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  • 301.
    Rawshani, Nina
    et al.
    Varberg Hospital, Varberg, Halland County, Sweden.
    Rawshani, Araz
    University of Gothenburg, Department of Medicine, Göteborg, Sweden.
    Gelang, Carita
    University College of Borås, The Pre-hospital Research Centre of Western Sweden, Prehospen, Borås, Sweden.
    Herlitz, Johan
    University of Gothenburg, Department of Medicine, Göteborg, Sweden.
    Bång, Angela
    University of Borås, School of Health Science, Borås, Sweden.
    Andersson, Jan-Otto
    Ambulance Service, Skaraborg, Sweden.
    Gellerstedt, Martin
    Högskolan Väst, Institutionen för ekonomi och it, Avd för juridik, ekonomi, statistik och politik.
    Could ten questions asked by the dispatch center predict the outcome for patients with chest discomfort?2016Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 209, nr April, s. 223-225Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND AND AIMS: From 2009 to 2010, approximately 14,000 consecutive persons who called for the EMS due to chest discomfort were registered. From the seventh month, dispatchers ask 2285 patient ten pre-specified questions. We evaluate which of these questions was independently able to predict an acute coronary syndrome (ACS), life-threatening condition (LTC) and death.

    METHODS: The questions asked mainly dealt with previous history and type of symptoms, each with yes/no answers. The dispatcher took a decision on priority; 1) immediately with sirens/blue light; 2) EMS on the scene within 30min; 3) normal waiting time.We examined the relationship between the answers to these questions and subsequent dispatch priority, as well as outcome, in terms of ACS, LTC and all-cause mortality.

    RESULTS: 2285 patients (mean age 67years, 49% women) took part, of which 12% had a final diagnosis of ACS and 15% had a LTC. There was a significant relationship between all the ten questions and the priority given by dispatchers. Localisation of the discomfort to the center of the chest, more intensive pain, history of angina or myocardial infarction as well as experience of cold sweat were the most important predictors when evaluating the probability of ACS and LTC. Not breathing normally and having diabetes were related to 30-day mortality.

    CONCLUSIONS: Among individuals, who call for the EMS due to chest discomfort, the intensity and the localisation of the pain, as well as a history of ischemic heart disease, appeared to be the most strongly associated with outcome.

  • 302. Renard, Marjolijn
    et al.
    Callewaert, Bert
    Baetens, Machteld
    Campens, Laurence
    MacDermot, Kay
    Fryns, Jean-Pierre
    Bonduelle, Maryse
    Dietz, Harry C.
    Gaspar, Isabel Mendes
    Cavaco, Diogo
    Stattin, Eva-Lena
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Medicinsk och klinisk genetik.
    Schrander-Stumpel, Constance
    Coucke, Paul
    Loeys, Bart
    De Paepe, Anne
    De Backer, Julie
    Novel MYH11 and ACTA2 mutations reveal a role for enhanced TGF beta signaling in FTAAD2013Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 165, nr 2, s. 314-321Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Thoracic aortic aneurysm/dissection (TAAD) is a common phenotype that may occur as an isolated manifestation or within the constellation of a defined syndrome. In contrast to syndromic TAAD, the elucidation of the genetic basis of isolated TAAD has only recently started. To date, defects have been found in genes encoding extracellular matrix proteins (fibrillin-1, FBN1; collagen type III alpha 1, COL3A1), proteins involved in transforming growth factor beta (TGF beta) signaling (TGF beta receptor 1 and 2, TGFBR1/2; and SMAD3) or proteins that build up the contractile apparatus of aortic smooth muscle cells (myosin heavy chain 11, MYH11; smooth muscle actin alpha 2, ACTA2; and MYLK).

    Methods and result: In 110 non-syndromic TAAD patients that previously tested negative for FBN1 or TGFBR1/2 mutations, we identified 7 ACTA2 mutations in a cohort of 43 familial TAAD patients, including 2 premature truncating mutations. Sequencing of MYH11 revealed an in frame splice-site alteration in one out of two probands with TAA(D) associated with PDA but none in the series of 22 probands from the cohort of 110 patients with non-syndromic TAAD. Interestingly, immunohistochemical staining of aortic biopsies of a patient and a family member with MYH11 and patients with ACTA2 missense mutations showed upregulation of the TGF beta signaling pathway.

    Conclusions: MYH11 mutations are rare and typically identified in patients with TAAD associated with PDA. ACTA2 mutations were identified in 16% of a cohort presenting familial TAAD. Different molecular defects in TAAD may account for a different pathogenic mechanism of enhanced TGF beta signaling.

    (C) 2011 Elsevier Ireland Ltd. All rights reserved.

  • 303.
    Rinnstrom, Daniel
    et al.
    Umeå University, Sweden.
    Dellborg, Mikael
    Gothenburg University, Sweden.
    Thilen, Ulf
    Lund University, Sweden.
    Sorensson, Peder
    Karolinska Institute, Sweden.
    Nielsen, Niels Erik
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Hälsouniversitetet. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Christersson, Christina
    Uppsala University, Sweden.
    Johansson, Bengt
    Umeå University, Sweden.
    Left ventricular hypertrophy in adults with previous repair of coarctation of the aorta; association with systolic blood pressure in the high normal range2016Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 218, s. 59-64Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Arterial hypertension is common in adults with repaired coarctation of the aorta (CoA). The associations between the diagnosis of hypertension, actual blood pressure, other factors affecting left ventricular overload, and left ventricular hypertrophy (LVH) are not yet fully explored in this population. Material and results: From the national register for congenital heart disease, 506 adult patients (amp;gt;= 18 years old) with previous repair of CoA were identified (37.0% female, mean age 35.7 +/- 13.8 years, with an average of 26.8 +/- 12.4 years post repair). Echocardiographic data were available for all patients, and showed LVH in 114 (22.5%) of these. Systolic blood pressure (SBP) (mm Hg) (OR 1.02, CI 1.01-1.04), aortic valve disease, (OR 2.17, CI 1.33-3.53), age (years) (OR 1.03, CI 1.01-1.05), diagnosis of arterial hypertension (OR 3.02, CI 1.81-5.02), and sex (female) (OR 0.41, CI 0.24-0.72) were independently associated with LVH. There was an association with LVH at SBP within the upper reference limits [ 130, 140] mm Hg (OR 2.23, CI 1.05-4.73) that further increased for SBP amp;gt; 140 mm Hg (OR 8.02, CI 3.76-17.12). Conclusions: LVH is common post repair of CoA and is associated with SBP even below the currently recommended target level. Lower target levels may therefore become justified in this population. ORCID Id: 0000-0003-0976-6910 (C) 2016 Elsevier Ireland Ltd. All rights reserved.

  • 304.
    Rinnström, Daniel
    et al.
    Umea Univ, Ctr Heart, S-90187 Umea, Sweden.;Umea Univ, Dept Publ Hlth & Clin Med, S-90187 Umea, Sweden..
    Dellborg, Mikael
    Gothenburg Univ, Dept Mol & Clin Med, S-41124 Gothenburg, Sweden..
    Thilen, Ulf
    Lund Univ, Dept Cardiol, Clin Sci, S-22100 Lund, Sweden..
    Sörensson, Peder
    Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden..
    Nielsen, Niels-Eric
    Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden..
    Christersson, Christina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Koagulation och inflammationsvetenskap. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Johansson, Bengt
    Umea Univ, Ctr Heart, S-90187 Umea, Sweden.;Umea Univ, Dept Publ Hlth & Clin Med, S-90187 Umea, Sweden..
    Left ventricular hypertrophy in adults with previous repair of coarctation of the aorta: association with systolic blood pressure in the high normal range2016Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 218, s. 59-64Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Arterial hypertension is common in adults with repaired coarctation of the aorta (CoA). The associations between the diagnosis of hypertension, actual blood pressure, other factors affecting left ventricular overload, and left ventricular hypertrophy (LVH) are not yet fully explored in this population. Material and results: From the national register for congenital heart disease, 506 adult patients (>= 18 years old) with previous repair of CoA were identified (37.0% female, mean age 35.7 +/- 13.8 years, with an average of 26.8 +/- 12.4 years post repair). Echocardiographic data were available for all patients, and showed LVH in 114 (22.5%) of these. Systolic blood pressure (SBP) (mm Hg) (OR 1.02, CI 1.01-1.04), aortic valve disease, (OR 2.17, CI 1.33-3.53), age (years) (OR 1.03, CI 1.01-1.05), diagnosis of arterial hypertension (OR 3.02, CI 1.81-5.02), and sex (female) (OR 0.41, CI 0.24-0.72) were independently associated with LVH. There was an association with LVH at SBP within the upper reference limits [ 130, 140] mm Hg (OR 2.23, CI 1.05-4.73) that further increased for SBP > 140 mm Hg (OR 8.02, CI 3.76-17.12). Conclusions: LVH is common post repair of CoA and is associated with SBP even below the currently recommended target level. Lower target levels may therefore become justified in this population. ORCID Id: 0000-0003-0976-6910

  • 305.
    Rinnström, Daniel
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Dellborg, Mikael
    Thilén, Ulf
    Sörensson, Peder
    Nielsen, Niels-Erik
    Christersson, Christina
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Left ventricular hypertrophy in adults with previous repair of coarctation of the aorta: association with systolic blood pressure in the high normal range2016Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 218, s. 59-64Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Arterial hypertension is common in adults with repaired coarctation of the aorta (CoA). The associations between the diagnosis of hypertension, actual blood pressure, other factors affecting left ventricular overload, and left ventricular hypertrophy (LVH) are not yet fully explored in this population.

    Material and results: From the national register for congenital heart disease, 506 adult patients (≥18 years old) with previous repair of CoA were identified (37.0% female, mean age 35.7 ± 13.8 years, with an average of 26.8 ± 12.4 years post repair). Echocardiographic data were available for all patients, and showed LVH in 114 (22.5%) of these. Systolic blood pressure (SBP) (mm Hg) (OR 1.02, CI 1.01–1.04), aortic valve disease, (OR 2.17, CI 1.33–3.53), age (years) (OR 1.03, CI 1.01–1.05), diagnosis of arterial hypertension (OR 3.02, CI 1.81–5.02), and sex (female) (OR 0.41, CI 0.24–0.72) were independently associated with LVH. There was an association with LVH at SBP within the upper reference limits [130, 140] mm Hg (OR 2.23, CI 1.05–4.73) that further increased for SBP N 140 mm Hg (OR 8.02, CI 3.76–17.12).

    Conclusions: LVH is common post repair of CoA and is associatedwith SBP even belowthe currently recommended target level. Lower target levels may therefore become justified in this population.

  • 306.
    Roos, Andreas
    et al.
    Karolinska Inst, Dept Med, Stockholm, Sweden;Karolinska Univ Hosp, Dept Emergency Med, C1 63, S-14186 Stockholm, Sweden.
    Hellgren, Anton
    Karolinska Inst, Dept Med, Stockholm, Sweden;Karolinska Univ Hosp, Dept Emergency Med, C1 63, S-14186 Stockholm, Sweden.
    Rafatnia, Farshid
    Karolinska Inst, Dept Med, Stockholm, Sweden;NYU Lutheran Med Ctr, Dept Internal Med, Brooklyn, NY USA.
    Hammarsten, Ola
    Univ Gothenburg, Sahlgrenska Univ Hosp, Sahlgrenska Acad, Dept Clin Chem & Transfus Med, Gothenburg, Sweden.
    Ljung, Rickard
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden.
    Carlsson, Axel C
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiovaskulär epidemiologi. Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med, Huddinge, Sweden.
    Holzmann, Martin J.
    Karolinska Inst, Dept Med, Stockholm, Sweden;Karolinska Univ Hosp, Dept Emergency Med, C1 63, S-14186 Stockholm, Sweden.
    Investigations, findings, and follow-up in patients with chest pain and elevated high-sensitivity cardiac troponin T levels but no myocardial infarction2017Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 232, s. 111-116Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Elevated troponin levels, in patients without myocardial infarction (MI), are associated with increased mortality. In an observational cohort study we aimed to assess how patients with elevated high-sensitivity cardiac troponin T (hs-cTnT) levels, and no MI are investigated and followed up, compared to patients with MI.

