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  • 101.
    El Marghani, Ahmed M.
    et al.
    Örebro University, School of Science and Technology.
    Abuabaid, Hanan M.
    Örebro University, School of Health and Medical Sciences.
    Hurtig-Wennlöf, Anita
    Örebro University, School of Health and Medical Sciences.
    Sirsjö, Allan
    Örebro University, School of Health and Medical Sciences.
    Norgren, Lars
    Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Kjellén, Peter
    Örebro University, School of Science and Technology.
    High MAPK p38 activity and low level of IL-10 in intermittent claudication as opposed to stable angina2010In: International Journal of Angiology, ISSN 0392-9590, E-ISSN 1827-1839, Vol. 29, no 4, p. 331-337Article in journal (Refereed)
    Abstract [en]

    AIM:

    The aim of the present pilot study was to relate the activity of MAPK p38 with the levels of pro- and anti-inflammatory cytokines in a small cohort of patients with either stable angina (N=5) or intermittent claudication (N=5) compared to healthy controls (N=10).

    METHODS:

    The activity of MAPK p38 was determined in peripheral blood mononuclear cells, isolated from whole blood by western blot using phospho-specific anti-MAPK p38 antibodies. Cytokine levels of 11 pro- and anti-inflammatory cytokines were determined from the serum using flow cytometry.

    RESULTS:

    We found a significant elevation of the MAPK p38 activity in the intermittent claudication group (P=0.0027) compared with the healthy control group whereas the stable angina group showed similar MAPK p38 activity as the healthy control group. The IL-10 level in serum found in the stable angina group was significantly higher compared with both the healthy control group (P=0.0116) and the intermittent claudication group (P=0.0317).

    CONCLUSION:

    Our results imply that there is a casual relationship between increased levels of the anti-inflammatory cytokines IL-10 and IL-4 and the activity of the MAPK p38. Possibly has IL-10 a protective role that down-regulates the activity of MAPK p38 and thereby further inflammatory processes in stable angina patients.

  • 102.
    Elfström, Peter
    et al.
    Örebro University, School of Health and Medical Sciences.
    Hamsten, Anders
    Montgomery, Scott M.
    Örebro University, School of Health and Medical Sciences.
    Ekbom, Anders
    Ludvigsson, Jonas F.
    Cardiomyopathy, pericarditis and myocarditis in a population-based cohort of inpatients with coeliac disease2007In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 262, no 5, p. 545-554Article in journal (Refereed)
    Abstract [en]

    Objectives: We investigated the risk of myocarditis, cardiomyopathy, and pericarditis in patients with celiac disease (CD) from a general population cohort.Subjects and methods: Through the Swedish national registers we identified 9363 children and 4969 adults with a diagnosis of CD (1964–2003). These individuals were matched with upto five reference individuals for age, sex, calendar year and county (n = 69 851). Cox regression estimated hazard ratios (HRs) for later heart disease. Main outcome measures: Myocarditis, cardiomyopathy (any or dilated), and pericarditis defined according torelevant international classification of disease codes in the Swedish national inpatient register.Results: Celiac disease diagnosed in childhood was not associated with later myocarditis (HR = 0.2; 95% CI = 0.0–1.5), cardiomyopathy of any type (HR = 0.8; 95% CI = 0.2–3.7), or pericarditis (HR = 0.4; 95% CI = 0.1–1.9). Restricting our analyses to adulthood CD and heart disease diagnosed from 1987 and onwards in departments of cardiology ⁄ internal medicine, we found no association between CD and later myocarditis (HR = 2.1; 95% CI = 0.4–11.7), dilated cardiomyopathy (HR = 1.7; 95% CI = 0.4– 6.5) or pericarditis (HR = 1.5; 95% CI = 0.5–4.0).Conclusion: This study found no association between CD, later myocarditis, cardiomyopathy or pericarditis

  • 103.
    Emilsson, Kent
    Department of Clinical Physiology, Karlskoga Hospital, Karlskoga, Sweden.
    Can the amplitude of mitral annulus motion be used in the assessment of left ventricular systolic function in patients with left ventricular wall thickness in the upper limit of normal to mild hypertrophy?2003In: Experimental and clinical cardiology, ISSN 1205-6626, Vol. 8, no 1, p. 29-30Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Mitral annulus motion (MAM) obtained by echocardiography can be used in the assessment of left ventricular systolic function (LVSF). However, it has been shown that the amplitude of MAM is decreased in patients with left ventricular wall thickness (LVWT) greater than 14 mm.

    OBJECTIVE: To study if the amplitude of MAM can be used in the assessment of LVSF in patients with LVWT in the upper limit of normal to mild hypertrophy (12 mm to 14 mm).

    METHODS: Eighteen consecutive patients with LVWT of 12 mm to 14 mm were compared to 18 age- and sex-matched patients with LVWT less than 12 mm.

    RESULTS: There was no significant difference between the amplitude of MAM in the two groups.

    CONCLUSIONS: MAM can be used in the assessment of LVSF in patients with LVWT in the upper limit of normal to mild hypertrophy and be related to reference values.

  • 104.
    Emilsson, Kent
    Linköpings universitet, Klinisk fysiologi.
    Mitral annulus motion in left ventricular pumping2001Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This thesis focus on the role of the mitral annulus motion (MAM) versus outer contour changes in the short axis, in left ventricular (LV) pumping. The influence of atrial contraction on LV dimensions and volumes and the relation between MAM and ejection fraction (EF) in sinus rhythm and in atrial fibrillation was also studied.

    Echocardiography was used in all studies and in the study about circumflex artery motion angiography was also used.

    In a study including 20 healthy adults the role of MAM, i.e. the systolic shortening of the left ventricle in the long axis, as the main mechanism of LV pumping was confirmed. There was also, however, a significant contribution to the stroke volume from an outer contour decrease in the short axis during systole. At the chordae tendineae level a cross sectional area decrease of 24% was measured. From calculations based on measures of the long axis shortening of the LV, the outer short axis diameter of the LV and calculated stroke volume, a mean systolic cross sectional area decrease of about 6% was found along the whole length of the ventricle. The higher cross-sectional area decrease at the chordae level is thougth to be caused by regional differences.

    In previous studies the relation between EF and MAM has been assumed to be linear, but in a meta-analysis of 434 patients it was shown that the relation is non-linear and that a linear regression model overestimates EF in the low range of MAM. It was shown that the relation between EF and MAM in adults is influenced by age but only in the normal range of EF or MAM and not in patients with decreased EF (EF <0.5 or MAM < 10mm). The relation was also shown to be influenced by the LV wall thickness.

    In 20 patients with atrial fibrillation the ratio EF/MAM was shown to be higher than in 20 age- and gender matched patients with sinus rhythm, due to a decrease in MAM, caused by the loss of atrial contraction.

    The relation between EF and MAM is thus complex and it therefore seems logical not to "translate" MAM to EF. MAM should be used as such related to reference values in the assessment of LV systolic function.

    In 13 patients who had atrial fibrillation the stroke volume was shown to increase after successful direct-current cardioversion due to an increase in long axis diastolic elongation of the LV and thereby increased diastolic volume, when atrial contraction was regained.

    In 28 patients the angiographic measure of circumflex artery motion amplitude tended to be higher than MAM in the higher range of amplitudes while the opposite was found in the lower range of amplitudes.

    In 13 patients with normal EF it was shown that the motion amplitude of a site epicardially at the most basal lateral part of the LV wall was significantly (P < 0.001) higher than endocardially, but in 13 patients with decreased EF (< 0.5) there was no significant difference between the two sites. The motion amplitude epicardially corresponds to the motion amplitude of the circumflex artery.

    In the 13 patients with normal EF the motion amplitude of the closed mitral valves was significantly lower than the motion amplitude epi- and endocardially during systole, with a rather conic shape of the atrioventricular plane at the onset of systole. In end-systole the different parts of the left atrioventricular plane, the epicardial part, the endocardial part (mitral annulus) and the valves were almost on the same level.

