (online) 1556-3871
    ISSN 1547-5271
    DOI 10.1016/j.hrthm.2022.04.016
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  7. Article ; Online: Lessons from Lisbon on AHF drug treatment: is it really true that all-old-failed-all-new-will-succeed?

    Pollesello, Piero / Papp, Zoltán / Nieminen, Markku S

    International journal of cardiology

    2013  Volume 168, Issue 5, Page(s) 4798–4799

    MeSH term(s) Acute Disease ; Cardiotonic Agents/therapeutic use ; Drug Discovery ; Heart Failure/drug therapy ; Humans
    Chemical Substances Cardiotonic Agents
    Language English
    Publishing date 2013-10-12
    Publishing country Netherlands
    Document type Letter
    ZDB-ID 779519-1
    ISSN 1874-1754 ; 0167-5273
    ISSN (online) 1874-1754
    ISSN 0167-5273
    DOI 10.1016/j.ijcard.2013.07.042
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  8. Article ; Online: Genetic basis and outcome in a nationwide study of Finnish patients with hypertrophic cardiomyopathy.

    Jääskeläinen, Pertti / Vangipurapu, Jagadish / Raivo, Joose / Kuulasmaa, Teemu / Heliö, Tiina / Aalto-Setälä, Katriina / Kaartinen, Maija / Ilveskoski, Erkki / Vanninen, Sari / Hämäläinen, Liisa / Melin, John / Kokkonen, Jorma / Nieminen, Markku S / Laakso, Markku / Kuusisto, Johanna

    ESC heart failure

    2019  Volume 6, Issue 2, Page(s) 436–445

    Abstract: Aims: Nationwide large-scale genetic and outcome studies in cohorts with hypertrophic cardiomyopathy (HCM) have not been previously published.: Methods and results: We sequenced 59 cardiomyopathy-associated genes in 382 unrelated Finnish patients ... ...

    Abstract Aims: Nationwide large-scale genetic and outcome studies in cohorts with hypertrophic cardiomyopathy (HCM) have not been previously published.
    Methods and results: We sequenced 59 cardiomyopathy-associated genes in 382 unrelated Finnish patients with HCM and found 24 pathogenic or likely pathogenic mutations in six genes in 38.2% of patients. Most mutations were located in sarcomere genes (MYBPC3, MYH7, TPM1, and MYL2). Previously reported mutations by our study group (MYBPC3-Gln1061Ter, MYH7-Arg1053Gln, and TPM1-Asp175Asn) and a fourth major mutation MYH7-Val606Met accounted for 28.0% of cases. Mutations in GLA and PRKAG2 were found in three patients. Furthermore, we found 49 variants of unknown significance in 31 genes in 20.4% of cases. During a 6.7 ± 4.2 year follow-up, annual all-cause mortality in 482 index patients and their relatives with HCM was higher than that in the matched Finnish population (1.70 vs. 0.87%; P < 0.001). Sudden cardiac deaths were rare (n = 8). Systolic heart failure (hazard ratio 17.256, 95% confidence interval 3.266-91.170, P = 0.001) and maximal left ventricular wall thickness (hazard ratio 1.223, 95% confidence interval 1.098-1.363, P < 0.001) were independent predictors of HCM-related mortality and life-threatening cardiac events. The patients with a pathogenic or likely pathogenic mutation underwent an implantable cardioverter defibrillator implantation more often than patients without a pathogenic or likely pathogenic mutation (12.9 vs. 3.5%, P < 0.001), but there was no difference in all-cause or HCM-related mortality between the two groups. Mortality due to HCM during 10 year follow-up among the 5.2 million population of Finland was studied from death certificates of the National Registry, showing 269 HCM-related deaths, of which 32% were sudden.
    Conclusions: We identified pathogenic and likely pathogenic mutations in 38% of Finnish patients with HCM. Four major sarcomere mutations accounted for 28% of HCM cases, whereas HCM-related mutations in non-sarcomeric genes were rare. Mortality in patients with HCM exceeded that of the general population. Finally, among 5.2 million Finns, there were at least 27 HCM-related deaths annually.
    MeSH term(s) Cardiac Myosins/genetics ; Cardiac Myosins/metabolism ; Cardiomyopathy, Hypertrophic/genetics ; Cardiomyopathy, Hypertrophic/metabolism ; Cardiomyopathy, Hypertrophic/mortality ; DNA Mutational Analysis ; Female ; Finland/epidemiology ; Follow-Up Studies ; Forecasting ; Heterozygote ; Humans ; Male ; Mutation ; Pedigree ; Registries ; Sarcomeres/metabolism ; Sarcomeres/pathology ; Survival Rate/trends
    Chemical Substances Cardiac Myosins (EC 3.6.1.-)
    Language English
    Publishing date 2019-02-18
    Publishing country England
    Document type Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 2814355-3
    ISSN 2055-5822 ; 2055-5822
    ISSN (online) 2055-5822
    ISSN 2055-5822
    DOI 10.1002/ehf2.12420
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  9. Article: Heart failure in the elderly: how risky is it to be discharged?

    Nieminen, Markku S / Harjola, Veli-Pekka

    European journal of heart failure

    2008  Volume 10, Issue 3, Page(s) 222–223

    MeSH term(s) Age Factors ; Aged ; Heart Failure/therapy ; Hospitalization ; Humans ; Patient Discharge ; Patient Readmission/statistics & numerical data ; Risk Assessment
    Language English
    Publishing date 2008-03
    Publishing country England
    Document type Comment ; Editorial
    ZDB-ID 1483672-5
    ISSN 1879-0844 ; 1388-9842
    ISSN (online) 1879-0844
    ISSN 1388-9842
    DOI 10.1016/j.ejheart.2008.02.014
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  10. Article ; Online: Health care costs related to hepatitis B in Finland are mostly due to chronic infections: a register-based study.

    Nieminen, Tanja / Salo, Heini / Nurhonen, Markku / Leino, Tuija

    Infectious diseases (London, England)

    2022  Volume 54, Issue 10, Page(s) 722–730

    Abstract: ... lost due to hepatitis B-related outcomes. An episode of care was constructed from each individual's ...

    Abstract Background: Finland is among the countries with low hepatitis B endemicity. We evaluate the hepatitis B-related disease and economic burden needed for evidence-based immunisation policy decision-making.
    Methods: Hepatitis B-related cases in 2004-2012 were retrieved from population-based nationwide registers. We evaluated the incidence, health care resource use, health care costs, and life years lost due to hepatitis B-related outcomes. An episode of care was constructed from each individual's hepatitis B-related events retrieved from individually linkable registers.
    Results: The mean health care costs per an acute hepatitis B case were €450 (
    Conclusions: When planning prevention of hepatitis B infection, it is pivotal to notice that the overall disease and economic burden due to hepatitis B is mostly due to chronic infection.
    MeSH term(s) Antiviral Agents/therapeutic use ; Finland/epidemiology ; Health Care Costs ; Hepatitis B/epidemiology ; Hepatitis B, Chronic/drug therapy ; Hepatitis B, Chronic/epidemiology ; Humans ; Liver Cirrhosis/epidemiology ; Liver Neoplasms/epidemiology ; Persistent Infection
    Chemical Substances Antiviral Agents
    Language English
    Publishing date 2022-07-20
    Publishing country England
    Document type Journal Article
    ZDB-ID 2839775-7
    ISSN 2374-4243 ; 2374-4235
    ISSN (online) 2374-4243
    ISSN 2374-4235
    DOI 10.1080/23744235.2022.2082519
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