    Methods: During January 1, 2011 to December 31, 2012, all patients > 25 years of age, with chest pain and elevated hs-cTnT levels or MI, at the Karolinska University Hospital were included. We calculated risk ratios (RR) with 95% confidence intervals (CI) for echocardiographies, stress tests, and follow-up, and compared medication in patients with and without MI.

    Results: 1848 patients with elevated hs-cTnT levels but no MI, of whom 871 (47%) had no prior heart disease, and 667 patients with MI were included. Echocardiography was performed in 609 patients (33%) without MI and 580 (87%) with MI (adjusted RR 0.42; 95% CI, 0.37-0.48). Follow-up was planned for 856 (46%) patients without MI and 611 (92%) with MI (adjusted RR 0.54; 95% CI, 0.48-0.60). Among patients without MI and no heart disease who underwent echocardiography 46 (14%) had a left ventricular ejection fraction of <= 40%, and on stress tests 27 (37%) had findings associated with ischemia. Platelet inhibitors and statins were started in 266 (25%) and 199 (17%) patients without MI, respectively, compared with 424 (93%), and 416 (86%) patients with MI.

    Conclusions: Patients with elevated hs-cTnT levels and no MI are rarely investigated for detection of cardiac disease or followed up, or started on cardiovascular medication that potentially could prevent future cardiovascular events and death.

  • 307. Ruigómez, A
    et al.
    Johansson, Saga
    Wallander, Mari-Ann
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Edvardsson, N
    García Rodríguez, LA
    Risk of cardiovascular and cerebrovascular events after atrial fibrillation diagnosis2009Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 136, nr 2, s. 186-192Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Atrial fibrillation (AF) is associated with subsequent cardiovascular events including ischemic stroke, transient ischemic events, and coronary events. This study aimed to evaluate the risk of ischemic cerebrovascular events (ICVE), coronary events (CE) or heart failure (HF) following a diagnosis of AF. METHODS: Patients were selected from the UK General Practice Research Database. The incidence of ICVE, CE and HF was determined during a 6-year follow-up period for patients with a first diagnosis of AF (n=831) and a control group without AF (n=8226). Relative risk of developing a cardiovascular event associated with prior AF and other potential risk factors was estimated using Cox regression analysis. RESULTS: A first diagnosis of ICVE, CE or HF was made in 261 patients in the AF group and 622 in the control group. The relative risks associated with AF were 2.1 for CE (95% CI: 1.6-2.9), 3.0 for ICVE (95% CI: 2.3-4.0) and 6.4 for HF (95% CI: 5.0-8.3). The risks of CE, HF and ICVE were higher in patients with chronic AF than paroxysmal AF (odds ratio: 1.5, 95% CI: 1.0-2.2) and in patients aged at least 60 years or with diabetes. Lifestyle factors did not significantly affect the risk of cardiovascular events in patients with AF. CONCLUSIONS: After a first episode of AF there is an increased risk of ICVE, CE and HF. Patients initially diagnosed with chronic AF have a higher risk than those with paroxysmal AF.

  • 308.
    Saha, Samir Kanti
    et al.
    Umeå University, Umeå, Sweden.
    Kiotsekoglou, Anatoli
    Region Örebro län. Örebro universitet, Institutionen för medicinska vetenskaper. Department of Clinical Physiology.
    Taking a deeper insight into the burden of cardiac amyloidosis: Has 3D speckle tracking echocardiographic strain come of age?2018Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 271, s. 396-397Artikkel i tidsskrift (Annet vitenskapelig)
  • 309.
    Saha, Samir Kanti
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Kiotsekoglou, Anatoli
    Taking a deeper insight into the burden of cardiac amyloidosis: Has 3D speckle tracking echocardiographic strain come of age?2018Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 271, s. 396-397Artikkel i tidsskrift (Annet vitenskapelig)
  • 310.
    Saha, Samir Kanti
    et al.
    Heart Center, Umeå University Hospital, Umeå, Sweden.
    Kiotsekoglou, Anatoli
    Region Örebro län. Örebro universitet, Institutionen för medicinska vetenskaper. Department of Clinical Physiology, Örebro University Hospital, Örebro, Sweden.
    Söderberg, Stephan
    Heart Center, Umeå University Hospital, Umeå, Sweden.
    Dobutamine stress echocardiography in pulmonary hypertension: A taste of old wine in a new bottle2018Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 270, s. 355-356Artikkel i tidsskrift (Annet vitenskapelig)
  • 311.
    Sandberg, Camilla
    et al.
    Department of Community Medicine and Rehabilitation, Umeå University.
    Crenshaw, Albert G.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Elcadi, Guilherme H.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Christensen, Christina
    Department of Medical Sciences, Uppsala University.
    Hlebowicz, Joanna
    Department of Cardiology, Lund University.
    Thilén, Ulf
    Department of Cardiology, Lund University.
    Johansson, Bengt
    Heart center and Department of Public Health and Clinical Medicine, Umeå University.
    Impaired skeletal muscle endurance in adults with complex congenital heart disease is associated with local muscle oxygenation2018Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754Artikkel i tidsskrift (Fagfellevurdert)
  • 312.
    Sandberg, Camilla
    et al.
    Umea Univ, Dept Publ Hlth & Clin Med, Umea, Sweden;Umea Univ, Dept Community Med & Rehabil, Umea, Sweden.
    Johansson, Karna
    Umea Univ, Dept Publ Hlth & Clin Med, Umea, Sweden.
    Christersson, Christina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi.
    Hlebowicz, Joanna
    Lund Univ, Dept Cardiol, Clin Sci, Lund, Sweden.
    Thilen, Ulf
    Lund Univ, Dept Cardiol, Clin Sci, Lund, Sweden.
    Johansson, Bengt
    Umea Univ, Dept Publ Hlth & Clin Med, Umea, Sweden.
    Sarcopenia is common in adults with complex congenital heart disease2019Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 296, s. 57-62Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Background: Adults with complex congenital heart disease (CHD) have reduced aerobic capacity and impaired muscle function. We therefore hypothesized that patients have a lower skeletal muscle mass and higher fat mass than controls. Methods: Body composition was examined with full body Dual-Energy x-ray Absorptiometry (DXA) in 73 patients with complex CHD (mean age 35.8 +/- 14.3, women n = 22) and 73 age and sex matched controls. Patients fulfilling criteria for low skeletal muscle mass in relation to their height and fat mass were defined as sarcopenic. Results: Male patients (n = 51) were shorter (177.4 +/- 6.6 cm vs. 180.9 +/- 6.7 cm, p = 0.009) and weighed less (76.0 +/- 10.8 kg vs. 82.0 +/- 12.4 kg, p = 0.01) than controls. Also, patients had a lower appendicular lean mass-index (ALM-index) (7.57 +/- 0.97 kg/m(2) vs. 8.46 +/- 0.90 kg/m(2), p < 0.001). Patients' relative tissue fat mass (27.9 +/- 7.0% vs. 25.4 +/- 8.6%, p = 0.1) did not differ. Forty-seven percent of the men (n = 24) were classified as sarcopenic. Female patients (n = 22) were also shorter (163.5 +/- 8.7 cm vs. 166.7 +/- 5.9 cm, p = 0.05) but had a higher BMI (25.7 +/- 4.2 vs. 23.0 +/- 2.5, p = 0.02) than controls. Patients also had a lower ALM-index (6.30 +/- 0.75 vs. 6.67 +/- 0.55, p = 0.05), but their relative body fat mass (40.8 +/- 7.6% vs. 32.0 +/- 7.0%, p < 0.001) were higher. Fifty-nine percent of the women (n = 13) were classified as sarcopenic. Conclusions: The body composition was altered toward lower skeletal muscle mass in patients with complex CHD. Approximately half of the patients were classified as sarcopenic. Contrary to men, the women had increased body fat and a higher BMI. Further research is required to assess the cause, possible adverse long-term effects and whether sarcopenia is preventable or treatable. (C) 2019 Elsevier B.V. All rights reserved.

  • 313.
    Sandberg, Camilla
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Johansson, Karna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Christersson, Christina
    Hlebowicz, Joanna
    Thilen, Ulf
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Sarcopenia is common in adults with complex congenital heart disease2019Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 296, s. 57-62Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Background: Adults with complex congenital heart disease (CHD) have reduced aerobic capacity and impaired muscle function. We therefore hypothesized that patients have a lower skeletal muscle mass and higher fat mass than controls.

    Methods: Body composition was examined with full body Dual-Energy x-ray Absorptiometry (DXA) in 73 patients with complex CHD (mean age 35.8 ± 14.3, women n = 22) and 73 age and sex matched controls. Patients fulfilling criteria for low skeletal muscle mass in relation to their height and fat mass were defined as sarcopenic.

    Results: Male patients (n = 51) were shorter (177.4 ± 6.6 cm vs. 180.9 ± 6.7 cm, p = 0.009) and weighed less (76.0 ± 10.8 kg vs. 82.0 ± 12.4 kg, p = 0.01) than controls. Also, patients had a lower appendicular lean mass-index (ALM-index) (7.57 ± 0.97 kg/m2 vs. 8.46 ± 0.90 kg/m2, p < 0.001). Patients’ relative tissue fat mass (27.9 ± 7.0% vs. 25.4 ± 8.6%, p = 0.1) did not differ. Forty-seven percent of the men (n = 24) were classified as sarcopenic.

    Female patients (n = 22) were also shorter (163.5 ± 8.7 cm vs. 166.7 ± 5.9 cm, p = 0.05) but had a higher BMI (25.7 ± 4.2 vs. 23.0 ± 2.5, p=0.02) than controls. Patients also had a lower ALM-index (6.30 ± 0.75 vs. 6.67 ± 0.55, p = 0.05), but their relative body fat mass (40.8 ± 7.6% vs. 32.0 ± 7.0%, p < 0.001) were higher. Fifty-nine percent of the women (n = 13) were classified as sarcopenic.

    Conclusions: The body composition was altered toward lower skeletal muscle mass in patients with complex CHD. Approximately half of the patients were classified as sarcopenic. Contrary to men, the women had increased body fat and a higher BMI. Further research is required to assess the cause, possible adverse long-term effects and whether sarcopenia is preventable or treatable.