    List of papers
    1. The mode of left ventricular pumping: is there an outer contour change in addition to the atrioventricular plane displacement?
    Open this publication in new window or tab >>The mode of left ventricular pumping: is there an outer contour change in addition to the atrioventricular plane displacement?
    2001 (English)In: Clinical Physiology, ISSN 0144-5979, E-ISSN 1365-2281, Vol. 21, no 4, p. 437-446Article in journal (Refereed) Published
    Abstract [en]

    The outer contour of the heart has in some studies been shown to be constant during the heart cycle and the epicardial apex almost stationary whilst the base of the ventricles moves towards apex during systole. The base of the left ventricle has been regarded as a cylinder with constant cross-sectional area with changes in height during the heart cycle, the latter corresponding to the amplitude of mitral annulus motion (MAM). In this echocardiographic study, including 20 healthy adults, the stroke volume calculated by the cylinder model was significantly lower than by a reference method (modified Simpson's rule). MAM explained 82% of the stroke volume and 18% must, therefore, be explained by an inward motion of the outer left ventricular wall. A mean outer diameter shortening of about 3% (about 2 mm) was calculated.

    Keywords
    adolescent, adult, echocardiography, female, heart ventricles, humans, male, mitral valve, stroke volume
    National Category
    Physiology
    Research subject
    Physiology
    Identifiers
    urn:nbn:se:oru:diva-38874 (URN)10.1046/j.1365-2281.2001.00343.x (DOI)000169889400006 ()11442577 (PubMedID)2-s2.0-0034963922 (Scopus ID)
    Available from: 2014-11-20 Created: 2014-11-20 Last updated: 2018-01-11Bibliographically approved
    2. The relation between mitral annulus motion and ejection fraction changes with age and heart size.
    Open this publication in new window or tab >>The relation between mitral annulus motion and ejection fraction changes with age and heart size.
    2000 (English)In: Clinical Physiology, ISSN 0144-5979, E-ISSN 1365-2281, Vol. 20, no 1, p. 38-43Article in journal (Refereed) Published
    Abstract [en]

    Mitral annulus motion (MAM) has recently been introduced as an index of left ventricular function. Several echocardiographic studies have shown good agreement between ejection fraction (EF) and MAM x 5, where MAM is the total mitral annulus motion, measured in mm, and EF is expressed as a percentage. This means that if MAM is used for estimation of left ventricular function, the conversion factor 5 is used, if the function is expressed as EF. In these studies, the mean age of the patients was over 60 years. The present study, including 102 patients, shows that in patients aged 20-40 years, the conversion factor is about 4.3, in patients aged 41-60 years it is about 4.6 and in patients aged 61-80 years it is about 5.0. It was also found that the ratio EF/MAM decreases with increasing height and left ventricular diameter, both variables closely connected to heart size. The results suggest that when MAM is used in assessment of left ventricular function, it is unwise to express the function in terms of EF. It is preferable to use MAM as a direct index of ventricular function, using reference values referred to aged and height. If the estimated function is expressed in terms of EF, different converting factors must be used depending on the age of the patients.

    Place, publisher, year, edition, pages
    John Wiley & Sons, 2000
    Keywords
    atrioventricular plane displacement, echocardiography, ejection fraction, left ventricular function, mitral annulus motion, mitral ring motion
    National Category
    Cardiac and Cardiovascular Systems
    Research subject
    Cardiology
    Identifiers
    urn:nbn:se:oru:diva-38822 (URN)10.1046/j.1365-2281.2000.00221.x (DOI)000085367300007 ()10651790 (PubMedID)2-s2.0-0033985379 (Scopus ID)
    Available from: 2014-11-20 Created: 2014-11-20 Last updated: 2017-12-05Bibliographically approved
    3. The relation between mitral annulus motion and ejection fraction: a nonlinear function.
    Open this publication in new window or tab >>The relation between mitral annulus motion and ejection fraction: a nonlinear function.
    2000 (English)In: Journal of the American Society of Echocardiography, ISSN 0894-7317, E-ISSN 1097-6795, Vol. 13, no 10, p. 896-901Article in journal (Refereed) Published
    Abstract [en]

    In previous studies of the relation between mitral annulus motion (MAM) and left ventricular ejection fraction (EF), a linear relationship has been suggested. In this meta-analysis of 434 patients, we show that the relation is nonlinear and that a linear regression model overestimates EF in the lower range of MAM. The relation is better described by an S function and is influenced by age and heart size.

    National Category
    Physiology
    Research subject
    Physiology
    Identifiers
    urn:nbn:se:oru:diva-38832 (URN)10.1067/mje.2000.107253 (DOI)000090033600004 ()11029713 (PubMedID)2-s2.0-0033793092 (Scopus ID)
    Available from: 2014-11-20 Created: 2014-11-20 Last updated: 2018-01-11Bibliographically approved
    4. The relation between mitral annulus motion and left ventricular ejection fraction in atrial fibrillation.
    Open this publication in new window or tab >>The relation between mitral annulus motion and left ventricular ejection fraction in atrial fibrillation.
    2000 (English)In: Clinical Physiology, ISSN 0144-5979, E-ISSN 1365-2281, Vol. 20, no 1, p. 44-9Article in journal (Refereed) Published
    Abstract [en]

    Mitral annulus motion (MAM) has recently been introduced as an index of left ventricular function. Previous studies have shown a good agreement between MAM (mm) x 5 and ejection fraction in middle-aged and elderly patients. These studies only included patients with sinus rhythm, while patients with atrial fibrillation were excluded. In the present study, MAM was reduced in patients with atrial fibrillation while ejection fraction (EF) did not differ from age-matched control patients with sinus rhythm. The 'conversion factor' (EF/MAM) was 7.2 in the group with atrial fibrillation and 5. 1 in controls with sinus rhythm. This difference must be taken into account when MAM is used to estimate left ventricular function in patients with atrial fibrillation. Patients with atrial fibrillation had lower stroke volume and higher heart rate than patients with sinus rhythm. A decreased systolic long-axis shortening was found (P<0.005) compared to patients with sinus rhythm, but no difference in short-axis diameter shortening.

    Keywords
    : atrioventricular plane displacement, mitral ring motion, stroke volume
    National Category
    Clinical Laboratory Medicine Cardiac and Cardiovascular Systems
    Research subject
    Cardiology
    Identifiers
    urn:nbn:se:oru:diva-38834 (URN)10.1046/j.1365-2281.2000.00222.x (DOI)000085367300008 ()10651791 (PubMedID)2-s2.0-0033983381 (Scopus ID)
    Available from: 2014-11-20 Created: 2014-11-20 Last updated: 2017-12-05Bibliographically approved
    5. The relation between ejection fraction and mitral annulus motion before and after direct-current electrical cardioversion.
    Open this publication in new window or tab >>The relation between ejection fraction and mitral annulus motion before and after direct-current electrical cardioversion.
    2000 (English)In: Clinical Physiology, ISSN 0144-5979, E-ISSN 1365-2281, Vol. 20, no 3, p. 218-24Article in journal (Refereed) Published
    Abstract [en]

    Mitral annulus motion (MAM) and the relation between left ventricular ejection fraction (EF) and MAM has been shown to differ between patients with sinus rhythm and patients with atrial fibrillation. However, it has not been investigated how the relation between EF and MAM changes on direct-current (DC) electrical cardioversion to sinus rhythm. Therefore, 31 consecutive patients on the waiting list for DC electrical cardioversion were examined by echocardiography before DC electrical cardioversion, and those who maintained sinus rhythm (13 patients) were examined again 4-8 weeks after cardioversion. The conversion factor (CF) (ratio EF/MAM) decreased from 8.4 +/- 1.7 before to 5.8 +/- 0.8 SD after cardioversion (P<0.001). The EF increased slightly (P<0.05) but the MAM had a much greater increase (P<0.001), resulting in the decrease in CF. There was no significant difference in CF between patients after cardioversion and age- and gender-matched control patients with sinus rhythm, indicating that CF is normalized or almost normalized 4-8 weeks after cardioversion. This indicates that when MAM is used for investigation of the left ventricular function, and the function is expressed as EF, the same CF as in other patients with sinus rhythm can be used 4-8 weeks after DC electrical cardioversion.

    Keywords
    atrial ®brillation, atrioventricular plane displacement, conversion factor, mitral ring motion
    National Category
    Cardiac and Cardiovascular Systems
    Research subject
    Cardiology
    Identifiers
    urn:nbn:se:oru:diva-38833 (URN)10.1046/j.1365-2281.2000.00249.x (DOI)000087037400007 ()10792415 (PubMedID)2-s2.0-0034121563 (Scopus ID)
    Available from: 2014-11-20 Created: 2014-11-20 Last updated: 2017-12-05Bibliographically approved
    6. Comparison between circumflex artery motion and mitral annulus motion.
    Open this publication in new window or tab >>Comparison between circumflex artery motion and mitral annulus motion.
    2001 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Scandinavian Cardiovascular Journal, ISSN 1401-7431, Vol. 35, no 5, p. 318-325Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: To compare mitral annulus motion (MAM) with circumflex artery motion (CXM) and the motion amplitude at an endocardial site (representing MAM) with an epicardial site (representing CXM) at the most basal lateral part of the atrioventricular plane (AVP).

    DESIGN: MAM and CXM were obtained in 28 patients examined by echocardiography and coronary angiography. The motion amplitude epicardially and endocardially was recorded by echocardiography in 13 patients with normal ejection fraction (EF) (> or = 0.50) and in 13 patients with decreased EF (<0.50).

    RESULTS: CXM was higher than MAM in most patients with normal EF but lower than MAM in most patients with decreased EF. The motion amplitude epicardially was significantly higher (p < 0.001) than endocardially in patients with normal EF. while there was no significant difference in patients with decreased EF.

    CONCLUSION: CXM represents the motion of the epicardial part of the AVP and differs from MAM, which represents the endocardial part of the wall. This must be considered when CXM is used for assessment of left ventricular systolic function.

    Keywords
    atrioventricular plane, circumflex artery motion, mitral annulus motion, tissue Doppler
    National Category
    Cardiac and Cardiovascular Systems
    Research subject
    Cardiology
    Identifiers
    urn:nbn:se:oru:diva-38841 (URN)000172480100006 ()11771823 (PubMedID)2-s2.0-0035700745 (Scopus ID)
    Available from: 2014-11-20 Created: 2014-11-20 Last updated: 2017-12-05Bibliographically approved
  • 105.
    Emilsson, Kent
    et al.
    Department of Clinical Physiology, Örebro University Hospital, Örebro, Sweden.
    Egerlid, Rigmor
    Department of Clinical Physiology, Örebro University Hospital, Örebro, Sweden; Department of Clinical Physiology, Karlskoga Hospital, Karlskoga, Sweden.
    Nygren, Britt Marie
    Department of Clinical Physiology, Örebro University Hospital, Örebro, Sweden.
    Comparison between aortic annulus motion and mitral annulus motion obtained using echocardiography2006In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 26, no 5, p. 257-262Article in journal (Refereed)
    Abstract [en]

    Earlier studies have shown that the aortic root, in analogy with the mitral annulus, moves towards the left ventricular apex during systole. However, there are no earlier studies comparing the amplitude of the aortic annulus motion (AAM) with that of the mitral annulus (MAM), which was the main aim of the study. Another aim was to study the intra- and interobserver reproducibility (IIOR) of measuring AAM with M-mode and 2-D echocardiography as it is not obvious which of the methods that should be used. Twenty-one healthy subjects were examined by echocardiography. AAM and MAM were measured at different sites. IIOR was measured in 10 of the subjects. There was no significant difference between average AAM (15.3 +/- 1.5 mm) and average MAM (15.6 +/- 1.5 mm) and there was a rather good agreement between the variables. There was also no significant difference between AAM at the septal site (16.3 +/- 2 mm) and average MAM, but a significant difference between AAM at the lateral site (14.2 +/- 1.6 mm) and average MAM (P<0.001) and between the both sites of measuring AAM (P<0.001). The significant difference between the two sites of measuring AAM may have anatomical reasons but may also depend on difficulties in measuring AAM at the septal site where it has lower reproducibility than at the lateral site. IIOR of measuring AAM was good when using M-mode but poor when using 2-D echocardiography and AAM should preferably be measured using M-mode and not using 2-D echocardiography.

  • 106.
    Emilsson, Kent
    et al.
    Department of Clinical Physiology, Karlskoga Hospital, Karlskoga, Sweden; Department of Clinical Physiology, Örebro University Hospital, Örebro, Sweden.
    Egerlid, Rigmor
    Department of Clinical Physiology, Örebro University Hospital, Örebro, Sweden.
    Nygren, Britt Marie
    Department of Clinical Physiology, Örebro University Hospital, Örebro, Sweden.
    Tricuspid annulus motion and mitral annulus motion: anatomical intimacy causing a good correlation?2005In: Experimental and clinical cardiology, ISSN 1205-6626, Vol. 10, no 2, p. 111-5Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Echocardiographic evaluation of the heart and its function, especially left ventricular systolic function, has great clinical importance. Systolic function can be measured using several methods, such as the amplitude of motion of the left atrioventricular plane (mitral annulus motion [MAM]) toward the apex during systole. Similarly, right ventricular systolic function can be measured using the motion of the right atrioventricular plane (tricuspid annulus motion [TAM]) toward the apex during systole.

    OBJECTIVES: Because the mitral and tricuspid annuli are situated close to each other in the fibrous skeleton between both ventricles and atria, one might think that a decrease in the amplitude of MAM would be followed by a decrease in the amplitude of TAM. The present study was developed to determinine if this anatomical intimacy causes a good correlation between the amplitudes of TAM and MAM.

    METHODS: Nineteen healthy subjects and 103 consecutive patients were included in the study and examined using echocardiography. The amplitudes of TAM and MAM were measured and the correlation between the amplitudes was calculated.

    RESULTS: In the 103 consecutive patients, a significant but relatively weak positive correlation was found between TAM and MAM amplitudes (Pearson's correlation coefficient [r]=0.58; P<0.001). In the 19 healthy subjects, no significant correlation was found.

    CONCLUSIONS: Despite the anatomical intimacy of the annuli, the correlation between the amplitudes of TAM and MAM in consecutive patients was rather weak, and there was no correlation in healthy subjects. These findings could be due to anatomical and physiological differences between the right and left ventricles.

  • 107.
    Emilsson, Kent
    et al.
    Department of Clinical Physiology, Karlskoga Hospital, Karlskoga, Sweden; Department of Clinical Physiology, Örebro University Hospital, Örebro, Sweden.
    Egerlid, Rigmor
    Department of Clinical Physiology, Örebro University Hospital, Örebro, Sweden.
    Nygren, Britt Marie
    Department of Clinical Physiology, Örebro University Hospital, Örebro, Sweden.
    Wandt, Birger
    Department of Clinical Physiology, Sahlgrens University Hospital, Gothenburg, Sweden.
    Mitral annulus motion versus long-axis fractional shortening2006In: Experimental & clinical cardiology, ISSN 1918-1515, Vol. 11, no 4, p. 302-304Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In most echocardiographic studies concerning mitral annulus motion (MAM) in the assessment of left ventricular (LV) systolic function, comparisons have been performed between MAM, which represents a distance, and ejection fraction (EF), which represents a ratio between volumes. However, in theory, it is probably more suitable to compare the long-axis fractional shortening (FS(L)) (the ratio between the change in length [ie, MAM] and the end-diastolic length of the left ventricle) with EF. OBJECTIVES: To compare EF with MAM and EF with FS(L) in the assessment of LV systolic function. METHODS: Thirty healthy subjects were investigated using echo-cardiography, and the linear correlations between EF and MAM, and EF and FS(L) were calculated. RESULTS: The linear correlation (r) was found to be higher between EF and FS(L) (r=0.65; P<0.001) than between EF and MAM (r=0.49; P<0.01). CONCLUSIONS: The higher correlation between EF and FS(L) than between EF and MAM suggests that FS(L), which includes a correction for ventricular length, may be a more suitable index of LV systolic function than MAM per se.

  • 108.
    Emilsson, Kent
    et al.
    Department of Clinical Physiology Karlskoga Hospital, Karlskoga, Sweden; Department of Clinical Physiology, Örebro University Hospital, Örebro, Sweden.
    Kähäri, Anders
    Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Bodin, Lennart
    Unit of Statistics Clinical Research Centre, Örebro University Hospital, Örebro, Sweden.
    Thunberg, Per
    Department of Biomedical Engineering Örebro University Hospital, Sweden.
    Comparison between angiographic right coronary artery motion and echocardiographic tricuspid annulus motion2004In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 38, no 2, p. 85-92Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To compare echocardiographic M-mode measurements of tricuspid annulus motion (TAM) with angiographic M-mode measurements of right coronary artery motion (RAM).

    DESIGN: Twenty-four patients were included and examined by echocardiography before the angiographic examination. The amplitudes and the velocities of TAM and the atrial contribution to the total amplitude of TAM were measured. The obtained values were compared with angiographic M-mode measurements of RAM at a proximal and a distal site of the second segment of the right coronary artery.

    RESULTS: There was no significant difference between several of the echocardiographic M-mode measurements of TAM and the angiographic M-mode measurements of RAM. However, the agreement was rather poor for some variables.

    CONCLUSION: Different parameters obtained from echocardiographic TAM are not interchangeable with values from angiographic RAM. If measurements of RAM are to be used in the assessment of right ventricular (RV) function further studies are needed to examine the correlation and agreement between RAM and different methods of measuring RV function, i.e. radionuclide angiography or magnetic resonance imaging.

  • 109.
    Emilsson, Kent
    et al.
    Department of Clinical Physiology Karlskoga Hospital, Karlskoga, Sweden; Department of Clinical Physiology, Örebro University Hospital, Örebro, Sweden.
    Kähäri, Anders
    Department of Radiology, Örebro University Hospital, Sweden.
    Bodin, Lennart
    Unit of Statistics Clinical Research Centre, Örebro University Hospital, ÖrebroSweden.
    Thunberg, Per
    Department of Biomedical Engineering Örebro University Hospital, Sweden.
    Outer contour and radial changes of the cardiac left ventricle: a magnetic resonance imaging study.2007In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692, Vol. 96, no 5, p. 272-278Article in journal (Refereed)
    Abstract [en]

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

  • 110.
    Emilsson, Kent
    et al.
    Department of Clinical Physiology Örebro Medical Centre Hospital, Örebro, Sweden Correspondence to Kent Emilsson, MD, PhD, Department of Clinical Physiology, Örebro Medical Centre Hospital, Örebro,Sweden.
    Kähäri, Anders
    Department of Radiology, Örebro Medical Centre Hospital, Örebro, Sweden.
    Wandt, Birger
    Department of Radiology, Örebro Medical Centre Hospital, Örebro, Sweden.
    Comparison between circumflex artery motion and mitral annulus motion.2001In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Scandinavian Cardiovascular Journal, ISSN 1401-7431, Vol. 35, no 5, p. 318-325Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To compare mitral annulus motion (MAM) with circumflex artery motion (CXM) and the motion amplitude at an endocardial site (representing MAM) with an epicardial site (representing CXM) at the most basal lateral part of the atrioventricular plane (AVP).

    DESIGN: MAM and CXM were obtained in 28 patients examined by echocardiography and coronary angiography. The motion amplitude epicardially and endocardially was recorded by echocardiography in 13 patients with normal ejection fraction (EF) (> or = 0.50) and in 13 patients with decreased EF (<0.50).

    RESULTS: CXM was higher than MAM in most patients with normal EF but lower than MAM in most patients with decreased EF. The motion amplitude epicardially was significantly higher (p < 0.001) than endocardially in patients with normal EF. while there was no significant difference in patients with decreased EF.

    CONCLUSION: CXM represents the motion of the epicardial part of the AVP and differs from MAM, which represents the endocardial part of the wall. This must be considered when CXM is used for assessment of left ventricular systolic function.

  • 111.
    Emilsson, Kent
    et al.
    Department of Clinical Physiology Karlskoga Hospital, Karlskoga, Sweden; Department of Clinical Physiology, Örebro University Hospital, Örebro, Sweden.
    Loiske, Karin
    Isovolumetric relaxation time of the right ventricle assessed by tissue Doppler imaging2004In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 38, no 5, p. 278-282Article in journal (Refereed)
    Abstract [en]

    Objectives-The isovolumetric relaxation time of the right ventricle (RV-IVRT) can be assessed using a method based on ECG and pulsed wave Doppler (PW). Recently pulsed wave Doppler tissue imaging (PW-DTI) has been introduced in the assessment.

    Design-RV-IVRT obtained by the two methods was compared in 20 consecutive patients as was the time from the R wave on the ECG to the onset of tricuspid flow (R-T), to the closure of the pulmonic valve (R-P), to the onset of early diastolic motion of the tricuspid annulus tissue (R-E) and to the end of the systolic motion (R-S).

    Results-RV-IVRT obtained by the PW method was significantly (p<0.001) shorter than RV-IVRT obtained by PW-DTI. R-S had significantly (p<0.001) shorter duration than R-P, while there was no significant difference between R-E and R-T.

    Conclusions-The methods are not measuring the same interval. Only the PW method measures RV-IVRT according to the usual definition. Different reference values have to be used if the methods are used in the assessment of RV diastolic function.

  • 112.
    Emilsson, Kent
    et al.
    Department of Clinical Physiology Karlskoga Hospital, Karlskoga, Sweden.
    Loiske, Karin
    Department of Clinical Physiology Karlskoga Hospital, Karlskoga, Sweden.
    Öhlin, B.
    Department of Clinical Physiology Karlskoga Hospital, Karlskoga, Sweden.
    Comparison between maximal early diastolic velocity in long-axis direction obtained by M-mode echocardiography and by tissue Doppler in the assessment of right ventricular diastolic function2005In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 25, no 3, p. 178-182Article in journal (Refereed)
    Abstract [en]

    Recently the maximal early diastolic velocity in long-axis direction of the right ventricle (RV) obtained by tissue Doppler imaging (MDV TDI) has been introduced in the assessment of RV diastolic function (RVDF). There are reasons to think that also the maximal early diastolic velocity in long-axis direction of the RV obtained using M-mode echocardiography (MDV TAM) could be used to assess RVDF. Therefore, 29 patients were examined with echocardiography and MDV TAM and MDV TDI were measured and compared. A good correlation (r = 0.76, P&LT; 0.001) was found between MDV TAM and MDV TDI indicating that MDV TAM might be used in the assessment of RVDF. However, the velocities obtained by MDV TDI (126.7 &PLUSMN; 38.9 mm s(-1)) were significantly (P&LT; 0.001) higher than the velocities obtained by MDV TAM (78.3 &PLUSMN; 27.8 mm s(-1)) and the agreement between MDV TAM and MDV TDI was rather poor probably mainly due to differences in the measuring technique. This means that reference values cannot be used interchangeably between MDV TAM and MDV TDI. If MDV TAM is going to be used in the assessment of RVDF new reference values have to be produced if today's technique and recommendations to measure MDV TAM and MDV TDI are used. However, as most new echocardiographs are equipped with PW-TDI technology it seems preferable to use this technique and compare obtained values with already established reference values.

  • 113.
    Emilsson, Kent
    et al.
    Department of Medicine, Örebro Medical Center Hospital, Örehro, Sweden.
    Oddsson, Hjortur
    Allared, Mats
    Department of Medicine, Örebro Medical Center Hospital, Örehro, Sweden.
    Brorson, Leif
    Department of Medicine, Örebro Medical Center Hospital, Örehro, Sweden.
    An unusual cause of high threshold values at pacemaker implantation1997In: Pacing and Clinical Electrophysiology, ISSN 0147-8389, E-ISSN 1540-8159, Vol. 20, no Part: 1, p. 366-7Article in journal (Refereed)
    Abstract [en]

    An 81-year old man with third-degree AV block and weakness underwent an unsuccessful attempt to DDD pacemaker implant caused by hypothyroidism. Administration of thyroxin until he was euthyroid permitted implantation with normal stimulation thresholds.

  • 114.
    Emilsson, Kent
    et al.
    Department of Clinical Physiology, OÈ rebro Medical Centre Hospital, Sweden.
    Wandt, Birger
    Department of Clinical Physiology, Örebro Medical Centre Hospital, Sweden.
    The relation between ejection fraction and mitral annulus motion before and after direct-current electrical cardioversion.2000In: Clinical Physiology, ISSN 0144-5979, E-ISSN 1365-2281, Vol. 20, no 3, p. 218-24Article in journal (Refereed)
    Abstract [en]

    Mitral annulus motion (MAM) and the relation between left ventricular ejection fraction (EF) and MAM has been shown to differ between patients with sinus rhythm and patients with atrial fibrillation. However, it has not been investigated how the relation between EF and MAM changes on direct-current (DC) electrical cardioversion to sinus rhythm. Therefore, 31 consecutive patients on the waiting list for DC electrical cardioversion were examined by echocardiography before DC electrical cardioversion, and those who maintained sinus rhythm (13 patients) were examined again 4-8 weeks after cardioversion. The conversion factor (CF) (ratio EF/MAM) decreased from 8.4 +/- 1.7 before to 5.8 +/- 0.8 SD after cardioversion (P<0.001). The EF increased slightly (P<0.05) but the MAM had a much greater increase (P<0.001), resulting in the decrease in CF. There was no significant difference in CF between patients after cardioversion and age- and gender-matched control patients with sinus rhythm, indicating that CF is normalized or almost normalized 4-8 weeks after cardioversion. This indicates that when MAM is used for investigation of the left ventricular function, and the function is expressed as EF, the same CF as in other patients with sinus rhythm can be used 4-8 weeks after DC electrical cardioversion.

  • 115.
    Emilsson, Kent
    et al.
    Department of Clinical Physiology, Örebro Medical Centre Hospital, Örebro, Sweden.
    Wandt, Birger
    Department of Clinical Physiology, Örebro Medical Centre Hospital, Örebro, Sweden.
    The relation between mitral annulus motion and ejection fraction changes with age and heart size.2000In: Clinical Physiology, ISSN 0144-5979, E-ISSN 1365-2281, Vol. 20, no 1, p. 38-43Article in journal (Refereed)
    Abstract [en]

    Mitral annulus motion (MAM) has recently been introduced as an index of left ventricular function. Several echocardiographic studies have shown good agreement between ejection fraction (EF) and MAM x 5, where MAM is the total mitral annulus motion, measured in mm, and EF is expressed as a percentage. This means that if MAM is used for estimation of left ventricular function, the conversion factor 5 is used, if the function is expressed as EF. In these studies, the mean age of the patients was over 60 years. The present study, including 102 patients, shows that in patients aged 20-40 years, the conversion factor is about 4.3, in patients aged 41-60 years it is about 4.6 and in patients aged 61-80 years it is about 5.0. It was also found that the ratio EF/MAM decreases with increasing height and left ventricular diameter, both variables closely connected to heart size. The results suggest that when MAM is used in assessment of left ventricular function, it is unwise to express the function in terms of EF. It is preferable to use MAM as a direct index of ventricular function, using reference values referred to aged and height. If the estimated function is expressed in terms of EF, different converting factors must be used depending on the age of the patients.

  • 116.
    Emilsson, Kent
    et al.
    Department of Clinical Physiology, Örebro Medical Centre Hospital, Örebro, Sweden.
    Wandt, Birger
    Department of Clinical Physiology, Örebro Medical Centre Hospital, Örebro, Sweden.
    The relation between mitral annulus motion and left ventricular ejection fraction in atrial fibrillation.2000In: Clinical Physiology, ISSN 0144-5979, E-ISSN 1365-2281, Vol. 20, no 1, p. 44-9Article in journal (Refereed)
    Abstract [en]

    Mitral annulus motion (MAM) has recently been introduced as an index of left ventricular function. Previous studies have shown a good agreement between MAM (mm) x 5 and ejection fraction in middle-aged and elderly patients. These studies only included patients with sinus rhythm, while patients with atrial fibrillation were excluded. In the present study, MAM was reduced in patients with atrial fibrillation while ejection fraction (EF) did not differ from age-matched control patients with sinus rhythm. The 'conversion factor' (EF/MAM) was 7.2 in the group with atrial fibrillation and 5. 1 in controls with sinus rhythm. This difference must be taken into account when MAM is used to estimate left ventricular function in patients with atrial fibrillation. Patients with atrial fibrillation had lower stroke volume and higher heart rate than patients with sinus rhythm. A decreased systolic long-axis shortening was found (P<0.005) compared to patients with sinus rhythm, but no difference in short-axis diameter shortening.

  • 117.
    Emilsson, Louise
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Cardiac complications in celiac disease2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Celiac disease (CD) is an immune-mediated enteropathy induced by dietary gluten that affects about 1% of western populations. CD has been associated to an increased risk of cardiovascular mortality in some studies; however associations to cardiovascular diseases have not been broadly researched.

    Aim: The aim of this thesis was to examine the associations between CD and some cardiovascular diseases, namely; atrial fibrialltion, dilated cardiomyopathy and risk factors of ischemic heart disease.Methods: We used computerized data on all Swedish patients with biopsy-verified CD equal to villous atrophy from 1969 to 31st of December 2008. All CD patients were matched on age, sex, county and calendar year with up to five reference individuals. Altogether we had data on 29,096 CD patients and 144,522 reference individuals. Data were linked to different Swedish national registries and the Swedish quality and cardiac care registry SWEDEHEART. Main outcomes in the studies were: I: atrial fibrillation registered in the national patient registry or the cause of death registry, II: chart validated idiopathic dilated cardiomyopathy, III: different risk factors, clinical presentation and parameters in patients with first myocardial infarction (MI) registered in SWEDEHEART and IV: follow-up parameters, 6-10 weeks and one year after MI, registered in SWEDEHEART.

    Result: We showed a 34% increased risk of atrial fibrillation in CD and a 73% increased risk of dilated cardiomyopathy, the latter only of borderline significance, p=0.052. In the third study we showed that CD patients with MI had a more beneficial cardiovascular risk factor profile, better left ventricular ejection fraction and fewer stenoses on coronary angiography compared to reference individuals with MI. The fourth study showed that follow-up after MI does not differ from follow-up in reference individuals.

    Conclusion: This thesis supports an association of cardiovascular diseases in CD. Potential mechanisms include shared risk factors and chronic in-flammation.

    List of papers
    1. Increased risk of atrial fibrillation in patients with coeliac disease: a nationwide cohort study
    Open this publication in new window or tab >>Increased risk of atrial fibrillation in patients with coeliac disease: a nationwide cohort study
    Show others...
    2011 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 32, no 19, p. 2430-7Article in journal (Refereed) Published
    Abstract [en]

    Aims: Inflammatory markers are established risk factors for atrial fibrillation (AF), but the role of autoimmune diseases is unknown. The aim of the study was to examine the association between coeliac disease (CD) and AF in a large cohort of patients with biopsy-verified CD.

    Metods and results: We identified 28,637 patients with CD through biopsy reports (defined as Marsh 3: villous atrophy) from all pathology departments (n = 28) in Sweden. Biopsies had been performed between 1969 and 2008. Age- and sex-matched reference individuals (n = 141,731) were identified from the Swedish Total Population Register. Data on AF were obtained from the Swedish Hospital Discharge Register, the Hospital Outpatient Register, and the Cause of Death Register. Hazard ratios (HRs) for AF were estimated using Cox regression. In the CD cohort, 941 individuals developed AF (vs. 2918 reference individuals) during a median follow-up of 9 years. The corresponding adjusted HR for AF was 1.34 (95% CI = 1.24-1.44). The absolute risk of AF in CD was 321 of 100,000 person-years, with an excess risk of 81 of 100,000. A prior AF diagnosis was also associated with an increased risk of subsequent CD (odds ratio = 1.45, 95% CI = 1.31-1.62).

    Conclusions Atrial fibrillation is more common both before and after CD diagnosis in patients with CD though the excess risk is small. Potential explanations for the increased risk of AF in CD include chronic inflammation and shared risk factors, but ascertainment bias may also have contributed.

    CLINICAL IMPLICATIONS: Coeliac disease affects 1-2% of the Western population. Our results indicate that patients with coeliac disease, verified by intestinal biopsy, are at increased risk of atrial fibrillation. This observation is consistent with previous findings that elevation of inflammatory markers predicts atrial fibrillation. Additional studies are needed to clarify the mechanistic link between atrial fibrillation and autoimmune diseases such as coeliac disease.

    Place, publisher, year, edition, pages
    Oxford, United Kingdom: Oxford University Press, 2011
    Keywords
    Autoimmunity, Coeliac, Inflammation, Atrial fibrillation
    National Category
    Medical and Health Sciences
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-32520 (URN)10.1093/eurheartj/ehr167 (DOI)000295684300023 ()21653560 (PubMedID)2-s2.0-80054052563 (Scopus ID)
    Available from: 2013-11-25 Created: 2013-11-25 Last updated: 2018-05-05Bibliographically approved
    2. Risk of idiopathic dilated cardiomyopathy in 29 000 patients with celiac disease
    Open this publication in new window or tab >>Risk of idiopathic dilated cardiomyopathy in 29 000 patients with celiac disease
    Show others...
    2012 (English)In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 1, no 3, article id e001594Article in journal (Refereed) Published
    Abstract [en]

    Background: Dilated cardiomyopathy (DCM) is a rare disease of largely unknown origin. Previous studies have suggested an increased prevalence of celiac disease (CD) in patients with DCM. These studies, however, were based on a maximum of 5 patients with both CD and DCM. In the present large Swedish population-based cohort study, we examined the risk of idiopathic DCM in patients with CD determined by small-intestinal histopathology.

    Methods and Results: From 2006 to 2008, we collected duodenal/jejunal biopsy data on CD (equal to villous atrophy, Marsh stage 3, n=29 071 unique individuals) from (all) 28 pathology departments in Sweden. These individuals were compared with 144 429 reference individuals matched for age, sex, calendar year, and county. Data on DCM were obtained through the National Patient Register and confirmed by patient charts and echocardiography data. During follow-up, 17 patients with CD and 52 reference individuals developed idiopathic DCM. Thus, patients with CD were at an increased risk of idiopathic DCM (hazard ratio, 1.73; 95% confidence interval, 1.00 to 3.00), although the risk estimate failed to attain statistical significance (P=0.052).

    Conclusion: This nationwide study found a moderately but not statistically significantly increased risk of idiopathic DCM in patients with biopsy-verified CD.

    Place, publisher, year, edition, pages
    Hoboken, USA: Wiley-Blackwell, 2012
    Keywords
    Autoimmunity, celiac disease, cohort studies, heart, inflammation, dilatation
    National Category
    Cardiac and Cardiovascular Systems
    Research subject
    Cardiology
    Identifiers
    urn:nbn:se:oru:diva-32521 (URN)10.1161/JAHA.112.001594 (DOI)000326333700005 ()23130142 (PubMedID)
    Available from: 2013-11-25 Created: 2013-11-25 Last updated: 2018-09-11Bibliographically approved
    3. The characterisation and risk factors of ischaemic heart disease in patients with coeliac disease
    Open this publication in new window or tab >>The characterisation and risk factors of ischaemic heart disease in patients with coeliac disease
    Show others...
    2013 (English)In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 37, no 9, p. 905-914Article in journal (Refereed) Published
    Abstract [en]

    Background: Studies have shown an increased risk of ischaemic heart disease (IHD) in patients with coeliac disease (CD), despite the patients' lack of traditional IHD risk factors.

    Aim: To characterise IHD according to CD status.

    Methods: Data on duodenal or jejunal biopsies were collected in 20062008 from all 28 pathology departments in Sweden and were used to define CD (equal to villous atrophy; Marsh stage 3). We used the Swedish cardiac care register SWEDEHEART to identify IHD and to obtain data on clinical status and risk factors at time of first myocardial infarction for this case-only comparison. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). CD patients were compared with general population reference individuals.

    Results: We identified 1075 CD patients and 4142 reference individuals with subsequent IHD. CD patients with myocardial infarction had lower body mass index (P<0.001) and cholesterol values (P<0.001) and were less likely to be active smokers (OR=0.74; 95% CI=0.560.98) than reference individuals with myocardial infarction. CD patients had less extensive coronary artery disease at angiography (any stenosis: OR=0.80; 95% CI=0.660.97; three-vessel disease: OR=0.73; 95% CI=0.570.94); but there was no difference in the proportions of CD patients with positive biochemical markers of myocardial infarction (CD: 92.2% vs. reference individuals: 91.5%, P=0.766).

    Conclusion: Despite evidence of an increased risk of IHD and higher cardiovascular mortality, patients with coeliac disease with IHD have a more favourable cardiac risk profile compared with IHD in reference individuals.

    National Category
    Medical and Health Sciences
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-29001 (URN)10.1111/apt.12271 (DOI)000317065600006 ()23451861 (PubMedID)
    Available from: 2013-05-14 Created: 2013-05-13 Last updated: 2018-05-17Bibliographically approved
    4. Follow-up of ischaemic heart disease in patients with coeliac disease
    Open this publication in new window or tab >>Follow-up of ischaemic heart disease in patients with coeliac disease
    Show others...
    2015 (English)In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 22, no 1, p. 83-90Article in journal (Refereed) Published
    Abstract [en]

    Patients with coeliac disease and myocardial infarction have a more favourable atherosclerotic risk factor profile than controls with myocardial infarction (MI). Therefore, MI prognosis and treatment may differ according to coeliac status. This paper reports on the study of Swedish MI patients with and without coeliac disease (equal to villous atrophy; Marsh histopathology stage 3) based on duodenal or jejunal biopsy data. We used the Swedish Quality Register (SWEDEHEART) to identify individuals with a record of MI from 2005 to 2008 and to obtain data on medication, coronary interventions, and clinical and laboratory parameters at 6–10 weeks and one year after first MI. One-year mortality and coronary interventions were assessed for 430 coeliac patients and 1988 controls. For other outcome variables, we compared 42 coeliac patients with MI and 201 general population controls with MI. Odds ratios (ORs) were calculated by logistic regression. The results showed that compared with controls with MI, coeliac individuals with MI had significantly higher one-year all-cause mortality (OR = 1.43; 95% confidence interval (CI) = 1.04–1.95) but less often underwent a percutaneous coronary intervention (OR = 0.77; 95% CI = 0.61–0.96). Coeliac patients were more often prescribed warfarin but less often aspirin and statins. The readmission rate due to cardiac events in coeliac patients was 15.2% vs. 12.6% in controls (p-value  = 0.69). Other clinical and laboratory parameters were similar. We conclude that the follow up of MI does not seem to differ between coeliac patients and controls, and is unlikely to explain the excess mortality from cardiovascular disease noted in Swedish patients with CD.

    Place, publisher, year, edition, pages
    London, United Kingdom: Sage Publications, 2015
    Keywords
    Autoimmunity, coeliac, inflammation, riskfactors, myocardialinfarction
    National Category
    Medical and Health Sciences Cardiac and Cardiovascular Systems
    Research subject
    Cardiology
    Identifiers
    urn:nbn:se:oru:diva-32523 (URN)10.1177/2047487313502446 (DOI)000346557500007 ()23963400 (PubMedID)2-s2.0-84918493520 (Scopus ID)
    Funder
    Swedish Research Council, 522-2A09-195
    Note

    Funding Agencies:

    Swedish Society of Medicine

    Swedish Celiac Society

    Värmland County

    Available from: 2013-11-25 Created: 2013-11-25 Last updated: 2018-06-26Bibliographically approved
  • 118.
    Emilsson, Louise
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Vårdcentralen Värmlands Nysäter, Värmland County, Sweden; Department of Medicine, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Andersson, Bert
    Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Elfström, Peter
    Department of Neonatology, Astrid Lindgren Children's Hospital Danderyd, Stockholm, Sweden; Karolinska University Hospital, Stockholm, Sweden.
    Green, Peter H. R.
    Department of Medicine, Columbia University College of Physicians and Surgeons, New York NY, USA.
    Ludvigsson, Jonas F.
    Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; the Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital, Solna, Sweden; Karolinska Institutet, Stockholm, Sweden.
    Risk of idiopathic dilated cardiomyopathy in 29 000 patients with celiac disease2012In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 1, no 3, article id e001594Article in journal (Refereed)
    Abstract [en]

    Background: Dilated cardiomyopathy (DCM) is a rare disease of largely unknown origin. Previous studies have suggested an increased prevalence of celiac disease (CD) in patients with DCM. These studies, however, were based on a maximum of 5 patients with both CD and DCM. In the present large Swedish population-based cohort study, we examined the risk of idiopathic DCM in patients with CD determined by small-intestinal histopathology.

    Methods and Results: From 2006 to 2008, we collected duodenal/jejunal biopsy data on CD (equal to villous atrophy, Marsh stage 3, n=29 071 unique individuals) from (all) 28 pathology departments in Sweden. These individuals were compared with 144 429 reference individuals matched for age, sex, calendar year, and county. Data on DCM were obtained through the National Patient Register and confirmed by patient charts and echocardiography data. During follow-up, 17 patients with CD and 52 reference individuals developed idiopathic DCM. Thus, patients with CD were at an increased risk of idiopathic DCM (hazard ratio, 1.73; 95% confidence interval, 1.00 to 3.00), although the risk estimate failed to attain statistical significance (P=0.052).

    Conclusion: This nationwide study found a moderately but not statistically significantly increased risk of idiopathic DCM in patients with biopsy-verified CD.

  • 119.
    Emilsson, Louise
    et al.
    Örebro University, School of Medicine, Örebro University, Sweden. Vårdcentralen Värmlands Nysäter, Värmlands Nysäter, Sweden.
    Carlsson, Roland
    PCI unit, Department of Cardiology, Central Hospital, Karlstad, Sweden .
    James, Stefan
    Department of Medical Sciences, Cardiology and Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden.
    Hambraeus, Kristina
    Department of Cardiology and Clinical Research Centre, Falun Hospital, Falun, Sweden .
    Ludvigsson, Jonas F.
    Örebro University Hospital. Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Follow-up of ischaemic heart disease in patients with coeliac disease2015In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 22, no 1, p. 83-90Article in journal (Refereed)
    Abstract [en]

    Patients with coeliac disease and myocardial infarction have a more favourable atherosclerotic risk factor profile than controls with myocardial infarction (MI). Therefore, MI prognosis and treatment may differ according to coeliac status. This paper reports on the study of Swedish MI patients with and without coeliac disease (equal to villous atrophy; Marsh histopathology stage 3) based on duodenal or jejunal biopsy data. We used the Swedish Quality Register (SWEDEHEART) to identify individuals with a record of MI from 2005 to 2008 and to obtain data on medication, coronary interventions, and clinical and laboratory parameters at 6–10 weeks and one year after first MI. One-year mortality and coronary interventions were assessed for 430 coeliac patients and 1988 controls. For other outcome variables, we compared 42 coeliac patients with MI and 201 general population controls with MI. Odds ratios (ORs) were calculated by logistic regression. The results showed that compared with controls with MI, coeliac individuals with MI had significantly higher one-year all-cause mortality (OR = 1.43; 95% confidence interval (CI) = 1.04–1.95) but less often underwent a percutaneous coronary intervention (OR = 0.77; 95% CI = 0.61–0.96). Coeliac patients were more often prescribed warfarin but less often aspirin and statins. The readmission rate due to cardiac events in coeliac patients was 15.2% vs. 12.6% in controls (p-value  = 0.69). Other clinical and laboratory parameters were similar. We conclude that the follow up of MI does not seem to differ between coeliac patients and controls, and is unlikely to explain the excess mortality from cardiovascular disease noted in Swedish patients with CD.

  • 120.
    Eriksson, Jan W.
    et al.
    Department of Medicine, Umeå University Hospital, Umeå, Sweden; Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden; AstraZeneca R&D, Mölndal, Sweden.
    Jansson, Per-Anders
    Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Carlberg, Bo
    Department of Medicine, Umeå University Hospital, Umeå, Sweden.
    Hägg, Anders
    Department of Medicine, Uppsala University Hospital, Uppsala, Sweden.
    Kurland, Lisa
    Department of Medicine, Uppsala University Hospital, Uppsala, Sweden.
    Svensson, Maria K.
    Department of Medicine, Umeå University Hospital, Umeå, Sweden; Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Ahlström, Håkan
    Department of Radiology, Uppsala University Hospital, Uppsala, Sweden.
    Ström, Conny
    Department of Radiology, Umeå University Hospital, Umeå, Sweden.
    Lönn, Lars
    Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Faculty of Health Sciences, Rigshospitalet, Copenhagen, Denmark.
    Öjbrandt, Kristina
    Department of Medicine, Umeå University Hospital, Umeå, Sweden.
    Johansson, Lars
    Department of Radiology, Uppsala University Hospital, Uppsala, Sweden; AstraZeneca R&D, Mölndal, Sweden.
    Lind, Lars
    Department of Medicine, Uppsala University Hospital, Uppsala, Sweden.
    Hydrochlorothiazide, but not Candesartan, aggravates insulin resistance and causes visceral and hepatic fat accumulation: the mechanisms for the diabetes preventing effect of Candesartan (MEDICA) Study2008In: Hypertension, ISSN 0194-911X, E-ISSN 1524-4563, Vol. 52, no 6, p. 1030-1037Article in journal (Refereed)
    Abstract [en]

    Treatment with angiotensin II receptor blockers is associated with lower risk for the development of type 2 diabetes mellitus compared with thiazide diuretics. The Mechanisms for the Diabetes Preventing Effect of Candesartan Study addressed insulin action and secretion and body fat distribution after treatment with candesartan, hydrochlorothiazide, and placebo. Twenty-six nondiabetic, abdominally obese, hypertensive patients were included in a multicenter 3-way crossover trial, and 22 completers (by predefined criteria; 10 men and 12 women) were included in the analyses. They underwent 12-week treatment periods with candesartan (C; 16 to 32 mg), hydrochlorothiazide (H; 25 to 50 mg), and placebo (P), respectively, and the treatment order was randomly assigned and double blinded. Intravenous glucose tolerance tests and euglycemic hyperinsulinemic (56 mU/m(2) per minute) clamps were performed. Intrahepatic and intramyocellular and extramyocellular lipid content and subcutaneous and visceral abdominal adipose tissue were measured using proton magnetic resonance spectroscopy and MRI. Insulin sensitivity (M-value) was reduced following H versus C and P (6.07+/-2.05, 6.63+/-2.04, and 6.90+/-2.10 mg/kg of body weight per minute, mean+/-SD; P<or=0.01). Liver fat content was higher (P<0.05) following H than both P and C. The subcutaneous to visceral abdominal adipose tissue ratio was reduced following H versus C and P (P<0.01). Glycosylated hemoglobin, alanine aminotransferase, aspartate aminotransferase, and high-sensitivity C-reactive protein levels were higher (P<0.05) after H, but not C, versus P. There were no changes in body fat, intramyocellular lipid, extramyocellular lipid, or first-phase insulin secretion. Blood pressure was reduced similarly by C and H versus P. In conclusion, visceral fat redistribution, liver fat accumulation, low-grade inflammation, and aggravated insulin resistance were demonstrated after hydrochlorothiazide but not candesartan treatment. These findings can partly explain the diabetogenic potential of thiazides.

  • 121.
    Erlinge, David
    et al.
    Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
    Koul, Sasha
    Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
    Eriksson, Peter
    Department of Cardiology, Umeå University, Umeå, Sweden.
    Scherstén, Fredrik
    Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
    Omerovic, Elmir
    Department of Cardiology, Sahlgrenska University, Gothenburg, Sweden.
    Linder, Rikard
    Department of Cardiology, Danderyd Karolinska University, Stockholm, Sweden.
    Östlund, Olof Petter
    Department of Medical Sciences, and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Wallentin, Lars
    Department of Medical Sciences, and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Fröbert, Ole
    Örebro University, School of Medical Sciences. Department of Cardiology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    James, Stefan
    Department of Medical Sciences, and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Bivalirudin versus heparin in non-ST and ST-segment elevation myocardial infarction-a registry-based randomized clinical trial in the SWEDEHEART registry (the VALIDATE-SWEDEHEART trial)2016In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 175, p. 34-36Article in journal (Refereed)
    Abstract [en]

    Background: The optimal anticoagulant for patients with acute coronary syndrome treated with percutaneous coronary intervention (PCI) has not been validated in current practice of radial approach and pretreatment with potent P2Y12 inhibitors. Several studies have indicated increased bleeding rate and, in some instances, even increased mortality by the routine use of heparin and glycoprotein IIb/IIIa inhibitors compared to bivalirudin. Direct comparison of bivalirudin versus heparin alone has yielded contradictory results depending on study designs.

    Methods/Design: The VALIDATE-SWEDEHEART trial is a multicenter, prospective, randomized, registry-based, controlled, and open-label clinical trial in patients with ST-segment elevation myocardial infarction (STEMI) or non-STEMI undergoing PCI pretreated with ticagrelor, prasugrel, or cangrelor. We hypothesize that bivalirudin is superior to heparin alone in reducing death, myocardial infarction, and major bleeding events at 180 days (primary end point). The trial will enroll 3,000 patients with STEMI and 3,000 patients with non-STEMI undergoing PCI. The trial will use a hybrid registry-based randomized clinical trial design where inclusion, randomization, and baseline data collection are performed using The Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry. The primary composite end point (death, myocardial infarction, or major bleeding events at 180 days) will be identified through active screening after 7 and 180 days and adjudicated by a blinded central end point committee. Secondary end points and long-term outcomes will be recorded from national registries.

    Conclusion: The VALIDATE-SWEDEHEART trial is founded on a nationwide clinical registry and uses a hybrid registry-based randomized clinical trial (RRCT) design methodology to evaluate efficacy and safety of bivalirudin as compared to heparin alone for acute coronary syndrome, in a large population receiving contemporary recommended therapies including predominantly radial invasive approach and pretreatment with potent P2Y12 inhibitors.

  • 122.
    Erlinge, David
    et al.
    Department of Cardiology, Lund University, Sweden.
    Koul, Sasha
    Department of Cardiology, Lund University, Sweden.
    Omerovic, Elmir
    Department of Cardiology, Sahlgrenska University Hospital, Sweden.
    Fröbert, Ole
    Örebro University, School of Medical Sciences. Department of Cardiology.
    Linder, Rikard
    Department of Cardiology, Danderyd Hospital, Sweden.
    Danielewicz, Mikael
    PCI-Unit, Karlstad Hospital, Sweden.
    Hamid, Mehmet
    Department of Cardiology, Mälarsjukhuset, Sweden.
    Venetsanos, Dimitrios
    Department of Cardiology, Karolinska University Hospital, Sweden.
    Henareh, Loghman
    Department of Cardiology, Karolinska University Hospital, Sweden.
    Pettersson, Björn
    Department of Cardiology, Umeå University, Sweden.
    Wagner, Henrik
    Department of Cardiology, Helsingborg Lasarett, Sweden.
    Grimfjärd, Per
    Department of Internal Medicine, Västmanlands Sjukhus, Sweden.
    Jensen, Jens
    Department of Cardiology, Capio S:t Görans Hospital AB, Sweden.
    Hofmann, Robin
    Department of Clinical Science and Education, Södersjukhuset, Sweden.
    Ulvenstam, Anders
    Department of Cardiology, Östersund Hospital, Sweden.
    Völz, Sebastian
    Department of Cardiology, Sahlgrenska University Hospital, Sweden.
    Petursson, Petur
    Department of Cardiology, Sahlgrenska University Hospital, Sweden.
    Östlund, Ollie
    Department of Medical Sciences, Uppsala University, Sweden.
    Sarno, Giovanna
    Department of Medical Sciences, Uppsala University, Sweden.
    Wallentin, Lars
    Department of Medical Sciences, Uppsala University, Sweden.
    Scherstén, Fredrik
    Department of Cardiology, Lund University, Sweden.
    Eriksson, Peter
    Department of Cardiology, Umeå University, Sweden.
    James, Stefan
    Department of Medical Sciences, Uppsala University, Sweden.
    Bivalirudin versus heparin monotherapy in non-ST-segment elevation myocardial infarction2019In: European heart journal. Acute cardiovascular care., ISSN 2048-8726, Vol. 8, no 6, p. 492-501Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The optimal anti-coagulation strategy for patients with non-ST-elevation myocardial infarction treated with percutaneous coronary intervention is unclear in contemporary clinical practice of radial access and potent P2Y12-inhibitors. The aim of this study was to investigate whether bivalirudin was superior to heparin monotherapy in patients with non-ST-elevation myocardial infarction without routine glycoprotein IIb/IIIa inhibitor use.

    METHODS: In a large pre-specified subgroup of the multicentre, prospective, randomised, registry-based, open-label clinical VALIDATE-SWEDEHEART trial we randomised patients with non-ST-elevation myocardial infarction undergoing percutaneous coronary intervention, treated with ticagrelor or prasugrel, to bivalirudin or heparin monotherapy with no planned use of glycoprotein IIb/IIIa inhibitors during percutaneous coronary intervention. The primary endpoint was the rate of a composite of all-cause death, myocardial infarction or major bleeding within 180 days.

    RESULTS: A total of 3001 patients with non-ST-elevation myocardial infarction, were enrolled. The primary endpoint occurred in 12.1% (182 of 1503) and 12.5% (187 of 1498) of patients in the bivalirudin and heparin groups, respectively (hazard ratio of bivalirudin compared to heparin treatment 0.96, 95% confidence interval 0.78-1.18, p=0.69). The results were consistent in all major subgroups. All-cause death occurred in 2.0% versus 1.7% (hazard ratio 1.15, 0.68-1.94, p=0.61), myocardial infarction in 2.3% versus 2.5% (hazard ratio 0.91, 0.58-1.45, p=0.70), major bleeding in 8.9% versus 9.1% (hazard ratio 0.97, 0.77-1.24, p=0.82) and definite stent thrombosis in 0.3% versus 0.2% (hazard ratio 1.33, 0.30-5.93, p=0.82).

    CONCLUSION: Bivalirudin as compared to heparin during percutaneous coronary intervention for non-ST-elevation myocardial infarction did not reduce the composite of all-cause death, myocardial infarction or major bleeding in non-ST-elevation myocardial infarction patients receiving current recommended treatments with modern P2Y12-inhibitors and predominantly radial access.

  • 123.
    Erlinge, David
    et al.
    Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
    Omerovic, Elmir
    Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Fröbert, Ole
    Örebro University, School of Medical Sciences. Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden.
    Linder, Rikard
    Department of Cardiology, Danderyd Hospital, Stockholm, Sweden.
    Danielewicz, Mikael
    PCI-Unit at Karlstad Hospital, Karlstad, Sweden.
    Hamid, Mehmet
    Department of Cardiology, Mälarsjukhuset, Eskilstuna, Sweden.
    Swahn, Eva
    Department of Cardiology, Linköping University Hospital, Linköping, Sweden.
    Henareh, Loghman
    Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
    Wagner, Henrik
    Department of Cardiology, Helsingborg Lasarett, Helsingborg, Sweden.
    Hårdhammar, Peter
    Department of Cardiology, Halmstad Hospital, Halmstad, Sweden.
    Sjögren, Iwar
    Department of Cardiology, Falun Hospital, Falun, Sweden.
    Stewart, Jason
    Department of Cardiology, Skaraborgs Hospital, Skövde, Sweden.
    Grimfjärd, Per
    Department of Internal Medicine, