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  • 1. Alfonso, Fernando
    et al.
    Zelveian, Parounak
    Monsuez, Jean-Jacques
    Aschermann, Michael
    Böhm, Michael
    Hernandez, Alfonso Buendia
    Wang, Tzung-Dau
    Cohen, Ariel
    Izetbegovic, Sebija
    Doubell, Anton
    Echeverri, Dario
    Enç, Nuray
    Ferreira-González, Ignacio
    Undas, Anetta
    Fortmüller, Ulrike
    Gatzov, Plamen
    Ginghina, Carmen
    Goncalves, Lino
    Addad, Faouzi
    Hassanein, Mahmoud
    Heusch, Gerd
    Huber, Kurt
    Hatala, Robert
    Ivanusa, Mario
    Lau, Chu-Pak
    Marinskis, Germanas
    Cas, Livio Dei
    Rochitte, Carlos Eduardo
    Nikus, Kjell
    Fleck, Eckart
    Pierard, Luc
    Obradović, Slobodan
    Del Pilar Aguilar Passano, María
    Jang, Yangsoo
    Rødevand, Olaf
    Sander, Mikael
    Shlyakhto, Evgeny
    Erol, Çetin
    Tousoulis, Dimitris
    Ural, Dilek
    Piek, Jan J
    Varga, Albert
    Flammer, Andreas J
    Mach, François
    Dibra, Alban
    Guliyev, Faiq
    Mrochek, Alexander
    Rogava, Mamanti
    Guzman Melgar, Ismael
    Di Pasquale, Giuseppe
    Kabdrakhmanov, Kanat
    Haddour, Laila
    Fras, Zlatko
    Held, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Shumakov, Valentyn
    Authorship: from credit to accountability. Reflections from the Editors' Network.2019In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692, Vol. 108, no 7, p. 723-729Article in journal (Refereed)
    Abstract [en]

    The Editors' Network of the European Society of Cardiology provides a dynamic forum for editorial discussions and endorses the recommendations of the International Committee of Medical Journal Editors (ICMJE) to improve the scientific quality of biomedical journals. Authorship confers credit and important academic rewards. Recently, however, the ICMJE emphasized that authorship also requires responsibility and accountability. These issues are now covered by the new (fourth) criterion for authorship. Authors should agree to be accountable and ensure that questions regarding the accuracy and integrity of the entire work will be appropriately addressed. This review discusses the implications of this paradigm shift on authorship requirements with the aim of increasing awareness on good scientific and editorial practices.

  • 2.
    Baron, Tomasz
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Berglund, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Hedin, Eva-Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Flachskampf, Frank
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Test-retest reliability of new and conventional echocardiographic parameters of left ventricular systolic function2019In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692, Vol. 108, no 4, p. 355-365Article in journal (Refereed)
    Abstract [en]

    Background: Reliability of left ventricular function measurements depends on actual biological conditions, repeated registrations and their analyses.

    Objective: To investigate test–retest reliability of speckle-tracking-derived strain measurements and its determinants compared to the conventional parameters, such as ejection fraction (EF), LV volumes and mitral annular plane systolic excursion (MAPSE).

    Methods: In 30 patients with a wide range of left ventricular function (mean EF 46.4 ± 16.4%, range 14–73%), standard echo views were acquired independently in a blinded fashion by two different echocardiographers in immediate sequence and analyzed off-line by two independent readers, creating 4 data sets per patient. Test–retest reliability of studied parameters was calculated using the smallest detectable change (SDC) and a total, inter-acquisition and inter-reader intra-class correlation coefficient (ICC).

    Results: The smallest detectable change normalized to the mean absolute value of the measured parameter (SDCrel) was lowest for MAPSE (10.7%). SDCrel for EF was similar to GLS (14.2 and 14.7%, respectively), while SDCrel for CS was much higher (35.6%). The intra-class correlation coefficient was excellent (> 0.9) for all measures of the left ventricular function. Intra-patient inter-acquisition reliability (ICCacq) was significantly better than inter-reader reliability (ICCread) (0.984 vs. 0.950, p = 0.03) only for EF, while no significant difference was observed for any other LV function parameter. Mean intra-subject standard deviations were significantly correlated to the mean values for CS and LV volumes, but not for the other studied parameters.

    Conclusions: In a test–retest setting, both with normal and impaired left ventricular function, the smallest relative detectable change of EF, GLS and MAPSE was similar (11–15%), but was much higher for CS (35%). Surprisingly, reliability of GLS was not superior to that of EF. Acquisition and reader to a similar extent influenced the reliability of measurements of all left ventricular function measures except for ejection fraction, where the reliability was more dependent on the reader than on the acquisition.

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  • 3.
    Carlsson, Jörg
    et al.
    Kalmar County Hospital.
    Danielsson, Tom
    Linnaeus University, Faculty of Social Sciences, Department of Sport Science.
    Bergman, Patrick
    Linnaeus University, Faculty of Social Sciences, Department of Sport Science.
    A two-peaked increase of serum myosin heavy chain-α after full distance triathlon demonstrates heart muscle cell death2017In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692, Vol. 106, no Suppl 1, article id P1159Article in journal (Refereed)
    Abstract [en]

    Background: There is an ongoing debate about the significance of cardiac troponin T (cTnT) elevation after strenuous exercise: heart muscle cell death versus physiologic mechanism of release through an intact cell membrane. While cTnT is a small molecule (37 kDa), cardiac specific myosin heavy chain-alpha (MHC-α) is much larger (224 kDa) and an increase after exercise could hardly be explained by passage through an intact cardiac cell membrane. PURPOSE: To measure MHC-α, and other biomarkers (C-reactive protein (CRP); cTnT, creatine kinase (CK), myoglobin (MG), creatinine (C), and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) before and after a full distance Ironman in order to answer the question of heart muscle cell death versus physiologic changes. 

    Methods: In 52 non-elite athletes (14 female, 38 male; age 41.1 ± 9.7, range 24-70 years; all completed the race) biomarkers were measured by standard laboratory methods 7 days before, directly after, and day 1, 4 and 6 after the race. MHC-α was measured with a commercially available ELISA with no cross reactivity with other myosins. 

    Results: The course of MHC-α concentration [µg/L] was 1.33 ± 0.53 (before), 2.57 ± 0.78 (directly after), 1.51 ± 0.53 (day 1), 2.74 ± 0.55 (day 4) and 1.83 ± 0.76 (day 6). Other biomarkers showed a one-peaked increase with maximal values either directly after the race or at day 1: cTnT 76 ± 80 ng/L (12-440; reference <15), NT-proBNP 776 ± 684 ng/L (92-4700; ref. < 300), CK 68 ± 55 µkat/L (5-280; ref. < 1.9), MG 2088 ± 2350 µg/L (130-17000; ref.< 72), and creatinine 100 ± 20 µmol/L (74-161; ref. < 100), CRP 49 ± 23 mg/L (15-119; ref.< 5). There was a significant correlation between MHC-α and NT-proBNP (R=0.48; p<0.001) but neither between MHC-α and cTnT (R=0.13; p=0.36) nor MHC-α and myoglobin (R=0.18; p=0.2). 

    Conclusion: An Ironman leads to remarkable disturbances in biomarkers as e.g. cTnT was in the range of myocardial infarction in 100% of women and 97% of men. This is to our best knowledge the first investigation of MHC-α after strenuous exercise and its two-peaked increase most likely represents first release from the cytosolic pool and later from cell necrosis including the contractile apparatus. However, many questions remain, not at least why MHC-α baseline levels are as high as 1.33 ± 0.53 µg/L. 

  • 4.
    Chen, Xiaojing
    et al.
    Sichuan Univ, Peoples R China; Univ Gothenburg, Sweden.
    Cui, Xiaotong
    Univ Gothenburg, Sweden; Fudan Univ, Peoples R China.
    Thunstrom, Erik
    Univ Gothenburg, Sweden.
    Pivodic, Aldina
    Univ Gothenburg, Sweden; Statistiska Konsultgruppen, Sweden.
    Dahlström, Ulf
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Fu, Michael
    Univ Gothenburg, Sweden.
    Guideline-directed medical therapy in real-world heart failure patients with low blood pressure and renal dysfunction2021In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692, Vol. 110, p. 1051-1062Article in journal (Refereed)
    Abstract [en]

    Background Among patients with heart failure and reduced ejection fraction (HFrEF), angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARB), beta-blockers (BB) and mineralocorticoid receptor antagonist (MRA) are known as guideline-directed medical therapy to improve prognosis. However, low blood pressure (BP) and renal dysfunction are often challenges prevent clinical implementation, so we investigated the association of different combinations of GDMT treatments with all-cause mortality in HFrEF population with low BP and renal dysfunction. Methods This study initially included 51, 060 HF patients from the Swedish Heart Failure Registry, and finally 1464 HFrEF patients with low BP (systolic BP &lt;= 100 mmHg) and renal dysfunction (estimated glomerular filtration rate (eGFR) &lt;= 60 ml/min/1.73m(2)) were ultimately enrolled. Patients were receiving oral medication for HF at study enrollment, and divided into four groups (group 1-4: ACEI/ARB + BB + MRA, ACEI/ARB + BB, ACEI/ARB + MRA or ACEI/ARB only, and other). The outcome is time to all-cause mortality. Results Among the study patients, 485 (33.1%), 672 (45.9%), 109 (7.4%) and 198 (13.5%) patients were in group 1-4. Patients in group 1 were younger, had highest hemoglobin, and most with EF &lt; 30%. During a median of 1.33 years follow-up, 937 (64%) patients died. After adjustment for age, gender, LVEF, eGFR, hemoglobin when compared with the group 1, the hazard ratio for all-cause mortality in group 2 was 1.04 (0.89-1.21) (p = 0.62), group 3 1.40 (1.09-1.79) (p = 0.009), and group 4 1.71 (1.39-2.09) (p &lt; 0.001). Conclusions In real-world HFrEF patients with low BP and renal dysfunction, full medication of guideline-directed medical therapy is associated with improved survival. The benefit was larger close to the index date and decreased with follow-up time.

  • 5.
    Chen, Xiaojing
    et al.
    Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China. chenxiaojing_058@163.com; Department of Molecular and Clinical Medicine,Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Savarese, Gianluigi
    Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Dahlström, Ulf
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Lund, Lars H.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping. Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden.
    Fu, Michael
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Age-dependent differences in clinical phenotype and prognosis in heart failure with mid-range ejection compared with heart failure with reduced or preserved ejection fraction2019In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692, Vol. 108, no 12, p. 1394-1405Article in journal (Refereed)
    Abstract [en]

    Background

    HFmrEF has been recently proposed as a distinct HF phenotype. How HFmrEF differs from HFrEF and HFpEF according to age remains poorly defined. We aimed to investigate age-dependent differences in heart failure with mid-range (HFmrEF) vs. preserved (HFpEF) and reduced (HFrEF) ejection fraction.

    Methods and results

    42,987 patients, 23% with HFpEF, 22% with HFmrEF and 55% with HFrEF, enrolled in the Swedish heart failure registry were studied. HFpEF prevalence strongly increased, whereas that of HFrEF strongly decreased with higher age. All cardiac comorbidities and most non-cardiac comorbidities increased with aging, regardless of the HF phenotype. Notably, HFmrEF resembled HFrEF for ischemic heart disease prevalence in all age groups, whereas regarding hypertension it was more similar to HFpEF in age ≥ 80 years, to HFrEF in age < 65 years and intermediate in age 65–80 years. All-cause mortality risk was higher in HFrEF vs. HFmrEF for all age categories, whereas HFmrEF vs. HFpEF reported similar risk in ≥ 80 years old patients and lower risk in < 65 and 65–80 years old patients. Predictors of mortality were more likely cardiac comorbidities in HFrEF but more likely non-cardiac comorbidities in HFpEF and HFmrEF with < 65 years. Differences among HF phenotypes for comorbidities were less pronounced in the other age categories.

    Conclusion

    HFmrEF appeared as an intermediate phenotype between HFpEF and HFrEF, but for some characteristics such as ischemic heart disease more similar to HFrEF. With aging, HFmrEF resembled more HFpEF. Prognosis was similar in HFmrEF vs. HFpEF and better than in HFrEF.

  • 6.
    Cui, Xiaotong
    et al.
    Sahlgrenska Akademin, Göteborgs Universitet; Fudan University.
    Mandalenakis, Zacharias
    Sahlgrenska Akademin, Göteborgs Universitet; Sahlgrenska University Hospital.
    Thunström, Erik
    Sahlgrenska Akademin, Göteborgs Universitet; Sahlgrenska University Hospital.
    Fu, Michael
    Sahlgrenska Akademin, Göteborgs Universitet; Sahlgrenska University Hospital.
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Hansson, Per-Olof
    Sahlgrenska Akademin, Göteborgs Universitet; Sahlgrenska University Hospital.
    The impact of time-updated resting heart rate on cause-specific mortality in a random middle-aged male population: a lifetime follow-up2021In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692, Vol. 110, no 6, p. 822-830Article in journal (Refereed)
    Abstract [en]

    Background

    A high resting heart rate (RHR) is associated with an increase in adverse events. However, the long-term prognostic value in a general population is unclear. We aimed to investigate the impact of RHR, based on both baseline and time-updated values, on mortality in a middle-aged male cohort.

    Methods

    A random population sample of 852 men, all born in 1913, was followed from age 50 until age 98, with repeated examinations including RHR over a period of 48 years. The impact of baseline and time-updated RHR on cause-specific mortality was assessed using Cox proportional hazard models and cubic spline models.

    Results

    A baseline RHR of ≥ 90 beats per minute (bpm) was associated with higher all-cause mortality, as compared with an RHR of 60–70 bpm (hazard ratio [HR] 1.60, 95% confidence interval [CI] 1.17–2.19, P = 0.003), but not with cardiovascular (CV) mortality. A time-updated RHR of < 60 bpm (HR 1.41, 95% CI 1.07–1.85, P = 0.014) and a time-updated RHR of 70–80 bpm (HR 1.34, 95% CI 1.02–1.75, P = 0.036) were both associated with higher CV mortality as compared with an RHR of 60–70 bpm after multivariable adjustment. Analyses using cubic spline models confirmed that the association of time-updated RHR with all-cause and CV mortality complied with a U-shaped curve with 60 bpm as a reference.

    Conclusion

    In this middle-aged male cohort, a time-updated RHR of 60–70 bpm was associated with the lowest CV mortality, suggesting that a time-updated RHR could be a useful long-term prognostic index in the general population.

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  • 7.
    Ek, Amanda
    et al.
    Swedish Sch Sport & Hlth Sci, Astrand Lab Work Physiol, POB 5626, S-11486 Stockholm, Sweden;Karolinska Univ Hosp, Allied Hlth Profess Funct, Funct Area Occupat Therapy & Physiotherapy, Stockholm, Sweden.
    Ekblom, Orjan
    Swedish Sch Sport & Hlth Sci, Astrand Lab Work Physiol, POB 5626, S-11486 Stockholm, Sweden.
    Hambraeus, Kristina
    Falun Cent Hosp, Dept Cardiol, Falun, Sweden.
    Cider, Asa
    Gothenburg Univ, Dept Neurosci & Physiol, Gothenburg, Sweden;Sahlgrens Univ Hosp, Gothenburg, Sweden.
    Kallings, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Swedish Sch Sport & Hlth Sci, Astrand Lab Work Physiol, POB 5626, S-11486 Stockholm, Sweden.
    Borjesson, Mats
    Gothenburg Univ, Dept Neurosci & Physiol, Gothenburg, Sweden;Sahlgrens Univ Hosp, Gothenburg, Sweden;Gothenburg Univ, Dept Food Nutr & Sports Sci, Gothenburg, Sweden.
    Physical inactivity and smoking after myocardial infarction as predictors for readmission and survival: results from the SWEDEHEART-registry2019In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692, Vol. 108, no 3, p. 324-332Article in journal (Refereed)
    Abstract [en]

    Background

    Physical activity (PA) and smoking cessation are included in the secondary prevention guidelines after myocardial infarction (MI), but they are still underutilised. This study aims to explore how PA level and smoking status (6-10weeks post-MI) were associated with 1-year readmission and mortality during full follow-up time, and with the cumulative 5-year mortality.

    Methods

    A population-based cohort of all hospitals providing MI-care in Sweden (SWEDEHEART-registry) in 2004-2014. PA was expressed as the number of exercise sessions of 30min in the last 7days: 0-1 (low), 2-4 (medium) and 5-7 (high) sessions/week. Individuals were categorised as smokers, former smokers or never-smokers. The associations were analysed by unadjusted and adjusted logistic and Cox regressions.

    Results

    During follow-up (M=3.58years), a total of 1702 deaths occurred among 30 644 individuals (14.1 cases per 1000 person-years). For medium and high PA, the hazard ratios (HRs) for mortality were 0.39 and 0.36, respectively, compared with low PA. For never-smokers, the HR was 0.45 and former smokers 0.56 compared with smokers. Compared with low PA, the odds ratios (ORs) for readmission in medium PA were 0.65 and 0.59 for CVD and non-CVD causes, respectively. For high PA, the corresponding ORs were 0.63 and 0.55. The association remained in adjusted models. There were no associations between smoking status and readmission.

    Conclusions

    The PA level and smoking status are strong predictors of mortality post-MI and the PA level also predicts readmission, highlighting the importance of adherence to the secondary prevention guidelines.

  • 8.
    Ek, Amanda
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology. Karolinska University Hospital.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Hambraeus, Kristina
    Falun Hospital.
    Cider, Åsa
    Gothenburg University and Sahlgrenska University Hospital.
    Kallings, Lena
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology. Uppsala University.
    Börjesson, Mats
    Gothenburg University and Sahlgrenska University Hospital.
    Physical inactivity and smoking after myocardial infarction as predictors for readmission and survival: results from the SWEDEHEART-registry.2019In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692, Vol. 108, no 3, p. 324-332Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Physical activity (PA) and smoking cessation are included in the secondary prevention guidelines after myocardial infarction (MI), but they are still underutilised. This study aims to explore how PA level and smoking status (6-10 weeks post-MI) were associated with 1-year readmission and mortality during full follow-up time, and with the cumulative 5-year mortality.

    METHODS: A population-based cohort of all hospitals providing MI-care in Sweden (SWEDEHEART-registry) in 2004-2014. PA was expressed as the number of exercise sessions of ≥ 30 min in the last 7 days: 0-1 (low), 2-4 (medium) and 5-7 (high) sessions/week. Individuals were categorised as smokers, former smokers or never-smokers. The associations were analysed by unadjusted and adjusted logistic and Cox regressions.

    RESULTS: During follow-up (M = 3.58 years), a total of 1702 deaths occurred among 30 644 individuals (14.1 cases per 1000 person-years). For medium and high PA, the hazard ratios (HRs) for mortality were 0.39 and 0.36, respectively, compared with low PA. For never-smokers, the HR was 0.45 and former smokers 0.56 compared with smokers. Compared with low PA, the odds ratios (ORs) for readmission in medium PA were 0.65 and 0.59 for CVD and non-CVD causes, respectively. For high PA, the corresponding ORs were 0.63 and 0.55. The association remained in adjusted models. There were no associations between smoking status and readmission.

    CONCLUSIONS: The PA level and smoking status are strong predictors of mortality post-MI and the PA level also predicts readmission, highlighting the importance of adherence to the secondary prevention guidelines.

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  • 9.
    Emilsson, Kent
    et al.
    Department of Clinical Physiology Karlskoga Hospital, Karlskoga, Sweden; Department of Clinical Physiology, Örebro University Hospital, Örebro, Sweden.
    Kähäri, Anders
    Department of Radiology, Örebro University Hospital, Sweden.
    Bodin, Lennart
    Unit of Statistics Clinical Research Centre, Örebro University Hospital, ÖrebroSweden.
    Thunberg, Per
    Department of Biomedical Engineering Örebro University Hospital, Sweden.
    Outer contour and radial changes of the cardiac left ventricle: a magnetic resonance imaging study.2007In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692, Vol. 96, no 5, p. 272-278Article in journal (Refereed)
    Abstract [en]

    Earlier studies have shown a +/-5% end-systolic decrease in the volume encompassed by the pericardial sack, manifesting as a radial diminution of the pericardial/epicardial contour of the left ventricle (LV). The aim of this study was to measure this radial displacement at different segmental levels of the LV and try to find out were it is as greatest and to calculate regional myocardial volume changes as a reference in healthy subjects. Eleven healthy subjects were examined by magnetic resonance imaging. Images were acquired using an ECG-triggered balanced fast field echo pulse sequence. The epicardial borders of the LV wall were delineated in end-diastole (ED) and end-systole (ES). Regional changes of the LV wall were analysed at three different levels (base, mid and apex) by dividing the myocardium into segments. The volumes obtained as the differences between the outer volume of the left ventricle at ED and ES at different slice levels were found to be greatest at the base of the heart and lowest at apex. The relative inward motion, that is the motion in short-axis direction of the epicardial border of the myocardium from ED to ES towards the centre of the LV, was greatest at the base and lowest at the mid level, something that has to be taken into account when measuring the LV during clinical exams. There was a significant difference in the relative inward motion between the segments at apex (p < 0.0001), mid (p = 0.036) and at base level (p < 0.0001).

  • 10.
    Ergatoudes, Constantinos
    et al.
    Univ Gothenburg, Sweden.
    Schaufelberger, Maria
    Univ Gothenburg, Sweden.
    Andersson, Bert
    Univ Gothenburg, Sweden.
    Pivodic, Aldina
    Statistiska Konsultgruppen, Sweden.
    Dahlström, Ulf
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Fu, Michael
    Univ Gothenburg, Sweden.
    Non-cardiac comorbidities and mortality in patients with heart failure with reduced vs. preserved ejection fraction: a study using the Swedish Heart Failure Registry2019In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692, Vol. 108, no 9, p. 1025-1033Article in journal (Refereed)
    Abstract [en]

    Background Heart failure (HF) and non-cardiac comorbidities often coexist and are known to have an adverse effect on outcome. However, the prevalence and prognostic impact of non-cardiac comorbidities in patients with HF with reduced ejection fraction (HFrEF) vs. those with preserved (HFpEF) remain inadequately studied. Methods and results We used data from the Swedish Heart Failure Registry from 2000 to 2012. HFrEF was defined as EF amp;lt; 50% and HFpEF as EF amp;gt;= 50%. Of 31 344 patients available for analysis, 79.3% (n = 24 856) had HFrEF and 20.7% (n = 6 488) HFpEF. The outcome was all-cause mortality. We examined the association between ten non-cardiac comorbidities and mortality and its interaction with EF using adjusted hazard ratio (HR). Stroke, anemia, gout and cancer had a similar impact on mortality in both phenotypes, whereas diabetes (HR 1.57, 95% confidence interval [CI] [1.50-1.65] vs. HR 1.39 95% CI [1.27-1.51], p = 0.0002), renal failure (HR 1.65, 95% CI [1.57-1.73] vs. HR 1.44, 95% CI [1.32-1.57], p = 0.003) and liver disease (HR 2.13, 95% CI [1.83-2.47] vs. HR 1.42, 95% CI [1.09-1.85] p = 0.02) had a higher impact in the HFrEF patients. Moreover, pulmonary disease (HR 1.46, 95% CI [1.40-1.53] vs. HR 1.66 95% CI [1.54-1.80], p = 0.007) was more prominent in the HFpEF patients. Sleep apnea was not associated with worse prognosis in either group. No significant variation was found in the impact over the 12-year study period. Conclusions Non-cardiac comorbidities contribute significantly but differently to mortality, both in HFrEF and HFpEF. No significant variation was found in the impact over the 12-year study period. These results emphasize the importance of including the management of comorbidities as a part of a standardized heart failure care in both HF phenotypes.

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  • 11.
    Fu, M.
    et al.
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden.;Sahlgrens Univ Hosp, Sect Cardiol, Dept Med, Ostra Hosp, S-41650 Gothenburg, Sweden..
    Ahrenmark, U.
    Hosp Halmstad, Dept Med, Halmstad, Sweden..
    Berglund, S.
    Hosp Falun, Dept Med, Falun, Sweden..
    Lindholm, C. J.
    Capio City Clin, Lund, Sweden..
    Lehto, A.
    Northern Alvsborg Cty Hosp, Dept Med, Trollhattan, Sweden..
    Broberg, A. Mansson
    Karolinska Inst, Karolinska Univ Hosp Stockholm, Div Cardiol, Dept Med, Stockholm, Sweden..
    Tasevska-Dinevska, G.
    Lund Univ, Malmo Univ Hosp, Dept Cardiol, Malmo, Sweden..
    Wikström, Gerhard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Agard, A.
    Angered Hosp, Dept Med, Gothenburg, Sweden..
    Andersson, B.
    Sahlgrens Univ Hosp, Sect Cardiol, Dept Med, Ostra Hosp, S-41650 Gothenburg, Sweden..
    Adherence to optimal heart rate control in heart failure with reduced ejection fraction: insight from a survey of heart rate in heart failure in Sweden (HR-HF study)2017In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692, Vol. 106, no 12, p. 960-973Article in journal (Refereed)
    Abstract [en]

    Despite that heart rate (HR) control is one of the guideline-recommended treatment goals for heart failure (HF) patients, implementation has been painstakingly slow. Therefore, it would be important to identify patients who have not yet achieved their target heart rates and assess possible underlying reasons as to why the target rates are not met. The survey of HR in patients with HF in Sweden (HR-HF survey) is an investigator-initiated, prospective, multicenter, observational longitudinal study designed to investigate the state of the art in the control of HR in HF and to explore potential underlying mechanisms for suboptimal HR control with focus on awareness of and adherence to guidelines for HR control among physicians who focus on the contributing role of beta-blockers (BBs). In 734 HF patients the mean HR was 68 +/- 12 beats per minute (bpm) (37.2% of the patients had a HR > 70 bpm). Patients with HF with reduced ejection fraction (HFrEF) (n = 425) had the highest HR (70 +/- 13 bpm, with 42% > 70 bpm), followed by HF with preserved ejection fraction and HF with mid-range ejection fraction. Atrial fibrillation, irrespective of HF type, had higher HR than sinus rhythm. A similar pattern was observed with BB treatment. Moreover, non-achievement of the recommended target HR (< 70 bpm) in HFrEF and sinus rhythm was unrelated to age, sex, cardiovascular risk factors, cardiovascular diseases, and comorbidities, but was related to EF and the clinical decision of the physician. Approximately 50% of the physicians considered a HR of > 70 bpm optimal and an equal number considered a HR of > 70 bpm too high, but without recommending further action. Furthermore, suboptimal HR control cannot be attributed to the use of BBs because there was neither a difference in use of BBs nor an interaction with BBs for HR > 70 bpm compared with HR < 70 bpm. Suboptimal control of HR was noted in HFrEF with sinus rhythm, which appeared to be attributable to physician decision making rather than to the use of BBs. Therefore, our results underline the need for greater attention to HR control in patients with HFrEF and sinus rhythm and thus a potential for improved HF care.

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  • 12.
    Fu, Michael
    et al.
    Univ Gothenburg, Sweden.
    Pivodic, Aldina
    Statistiska Konsultgruppen, Sweden; Univ Gothenburg, Sweden.
    Käck, Oskar
    Novartis Sweden AB, Sweden.
    Costa-Scharplatz, Madlaina
    Novartis Sweden AB, Sweden.
    Dahlström, Ulf
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Lund, Lars H.
    Karolinska Inst, Sweden.
    Real-world comparative effectiveness of ARNI versus ACEi/ARB in HF with reduced or mildly reduced ejection fraction2023In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692, Vol. 112, no 1, p. 167-174Article in journal (Refereed)
    Abstract [en]

    Aims Sacubitril/valsartan is a first-in-class angiotensin receptor-neprilysin inhibitor (ARNI) with a class-1 guideline recommendation. We assessed the real-world effectiveness of ARNI versus angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEi/ARB) on all-cause and cardiovascular (CV)-related mortality and hospitalizations in heart failure (HF) with reduced or mildly reduced ejection fraction (EF). Methods Patient-level clinical, laboratory, drug dispensation, hospitalization, and mortality data were derived from the Swedish Heart Failure Registry (SwedeHF) and interlinked databases (1 April 2016-31 December 2020). Eligible ARNI:ACEi/ARB patients (n = 7275:24,604) had a left ventricular EF &lt; 50%. Mortality and hospitalizations with ARNI (&lt;= 3 months pre-/post-1 April 2016 index [SwedeHF]; n = 1506) versus ACEi/ARB (&lt;= 3 months post-index; n = 17,108) were assessed using propensity score matching (1:1 ratio) with clinical variables, and sensitivity analysis (1:2/1:3 with, and 1:2 without clinical variables). Results ARNI induced a 23% reduction in all-cause mortality versus ACEi/ARB (1:1 hazard ratio [HR; 95% confidence interval (CI)]: 0.77 [0.63-0.95], p = 0.013), and a non-significant 23% relative risk reduction in CV-related mortality (0.77 [0.54-1.09], p = 0.13), but no difference in all-cause or CV-related hospitalization (1.02 [0.91-1.13]; p = 0.76; 1.01 [0.91-1.15]; p = 0.84, respectively). Sensitivity analyses confirmed all-cause mortality was reduced for ARNI versus ACEi/ARB (HR 0.90 [95% CI 0.82-0.99], p = 0.026), but not CV-related mortality (HR 1.04 [95% CI 0.89-1.22], p = 0.63). Conclusions In this nationwide real-world study including a population of patients with HF with reduced or mildly reduced EF, ARNI as part of guideline-led Swedish clinical practice was associated with a statistically significant relative risk reduction in all-cause mortality compared with ACEi/ARB.

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  • 13. Gomes, Daniel A
    et al.
    Santos, Rita Reis
    Freitas, Pedro
    Paiva, Mariana Sousa
    Abecasis, João
    Carvalho, Maria Salomé
    Flachskampf, Frank
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Andrade, Maria João
    Impact of common rhythm disturbances on echocardiographic measurements and interpretation2022In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692, Vol. 111, no 12, p. 1301-1312Article in journal (Refereed)
    Abstract [en]

    Transthoracic echocardiography (TTE) remains the workhorse of noninvasive cardiac imaging, allowing to easily obtain precise information on cardiac structure and function. Over time, Doppler interrogation of blood flow velocities, direction, and timing in several locations within the heart became the primary method for haemodynamic assessment, replacing cardiac catheterization in most clinical settings and providing valuable diagnostic and prognostic information on a wide spectrum of cardiac pathological processes. Abnormalities in heart rate, rhythm, and intracardiac electrical conduction are commonly encountered during the performance of echocardiographic studies. Up to now, only a modest attention has been given to the impact of these abnormalities on the reading and interpretation of echocardiographic examination and this assessment has not yet been carried out in a global and systematic way. Tachyarrhythmias, bradyarrhythmias and atrioventricular conduction disturbances influence cardiac structure and mechanics as well as Doppler flow patterns. For this reason, and to be able to avoid misinterpretation, echocardiographers must be aware of the consequences of these common rhythm disturbances on echocardiographic findings. This narrative review aims to describe the current knowledge on this topic, focusing on the expected mechanical effects and Doppler patterns observed on transthoracic echocardiography in patients with common rhythm (tachycardia and bradycardia, atrial flutter and fibrillation and ectopic beats) and conduction disturbances (namely, atrioventricular block).

  • 14.
    Lenell, Joel
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Uppsala Clinical Research Center (UCR).
    Lindahl, Bertil
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Uppsala Clinical Research Center (UCR). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Karlsson, Per
    Batra, Gorav
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Uppsala Clinical Research Center (UCR). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Erlinge, David
    Jernberg, Tomas
    Spaak, Jonas
    Baron, Tomasz
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Uppsala Clinical Research Center (UCR). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Reliability of estimating left ventricular ejection fraction in clinical routine: a validation study of the SWEDEHEART registry.2023In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692, Vol. 112, p. 68-74Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Patients hospitalized with acute coronary syndrome (ACS) in Sweden routinely undergo an echocardiographic examination with assessment of left ventricular ejection fraction (LVEF). LVEF is a measurement widely used for outcome prediction and treatment guidance. The obtained LVEF is categorized as normal (> 50%) or mildly, moderately, or severely impaired (40-49, 30-39, and < 30%, respectively) and reported to the nationwide registry for ACS (SWEDEHEART). The purpose of this study was to determine the reliability of the reported LVEF values by validating them against an independent re-evaluation of LVEF.

    METHODS: A random sample of 130 patients from three hospitals were included. LVEF re-evaluation was performed by two independent reviewers using the modified biplane Simpson method and their mean LVEF was compared to the LVEF reported to SWEDEHEART. Agreement between reported and re-evaluated LVEF was assessed using Gwet's AC2 statistics.

    RESULTS: Analysis showed good agreement between reported and re-evaluated LVEF (AC2: 0.76 [95% CI 0.69-0.84]). The LVEF re-evaluations were in agreement with the registry reported LVEF categorization in 86 (66.0%) of the cases. In 33 (25.4%) of the cases the SWEDEHEART-reported LVEF was lower than re-evaluated LVEF. The opposite relation was found in 11 (8.5%) of the cases (p < 0.005).

    CONCLUSION: Independent validation of SWEDEHEART-reported LVEF shows an overall good agreement with the re-evaluated LVEF. However, a tendency towards underestimation of LVEF was observed, with the largest discrepancy between re-evaluated LVEF and registry LVEF in subjects with subnormal LV-function in whom the reported assessment of LVEF should be interpreted more cautiously.

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  • 15.
    Marcks, Nick
    et al.
    Maastricht Univ, Med Ctr, Dept Cardiol, POB 5800, NL-6202AZ Maastricht, Netherlands..
    Aimo, Alberto
    Univ Hosp Pisa, Cardiol Div, Pisa, Italy..
    Januzzi, James L., Jr.
    Massachusetts Gen Hosp, Boston, MA 02114 USA.;Baim Inst Clin Res, Boston, MA USA..
    Vergaro, Giuseppe
    Scuola Super Sant Anna, Inst Life Sci, Pisa, Italy.;Fdn Toscana G Monasterio, Pisa, Italy..
    Clerico, Aldo
    Scuola Super Sant Anna, Inst Life Sci, Pisa, Italy.;Fdn Toscana G Monasterio, Pisa, Italy..
    Latini, Roberto
    IRCCS, Inst Pharmacol Res Mario Negri, Dept Cardiovasc Med, Milan, Italy..
    Meessen, Jennifer
    IRCCS, Inst Pharmacol Res Mario Negri, Dept Cardiovasc Med, Milan, Italy..
    Anand, Inder S.
    Univ Minnesota, Div Cardiovasc Med, Minneapolis, MN USA.;VA Med Ctr, Dept Cardiol, Minneapolis, MN USA..
    Cohn, Jay N.
    Univ Minnesota, Div Cardiovasc Med, Minneapolis, MN USA..
    Gravning, Jorgen
    Oslo Univ Hosp, Dept Cardiol, Oslo, Norway.;Univ Oslo, Ctr Heart Failure Res, Oslo, Norway..
    Ueland, Thor
    Oslo Univ Hosp, Rikshosp, Res Inst Internal Med, Oslo, Norway.;Univ Oslo, Fac Med, Oslo, Norway.;Univ Tromso, KG Jebsen Thrombosis Res & Expertise Ctr, Tromso, Norway..
    Bayes-Genis, Antoni
    Hosp Univ Germans Trias I Pujol, Badalona, Spain..
    Lupon, Josep
    Hosp Univ Germans Trias I Pujol, Badalona, Spain..
    de Boer, Rudolf A.
    Univ Med Ctr Groningen, Groningen, Netherlands..
    Yoshihisa, Akiomi
    Fukushima Med Univ, Dept Cardiovasc Med, Fukushima, Japan..
    Takeishi, Yasuchika
    Fukushima Med Univ, Dept Cardiovasc Med, Fukushima, Japan..
    Egstrup, Michael
    Bispebjerg Hosp, Dept Cardiol, Copenhagen, Denmark..
    Gustafsson, Ida
    Bispebjerg Hosp, Dept Cardiol, Copenhagen, Denmark..
    Gaggin, Hanna K.
    Massachusetts Gen Hosp, Boston, MA 02114 USA.;Baim Inst Clin Res, Boston, MA USA..
    Eggers, Kai M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Huber, Kurt
    Wilhelminenspital Stadt Wien, Fac Internal Med, Vienna, Austria.;Sigmund Freud Univ, Med Sch, Vienna, Austria..
    Tentzeris, Ioannis
    Wilhelminenspital Stadt Wien, Fac Internal Med, Vienna, Austria.;Sigmund Freud Univ, Med Sch, Vienna, Austria..
    Ripoli, Andrea
    Fdn Toscana G Monasterio, Pisa, Italy..
    Passino, Claudio
    Scuola Super Sant Anna, Inst Life Sci, Pisa, Italy.;Fdn Toscana G Monasterio, Pisa, Italy..
    Sanders-van Wijk, Sandra
    Maastricht Univ, Med Ctr, Dept Cardiol, POB 5800, NL-6202AZ Maastricht, Netherlands..
    Emdin, Michele
    Scuola Super Sant Anna, Inst Life Sci, Pisa, Italy.;Fdn Toscana G Monasterio, Pisa, Italy..
    Brunner-La Rocca, Hans-Peter
    Maastricht Univ, Med Ctr, Dept Cardiol, POB 5800, NL-6202AZ Maastricht, Netherlands..
    Re-appraisal of the obesity paradox in heart failure: a meta-analysis of individual data2021In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692, Vol. 110, no 8, p. 1280-1291Article in journal (Refereed)
    Abstract [en]

    Background Higher body mass index (BMI) is associated with better outcome compared with normal weight in patients with HF and other chronic diseases. It remains uncertain whether the apparent protective role of obesity relates to the absence of comorbidities. Therefore, we investigated the effect of BMI on outcome in younger patients without co-morbidities as compared to older patients with co-morbidities in a large heart failure (HF) population. Methods In an individual patient data analysis from pooled cohorts, 5,819 patients with chronic HF and data available on BMI, co-morbidities and outcome were analysed. Patients were divided into four groups based on BMI (i.e. <= 18.5 kg/m(2), 18.5-25.0 kg/m(2); 25.0-30.0 kg/m(2); 30.0 kg/m(2)). Primary endpoints included all-cause mortality and HF hospitalization-free survival. Results Mean age was 65 +/- 12 years, with a majority of males (78%), ischaemic HF and HF with reduced ejection fraction. Frequency of all-cause mortality or HF hospitalization was significantly worse in the lowest two BMI groups as compared to the other two groups; however, this effect was only seen in patients older than 75 years or having at least one relevant co-morbidity, and not in younger patients with HF only. After including medications and N-terminal pro-B-type natriuretic peptide and high-sensitivity cardiac troponin concentrations into the model, the prognostic impact of BMI was largely absent even in the elderly group with co-morbidity. Conclusions The present study suggests that obesity is a marker of less advanced disease, but does not have an independent protective effect in patients with chronic HF. [GRAPHICS] .

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  • 16. Navarese, Eliano Pio
    et al.
    Austin, David
    Gurbel, Paul A
    Andreotti, Felicita
    Tantry, Udaya
    James, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Buffon, Antonino
    Kozinski, Marek
    Obonska, Karolina
    Bliden, Kevin
    Jeong, Young-Hoon
    Kubica, Jacek
    Kunadian, Vijay
    Drug-coated balloons in treatment of in-stent restenosis: a meta-analysis of randomised controlled trials2013In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692, Vol. 102, no 4, p. 279-287Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Drug-coated balloons (DCBs) have been developed for the percutaneous treatment of coronary artery disease. An initial focus has been the management of in-stent restenosis (ISR) but randomised controlled trials (RCTs) have been small and powered only for angiographic endpoints.

    OBJECTIVE:

    The aim of the work was to assess the clinical and angiographic outcomes of patients treated for ISR with DCB versus control (balloon angioplasty or drug-eluting stents) by a meta-analysis of RCTs.

    METHODS:

    A comprehensive search was performed of RCTs where patients with ISR were randomly assigned to either DCB or alternative coronary intervention. Outcome measurements were death, myocardial infarction (MI), target lesion revascularisation (TLR), binary definition of restenosis and in-lesion late luminal loss (LLL).

    RESULTS:

    Four studies were identified that fulfilled the inclusion criteria. Pooled odds ratios (ORs) were calculated for patients treated for ISR (n = 399). Mean follow-up duration was 14.5 months. DCBs were associated with lower rates of TLR [8.8 vs. 29.7 % OR (95 % confidence interval, CI) 0.20 (0.11-0.36), p < 0.0001], binary restenosis [10.3 vs. 41.3 % OR (95 % CI) 0.13 (0.07-0.24), p < 0.00001] and MI [0.5 vs. 3.8 %, OR (95 % CI) 0.21 (0.04-1.00), p = 0.05]. No significant heterogeneity was identified.

    CONCLUSION:

    Drug-coated balloons appear to be effective versus control in reducing TLR and possibly MI versus balloon angioplasty or drug-eluting stents in the management of ISR.

  • 17.
    Neumann, Johannes Tobias
    et al.
    Univ Med Ctr Hamburg Eppendorf, Univ Heart & Vasc Ctr, Dept Cardiol, Martinistr 52, D-20246 Hamburg, Germany.;German Ctr Cardiovasc Res DZHK, Partner SiteHamburg Kiel Lubeck, Hamburg, Germany.;Univ Med Ctr Hamburg Eppendorf, Univ Heart & Vasc Ctr Hamburg, Populat Hlth Res Dept, Hamburg, Germany.;Monash Univ, Sch Publ Hlth & Prevent Med, Dept Epidemiol & Prevent Med, Melbourne, Australia..
    Twerenbold, Raphael
    Univ Med Ctr Hamburg Eppendorf, Univ Heart & Vasc Ctr, Dept Cardiol, Martinistr 52, D-20246 Hamburg, Germany.;German Ctr Cardiovasc Res DZHK, Partner SiteHamburg Kiel Lubeck, Hamburg, Germany.;Univ Med Ctr Hamburg Eppendorf, Univ Heart & Vasc Ctr Hamburg, Populat Hlth Res Dept, Hamburg, Germany.;Univ Med Ctr Hamburg Eppendorf, Univ Ctr Cardiovasc Sci, Univ Heart & Vasc Ctr Hamburg, Hamburg, Germany..
    Ojeda, Francisco
    Univ Med Ctr Hamburg Eppendorf, Univ Heart & Vasc Ctr, Dept Cardiol, Martinistr 52, D-20246 Hamburg, Germany.;Univ Med Ctr Hamburg Eppendorf, Univ Heart & Vasc Ctr Hamburg, Populat Hlth Res Dept, Hamburg, Germany..
    Aldous, Sally
    Christchurch Hosp, Dept Cardiol, Christchurch, New Zealand..
    Allen, Brandon
    Univ Florida, Coll Med, Dept Emergency Med, Gainesville, FL USA..
    Apple, Fred M.
    Hennepin Healthcare HCMC, Dept Lab Med & Pathol, Minneapolis, MN USA..
    Babel, Hugo
    Medizincampus Davos, CardioCARE, Davos, Switzerland..
    Christenson, Robert
    Univ Maryland, Sch Med, Dept Pathol, Baltimore, MD USA..
    Cullen, Louise
    Royal Brisbane & Womens Hosp, Dept Emergency Med, Herston, Qld, Australia..
    Di Carluccio, Eleonora
    Medizincampus Davos, CardioCARE, Davos, Switzerland..
    Doudesis, Dimitrios
    Univ Edinburgh, BHF Ctr Cardiovasc Sci, Edinburgh, Scotland..
    Ekelund, Ulf M.
    Lund Univ, Skane Univ Hosp, Dept Internal & Emergency Med, Lund, Sweden..
    Giannitsis, Evangelos
    Heidelberg Univ Hosp, Dept Cardiol, Heidelberg, Germany..
    Greenslade, Jaimi
    Royal Brisbane & Womens Hosp, Dept Emergency Med, Herston, Qld, Australia..
    Inoue, Kenji
    Juntendo Univ, Nerima Hosp, Tokyo, Japan..
    Jernberg, Tomas
    Karolinska Inst, Danderyd Univ Hosp, Dept Clin Sci, Stockholm, Sweden..
    Kavsak, Peter
    McMaster Univ, Dept Pathol & Mol Med, Hamilton, ON, Canada..
    Keller, Till
    Kerckhoff Heart & Thorax Ctr, Dept Cardiol, Bad Nauheim, Germany..
    Lee, Kuan Ken
    Univ Edinburgh, BHF Ctr Cardiovasc Sci, Edinburgh, Scotland..
    Lindahl, Bertil
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Uppsala Clinical Research Center (UCR).
    Lorenz, Thiess
    Univ Med Ctr Hamburg Eppendorf, Univ Heart & Vasc Ctr, Dept Cardiol, Martinistr 52, D-20246 Hamburg, Germany.;German Ctr Cardiovasc Res DZHK, Partner SiteHamburg Kiel Lubeck, Hamburg, Germany.;Univ Med Ctr Hamburg Eppendorf, Univ Heart & Vasc Ctr Hamburg, Populat Hlth Res Dept, Hamburg, Germany..
    Mahler, Simon
    Wake Forest Sch Med, Dept Emergency Med, Winston Salem, NC USA..
    Mills, Nicholas
    Univ Edinburgh, BHF Ctr Cardiovasc Sci, Edinburgh, Scotland..
    Mokhtari, Arash
    Lund Univ, Skane Univ Hosp, Dept Internal Med & Emergency Med, Lund, Sweden.;Lund Univ, Skane Univ Hosp, Dept Cardiol, Lund, Sweden..
    Parsonage, William
    Queensland Univ Technol, Australian Ctr Hlth Serv Innovat, Kelvin Grove, Australia..
    Pickering, John
    Dept Med, Christchurch, New Zealand.;Univ Otago, Christchurch Hosp, Emergency Dept, Christchurch, New Zealand..
    Pemberton, Christopher
    Univ Otago, Christchurch Heart Inst, Dept Med, Christchurch, New Zealand..
    Reich, Christoph
    Heidelberg Univ Hosp, Dept Cardiol, Heidelberg, Germany..
    Richards, A. Mark
    Dept Med, Christchurch, New Zealand.;Univ Otago, Christchurch Hosp, Emergency Dept, Christchurch, New Zealand..
    Sandoval, Yader
    Abbott NW Hosp, Minneapolis Heart Inst, Minneapolis, MN USA.;Minneapolis Heart Inst Fdn, Minneapolis, MN USA..
    Than, Martin A.
    Dept Med, Christchurch, New Zealand.;Univ Otago, Christchurch Hosp, Emergency Dept, Christchurch, New Zealand..
    Toprak, Betül
    Univ Med Ctr Hamburg Eppendorf, Univ Heart & Vasc Ctr, Dept Cardiol, Martinistr 52, D-20246 Hamburg, Germany.;German Ctr Cardiovasc Res DZHK, Partner SiteHamburg Kiel Lubeck, Hamburg, Germany.;Univ Med Ctr Hamburg Eppendorf, Univ Heart & Vasc Ctr Hamburg, Populat Hlth Res Dept, Hamburg, Germany.;Univ Med Ctr Hamburg Eppendorf, Univ Ctr Cardiovasc Sci, Univ Heart & Vasc Ctr Hamburg, Hamburg, Germany..
    Troughton, Richard
    Univ Otago, Christchurch Heart Inst, Dept Med, Christchurch, New Zealand..
    Worster, Andrew
    McMaster Univ, Div Emergency Med, Hamilton, ON, Canada..
    Zeller, Tanja
    Univ Med Ctr Hamburg Eppendorf, Univ Heart & Vasc Ctr, Dept Cardiol, Martinistr 52, D-20246 Hamburg, Germany.;German Ctr Cardiovasc Res DZHK, Partner SiteHamburg Kiel Lubeck, Hamburg, Germany.;Univ Med Ctr Hamburg Eppendorf, Univ Heart & Vasc Ctr Hamburg, Populat Hlth Res Dept, Hamburg, Germany.;Univ Med Ctr Hamburg Eppendorf, Univ Ctr Cardiovasc Sci, Univ Heart & Vasc Ctr Hamburg, Hamburg, Germany..
    Ziegler, Andreas
    Medizincampus Davos, CardioCARE, Davos, Switzerland.;Univ KwaZulu Natal, Sch Math Stat & Comp Sci, Pietermaritzburg, South Africa..
    Blankenberg, Stefan
    Univ Med Ctr Hamburg Eppendorf, Univ Heart & Vasc Ctr, Dept Cardiol, Martinistr 52, D-20246 Hamburg, Germany.;German Ctr Cardiovasc Res DZHK, Partner SiteHamburg Kiel Lubeck, Hamburg, Germany.;Univ Med Ctr Hamburg Eppendorf, Univ Heart & Vasc Ctr Hamburg, Populat Hlth Res Dept, Hamburg, Germany..
    Personalized diagnosis in suspected myocardial infarction2023In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692, Vol. 112, p. 1288-1301Article in journal (Refereed)
    Abstract [en]

    Background: In suspected myocardial infarction (MI), guidelines recommend using high-sensitivity cardiac troponin (hscTn)- based approaches. These require fixed assay-specific thresholds and timepoints, without directly integrating clinical information. Using machine-learning techniques including hs-cTn and clinical routine variables, we aimed to build a digital tool to directly estimate the individual probability of MI, allowing for numerous hs-cTn assays.

    Methods: In 2,575 patients presenting to the emergency department with suspected MI, two ensembles of machine-learning models using single or serial concentrations of six different hs-cTn assays were derived to estimate the individual MI probability ( ARTEMIS model). Discriminative performance of the models was assessed using area under the receiver operating characteristic curve (AUC) and logLoss. Model performance was validated in an external cohort with 1688 patients and tested for global generalizability in 13 international cohorts with 23,411 patients.

    Results: Eleven routinely available variables including age, sex, cardiovascular risk factors, electrocardiography, and hs-cTn were included in the ARTEMIS models. In the validation and generalization cohorts, excellent discriminative performance was confirmed, superior to hs-cTn only. For the serial hs-cTn measurement model, AUC ranged from 0.92 to 0.98. Good calibration was observed. Using a single hs-cTn measurement, the ARTEMIS model allowed direct rule-out of MI with very high and similar safety but up to tripled efficiency compared to the guideline- recommended strategy.

    Conclusion We developed and validated diagnostic models to accurately estimate the individual probability of MI, which allow for variable hs-cTn use and flexible timing of resampling. Their digital application may provide rapid, safe and efficient personalized patient care.

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  • 18. Sakalaki, Maria
    et al.
    Pivodic, Aldina
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Hansson, Per-Olof
    Fu, Michael
    Cumulative incidence and risk factors of myocardial infarction during 20 years of follow-up: comparing two cohorts of middle-aged men born 30 years apart.2023In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To study cumulative incidence and predictors of myocardial infarction (MI) in two random general population samples consisting of middle-aged Swedish men born 30 years apart.

    METHOD: Results from the "Study of Men Born In 1913" and the "Study of Men Born In 1943", two longitudinal cohort studies performed in the same geographic area and using the same methodology were compared. Both cohorts were followed prospectively from 50 to 70 years of age. MI was defined as first myocardial infarction, fatal or non-fatal.

    RESULTS: Men born in 1943 had a 34% lower cumulative risk of first MI [HR 0.66 (0.50-0.88), p = 0.0051] during follow-up as compared to men born in 1913. Interaction analysis showed that hypertension had a significantly higher impact on risk of MI in cohort 1943 than in cohort 1913 [HR 2.33 (95% CI 1.41-3.83)] and [HR 1.10 (0.74-1.62)], p = 0.0009 respectively. The population attributable risk for hypertension was 2.5-fold higher in the cohort of men born in 1943 as compared to men born in 1913, and diabetes mellitus and sedentary lifestyle attributed more to MI risk in cohort 1943 than in cohort 1913. On the contrary, smoking and total cholesterol have less attributable risk to MI in cohort 1943 than in cohort 1913.

    CONCLUSION: Despite declining incident MI and improved cardiovascular prevention in general, hypertension remains an increasingly important attributable risk factor to MI together with diabetes mellitus and sedentary lifestyle over time.

  • 19.
    Screever, Elles M.
    et al.
    Univ Groningen, Netherlands.
    van der Wal, Martje H. L.
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Univ Groningen, Netherlands.
    van Veldhuisen, Dirk J.
    Univ Groningen, Netherlands.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Koops, Astrid
    Univ Groningen, Netherlands.
    van Dijk, Kuna S.
    Univ Groningen, Netherlands.
    Warink-Riemersma, Janke
    Univ Groningen, Netherlands.
    Coster, Jenifer E.
    Univ Groningen, Netherlands.
    Westenbrink, B. Daan
    Univ Groningen, Netherlands.
    van der Meer, Peter
    Univ Groningen, Netherlands.
    de Boer, Rudolf A.
    Univ Groningen, Netherlands.
    Meijers, Wouter C.
    Univ Groningen, Netherlands.
    Comorbidities complicating heart failure: changes over the last 15 years2023In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692, Vol. 112, no 1, p. 123-133Article in journal (Refereed)
    Abstract [en]

    Aims Management of comorbidities represents a critical step in optimal treatment of heart failure (HF) patients. However, minimal attention has been paid whether comorbidity burden and their prognostic value changes over time. Therefore, we examined the association between comorbidities and clinical outcomes in HF patients between 2002 and 2017. Methods and results The 2002-HF cohort consisted of patients from The Coordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure (COACH) trial (n = 1,032). The 2017-HF cohort were outpatient HF patients enrolled after hospitalization for HF in a tertiary referral academic hospital (n = 382). Kaplan meier and cox regression analyses were used to assess the association of comorbidities with HF hospitalization and all-cause mortality. Patients from the 2017-cohort were more likely to be classified as HF with preserved ejection fraction (24 vs 15%, p &lt; 0.001), compared to patients from the 2002-cohort. Comorbidity burden was comparable between both cohorts (mean of 3.9 comorbidities per patient) and substantially increased with age. Higher comorbidity burden was significantly associated with a comparable increased risk for HF hospitalization and all-cause mortality (HR 1.12 [1.02-1.22] and HR 1.18 [1.05-1.32]), in the 2002- and 2017-cohort respectively. When assessing individual comorbidities, obesity yielded a statistically higher prognostic effect on outcome in the 2017-cohort compared to the 2002-HF cohort (p for interaction 0.026). Conclusion Despite major advances in HF treatment over the past decades, comorbidity burden remains high in HF and influences outcome to a large extent. Obesity emerges as a prominent comorbidity, and efforts should be made for prevention and treatment. [GRAPHICS] .

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  • 20.
    Thorén, Emma
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
    Wernroth, Lisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Uppsala Clinical Research Center (UCR). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    Christersson, Christina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Grinnemo, Karl-Henrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
    Jideus, L
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
    Ståhle, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
    Compared with matched controls, patients with postoperative atrial fibrillation (POAF) have increased long-term AF after CABG, and POAF is further associated with increased ischemic stroke, heart failure and mortality even after adjustment for AF.2020In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692, Vol. 109, no 10, p. 1232-1242Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To analyze (1) associations between postoperative atrial fibrillation (POAF) after CABG and long-term cardiovascular outcome, (2) whether associations were influenced by AF during follow-up, and (3) if morbidities associated with POAF contribute to mortality.

    METHODS: An observational cohort study of 7145 in-hospital survivors after isolated CABG (1996-2012), with preoperative sinus rhythm and without AF history. Incidence of AF was compared with matched controls. Time-updated covariates were used to adjust for POAF-related morbidities during follow-up, including AF.

    RESULTS: Thirty-one percent of patients developed POAF. Median follow-up was 9.8 years. POAF patients had increased AF compared with matched controls (HR 3.03; 95% CI 2.66-3.49), while AF occurrence in non-POAF patients was similar to controls (1.00; 0.89-1.13). The observed AF increase among POAF patients compared with controls persisted over time (> 10 years 2.73; 2.13-3.51). Conversely, the non-POAF cohort showed no AF increase beyond the first postoperative year. Further, POAF was associated with long-term AF (adjusted HR 3.20; 95% CI 2.73-3.76), ischemic stroke (1.23; 1.06-1.42), heart failure (1.44; 1.27-1.63), overall mortality (1.21; 1.11-1.32), cardiac mortality (1.35; 1.18-1.54), and cerebrovascular mortality (1.54; 1.17-2.02). These associations remained after adjustment for AF during follow-up. Adjustment for other POAF-associated morbidities weakened the association between POAF and overall mortality, which became non-significant.

    CONCLUSIONS: Patients with POAF after CABG had three times the incidence of long-term AF compared with both non-POAF patients and matched controls. POAF was associated with long-term ischemic stroke, heart failure, and corresponding mortality even after adjustment for AF during follow-up. The increased overall mortality was partly explained by morbidities associated with POAF.

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  • 21.
    Tossavainen, E.
    et al.
    Umea Univ, Dept Publ Hlth & Clin Med, Cardiol, S-90185 Umea, Sweden.
    Wikström, Gerhard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Henein, M. Y.
    Umea Univ, Dept Publ Hlth & Clin Med, Cardiol, S-90185 Umea, Sweden.
    Lundqvist, M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Wiklund, U.
    Umea Univ, Dept Radiat Sci, Biomed Engn, Umea, Sweden.
    Lindqvist, P.
    Umea Univ, Dept Surg & Perioperat Sci, Clin Physiol, Umea, Sweden.
    Passive leg-lifting in heart failure patients predicts exercise-induced rise in left ventricular filling pressures2020In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692, Vol. 109, no 4, p. 498-507Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to assess PCWP with passive leg-lifting (PLL) and exercise, in two groups of patients presenting with normal left ventricular ejection fraction (LVEF); one group with elevated NT-proBNP (eBNP), and one with normal NT-proBNP (nBNP) plasma concentration.

    Methods and results: Fifty-one patients with eBNP (NT-proBNP >= 125 ng/l) and LVEF > 50%, were investigated and compared with 34 patients with nBNP (NT-proBNP < 125 ng/l) and LVEF > 50%. Both groups underwent right heart catheterization (RHC) at rest, PLL and exercise. From RHC, mean pulmonary arterial pressure (mPAP), cardiac output (CO), and PCWP were measured. All nBNP patients had PCWP < 15 mmHg at rest, and a PCWP of < 25 mmHg with PLL and during exercise. Patients with eBNP had higher (p < 0.01) resting mPAP, PCWP, and mPAP/CO. These values increased with exercise; however, CO increased less in comparison with nBNP patients (p = 0.001). 20% of patients with eBNP had a PCWP > 15 mmHg at rest, this percentage increased to 47% with PLL and 41% had a PCWP > 25 mmHg during exercise. Of those with PCWP > 25 mmHg during exercise, 91% had a PCWP > 15 mmHg with PLL. A PCWP > 15 mmHg on PLL had a 91% sensitivity and 92% specificity in predicting exercise-induced PCWP of > 25 mmHg.

    Conclusion: In patients presenting with eBNP, PLL can predict which patients will develop elevated PCWP with exercise. These findings highlight the role of stress assessment.

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  • 22.
    Tossavainen, Erik
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Wikström, G.
    Henein, Michael Y.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Lundqvist, M.
    Wiklund, Urban
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Lindqvist, Per
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Passive leg-lifting in heart failure patients predicts exercise-induced rise in left ventricular filling pressures2020In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692, Vol. 109, no 4, p. 498-507Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to assess PCWP with passive leg-lifting (PLL) and exercise, in two groups of patients presenting with normal left ventricular ejection fraction (LVEF); one group with elevated NT-proBNP (eBNP), and one with normal NT-proBNP (nBNP) plasma concentration.

    Methods and results: Fifty-one patients with eBNP (NT-proBNP ≥ 125 ng/l) and LVEF > 50%, were investigated and compared with 34 patients with nBNP (NT-proBNP < 125 ng/l) and LVEF > 50%. Both groups underwent right heart catheterization (RHC) at rest, PLL and exercise. From RHC, mean pulmonary arterial pressure (mPAP), cardiac output (CO), and PCWP were measured. All nBNP patients had PCWP < 15 mmHg at rest, and a PCWP of < 25 mmHg with PLL and during exercise. Patients with eBNP had higher (p < 0.01) resting mPAP, PCWP, and mPAP/CO. These values increased with exercise; however, CO increased less in comparison with nBNP patients (p = 0.001). 20% of patients with eBNP had a PCWP > 15 mmHg at rest, this percentage increased to 47% with PLL and 41% had a PCWP > 25 mmHg during exercise. Of those with PCWP > 25 mmHg during exercise, 91% had a PCWP > 15 mmHg with PLL. A PCWP > 15 mmHg on PLL had a 91% sensitivity and 92% specificity in predicting exercise-induced PCWP of > 25 mmHg.

    Conclusion: In patients presenting with eBNP, PLL can predict which patients will develop elevated PCWP with exercise. These findings highlight the role of stress assessment.

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  • 23.
    Tse, Yi-Kei
    et al.
    Univ Hong Kong, Shenzhen Hosp, Dept Med, Div Cardiol, Shenzhen, Peoples R China.;Univ Hong Kong, Queen Mary Hosp, Dept Med, Div Cardiol, Hong Kong, Peoples R China..
    Li, Hang-Long
    Univ Hong Kong, Shenzhen Hosp, Dept Med, Div Cardiol, Shenzhen, Peoples R China.;Univ Hong Kong, Queen Mary Hosp, Dept Med, Div Cardiol, Hong Kong, Peoples R China..
    Ren, Qing-Wen
    Univ Hong Kong, Shenzhen Hosp, Dept Med, Div Cardiol, Shenzhen, Peoples R China.;Univ Hong Kong, Queen Mary Hosp, Dept Med, Div Cardiol, Hong Kong, Peoples R China..
    Huang, Jia-Yi
    Univ Hong Kong, Shenzhen Hosp, Dept Med, Div Cardiol, Shenzhen, Peoples R China.;Univ Hong Kong, Queen Mary Hosp, Dept Med, Div Cardiol, Hong Kong, Peoples R China..
    Wu, Mei-Zhen
    Univ Hong Kong, Shenzhen Hosp, Dept Med, Div Cardiol, Shenzhen, Peoples R China.;Univ Hong Kong, Queen Mary Hosp, Dept Med, Div Cardiol, Hong Kong, Peoples R China..
    Leung, Calvin Ka-Lam
    Univ Hong Kong, Shenzhen Hosp, Dept Med, Div Cardiol, Shenzhen, Peoples R China.;Univ Hong Kong, Queen Mary Hosp, Dept Med, Div Cardiol, Hong Kong, Peoples R China..
    Yu, Si-Yeung
    Univ Hong Kong, Shenzhen Hosp, Dept Med, Div Cardiol, Shenzhen, Peoples R China.;Univ Hong Kong, Queen Mary Hosp, Dept Med, Div Cardiol, Hong Kong, Peoples R China..
    Hung, Denise
    Univ Hong Kong, Shenzhen Hosp, Dept Med, Div Cardiol, Shenzhen, Peoples R China.;Univ Hong Kong, Queen Mary Hosp, Dept Med, Div Cardiol, Hong Kong, Peoples R China..
    Tse, Hung-Fat
    Univ Hong Kong, Shenzhen Hosp, Dept Med, Div Cardiol, Shenzhen, Peoples R China.;Univ Hong Kong, Queen Mary Hosp, Dept Med, Div Cardiol, Hong Kong, Peoples R China..
    Flachskampf, Frank
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala Univ Hosp, Uppsala, Sweden..
    Yiu, Kai-Hang
    Univ Hong Kong, Shenzhen Hosp, Dept Med, Div Cardiol, Shenzhen, Peoples R China.;Univ Hong Kong, Queen Mary Hosp, Dept Med, Div Cardiol, Hong Kong, Peoples R China..
    Morphological and functional types of tricuspid regurgitation: prognostic value in patients undergoing tricuspid annuloplasty during left-sided valvular surgery2023In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692, Vol. 112, no 10, p. 1463-1474Article in journal (Refereed)
    Abstract [en]

    Background The nonuniform benefit of tricuspid annuloplasty may be explained by the proportionality of tricuspid regurgitation (TR) severity to right ventricular (RV) area. The purpose of this study was to delineate distinct morphological phenotypes of functional TR and investigate their prognostic implications in patients undergoing tricuspid annuloplasty during left-sided valvular surgery. Methods The ratios of pre-procedural effective regurgitant orifice area (EROA) with right ventricular end-diastolic area ( RVDA) were retrospectively assessed in 290 patients undergoing tricuspid annuloplasty. Based on optimal thresholds derived from penalized splines and maximally selected rank statistics, patients were stratified into proportionate (EROA/RVDA ratio <= 1.74) and disproportionate TR (EROA/RVDA ratio > 1.74). Results Overall, 59 (20%) and 231 (80%) patients had proportionate and disproportionate TR, respectively. Compared to those with proportionate TR, patients with disproportionate TR were older, had a higher prevalence of atrial fibrillation, lower pulmonary pressures, more impaired RV function, and larger tricuspid leaflet tenting area. Over a median follow-up of 4.1 years, 79 adverse events (47 heart failure hospitalizations and 32 deaths) occurred. Patients with disproportionate TR had higher rates of adverse events than those with proportionate TR (32% vs 10%; P = 0.001) and were independently associated with poor outcomes on multivariate analysis. TR proportionality outperformed guideline-based classification of TR severity in outcome prediction and provided incremental prognostic value to both the EuroSCORE II and STS score (incremental chi(2) = 6.757 and 9.094 respectively; both P < 0.05). Conclusions Disproportionate TR is strongly associated with adverse prognosis and may aid patient selection and risk stratification for tricuspid annuloplasty with left-sided valvular surgery.

  • 24.
    Varenhorst, Christoph
    et al.
    Uppsala University, Sweden.
    Lindholm, Martin
    Västerås County Hospital, Sweden.
    Sarno, Giovanna
    Uppsala University, Sweden.
    Olivecrona, Goran
    Lund University, Sweden.
    Jensens, Ulf
    Karolinska Institutet, Sweden.
    Nilsson, Johan
    Umeå University, Sweden.
    Carlsson, Jörg
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    James, Stefan
    Uppsala University, Sweden.
    Lagergvist, Bo
    Uppsala University, Sweden.
    Stent thrombosis rates the first year and beyond with new- and old-generation drug-eluting stents compared to bare metal stents2018In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692, Vol. 107, no 9, p. 816-823Article in journal (Refereed)
    Abstract [en]

    Old-generation drug-eluting coronary stents (o-DES) have despite being safe and effective been associated with an increased propensity of late stent thrombosis (ST). We evaluated ST rates in o-DES, new-generation DES (n-DES) and bare metal stents (BMS) the first year (< 1 year) and beyond 1 year (> 1 year). We evaluated all implantations with BMS, o-DES (Cordis Cypher, Boston Scientific Taxus Libert, and Medtronic Endeavor) and n-DES in the Swedish coronary angiography and angioplasty registry (SCAAR) between 1 January 2007 and 8 January 2014 (n = 207 291). All cases of ST (n = 2 268) until 31 December 2014 were analyzed. The overall risk of ST was lower in both n-DES and o-DES compared with BMS up to 1 year (n-DES versus BMS: adjusted risk ratio (RR) 0.48 (0.41-0.58) and o-DES versus BMS: 0.56 (0.46-0.67), both p < 0.001). From 1 year after stent implantation and onward, the risk for ST was higher in o-DES compared with BMS [adjusted RR, 1.82 (1.47-2.25], p < 0.001). N-DES were associated with similar low ST rates as BMS from 1 year and onward [adjusted RR 1.21 (0.94-1.56), p = 0.135]. New-generation DES were associated with lower ST rates in comparison to BMS during the first-year post-stenting. After 1 year, n-DES and BMS were associated with similar ST rates. This study was a retrospective observational study and as such did not require clinical trial database registration.

  • 25.
    Varenhorst, Christoph
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Lindholm, Martin
    Vasteras Cty Hosp, Dept Internal Med, Cardiol, Vasteras, Sweden.
    Sarno, Giovanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Olivecrona, Göran
    Lund Univ, Dept Cardiol, Lund, Sweden.
    Jensens, Ulf
    Karolinska Inst, Dept Clin Sci & Educ, Sodersjukhuset, Stockholm, Sweden.
    Nilsson, Johan
    Umea Univ, Heart Ctr, Dept Cardiol, Umea, Sweden.
    Carlsson, Jorg
    Linnaeus Univ, Fac Hlth & Life Sci, Kalmar, Sweden.
    James, Stefan K
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Lagerqvist, Bo
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Stent thrombosis rates the first year and beyond with new- and old-generation drug-eluting stents compared to bare metal stents2018In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692, Vol. 107, no 9, p. 816-823Article in journal (Refereed)
    Abstract [en]

    Old-generation drug-eluting coronary stents (o-DES) have despite being safe and effective been associated with an increased propensity of late stent thrombosis (ST). We evaluated ST rates in o-DES, new-generation DES (n-DES) and bare metal stents (BMS) the first year (< 1 year) and beyond 1 year (> 1 year). We evaluated all implantations with BMS, o-DES (Cordis Cypher, Boston Scientific Taxus Libert, and Medtronic Endeavor) and n-DES in the Swedish coronary angiography and angioplasty registry (SCAAR) between 1 January 2007 and 8 January 2014 (n = 207 291). All cases of ST (n = 2 268) until 31 December 2014 were analyzed. The overall risk of ST was lower in both n-DES and o-DES compared with BMS up to 1 year (n-DES versus BMS: adjusted risk ratio (RR) 0.48 (0.41-0.58) and o-DES versus BMS: 0.56 (0.46-0.67), both p < 0.001). From 1 year after stent implantation and onward, the risk for ST was higher in o-DES compared with BMS [adjusted RR, 1.82 (1.47-2.25], p < 0.001). N-DES were associated with similar low ST rates as BMS from 1 year and onward [adjusted RR 1.21 (0.94-1.56), p = 0.135]. New-generation DES were associated with lower ST rates in comparison to BMS during the first-year post-stenting. After 1 year, n-DES and BMS were associated with similar ST rates. This study was a retrospective observational study and as such did not require clinical trial database registration.

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  • 26. Varenhorst, Christoph
    et al.
    Lindholm, Martin
    Sarno, Giovanna
    Olivecrona, Göran
    Jensens, Ulf
    Nilsson, Johan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Carlsson, Jörg
    James, Stefan
    Lagergvist, Bo
    Stent thrombosis rates the first year and beyond with new- and old-generation drug-eluting stents compared to bare metal stents2018In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692, Vol. 107, no 9, p. 816-823Article in journal (Refereed)
    Abstract [en]

    Objectives: Old-generation drug-eluting coronary stents (o-DES) have despite being safe and effective been associated with an increased propensity of late stent thrombosis (ST). We evaluated ST rates in o-DES, new-generation DES (n-DES) and bare metal stents (BMS) the first year (< 1 year) and beyond 1 year (> 1 year).

    Methods: We evaluated all implantations with BMS, o-DES (Cordis Cypher, Boston Scientific Taxus Libert, and Medtronic Endeavor) and n-DES in the Swedish coronary angiography and angioplasty registry (SCAAR) between 1 January 2007 and 8 January 2014 (n = 207 291). All cases of ST (n = 2 268) until 31 December 2014 were analyzed.

    Results: The overall risk of ST was lower in both n-DES and o-DES compared with BMS up to 1 year (n-DES versus BMS: adjusted risk ratio (RR) 0.48 (0.41-0.58) and o-DES versus BMS: 0.56 (0.46-0.67), both p < 0.001). From 1 year after stent implantation and onward, the risk for ST was higher in o-DES compared with BMS [adjusted RR, 1.82 (1.47-2.25], p < 0.001). N-DES were associated with similar low ST rates as BMS from 1 year and onward [adjusted RR 1.21 (0.94-1.56), p = 0.135].

    Conclusion: New-generation DES were associated with lower ST rates in comparison to BMS during the first-year post-stenting. After 1 year, n-DES and BMS were associated with similar ST rates.

    Trial Registration: This study was a retrospective observational study and as such did not require clinical trial database registration.

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  • 27. Vargas, Kris G
    et al.
    Haller, Paul M
    Jäger, Bernhard
    Tscharre, Maximilian
    Binder, Ronald K
    Mueller, Christian
    Lindahl, Bertil
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Huber, Kurt
    Variations on classification of main types of myocardial infarction: a systematic review and outcome meta-analysis2019In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692, Vol. 108, no 7, p. 749-762Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Classifying myocardial infarction into type 1 (T1MI) or type 2 (T2MI) remains a challenge in clinical practice. We aimed to identify factors contributing to variation in the classifications of MI into type 1 or type 2. In addition, pooled analyses of long-term mortality and reinfarction outcomes were performed.

    METHODS: We searched Medline, Embase and Web of Science through January 2018 for observational studies or clinical trials classifying patients as either T1MI or T2MI. Studies with baseline characteristics allowing a comparison between both groups were included. Inverse variance random-effects models were used to pool risk ratios (RR).

    RESULTS: Overall, 93,194 patients from 20 included observational studies were classified as T1MI and 9291 as T2MI; corresponding to 87.9% and 8.8% of all patients diagnosed with MI. Inclusion of ST-elevation MI patients was inconsistent among studies. Coronary angiography was performed in 77.7% and 31.5% of all patients with T1MI and T2MI, respectively. From a subgroup of 11 studies, percutaneous coronary intervention was performed in 79.2% of all patients classified as T1MI (range 44.2-93.0%) and 40.2% of all T2MI patients (range 0-87.5%). A meta-analysis of 6 studies (44,366 in total) on 2-year mortality showed worse outcome among T2MI patients (RR: 1.52, CI 1.07-2.17, P = 0.02; I2 = 92%). Risk of reinfarction at 1.6 years was higher among T2MI patients (RR: 1.68, CI 1.22-2.31, P = 0.001; I2 = 9%).

    CONCLUSIONS: Classification of T1MI and T2MI varies widely among studies. A standardized approach with clear definitions is needed to avoid misclassification and ensure appropriate patient management.

  • 28.
    Vegter, Eline L.
    et al.
    University of Medical Centre Groningen, Netherlands.
    Ovchinnikova, Ekaterina S.
    University of Medical Centre Groningen, Netherlands; University of Groningen, Netherlands.
    van Veldhuisen, Dirk J.
    University of Medical Centre Groningen, Netherlands.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Berezikov, Eugene
    University of Groningen, Netherlands.
    van der Meer, Peter
    University of Medical Centre Groningen, Netherlands.
    Voors, Adriaan A.
    University of Medical Centre Groningen, Netherlands.
    Low circulating microRNA levels in heart failure patients are associated with atherosclerotic disease and cardiovascular-related rehospitalizations2017In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692, Vol. 106, no 8, p. 598-609Article in journal (Refereed)
    Abstract [en]

    Objective Circulating microRNAs (miRNAs) have been implicated in both heart failure and atherosclerotic disease. The aim of this study was to examine associations between heart failure specific circulating miRNAs, atherosclerotic disease and cardiovascular-related outcome in patients with heart failure. Methods The levels of 11 heart failure-specific circulating miRNAs were compared in plasma of 114 heart failure patients with and without different manifestations of atherosclerotic disease. We then studied these miRNAs in relation to biomarkers associated to atherosclerosis and to cardiovascular-related rehospitalizations during 18 months of follow-up. Results At least one manifestation of atherosclerotic disease was found in 70 (61%) of the heart failure patients. A consistent trend was found between an increasing number of manifestations of atherosclerosis (peripheral arterial disease in specific), and lower levels of miR-18a-5p, miR27a-3p, miR-199a-3p, miR-223-3p and miR-652-3p (all P amp;lt; 0.05). Target prediction and network analyses identified several interactions between miRNA targets and biomarkers related to inflammation, angiogenesis and endothelial dysfunction. Lower miRNA levels were associated with higher levels of these atherosclerosis-related biomarkers. In addition, lower miRNA levels were significantly associated with rehospitalizations due to cardiovascular causes within 18 months, with let-7i-5p as strongest predictor [HR 2.06 (95% CI 1.29-3.28), C-index 0.70, P = 0.002]. Conclusions A consistent pattern of lower levels of circulating miRNAs was found in heart failure patients with atherosclerotic disease, in particular peripheral arterial disease. In addition, lower levels of miRNAs were associated with higher levels of biomarkers involved in atherosclerosis and an increased risk of a cardiovascular-related rehospitalization.

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  • 29.
    Wang, Rutao
    et al.
    Xijing Hosp, Dept Cardiol, Xian, Peoples R China.;Natl Univ Ireland, Galway NUIG, Dept Cardiol, PO Univ Rd, Galway H91 TK33, Ireland.;Radboud Univ Nijmegen, Med Ctr, Dept Cardiol, Nijmegen, Netherlands..
    Tomaniak, Mariusz
    Med Univ Warsaw, Dept Cardiol 1, Warsaw, Poland.;Erasmus MC, Dept Cardiol, Rotterdam, Netherlands..
    Takahashi, Kuniaki
    Univ Amsterdam, Locat Acad Med Ctr, Med Ctr, Dept Cardiol, Amsterdam, Netherlands..
    Gao, Chao
    Xijing Hosp, Dept Cardiol, Xian, Peoples R China.;Natl Univ Ireland, Galway NUIG, Dept Cardiol, PO Univ Rd, Galway H91 TK33, Ireland.;Radboud Univ Nijmegen, Med Ctr, Dept Cardiol, Nijmegen, Netherlands..
    Kawashima, Hideyuki
    Natl Univ Ireland, Galway NUIG, Dept Cardiol, PO Univ Rd, Galway H91 TK33, Ireland.;Univ Amsterdam, Locat Acad Med Ctr, Med Ctr, Dept Cardiol, Amsterdam, Netherlands..
    Hara, Hironori
    Natl Univ Ireland, Galway NUIG, Dept Cardiol, PO Univ Rd, Galway H91 TK33, Ireland.;Univ Amsterdam, Locat Acad Med Ctr, Med Ctr, Dept Cardiol, Amsterdam, Netherlands..
    Ono, Masafumi
    Natl Univ Ireland, Galway NUIG, Dept Cardiol, PO Univ Rd, Galway H91 TK33, Ireland.;Univ Amsterdam, Locat Acad Med Ctr, Med Ctr, Dept Cardiol, Amsterdam, Netherlands..
    van Klaveren, David
    Erasmus MC, Dept Publ Hlth, Rotterdam, Netherlands.;Tufts Med Ctr, Inst Clin Res & Hlth Policy Studies, Predict Analyt & Comparat Effectiveness Ctr, Boston, MA 02111 USA..
    van Geuns, Robert-Jan
    Radboud Univ Nijmegen, Med Ctr, Dept Cardiol, Nijmegen, Netherlands..
    Morice, Marie-Claude
    ICPS Ramsay Gen Sante, Massy, France..
    Davierwala, Piroze M.
    Heart Ctr Leipzig, Dept Cardiac Surg, Leipzig, Germany..
    Mack, Michael J.
    Baylor Scott & White Hlth, Plano, TX USA..
    Witkowski, Adam
    Natl Inst Cardiol, Dept Intervent Cardiol & Angiol, Warsaw, Poland..
    Curzen, Nick
    Univ Hosp Southampton, Cardiol Dept, Southampton, Hants, England..
    Berti, Sergio
    Fdn CNR Reg Toscana G Monasterio, Heart Hosp, Cardiol Dept, Massa, Italy..
    Burzotta, Francesco
    Univ Cattolica Sacro Cuore, IRCCS, Fdn Policlin Univ Agostino Gemelli, Inst Cardiol, Rome, Italy..
    James, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Uppsala Clinical Research Center (UCR).
    Kappetein, Arie Pieter
    Erasmus MC, Dept Cardiothorac Surg, Rotterdam, Netherlands..
    Head, Stuart J.
    Erasmus MC, Dept Cardiothorac Surg, Rotterdam, Netherlands..
    Thuijs, Daniel J. F. M.
    Erasmus MC, Dept Cardiothorac Surg, Rotterdam, Netherlands..
    Mohr, Friedrich W.
    Heart Ctr Leipzig, Dept Cardiac Surg, Leipzig, Germany..
    Holmes, David R.
    Mayo Clin, Rochester, MN USA..
    Tao, Ling
    Xijing Hosp, Dept Cardiol, Xian, Peoples R China..
    Onuma, Yoshinobu
    Natl Univ Ireland, Galway NUIG, Dept Cardiol, PO Univ Rd, Galway H91 TK33, Ireland..
    Serruys, Patrick W.
    Natl Univ Ireland, Galway NUIG, Dept Cardiol, PO Univ Rd, Galway H91 TK33, Ireland.;Imperial Coll London, NHLI, London, England.;Erasmus MC, Rotterdam, Netherlands..
    Impact of chronic obstructive pulmonary disease on 10-year mortality after percutaneous coronary intervention and bypass surgery for complex coronary artery disease: insights from the SYNTAX Extended Survival study2021In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692, Vol. 110, no 7, p. 1083-1095Article in journal (Refereed)
    Abstract [en]

    Aims

    To evaluate the impact of chronic obstructive pulmonary disease (COPD) on 10-year all-cause death and the treatment effect of CABG versus PCI on 10-year all-cause death in patients with three-vessel disease (3VD) and/or left main coronary artery disease (LMCAD) and COPD.

    Methods

    Patients were stratified according to COPD status and compared with regard to clinical outcomes. Ten-year all-cause death was examined according to the presence of COPD and the revascularization strategy.

    Results

    COPD status was available for all randomized 1800 patients, of whom, 154 had COPD (8.6%) at the time of randomization. Regardless of the revascularization strategy, patients with COPD had a higher risk of 10-year all-cause death, compared with those without COPD (43.1% vs. 24.9%; hazard ratio [HR]: 2.03; 95% confidence interval [CI]: 1.56–2.64; p < 0.001). Among patients with COPD, CABG appeared to have a slightly lower risk of 10-year all-cause death compared with PCI (42.3% vs. 43.9%; HR: 0.96; 95% CI: 0.59–1.56, p = 0.858), whereas among those without COPD, CABG had a significantly lower risk of 10-year all-cause death (22.7% vs. 27.1%; HR: 0.81; 95% CI: 0.67–0.99, p = 0.041). There was no significant differential treatment effect of CABG versus PCI on 10-year all-cause death between patients with and without COPD (p interaction = 0.544).

    Conclusions

    COPD was associated with a higher risk of 10-year all-cause death after revascularization for complex coronary artery disease. The presence of COPD did not significantly modify the beneficial effect of CABG versus PCI on 10-year all-cause death.

    Trial registration: SYNTAX: ClinicalTrials.gov reference: NCT00114972. SYNTAX Extended Survival: ClinicalTrials.gov reference: NCT03417050

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    FULLTEXT01
  • 30. Zimmermann, Stefan
    et al.
    Ruthrof, Susanne
    Nowak, Kathrin
    Alff, Anna
    Klinghammer, Lutz
    Schneider, Reinhard
    Ludwig, Josef
    Pfahlberg, Annette B
    Daniel, Werner G
    Flachskampf, Frank A
    Medizinische Klinik 2 (Kardiologie/Angiologie), Universitätsklinikum Erlangen, Erlangen, Germany .
    Short-term prognosis of contemporary interventional therapy of ST-elevation myocardial infarction: does gender matter?2009In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692, Vol. 98, no 11, p. 709-715Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    A higher mortality risk for women with acute ST-elevation myocardial infarction (STEMI) has been a common finding in the past, even after acute percutaneous coronary intervention (PCI). We set out to analyze whether there are gender differences in real-world contemporary treatment and outcomes of STEMI.

    PATIENTS AND METHODS:

    A retrospective analysis of all consecutive patients with STEMI and acute coronary angiography with the intention of performing a PCI at our center 6/1999-6/2006 was carried out (n = 566). Data were examined for gender-specific differences regarding patients' characteristics, referral patterns, timing of acute symptoms, angiographic findings, procedural details, and adverse events at 30 days after PCI.

    RESULTS:

    Women (n = 161) were on average 8 years older than men (n = 405), had higher co-morbidity, were more often transported to the hospital by ambulance and presented less often to the emergency room on their own (4.2% vs. 12.6% in men, P = 0.02). The pre-hospital delay from symptom onset to admission was significantly longer for women (median 185 vs. 135 min, P < 0.02). There was no gender difference in time from admission to PCI (median 46 min vs. 48 min, P = 0.42). Both genders received PCI with similar frequency (88.8% vs. 92.4%, P = 0.19), with similar success rates (83.2% vs. 85.3%, P = 0.68). Thirty-day overall mortality for women was not significantly higher than for men (8.7% vs. 7.2%, P = 0.6). Re-infarction or stroke within 30 days were rare for both genders without gender-specific differences whereas bleeding necessitating blood replacement was significantly more frequent in women (16.8% vs. 5.9%, P < 0.001). In multivariate analysis, female gender was not independently associated with a higher risk of 30-day mortality (OR 0.964, P = 0.93).

    CONCLUSIONS:

    Women underwent PCI therapy for STEMI with the same frequency and the same angiographic success as men. Despite their more advanced age and the higher prevalence of co-morbidities, they did not have a significantly higher 30-day mortality rate than men. Female gender was not an independent risk factor of 30-day mortality. Longer pre-hospital delays before hospital admission in women indicate that awareness of risk from coronary artery disease should be further raised in women.

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