  • 314.
    Sandberg, Camilla
    et al.
    Umeå University, Sweden; Umeå University, Sweden; Umeå University, Sweden.
    Rinnstrom, Daniel
    Umeå University, Sweden; Umeå University, Sweden.
    Dellborg, Mikael
    University of Gothenburg, Sweden.
    Thilen, Ulf
    Lund University, Sweden.
    Sorensson, Peder
    Karolinska Institute, Sweden.
    Nielsen, Niels Erik
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Hälsouniversitetet. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Christersson, Christina
    Uppsala University, Sweden.
    Wadell, Karin
    Umeå University, Sweden.
    Johansson, Bengt
    Umeå University, Sweden; Umeå University, Sweden.
    Height, weight and body mass index in adults with congenital heart disease2015Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 187, s. 219-226Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: High BMI is a risk factor for cardiovascular disease and, in contrast, low BMI is associated with worse prognosis in heart failure. The knowledge on BMI and the distribution in different BMI-classes in adults with congenital heart disease (CHD) are limited. Methods and results: Data on 2424 adult patients was extracted from the Swedish Registry on Congenital Heart Disease and compared to a reference population (n = 4605). The prevalence of overweight/obesity (BMI greater than= 25) was lower in men with variants of the Fontan procedure, pulmonary atresia (PA)/double outlet right ventricle (DORV) and aortic valve disease (AVD) (Fontan 22.0% and PA/DORV 15.1% vs. 43.0%, p = 0.048 and p less than 0.001) (AVD 37.5% vs. 49.3%, p less than 0.001). Overt obesity (BMI greater than= 30) was only more common in women with AVD (12.8% vs. 9.0%, p = 0.005). Underweight (BMI less than 18.5) was generally more common in men with CHD (complex lesions 4.9% vs. 0.9%, p less than 0.001 and simple lesions 3.2% vs. 0.6%, less than0.001). Men with complex lesions were shorter than controls in contrast to females that in general did not differ from controls. Conclusion: Higher prevalence of underweight in men with CHD combined with a lower prevalence of over-weight/obesity in men with some complex lesions indicates that men with CHD in general has lower BMI compared to controls. In women, only limited differences between those with CHD and the controls were found. The complexity of the CHD had larger impact on height in men. The cause of these gender differences as well as possible significance for prognosis is unknown. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

  • 315. Sandberg, Camilla
    et al.
    Rinnström, Daniel
    Dellborg, Mikael
    Thilén, Ulf
    Sörensson, Peder
    Nielsen, Niels-Erik
    Christersson, Christina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Koagulation och inflammationsvetenskap.
    Wadell, Karin
    Johansson, Bengt
    Height, weight and body mass index in adults with congenital heart disease2015Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 187, s. 219-226Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: High BMI is a risk factor for cardiovascular disease and, in contrast, low BMI is associated with worse prognosis in heart failure. The knowledge on BMI and the distribution in different BMI-classes in adults with congenital heart disease (CHD) are limited.

    METHODS AND RESULTS: Data on 2424 adult patients was extracted from the Swedish Registry on Congenital Heart Disease and compared to a reference population (n=4605). The prevalence of overweight/obesity (BMI≥25) was lower in men with variants of the Fontan procedure, pulmonary atresia (PA)/double outlet right ventricle (DORV) and aortic valve disease (AVD) (Fontan 22.0% and PA/DORV 15.1% vs. 43.0%, p=0.048 and p<0.001) (AVD 37.5% vs. 49.3%, p<0.001). Overt obesity (BMI≥30) was only more common in women with AVD (12.8% vs. 9.0%, p=0.005). Underweight (BMI<18.5) was generally more common in men with CHD (complex lesions 4.9% vs. 0.9%, p<0.001 and simple lesions 3.2% vs. 0.6%, <0.001). Men with complex lesions were shorter than controls in contrast to females that in general did not differ from controls.

    CONCLUSION: Higher prevalence of underweight in men with CHD combined with a lower prevalence of overweight/obesity in men with some complex lesions indicates that men with CHD in general has lower BMI compared to controls. In women, only limited differences between those with CHD and the controls were found. The complexity of the CHD had larger impact on height in men. The cause of these gender differences as well as possible significance for prognosis is unknown.

  • 316.
    Sandberg, Camilla
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Rinnström, Daniel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Dellborg, Mikael
    Thilén, Ulf
    Sörensson, Peder
    Nielsen, Niels-Erik
    Christersson, Christina
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Height, weight and body mass index in adults with congenital heart disease2015Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 187, s. 219-226Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: High BMI is a risk factor for cardiovascular disease and, in contrast, low BMI is associated with worse prognosis in heart failure. The knowledge on BMI and the distribution in different BMI-classes in adults with congenital heart disease (CHD) are limited. Methods and results: Data on 2424 adult patients was extracted from the Swedish Registry on Congenital Heart Disease and compared to a reference population (n = 4605). The prevalence of overweight/obesity (BMI >= 25) was lower in men with variants of the Fontan procedure, pulmonary atresia (PA)/double outlet right ventricle (DORV) and aortic valve disease (AVD) (Fontan 22.0% and PA/DORV 15.1% vs. 43.0%, p = 0.048 and p < 0.001) (AVD 37.5% vs. 49.3%, p < 0.001). Overt obesity (BMI >= 30) was only more common in women with AVD (12.8% vs. 9.0%, p = 0.005). Underweight (BMI < 18.5) was generally more common in men with CHD (complex lesions 4.9% vs. 0.9%, p < 0.001 and simple lesions 3.2% vs. 0.6%, <0.001). Men with complex lesions were shorter than controls in contrast to females that in general did not differ from controls. Conclusion: Higher prevalence of underweight in men with CHD combined with a lower prevalence of over-weight/obesity in men with some complex lesions indicates that men with CHD in general has lower BMI compared to controls. In women, only limited differences between those with CHD and the controls were found. The complexity of the CHD had larger impact on height in men. The cause of these gender differences as well as possible significance for prognosis is unknown.

  • 317.
    Sarno, Giovanna
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR). Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi.
    Lagerqvist, Bo
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR). Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi.
    Carlsson, Jörg
    Olivecrona, Göran
    Nilsson, Johan
    Calais, Fredrik
    Götberg, Matthias
    Nilsson, Tage
    Sjögren, Iwar
    James, Stefan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR). Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi.
    Initial clinical experience with an everolimus eluting platinum chromium stent (Promus Element) in unselected patients from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR)2013Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 167, nr 1, s. 146-150Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND:

    The safety and efficacy of the Promus Element stent have been recently demonstrated in a selected population from one randomized trial. The aim of this study was to describe the initial clinical experience with the everolimus eluting platinum chromium stent (Promus Element) in unselected patients from a real life nationwide registry.

    METHODS:

    The Promus Element DES was compared to all other DES implanted in Sweden (with more than 500 implants) from November 2009 to March 2011. The results were assessed using Cox regression.

    RESULTS:

    A total of 13,577 stents (Promus Element, n=2724, Cypher, n=782; Endeavor, n=747; Taxus Liberté, n=1393, Xience V/Promus, n=4832, Resolute, n=1566, Xience Prime, n=4832) were implanted at 8375 procedures. At one year the restenosis rate in the Promus Element was not significantly different from the overall DES group (2.8% vs. 2.7%, adjusted HR:1.17, 95% CI: 0.75-1.75). A significantly lower restenosis rate was observed in the Promus Element when compared with Endeavor (2.8% vs. 5.8%; adjusted HR: 0.44; 95% CI: 0.26-0.74). The stent thrombosis (ST) rate at one year was not significantly different in the Promus Element as compared with the overall DES group (0.2% vs. 0.5% adjusted HR: 0.59; 95% CI: 025-1.40). ST rate was significantly lower as compared with Endeavor stent (0.2% vs. 0.8%; HR: 0.24; 95% CI: 0.08-0.67).

    CONCLUSIONS:

    In a large unselected population the Promus Element stent appears to be safe and effective with a low risk of restenosis and ST.

  • 318. Sarno, Giovanna
    et al.
    Lagerqvist, Bo
    Carlsson, Jörg
    Olivecrona, Göran
    Nilsson, Johan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Calais, Fredrik
    Götberg, Matthias
    Nilsson, Tage
    Sjögren, Iwar
    James, Stefan
    Initial clinical experience with an everolimus eluting platinum chromium stent (Promus Element) in unselected patients from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR)2013Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 167, nr 1, s. 146-150Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: The safety and efficacy of the Promus Element stent have been recently demonstrated in a selected population from one randomized trial. The aim of this study was to describe the initial clinical experience with the everolimus eluting platinum chromium stent (Promus Element) in unselected patients from a real life nationwide registry. METHODS: The Promus Element DES was compared to all other DES implanted in Sweden (with more than 500 implants) from November 2009 to March 2011. The results were assessed using Cox regression. RESULTS: A total of 13,577 stents (Promus Element, n=2724, Cypher, n=782; Endeavor, n=747; Taxus Liberté, n=1393, Xience V/Promus, n=4832, Resolute, n=1566, Xience Prime, n=4832) were implanted at 8375 procedures. At one year the restenosis rate in the Promus Element was not significantly different from the overall DES group (2.8% vs. 2.7%, adjusted HR:1.17, 95% CI: 0.75-1.75). A significantly lower restenosis rate was observed in the Promus Element when compared with Endeavor (2.8% vs. 5.8%; adjusted HR: 0.44; 95% CI: 0.26-0.74). The stent thrombosis (ST) rate at one year was not significantly different in the Promus Element as compared with the overall DES group (0.2% vs. 0.5% adjusted HR: 0.59; 95% CI: 025-1.40). ST rate was significantly lower as compared with Endeavor stent (0.2% vs. 0.8%; HR: 0.24; 95% CI: 0.08-0.67). CONCLUSIONS: In a large unselected population the Promus Element stent appears to be safe and effective with a low risk of restenosis and ST.

  • 319.
    Sarno, Giovanna
    et al.
    Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University Hospital, Uppsala University, Uppsala, Sweden .
    Lagerqvist, Bo
    Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University Hospital, Uppsala University, Uppsala, Sweden .
    Carlsson, Jörg
    Department of Medicine, Länssjukhuset, Kalmar, Sweden .
    Olivecrona, Göran
    Department of Cardiology, Lund University Hospital, Lund, Sweden.
    Nilsson, Johan
    Department of Cardiology, Norrlands University Hospital, Umeå, Sweden .
    Calais, Fredrik
    Department of Cardiology, Örebro University Hospital, Örebro, Sweden .
    Götberg, Matthias
    Department of Cardiology, Lund University Hospital, Lund, Sweden .
    Nilsson, Tage
    Department of Cardiology, Karlstad Hospital, Karlstad, Sweden .
    Sjögren, Iwar
    Department of Cardiology, Falun Lasarett, Falun, Sweden .
    James, Stefan
    Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; University Hospital, Uppsala Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden .
    Initial clinical experience with an everolimus eluting platinum chromium stent (Promus Element) in unselected patients from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR)2013Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 167, nr 1, s. 146-150Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The safety and efficacy of the Promus Element stent have been recently demonstrated in a selected population from one randomized trial. The aim of this study was to describe the initial clinical experience with the everolimus eluting platinum chromium stent (Promus Element) in unselected patients from a real life nationwide registry.

    Methods: The Promus Element DES was compared to all other DES implanted in Sweden (with more than 500 implants) from November 2009 to March 2011. The results were assessed using Cox regression.

    Results: A total of 13,577 stents (Promus Element, n = 2724, Cypher, n = 782; Endeavor, n = 747; Taxus Liberte, n = 1393, Xience V/Promus, n = 4832, Resolute, n = 1566, Xience Prime, n = 4832) were implanted at 8375 procedures. At one year the restenosis rate in the Promus Element was not significantly different from the overall DES group (2.8% vs. 2.7%, adjusted HR: 1.17, 95% CI: 0.75-1.75). A significantly lower restenosis rate was observed in the Promus Element when compared with Endeavor (2.8% vs. 5.8%; adjusted HR: 0.44; 95% CI: 0.26-0.74). The stent thrombosis (ST) rate at one year was not significantly different in the Promus Element as compared with the overall DES group (0.2% vs. 0.5% adjusted HR: 0.59; 95% CI: 025-1.40). ST rate was significantly lower as compared with Endeavor stent (0.2% vs. 0.8%; HR: 0.24; 95% CI: 0.08-0.67).

    Conclusions: In a large unselected population the Promus Element stent appears to be safe and effective with a low risk of restenosis and ST. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

  • 320.
    Savarese, Gianluigi
    et al.
    Karolinska Institute, Sweden; University of Naples Federico II, Italy.
    Edner, Magnus
    Karolinska Institute, Sweden.
    Dahlström, Ulf
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Perrone-Filardi, Pasquale
    University of Naples Federico II, Italy.
    Hage, Camilla
    Karolinska Institute, Sweden.
    Cosentino, Francesco
    Karolinska Institute, Sweden.
    Lund, Lars H.
    Karolinska Institute, Sweden.
    Comparative associations between angiotensin converting enzyme inhibitors, angiotensin receptor blockers and their combination, and outcomes in patients with heart failure and reduced ejection fraction2015Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 199, s. 415-423Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Angiotensin converting enzyme inhibitors (ACE-Is) and angiotensin receptor blockers (ARBs) are recommended in heart failure with reduced ejection fraction (HFREF), but there is limited data on ARB vs. ACE-I and their combination in unselected populations. The purpose of this study was to compare the associations between the use of ACE-I, ARB and their combination, and outcomes in HFREF. Methods and results: We prospectively studied 22,947 patients with HFREF (ejection fraction b 40%) enrolled in the Swedish Heart Failure Registry who received ACE-I but not ARB (n = 15,801, 69%), ARB but not ACE-I (n = 4335, 19%), their combination (n = 571, 2%) or neither (n = 2240, 10%). As compared with ACE-I alone, the hazard ratios (HRs) for ARB alone for all-cause mortality was 0.97 (95% CI = 0.91-1.03; p = 0.27), for HF hospitalization 1.08 (CI = 1.02-1.15; p less than 0.01) and for the composite outcome 1.03 (CI = 0.99-1.08; p = 0.15). ACE-I and ARB combination had for death HR = 0.98 (95% CI = 0.84-1.14; p = 0.76), for HF hospitalization HR = 1.49 (CI = 1.33-1.68; p less than 0.01) and for the composite outcome HR = 1.35 (CI = 1.21-1.50; p less than 0.01). Use of neither ACE-I nor ARB was associated with HR for death 1.41 (CI = 1.33-1.50; p less than 0.01), for HF hospitalization 1.16 (CI = 1.08-1.25; p less than 0.01) and for the composite outcome 1.28 (CI = 1.21-1.35; p less than 0.01). Conclusion: This large generalizable analysis confirms the current recommendation of using ACE-I as first choice in HFREF. ARB can be considered an alternative in patients who cannot use ACE-I but should not routinely replace ACE-I. The combination of ACE-I and ARB was not associated with additional benefit over either one alone, and may potentially be harmful. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

  • 321.
    Sederholm Lawesson, Sofia
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Alfredsson, Joakim
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Fredrikson, Mats
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Yrkes- och miljömedicin. Linköpings universitet, Hälsouniversitetet.
    Swahn, Eva
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    A gender perspective on short- and long term mortality in ST-elevation myocardial infarction: a report from the SWEDEHEART register2013Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 18, nr 2, s. 1041-1047Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Previous studies of patients admitted for ST-elevation myocardial infarction [STEMI] have indicated that women have a higher risk of early mortality than do men. These studies have presented limited information on gender related differences in the short term and almost no information on the long term. Methods and results: We analysed a prospective, consecutively included STEMI population consisting of 54,146 patients (35% women). This population consists of almost all patients hospitalised in Sweden between January 1, 1995 and December 31, 2006 as recorded in the SWEDEHEART register (formerly RIKS-HIA). Follow-up time ranged from one to 13 years (mean 4.6). Women had a lower probability of being given reperfusion therapy, odds ratio [OR] 0.83 (95% confidence interval [CI] 0.79-0.88). During the time these STEMI patients were in the hospital, 13% of the women and 7% of men died, multivariable adjusted OR 1.21 (95% CI 1.11-1.32). During the follow up period, 46% of the women died as compared with 32% of the men. There was, however, no gender difference in age-adjusted risk of long term mortality (hazard ratio [HR] 0.98, 95% CI 0.95-1.01) whereas the multivariable adjusted risk was lower in women (HR 0.92, 95% CI 0.89-0.96). The long term risk of re-infarction was the same in men and women (HR 0.98, 95% CI 0.93-1.03) whereas men in the youngest group had a higher risk than women in that age group (HR 0.82, 95% CI 0.72-0.94). Conclusion: In STEMI, women had a higher risk of in-hospital mortality but the long-term risk of death was higher in men. More studies are needed in the primary percutaneous coronary intervention (pPCI) era that are designed to determine why women fare worse than men after STEMI during the first phase when they are in hospital

  • 322.
    Sederholm Lawesson, Sofia
    et al.
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin.
    Isaksson, Rose-Marie
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Norrbotten Cty Council, Sweden.
    Thylén, Ingela
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Ericsson, Maria
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Angerud, Karin
    Umea Univ, Sweden.
    Swahn, Eva
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Gender differences in symptom presentation of ST-elevation myocardial infarction - An observational multicenter survey study2018Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 264Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Symptom presentation has been sparsely studied from a gender perspective restricting the inclusion to ST elevation myocardial infarction (STEMI) patients. Correct symptom recognition is vital in order to promptly seek care in STEMI where fast reperfusion therapy is of utmost importance. Female gender has been found associated with atypical presentation in studies on mixed MI populations but it is unclear whether this is valid also in STEMI. Objectives: We assessed whether there are gender differences in symptoms and interpretation of these in STEMI, and if this is attributable to sociodemographic and clinical factors. Methods: SymTime was a multicenter observational study including a validated questionnaire and data from medical records. Eligible STEMI patients (n = 532) were enrolled within 24 h after admittance at five Swedish hospitals. Results: Women were older, more often single and had lower educational level. Chest pain was less prevalent in women (74 vs 93%, p amp;lt; 0.001), whereas shoulder (33 vs 15%, p amp;lt; 0.001), throat/neck (34 vs 18%, p amp;lt; 0.001), back pain (29 versus 12%, p amp;lt; 0.001) and nausea (49 vs 29%, p amp;lt; 0.001) were more prevalent. Women less often interpreted their symptoms as of cardiac origin (60 vs 69%, p = 0.04). Female gender was the strongest independent predictor of non-chest pain presentation, odds ratio 5.29, 95% confidence interval 2.85-9.80. Conclusions: A striking gender difference in STEMI symptoms was found. As women significantly misinterpreted their symptoms more often, it is vital when informing about MI to the society or to high risk individuals, to highlight also other symptoms than just chest pain. (C) 2018 Elsevier B.V. All rights reserved.

  • 323. Sederholm Lawesson, Sofia
    et al.
    Isaksson, Rose-Marie
    Thylén, Ingela
    Ericsson, Maria
    Ängerud, Karin H
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Swahn, Eva
    Gender differences in symptom presentation of ST-elevation myocardial infarction: an observational multicenter survey study2018Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 264, s. 7-11Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Symptom presentation has been sparsely studied from a gender perspective restricting the inclusion to ST elevation myocardial infarction (STEMI) patients. Correct symptom recognition is vital in order to promptly seek care in STEMI where fast reperfusion therapy is of utmost importance. Female gender has been found associated with atypical presentation in studies on mixed MI populations but it is unclear whether this is valid also in STEMI.

    OBJECTIVES: We assessed whether there are gender differences in symptoms and interpretation of these in STEMI, and if this is attributable to sociodemographic and clinical factors.

    METHODS: SymTime was a multicenter observational study including a validated questionnaire and data from medical records. Eligible STEMI patients (n = 532) were enrolled within 24 h after admittance at five Swedish hospitals.

    RESULTS: Women were older, more often single and had lower educational level. Chest pain was less prevalent in women (74 vs 93%, p < 0.001), whereas shoulder (33 vs 15%, p < 0.001), throat/neck (34 vs 18%, p < 0.001), back pain (29 versus 12%, p < 0.001) and nausea (49 vs 29%, p < 0.001) were more prevalent. Women less often interpreted their symptoms as of cardiac origin (60 vs 69%, p = 0.04). Female gender was the strongest independent predictor of non-chest pain presentation, odds ratio 5.29, 95% confidence interval 2.85-9.80.

    CONCLUSIONS: A striking gender difference in STEMI symptoms was found. As women significantly misinterpreted their symptoms more often, it is vital when informing about MI to the society or to high risk individuals, to highlight also other symptoms than just chest pain.

  • 324. Shewan, Louise G.
    et al.
    Rosano, Giuseppe
    Henein, Michael Y.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Umeå Heart Centre.
    Coats, Andrew J. S.
    A statement on ethical standards in publishing scientific articles in the International Journal of Cardiology family of journals2014Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 170, nr 3, s. 253-254Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    All authors of manuscripts in the International Journal of Cardiology family of journals: The International Journal of Cardiology, IJC Heart & Vessels and IJC Metabolic & Endocrine are required to make a binding statement that they as authors adhere to the following principles: 1. That the corresponding author has the approval of all other listed authors for the submission and publication of all versions of the manuscript, that all authors have made a significant independent contribution and that no one who justifies being an author has been omitted from authorship 2. That the work has not been published nor is under consideration for publication elsewhere other than in oral, poster or abstract format, and that appropriate attribution and citation is given for any material reproduced from any other source including the authors' prior publications 3. That the material in the manuscript has been acquired according to modern ethical standards and has been approved by the legally appropriate ethical committee(s) 4. That all material conflicts of interest have been declared including the use of paid medical writers and their funding source. 5. That the manuscript will be maintained on the servers of the journals and held to be a valid publication by the journals only as long as all statements in these principles remain true, and that the authors have a duty to notify the journal editors immediately if any of the statements above ceases to be true withdrawn.

  • 325.
    Själander, Sara
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Svensson, Peter J.
    Friberg, Leif
    Atrial fibrillation patients with CHA2DS2-VASc > 1 benefit from oral anticoagulation prior to cardioversion2016Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 215, s. 360-363Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Electrical cardioversion of atrial fibrillation is associated with an increased risk of embolic stroke, but is generally considered safe if performed within 48 h after onset. Our objective was to investigate if thromboembolism and bleeding in association with cardioversion of atrial fibrillation differed between patients with and without oral anticoagulation.

    Methods: Retrospective study of patients with atrial fibrillation undergoing electrical cardioversion from national Swedish health registries from January 1st 2006 until December 1st 2010. Main outcome measures were thromboembolism and bleeding.

    Results: In total 22,874 atrial fibrillation patients underwent electrical cardioversion, 10,722 with and 12,152 without oral anticoagulation pre-treatment. Patients with low stroke risk (CHA(2)DS(2)-VASc 0-1) did not suffer from any thromboembolic complications within 30 days after cardioversion. After adjustment for factors included in CHA(2)DS(2)-VASc and after propensity score matching, patients without oral anticoagulation had higher risk for thromboembolic complications, odds ratio 2.54 (95% confidence interval 1.70-3.79) and odds ratio 2.51 (95% confidence interval 1.69-3.75). There were no significant differences regarding bleeding complications between patients with or without anticoagulation after adjustment for factors included in HAS-BLED, odds ratio 1.08 (95% confidence interval 0.51-2.25), nor after propensity score matching, odds ratio 1.00 (95% confidence interval 0.48-2.10).

    Conclusion: The results suggest that electrical cardioversion without prior anticoagulation may not be safe for patients with risk factors for thromboembolism (CHA(2)DS(2)-VASc score >1 point).

  • 326. Sjöland, H
    et al.
    Caidahl, K
    Karlson, BW
    Karlsson, T
    Herlitz, Johan
    [external].
    Limitation of physical activity, dyspnea and chest pain before and two years after coronary artery bypass grafting in relation to sex1997Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 61, nr 2, s. 123-133Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim: To describe the limitation of physical activity and its causes, and symptoms of dyspnea and chest pain prior to and during two years after coronary artery bypass grafting (CABG) in relation to sex. Methods: All patients from western Sweden who underwent CABG between June 1988 and June 1991 were approached with a questionnaire prior to, three months and two years after CABG evaluating the issues raised above. Results: In all, 2121 patients were operated on, of which 81% were males. Physical activity was significantly improved and symptoms of chest pain and dyspnea were significantly reduced in both men and women after CABG. The improvement was significantly greater in males than in females even after adjustment for preoperative differences between the sexes. Conclusion: There was an improvement for both men and women in terms of limitations for physical activity and cardiovascular symptoms three months and two years after CABG as compared with prior to the operation. Female patients suffered from significantly more symptoms of chest pain and dyspnea and limitations in physical activity after CABG than men, also when adjustment was made for preoperative differences between the sexes.

  • 327. Sjöland, H
    et al.
    Wiklund, I
    Caidahl, K
    Albertsson, P
    Herlitz, Johan
    [external].
    Relationship between quality of life and exercise test findings after coronary artery bypass surgery1995Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 51, nr 3, s. 221-232Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    We studied the correlation between quality of life and exercise testing in 554 patients 2 years after coronary artery bypass surgery. Quality of life constitutes a person's perceptions of physical and mental functional capacity, health and symptoms. Traditionally, evaluations after coronary bypass surgery have focused on physical performance, medication and anginal symptoms, which cannot be said to represent quality of life. We used the Physical Activity Score, the Nottingham Health Profile and the Psychological General Well-being Index for evaluation of quality of life. Significant correlations were found between quality of life and exercise capacity (P < 0.0001), and quality of life and chest pain at exercise for all questionnaires (P < 0.0001). Significant correlations, although of small or moderate magnitude, were found between exercise capacity, chest pain and most subscales of quality of life, with the highest correlation coefficients for dimensions reflecting physical abilities and pain. We conclude that quality of life correlates significantly with exercise capacity and chest pain during exercise 2 years after coronary bypass surgery. However, only dimensions of pain and physical performance are reasonably well correlated with exercise test results. Several aspects of quality of life are only weakly related to exercise test results and may escape identification in an exercise test.

  • 328.
    Svennberg, Emma
    et al.
    Danderyds Univ Hosp, Karolinska Inst, Dept Clin Sci, Cardiol Unit, Stockholm, Sweden.
    Lindahl, Bertil
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Berglund, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Eggers, Kai M.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Venge, Per
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Biokemisk struktur och funktion.
    Zethelius, Björn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik. Med Prod Agcy, Sci Support, Uppsala, Sweden.
    Rosenqvist, Mårten
    Danderyds Univ Hosp, Karolinska Inst, Dept Clin Sci, Cardiol Unit, Stockholm, Sweden.
    Lind, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiovaskulär epidemiologi.
    Hijazi, Ziad
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR). Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi.
    NT-proBNP is a powerful predictor for incident atrial fibrillation: Validation of a multimarker approach2016Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 223, s. 74-81Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Biomarkers may be of value to identify individuals at risk of developing atrial fibrillation (AF). Using a multimarker approach, this study investigated if the biomarkers; NT-proBNP, high-sensitivity cardiac troponin (hs-cTn), growth differentiation factor-15 (GDF-15), cystatin C and high-sensitivity C-reactive protein (CRP) are independent predictors for incident AF.

    METHODS: Blood samples were collected from 883 individuals in the Uppsala Longitudinal Study of Adult Men (ULSAM) and 978 individuals in the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study. Participants were followed for 10-13years with n=113 incident AF cases in ULSAM and n=148 in PIVUS. The associations between biomarkers and incident AF were analysed in Cox proportional hazards regression models.

    RESULTS: The hazard ratio (HR) for incident AF was significant for all five biomarkers in unadjusted analyses in both cohorts. Only NT-proBNP remained significant when adjusting for cardiovascular risk factors and the other biomarkers (HR (1SD) 2.05 (1.62-2.59) (ULSAM) and 1.56 (1.30-1.86) (PIVUS), both p<0.001). The C-index improved from 0.64 to 0.69 in ULSAM and from 0.62 to 0.68 in PIVUS, by adding NT-proBNP to cardiovascular risk factors (both p<0.001). The C-index of the CHARGE-AF risk score increased from 0.62 to 0.68 (ULSAM) and 0.60 to 0.66 (PIVUS) by addition of NT-proBNP (p<0.001).

    CONCLUSIONS: Using a multimarker approach NT-proBNP was the strongest predictor of incident AF in two cohorts, and improved risk prediction when added to traditional risk factors. NT-proBNP significantly improved the predictive ability of the novel CHARGE-AF risk score, although the predictive value remained modest.

  • 329. Svensson, A-M
    et al.
    Dellborg, M
    Abrahamsson, P
    Karlsson, T
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap. [external].
    Duval, SJ
    Berger, AK
    Luepker, RV
    The influence of a history of diabetes on treatment and outcome in acute myocardial infarction, during two time periods and in two different countries.2007Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 119, nr 3, s. 319-325Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIMS: The aim of this study was to investigate the influence of diabetes on treatment and outcome in acute myocardial infarction (AMI), during two time periods, in two countries, and to assess whether this influence has changed over the past decades. METHODS: Patients, aged 30 to 74, with a diagnosis of AMI in two urban areas--Göteborg, Sweden and Minneapolis-St. Paul, Minnesota, USA--hospitalized during 1990-1991 and 1995-1996 were included. The primary endpoint was 7-year all-cause mortality. RESULTS: The study included 3824 patients, 734 (19%) had diabetes. Age-adjusted in-hospital mortality of diabetic patients was nearly twofold higher compared with non-diabetic patients (9.8% vs. 5.0%, p<0.05). Between 1990-1991 and 1995-1996 in-hospital mortality declined for both diabetic (11.9% vs. 7.6%, p=0.07) and non-diabetic (6.3% vs. 3.6%, p=0.002) patients. A history of diabetes was associated with nearly twofold higher long-term mortality rate (48.5% vs. 26%, p<0.05). Seven-year mortality was reduced between 1990-1991 and 1995-1996 in both diabetic (51.6% vs. 45.2%, p=0.13) and non-diabetic patients (29.3% vs. 22.1%, p<0.0001) (The results did not reach statistical significance for diabetic patients, due to smaller sample size.) During their hospital stay, diabetic patients received significantly less aspirin, beta-blockers and thrombolysis. After adjustment, a history of diabetes remained significantly associated with 7-year mortality following AMI, doubling the hazard of death (hazard ratio (HR)=2.11; 95% confidence interval (CI): 1.80-2.46). CONCLUSION: A history of diabetes is associated with nearly twofold higher long-term mortality rate and is independently associated with 7-year mortality following AMI. Short- and long-term mortality decreased from 1990 to 1995 in both non-diabetic and diabetic patients. Underutilization of evidence-based treatments contributes to the remaining increased mortality in diabetic patients with acute coronary disease.

  • 330. Svensson, L
    et al.
    Axelsson, C
    [external].
    Nordlander, R
    Herlitz, Johan
    [external].
    Prehospital identification of acute coronary syndrome/myocardial infarction in relation to ST elevation2005Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 98, nr 2, s. 237-244Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: To evaluate factors that identify patients with an acute coronary syndrome/myocardial infarction prior to hospital admission among patients with a suspected acute coronary syndrome who were transported by ambulance with and without ST elevation on the ambulance electrocardiogram (ECG). METHODS: This was a prospective observational study in the part of Stockholm that is served by South Hospital ambulance organisation and the Municipality of Goteborg. All the patients who called for an ambulance due to acute chest pain or other symptoms raising the suspicion of an acute coronary syndrome took part. Immediately after the arrival of the ambulance, a blood sample was drawn for the analysis of serum myoglobin, creatine kinase (CK) MB and troponin I. A 12-lead ECG was simultaneously recorded. Further factors that were taken into consideration were age, gender, history of cardiovascular disease, symptoms and clinical findings. RESULTS: In patients with ST elevation in prehospital ECG, the likelihood of an acute myocardial infarction increased if there were simultaneous ST depression in other leads (OR 3.94, 95% CL 1.26-12.38). For patients without an ST elevation, the likelihood of an acute myocardial infarction increased if there were: elevation of any biochemical marker OR 2.96, 95% CL 1.32-6.64; ST depression (OR 2.54, 95% CL 1.43-4.51), T-inversion (OR 2.22, 95% CL 1.10-4.48), male gender (OR 2.21, 95% CL 1.24-3.93) and increasing age (OR 1.04, 95% CL 1.01-1.06). CONCLUSION: Among patients with a suspected acute coronary syndrome, factors that increased the likelihood for an ongoing acute myocardial infarction could already be defined prior to hospital admission. For those with an ST elevation, factors were found in ECG pattern. For those without an ST elevation, such factors were found in elevation of biochemical markers, admission ECG, male gender and increasing age.

  • 331. Svensson, L
    et al.
    Karlsson, T
    Nordlander, R
    Wahlin, M
    Zedigh, C
    Herlitz, Johan
    [external].
    Implementation of prehospital thrombolysis in Sweden. Components of delay until delivery of treatment and examination of treatment feasibility2003Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 88, nr 2-3, s. 247-256Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To evaluate the feasibility of prehospital thrombolysis in Sweden in terms of safety and to examine the various components of the delay between onset of symptoms and start of treatment. SETTING: A total of 16 hospitals in Sweden in both urban and less populated areas and the associated ambulance organisations. DESIGN: Prospective evaluation of patients with an ST-elevation infarction treated with reteplase. An ECG was recorded and transmitted to hospital. The ambulances were staffed by a physician in 1% of cases, a nurse in 67% and a staff nurse in 32%. RESULTS: Of the 148 patients who received treatment prior to hospital admission, six (4%) had a cardiac arrest prior to hospital admission and two (1%) died prior to arrival at hospital. One patient was given treatment despite an exclusion criterion (previous stroke) and died on the 1st day in hospital due to a cerebral haemorrhage. The overall 30-day mortality was 7.1% and 1-year mortality 9.8%. Treatment was initiated within 2 h after the onset of symptoms in 53% of patients and within 1 h in 17% of patients. The median interval between the arrival of the ambulance and sending an ECG was 13 min and the median interval between sending an ECG and the start of thrombolysis was 18 min. The delay was similar regardless of ambulance staff. CONCLUSION: Implementation of prehospital thrombolysis on a national basis in Sweden appears to be safe. More than half the patients can be given treatment less than 2 h after the onset of symptoms. There is potential for reducing this time still further.

  • 332. Svensson, L
    et al.
    Nordlander, E
    Axelsson, C
    [external].
    Herlitz, Johan
    [external].
    Are predictors for myocardial infarction the same for women and men when evaluated prior to hospital admission?2006Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 109, nr 2, s. 241-247Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: To describe predictors of myocardial infarction prior to hospital admission in women and men among patients with a suspected acute coronary syndrome without ST-elevation. DESIGN: Prospective observational study in Stockholm and Göteborg, Sweden. RESULTS: Of 433 patients who did fulfill the inclusion criteria 45% were women. Fewer women (17%) than men (26%) developed acute myocardial infarction (AMI) (p=0.054), particularly among patients with initial ST-depression, in whom AMI was developed in 22% of women and 54% of men (p = 0.001). Predictors for infarct development in women were: a history of AMI and advanced age. Among men they were: initial ST-depression or a Q-wave on ECG and elevation of biochemical markers (both recorded on admission of the ambulance crew). There was a significant interaction between gender and the influence of ST-depression on the risk for development of myocardial infarction (p < 0.05). CONCLUSION: Among patients transported with ambulance due to a suspected acute coronary syndrome and no ST-elevation fewer women than men seem to develop AMI particularly among patients with ST-depression. These results suggest that early prediction of myocardial infarction might differ between women and men with acute chest pain.

  • 333.
    Svensson, S.
    et al.
    Department of Clinical Pharmacology, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden.
    Kjellgren, K.I.
    Ahlner, Johan
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Klinisk farmakologi.
    Saljo, R.
    Säljö, R., Department of Education, Göteborg University, Box 300, SE-405 30 Gothenburg, Sweden.
    Reasons for adherence with antihypertensive medication2000Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 76, nr 2-3, s. 157-163Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Hypertension is often insufficiently controlled in clinical practice, a prominent reason for this being poor patient adherence with therapy. Little is known about the underlying reasons for poor adherence. We set out to investigate hypertensive patients' self-reported reasons for adhering to or ignoring medical advice regarding antihypertensive medication. Methods: Qualitative analysis of semi-structured interviews with 33 hypertensive patients in a general-practice centre and a specialist hypertension unit in Southern Sweden. Blood-pressure measurements and laboratory measurements of antihypertensive medication were performed. Results: Nineteen out of 33 patients were classified as adherent. Adherence was a function of faith in the physician, fear of complications of hypertension, and a desire to control blood pressure. Non-adherence was an active decision, partly based on misunderstandings of the condition and general disapproval of medication, but mostly taken in order to facilitate daily life or minimize adverse effects. Adherent patients gave less evidence of involvement in care than non-adherent patients. There was no obvious relation between reported adherence, laboratory markers of adherence and blood-pressure levels. Conclusions: The interview is a powerful tool for ascertaining patients' concepts and behaviour. To optimize treatment of hypertension, it is important to form a therapeutic alliance in which patients' doubts and difficulties with therapy can be detected and addressed. For this, effective patient-physician communication is of vital importance. Copyright (C) 2000 Elsevier Science Ireland Ltd.

  • 334.
    Svensson, Staffan
    et al.
    Sahlgrenska Academy at Göteborg University, Sweden.
    Linell, Per
    Linköpings universitet, Institutionen för kultur och kommunikation. Linköpings universitet, Filosofiska fakulteten.
    Kjellgren, Karin I.
    Sahlgrenska Academy at Göteborg University, Sweden.
    Making sense of blood pressure values in follow-up appointments for hypertension2008Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 123, nr 2, s. 108-116Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND:

    Although there are effective ways of treating hypertension, only a minority of all hypertensive people reach target blood pressure levels. This may be a function of how patients and physicians put measured values into context when they decide if the blood pressure is well controlled or too high.

    METHODOLOGY:

    Qualitative analysis of audio-taped follow-up appointments for hypertension between 51 outpatients and their 11 physicians. All patients came for routine follow-up appointments for hypertension. The setting was primary and a specialist outpatient care in the south of Sweden.

    PRINCIPAL FINDINGS:

    Borderline blood pressure values led to more deliberation. Common ways of contextualising the blood pressure were by comparing it to previous values and by explaining it in terms of stress or lack of rest. The net effect of this was that the representativity and severity of the measured blood pressure value were downplayed by both patients and physicians. In some instances, physicians (but not patients) worked in the opposite direction. Patients were less actively engaged in interpreting the blood pressure values, stated their views about therapy less often, and were careful not to express views that were overly critical of the drug treatment.

    CONCLUSIONS:

    Patients and physicians make sense of the blood pressure through a contextualisation process which tends to normalise the face values towards the reference values. The resulting (processed) value is the one acted upon. Discursive handling of the blood pressure therefore makes up an important part of the decision-making.

  • 335. Szummer, Karolina
    et al.
    Lindahl, Bertil
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Sylvén, Christer
    Jernberg, Tomas
    Relationship of plasma erythropoietin to long-term outcome in acute coronary syndrome2010Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 143, nr 2, s. 165-170Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Erythropoietin has been related to adverse prognosis in patients with heart failure, but it is unknown whether it adds prognostic information in acute coronary syndrome. METHODS: Plasma erythropoietin was measured on admission with enzyme-linked immunosorbent assay in 627 patients. Patients were divided into three groups depending on their erythropoietin level and followed for myocardial infarction (MI) (median 6 months) and mortality (median 39 months). Cox regression models were used to evaluate erythropoietin compared to clinical variables; age, gender, diabetes, smoking, prior MI, heart failure, hypertension and revascularization. In a second Cox regression model, laboratory markers were assessed; hemoglobin, estimated glomerular filtration rate (eGFR), C-reactive protein (CRP), cardiac troponin T (cTnT) and N-terminal pro-brain-natriuretic peptide (NT-proBNP). RESULTS: Patients with the highest erythropoietin level (>8.8 mU/mL, n=205) had a 47% increased mortality (HR 1.47, 95% CI 1.04-2.06, p=0.028) when adjusted for clinical variables. Compared to laboratory risk markers, erythropoietin added prognostic information (HR 1.59, 95% CI 1.05-2.38, p=0.027) when adjusted for hemoglobin, eGFR and CRP. Erythropoietin (HR 1.21, 95% CI 0.79-1.86, p=0.387) was no longer significantly associated with mortality when cTnT and NT-proBNP were added. Erythropoietin was not related to the risk of future MI (HR 1.24, 95% CI 0.65-2.33, p=0.513). CONCLUSION: Elevated erythropoietin level was associated with increased mortality in patients admitted with possible ACS when adjusted for clinical variables, or for kidney function and hemoglobin. However, erythropoietin does not add prognostic information when markers of myocardial necrosis and dysfunction are available in ACS.

  • 336.
    Teng, Tiew-Hwa Katherine
    et al.
    Natl Heart Ctr Singapore, Singapore; Univ Western Australia, Australia.
    Tay, Wan Ting
    Natl Heart Ctr Singapore, Singapore.
    Dahlström, Ulf
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Benson, Lina
    Karolinska Inst, Sweden.
    Lam, Carolyn S. P.
    Natl Heart Ctr Singapore, Singapore; Duke Natl Univ Singapore, Singapore.
    Lund, Lars H.
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Different relationships between pulse pressure and mortality in heart failure with reduced, mid-range and preserved ejection fraction2018Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 254, s. 203-209Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives/Background: In heart failure (HF), pulse pressure (PP) may reflect both vascular stiffness and left ventricular function, but its prognostic role in relation to ejection fraction (EF) is poorly understood. Methods: In the Swedish Heart Failure Registry, we investigated the association between PP and 1-year mortality in patients with HF and reduced (HFrEF, amp;lt;40%), mid-range (HFmrEF, 40-49%) and preserved EF (HFpEF, amp;gt;= 50%), using multivariable logistic regression and restricted cubic splines. Results: Among 36,770 patients discharged alive or enrolled as out-patients with 1-year follow-up (mean age 74 +/- 12 years, 63% men, 56% HFrEF, 21% HFmrEF, 23% HFpEF), crude one-year mortality was 18%. Mean PP increased across EF groups: 51 +/- 16 in HFrEF, 57 +/- 18 in HFmrEF, 60 +/- 19 mm Hg in HFpEF. In crude regression splines, the association between PP and mortality was U-shaped in HFmrEF and HFpEF, but curvilinear with only low PP associated with mortality in HFrEF. In multivariable analyses, a significant interaction by EF group and PP was observed (p(interaction) = 0.015): low PP was associated with higher mortality in HFrEF (adjusted OR [1st vs. 4th quintile] = 1.40, 95% CI 1.18-1.67) and HFpEF (1.43, 1.14-1.81) but only by trend in HFmrEF; high PP had a trend towards higher mortality in HFmrEF (5th vs. 3rd quintile = 1.30, 1.00-1.69) and HFpEF (1.25, 0.98-1.61). Conclusions: The association between PP and mortality in HF was influenced by EF. Low PP was independently associated with mortality in HFrEF and HFpEF and by trend in HFmrEF. High PP was independently associated with mortality by trend in HFmrEF and HFpEF. (C) 2017 Elsevier B.V. All rights reserved.

  • 337. Thang, ND
    et al.
    Karlsson, BW
    Bergman, B
    Santos, M
    Karlsson, T
    Benttson, A
    Johanson, P
    Rawshani, A
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Patients admitted to hospital with chest pain-changes in a 20 year perspective.2013Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 166, nr 1, s. 141-146Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: To describe the differences in characteristics and outcome between two consecutive series of patients admitted to hospital with chest pain in a 20-year perspective. Particular emphasis is placed on changes in outcome in relation to the initial electrocardiogram (ECG). SUBJECTS: In the two periods, 1986-1987 and 2008, all patients with chest pain admitted to the study hospitals in Gothenburg, Sweden, were included. RESULTS: Five thousand and sixteen patients were registered in a period of 21 months in 1986-1987 and 2287 patients were registered during 3 months in 2008. In a comparison of the two time periods, the age of chest pain patients was not significantly different (mean age 60.1 ± 17.8 years in 1986-1987 and 59.8 ± 19.1 years in 2008, p=0.50). There was a lower prevalence of previous angina pectoris, congestive heart failure and current smoking in the second period, whereas a history of acute myocardial infarction, hypertension and diabetes mellitus had become more prevalent. The use of cardio-protective drugs increased and ECG changes indicating acute myocardial ischemia on admission to hospital decreased. Length of hospitalisation was reduced from a median of 5 days to 3 days (p<0.0001). A significant decrease in 30-day and 1-year mortality was found (3.8% in 1986-1987 vs 2.0% in 2008 and 9.9% vs 6.3% respectively, p<0.0001 for both comparisons). CONCLUSIONS: During a period of 20 years, the characteristics and outcome of patients admitted to hospital with chest pain changed. The most important changes were a lower prevalence of ECG signs indicating acute myocardial ischemia on admission, shorter hospitalisation time and a lower 30-day and 1-year mortality.

  • 338.
    Thang, Nguyen Dang
    et al.
    Göteborgs Universitet.
    Karlson, Björn Wilgot
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Karlsson, Thomas
    Herlitz, Johan
    Pre-hospital prediction of death or cardiovascular complications during hospitalisation and death within one year in suspected acute coronary syndrome patients.2015Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 185, s. 308-312Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: To identify pre-hospital predictors of a) death or the development of cardiovascular complications during hospitalisation (primary objective) and b) all-cause death during one year of follow-up (secondary objective), in chest pain patients with suspected acute coronary syndrome (ACS).

    METHODS: A prospective study that comprised patients in western Sweden, who were transported to hospital by the emergency medical service (EMS) due to chest pain and suspected ACS. Multiple logistic regression was used to identify independent predictors of adverse outcomes.

    RESULTS: Among all 1600 eligible patients, 21% died or had a cardiovascular complication during hospitalisation and 10% died during one year of follow-up. Nine factors were identified pre-hospitalisation as independent predictors of death or cardiovascular complications during hospitalisation. They were increasing age, a history of congestive heart failure, nausea and/or vomiting, rapid breathing rate, low oxygen saturation, high heart rate, together with ST-segment elevation, ST-segment depression and right bundle branch block on the pre-hospital electrocardiogram (ECG). For the secondary objective of death during one year of follow-up, the following five factors were identified as independent predictors: increasing age, a history of congestive heart failure, dyspnea, low oxygen saturation and left bundle branch block on the pre-hospital ECG.

    CONCLUSIONS: In the pre-hospital setting of chest pain and suspected ACS, we identified nine predictors of the primary adverse outcome. They were factors representing previous history, symptoms and ECG findings. This information may contribute to the development of a decision support system for the EMS, which then needs to be clinically tested.

  • 339.
    Thilen, Maria
    et al.
    Department of Medicine, Halmstad Hospital, Sweden.
    Christersson, Christina
    Department of Medical Sciences, Cardiology, Uppsala University, Sweden.
    Dellborg, Mikael
    Department of Medicine, Sahlgrenska University Hospital/Östra, Inst of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Mattsson, Eva
    Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
    Trzebiatowska-Krzynska, Aleksandra
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Thilen, Ulf
    Department of Cardiology, Skåne University Hospital, Lund University, Sweden.
    Catheter closure of atrial septal defect in the elderly (≥ 65 years). A worthwhile procedure2016Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 218, s. 25-30Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Secundum atrial septal defect (ASD2) is one of the most common cardiac malformations diagnosed in adult life. Catheter closure has made treatment possible even in patients of high age. However, published outcome data for elderly patients is limited. The aim of this study was to report, on a national basis, the long-term outcome of ASD2 catheter closure in the elderly. Material and results: We report the clinical and echocardiographic outcome of catheter closure of ASD2 in 148 patients aged 65-87 years. Data was obtained from a national registry, medical records and a questionnaire. The proportion of patients in NYHAI increased from 34% to 61% (p amp;lt; 0.001) one year after closure and remained stable at the latest follow-up 4,4 (SD 2,6) years post-closure. The proportion of patients with moderate/severe enlargement of the right ventricle and atrium fell from 77% and 76% to 25% and 40%, respectively, (p amp;lt; 0.001) and right ventricular systolic pressure dropped significantly. Improvement of NYHA class was associated with reduced right ventricular systolic pressure but not with remodelling of the right heart. NYHA deteriorated in 9 patients, despite reduced right ventricular size. Overall, the prevalence of atrial fibrillation was unchanged after closure. Major complication rate was 2% and there was no procedure-or device-related mortality. Conclusion: Catheter closure of ASD2 in the elderly is a worthwhile procedure since it improves symptoms and has a low complication rate. However, a subset of patients do not improve, in which we suggest that concealed left ventricular dysfunction may play a causative role. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

  • 340.
    Thilén, Maria
    et al.
    Halmstad Cty Hosp, Dept Med, Halmstad, Sweden..
    Christersson, Christina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Koagulation och inflammationsvetenskap. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Dellborg, Mikael
    Sahlgrens Univ Hosp, Dept Med, Ostra, Sweden.;Gothenburg Univ, Sahlgrenska Acad, Inst Med, S-41124 Gothenburg, Sweden..
    Mattsson, Eva
    Karolinska Univ Hosp, Dept Cardiol, Stockholm, Sweden..
    Trzebiatowska-Krzynska, Aleksandra
    Linkoping Univ Hosp, Dept Cardiol, Linkoping, Sweden..
    Thilén, Ulf
    Lund Univ, Skane Univ Hosp, Dept Cardiol, S-22100 Lund, Sweden..
    Catheter closure of atrial septal defect in the elderly (>= 65 years): A worthwhile procedure2016Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 218, s. 25-30Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Secundum atrial septal defect (ASD2) is one of the most common cardiac malformations diagnosed in adult life. Catheter closure has made treatment possible even in patients of high age. However, published outcome data for elderly patients is limited. The aim of this study was to report, on a national basis, the long-term outcome of ASD2 catheter closure in the elderly. Material and results: We report the clinical and echocardiographic outcome of catheter closure of ASD2 in 148 patients aged 65-87 years. Data was obtained from a national registry, medical records and a questionnaire. The proportion of patients in NYHAI increased from 34% to 61% (p < 0.001) one year after closure and remained stable at the latest follow-up 4,4 (SD 2,6) years post-closure. The proportion of patients with moderate/severe enlargement of the right ventricle and atrium fell from 77% and 76% to 25% and 40%, respectively, (p < 0.001) and right ventricular systolic pressure dropped significantly. Improvement of NYHA class was associated with reduced right ventricular systolic pressure but not with remodelling of the right heart. NYHA deteriorated in 9 patients, despite reduced right ventricular size. Overall, the prevalence of atrial fibrillation was unchanged after closure. Major complication rate was 2% and there was no procedure-or device-related mortality. Conclusion: Catheter closure of ASD2 in the elderly is a worthwhile procedure since it improves symptoms and has a low complication rate. However, a subset of patients do not improve, in which we suggest that concealed left ventricular dysfunction may play a causative role.

  • 341.
    Thorvaldsen, Tonje
    et al.
    Karolinska Institutet, Stockholm; Karolinska University Hospital, Stockholm, Sweden.
    Benson, Lina
    Karolinska Institutet, Stockholm, Sweden.
    Hagerman, Inger
    Karolinska University Hospital, Stockholm, Sweden.
    Dahlström, Ulf
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Edner, Magnus
    Karolinska Institutet, Stockholm, Sweden.
    Lund, Lars H.
    Karolinska Institutet, Stockholm; Karolinska University Hospital, Stockholm, Sweden.
    Planned repetitive use of levosimendan for heart failure in cardiology and internal medicine in Sweden2014Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 175, nr 1, s. 55-61Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND/OBJECTIVES: Levosimendan is used in acute heart failure (HF) and increasingly as planned repetitive infusions in stable chronic HF, but the extent of this practice is unknown. The aim was to assess the use of levosimendan vs. conventional inotropes and the use as planned repetitive vs. acute treatment, in Sweden.

    METHODS: We performed a descriptive study with individual patient validation assessing the use of levosimendan and conventional intravenous inotropes, indications for levosimendan, clinical characteristics and survival in the Swedish Heart Failure Registry between 2000 and 2011. For repetitive levosimendan, we assessed potential indications for alternative interventions.

    RESULTS: Of 53,548 total registrations, there were 655 confirmed with inotrope use (597 levosimendan, 37 conventional, 21 both) from 22 hospitals responding to validation, and 6069 in-patient controls with New York Heart Association III-IV and ejection fraction <40%. The indications for levosimendan were acute HF in 384 registrations (306 patients), and planned repetitive in 234 registrations (87 patients). Planned repetitive as a proportion of total levosimendan registrations ranged 0-65% and of total levosimendan patients ranged 0-54% in different hospitals. Of planned repetitive patients without existing cardiac resynchronization therapy, implantable cardioverter defibrillator, transplant and/or assist device, 46-98% were potential candidates for such interventions.

    CONCLUSION: In HF in cardiology and internal medicine in Sweden, levosimendan was the overwhelming inotrope of choice, and the use of planned repetitive levosimendan was extensive, highly variable between hospitals and may have pre-empted other interventions. Potential effects of and indications for planned repetitive levosimendan need to be evaluated in prospective studies.

  • 342.
    Tikkanen, Matti J.
    et al.
    University of Helsinki, Finland .
    Fayyad, Rana
    Pfizer Inc, NY USA .
    Faergeman, Ole
    Arhus University Hospital, Denmark .
    Olsson, Anders
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Endokrinmedicinska enheten.
    Wun, Chuan-Chuan
    Pfizer Inc, NY USA .
    Laskey, Rachel
    Pfizer Inc, NY USA .
    Kastelein, John J.
    University of Amsterdam, Netherlands .
    Holme, Ingar
    Oslo University Hospital, Norway .
    Pedersen, Terje R.
    University of Oslo, Norway .
    Effect of intensive lipid lowering with atorvastatin on cardiovascular outcomes in coronary heart disease patients with mild-to-moderate baseline elevations in alanine aminotransferase levels2013Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 168, nr 4, s. 3846-3852Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Statins may reduce cardiovascular (CV) morbidity in patients with mild-to-moderate elevations in liver enzyme levels. This post-hoc analysis of the IDEAL study compared intensive versus moderate statin therapy for the prevention of CV events in coronary heart disease patients with normal and elevated baseline levels of serum alanine aminotransferase (ALT). less thanbrgreater than less thanbrgreater thanMethods: Cox regression analysis was used to investigate the effect of atorvastatin 80 mg/day versus simvastatin 20-40 mg/day on the risk of IDEAL study end points in patients with normal baseline ALT (defined as ALT andlt; ULN [upper limit of normal]) versus elevated baseline ALT (ALT andgt;= ULN). less thanbrgreater than less thanbrgreater thanResults: Of 8863 IDEAL patients with non-missing baseline ALT values, 7782 (87.8%) had an ALT andlt; ULN and 1081 (12.2%) had an ALT andgt;= ULN. In patients with elevated baseline ALT, major CV event rates were 11.5% for simvastatin and 6.5% for atorvastatin, indicating a significant risk reduction with intensive statin therapy (hazard ratio, 0.556; 95% confidence interval, 0.367-0.842; p = 0.0056). Significant heterogeneity of treatment effect was observed for major CV events, cerebrovascular events, and major coronary events, with a trend towards treatment difference for the other outcomes, indicating a greater benefit with atorvastatin in the elevated ALT group. less thanbrgreater than less thanbrgreater thanConclusions: The CV benefit of intensive lipid lowering with atorvastatin compared with a more moderate regimen with simvastatin was generally greater in patients with mildly-to-moderately elevated baseline ALT than patients with normal baseline ALT. Moderate elevations in liver enzyme levels should not present a barrier to prescribing statins, even at higher doses, in high-risk patients.

  • 343.
    Toss, Fredrik
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Nordström, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Nordström, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Association between hematocrit in late adolescence and subsequent myocardial infarction in Swedish men2013Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 168, nr 4, s. 3588-3593Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Hematocrit is an independent predictor of cardiovascular risk in middle and old age, but whether hematocrit is also a predictor at younger ages is presently not known. In this study, we examined whether hematocrit measured in adolescence was associated with the risk of myocardial infarction later in life. METHODS: During Swedish national conscription tests conducted between 1969 and 1978, the hematocrit was measured in 417,099 young Swedish men. The cohort was followed for subsequent myocardial infarction events through December 2010. Associations between hematocrit and myocardial infarction were accessed using Cox regression models. RESULTS: During a median follow-up period of 36years, 9322 first-time myocardial infarctions occurred within the study cohort. After adjusting for relevant confounders and potential risk factors for myocardial infarction, men with a hematocrit≥49% had a 1.4-fold increased risk of myocardial infarction compared with men with a hematocrit≤44%. This relationship was dose dependent (p<0.001 for trend) and remained consistent throughout the follow-up period. CONCLUSIONS: In this cohort of young Swedish men, hematocrit was associated with the risk of myocardial infarction later in life after controlling for other coronary risk factors. The study findings indicate that hematocrit may aid future risk assessments in young individuals.

  • 344. van der Wal, Martje H L
    et al.
    Jaarsma, Tiny
    Adherence in heart failure in the elderly: problem and possible solutions.2008Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 125, nr 2, s. 203-8Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: As a result of the improvement of pharmacological and non-pharmacological treatment of heart failure patients, the heart failure regimen is becoming more complicated, especially for elderly patients with co-morbid diseases. Non-adherence to this regimen is a problem in many heart failure patients, leading to worsening symptoms, rehospitalization and decreased quality of life. AIM: This paper gives an overview of literature on adherence to pharmacological and non-pharmacological treatment in elderly heart failure patients. The paper addresses the definition of adherence and the extent and significance of the problem of non-adherence in elderly heart failure patients. Factors contributing to non-adherence, focused on the elderly are outlined and finally interventions to improve adherence in this elderly heart failure patient group are described. CONCLUSION: Non-adherence to medication and lifestyle recommendations is a major problem in elderly heart failure patients. Five dimensions that affect adherence are described consisting of social and economic factors, factors related to the health care system, to the condition of the patient, the therapy and factors related to the patient. Since non-adherences is a multidimensional problem, interventions need to be directed to all factors that are related to adherence in elderly heart failure patients. A multidisciplinary approach in a heart failure team is crucial to improve adherence in this vulnerable patient group. Effectiveness of interventions to improve adherence in elderly heart failure patients needs to be further tested.

  • 345. van Diepen, Sean
    et al.
    Newby, L. Kristin
    Lopes, Renato D.
    Stebbins, Amanda
    Hasselblad, Vic
    James, Stefan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi.
    Roe, Matthew T.
    Ezekowitz, Justin A.
    Moliterno, David J.
    Neumann, Franz-Josef
    Reist, Craig
    Mahaffey, Kenneth W.
    Hochman, Judith S.
    Hamm, Christian W.
    Armstrong, Paul W.
    Granger, Christopher B.
    Theroux, Pierre
    Prognostic relevance of baseline pro- and anti-inflammatory markers in STEMI: An APEX AMI substudy2013Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 168, nr 3, s. 2127-2133Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Plaque rupture, acute ischemia, and necrosis in acute coronary syndromes are accompanied by concurrent pro-and anti-inflammatory cascades. Whether STEMI clinical prediction models can be improved with the addition of baseline inflammatory biomarkers remains unknown. Methods: In an APEX-AMI trial substudy, 772 patients had a panel of 9 inflammatory serum biomarkers, high sensitivity C reactive protein (hsCRP), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) measured at baseline after randomization. Baseline biomarkers were incorporated into a clinical prediction model for a composite of 90-day death, shock, or heart failure. Incremental prognostic value was assessed using Net Reclassification Improvement (NRI) and Integrated Discrimination Improvement (IDI). Results: Individually, several biomarkers were independent predictors of clinical outcome: hsCRP (hazard ratio [HR] 1.12; 95% confidence interval [CI], 1.03-1.21; p=0.007, per doubling), NT-proBNP (HR 1.14; 95% CI, 1.06-1.23; p<0.001, per doubling), interleukin (IL)-6 (HR 1.26; 95% CI, 1.12-1.41; p<0.001, per doubling), and inducible protein-10 (IP-10) (HR 0.86; 95% CI, 0.76-0.98; p<0.025, per doubling). The addition of baseline NT-proBNP (NRI 8.6%, p=0.028; IDI 0.030, p<0.001) and IL-6 (NRI 8.8%, p=0.012; IDI 0.036, p<0.001) improved the clinical risk prediction model and the addition of hsCRP (NRI 6.5%, p=0.069; IDI 0.018, p=0.004) yielded minimal improvement. After incorporating NT-proBNP into the model, the remaining biomarkers added little additional predictive value. Conclusions: Multiple inflammatory biomarkers independently predicted 90-day death, shock or heart failure; however, they added little value to a clinical prediction model that included NT-proBNP. Future studies of inflammatory biomarkers in STEMI should report incremental value in a prediction model that includes NT-proBNP.

  • 346. Vazir, A
    et al.
    Hastings, P C
    Morrell, M J
    Pepper, J
    Henein, Michael Y
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Westaby, S
    Poole-Wilson, P A
    Cowie, M R
    Simonds, A K
    Resolution of central sleep apnoea following implantation of a left ventricular assist device.2010Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 4, nr 138, s. 317-319Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Central sleep apnoea (CSA) occurs in up to 40% of patients with chronic heart failure (CHF). It is thought to be a consequence of CHF and is associated with an accelerated decline in cardiac function, and increased morbidity and mortality. The optimal treatment of CSA remains unclear. Resolution of CSA has been reported after cardiac transplantation. We report the first case of resolution of CSA 10 months following implantation of a permanent Jarviktrade mark 2000 left ventricular assist device (LVAD). The correction of CSA after implantation of the LVAD was associated with improvements in symptoms, exercise capacity, renal function, and increased arterial carbon dioxide levels at rest during wakefulness and also reduction in brain natriuretic peptide.

  • 347.
    Vedin, Ola
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR). Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi.
    Hagström, Emil
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR). Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi.
    Östlund, Ollie
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Avezum, Alvaro
    Dante Pazzanese Inst Cardiol, Sao Paulo, Brazil..
    Budaj, Andrzej
    Grochowski Hosp, Postgrad Med Sch, Warsaw, Poland..
    Flather, Marcus D.
    Univ East Anglia, Norwich Med Sch, Norwich, Norfolk, England.;Norfolk & Norwich Univ Hosp, Norwich Med Sch, Norwich, Norfolk, England..
    Harrington, Robert A.
    Stanford Univ, Dept Med, Stanford, CA 94305 USA..
    Koenig, Wolfgang
    Univ Ulm, Dept Internal Med Cardiol 2, Med Ctr, Ulm, Germany.;Tech Univ Munich, Deutsch Herzzentrum Munchen, Munich, Germany.;DZHK German Ctr Cardiovascular Res, Partner Site Munich Heart Alliance, Munich, Germany..
    Soffer, Joseph
    GlaxoSmithKline, Metab Pathways & Cardiovasc Therapeut Area, King Of Prussia, PA USA..
    Siegbahn, Agneta
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Steg, Philippe Gabriel
    INSERM Unite 1148, Paris, France.;Dept Hosp Univ FIRE, Hop Bichat, AP HP, Paris, France.;Univ Paris Diderot, Sorbonne Paris Cite, Paris, France.;NHLI Imperial Coll, Royal Brompton Hosp, ICMS, London, England..
    Stewart, Ralph A. H.
    Univ Auckland, Auckland City Hosp, Green Lane Cardiovasc Serv, Auckland, New Zealand..
    Wallentin, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    White, Harvey D.
    Held, Claes
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR). Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi.
    Associations between tooth loss and prognostic biomarkers and the risk for cardiovascular events in patients with stable coronary heart disease2017Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 245, s. 271-276Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background:

    Underlying mechanisms behind the hypothesized relationship between periodontal disease (PD) and coronary heart disease (CHD) have been insufficiently explored. We evaluated associations between self-reported tooth loss-a marker of PD- and prognostic biomarkers in 15,456 (97%) patients with stable CHD in the global STABILITY trial.

    Methods and results:

    Baseline blood samples were obtained and patients reported their number of teeth according to the following tooth loss levels: "26-32 (All)" [lowest level], "20-25", "15-19", "1-14", and "No Teeth" [highest level]. Linear and Cox regression models assessed associations between tooth loss levels and biomarker levels, and the relationship between tooth loss levels and outcomes, respectively.

    After multivariable adjustment, the relative biomarker increase between the highest and the lowest tooth loss level was: high-sensitivity C-reactive protein 1.21 (95% confidence interval, 1.14-1.29), interleukin 6 1.14 (1.10-1.18), lipoprotein-associated phospholipase A(2) activity 1.05 (1.03-1.06), growth differentiation factor 15 1.11 (1.08-1.14), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) 1.18 (1.11-1.25). No association was detected for high-sensitivity troponin T 1.02 (0.98-1.05). Some attenuation of the relationship between tooth loss and outcomes resulted from the addition of biomarkers to the multivariable analysis, of which NT-proBNP had the biggest impact.

    Conclusions:

    A graded and independent association between tooth loss and several prognostic biomarkers was observed, suggesting that tooth loss and its underlying mechanisms may be involved in multiple pathophysiological pathways also implicated in the development and prognosis of CHD. The association between tooth loss and cardiovascular death and stroke persisted despite comprehensive adjustment including prognostic biomarkers.

  • 348.
    Virtanen, Marianna
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Folkhälsovetenskap.
    Vahtera, Jussi
    Department of Public Health, University of Turku, Turku University Hospital, Turku, Finland.
    Singh-Manoux, Archana
    French National Institute for Health & Medical Research, Inserm, U1018, Villejuif, France.
    Elovainio, Marko
    Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland.
    Ferrie, Jane
    Department of Epidemiology and Public Health, University College London, London, UK.
    Kivimäki, Mika
    Department of Epidemiology and Public Health, University College London, London, UK.
    Unfavorable and favorable changes in modifiable risk factors and incidence of coronary heart disease: The Whitehall II cohort study2018Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 269, s. 7-12Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Few studies have examined long-term associations of unfavorable and favorable changes in vascular risk factors with incident coronary heart disease (CHD). We examined this issue in a middle-aged disease-free population.

    Methods

    We used repeat data from the Whitehall II cohort study. Five biomedical, behavioral and psychosocial examinations of 8335 participants without CHD produced up to 20,357 person-observations to mimic a non-randomized pseudo-trial. After measurement of potential change in 6 risk factors twice (total cholesterol, blood pressure, smoking, overweight, psychological distress, problems in social relationships), a 5-year follow-up of CHD was undertaken.

    Results

    Incidence of CHD was 7.4/1000 person-years. Increases from normal to high cholesterol (hazard ratio, HR = 1.59, 95% CI 1.26–2.00) and from normal to high blood pressure (HR = 1.64, 95% CI 1.33–2.03), as compared to remaining at the normal level, were associated with increased risk of CHD. In contrast, decreases from high to low levels of cholesterol (HR = 0.73, 95% CI 0.58–0.91), psychological distress (HR = 0.68, 95% CI 0.51–0.90), and problems in social relationships (HR = 0.65, 95% CI 0.50–0.85), and quitting smoking (HR = 0.49, 95% CI 0.29–0.82) were associated with a reduced CHD risk compared to remaining at high risk factor levels. The highest absolute risk was associated with persistent exposure to both high cholesterol and hypertension (incidence 18.1/1000 person-years) and smoking and overweight (incidence 17.7/1000 person-years).

    Conclusions

    While persistent exposures and changes in biological and behavioral risk factors relate to the greatest increases and reductions in 5-year risk of CHD, also favorable changes in psychosocial risk factors appear to reduce CHD risk.

  • 349. Vorkas, Panagiotis A.
    et al.
    Isaac, Giorgis
    Holmgren, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Want, Elizabeth J.
    Shockcor, John P.
    Holmes, Elaine
    Henein, Michael Y.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Perturbations in fatty acid metabolism and apoptosis are manifested in calcific coronary artery disease: An exploratory lipidomic study2015Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 197, s. 192-199Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Controversy exists concerning the beneficial or harmful effects of the presence of ectopic calcification in the coronary arteries. Additionally, further elucidation of the exact pathophysiological mechanism is needed. In this study, we sought to identify metabolic markers of vascular calcification that could assist in understanding the disease, monitoring its progress and generating hypotheses describing its pathophysiology. Methods: Untargeted lipid profiling and complementary modeling strategies were employed to compare serum samples from patients with different levels of calcific coronary artery disease (CCAD) based on their calcium score (CS). Subsequently, patients were divided into three groups: no calcification (NC; CS = 0; n = 26), mild calcification (MC; CS: 1-250; n = 27) and severe (SC; CS > 250; n = 17). Results: Phosphatidylcholine levels were found to be significantly altered in the disease states (p = 0.001-0.04). Specifically, 18-carbon fatty acyl chain (FAC) phosphatidylcholines were detected in lower levels in the SC group, while 20:4 FAC lipid species were detected in higher concentrations. A statistical trend was observed with phosphatidylcholine lipids in the MC group, showing the same tendency as with the SC group. We also observed several sphingomyelin signals present at lower intensities in SC when compared with NC or MC groups (p = 0.000001-0.01). Conclusions: This is the first lipid profiling study reported in CCAD. Our data demonstrate dysregulations of phosphatidylcholine lipid species, which suggest perturbations in fatty acid elongation/desaturation. The altered levels of the 18-carbon and 20:4 FAC lipids may be indicative of disturbed inflammation homeostasis. The marked sphingomyelin dysregulation in SC is consistent with profound apoptosis as a potential mechanism of CCAD. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

  • 350.
    Wallentin, Lars
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Becker, Richard C.
    Cannon, Christopher P.
    Held, Claes
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Himmelmann, Anders
    Husted, Steen
    James, Stefan K.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Katus, Hugo A.
    Mahaffey, Kenneth M.
    Pieper, Karen S.
    Storey, Robert F.
    Steg, Philippe Gabriel
    Harrington, Robert A.
    No misrepresentation of vital status follow-up in PLATO : Predefined analyses guarantee the integrity of the benefits of ticagrelor over clopidogrel in the PLATO trial: Commentary on: DiNicolantonio JJ, Tomek A, Misrepresentation of vital status follow-up: Challenging the integrity of the PLATO trial and the claimed mortality benefit of ticagrelor versus clopidogrel, International Journal of Cardiology, 2013 Serebruany VL. Discrepancies in the primary PLATO trial publication and the FDA reviews, International Journal of Cardiology, 20142014Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 176, nr 1, s. 300-302Artikkel i tidsskrift (Fagfellevurdert)
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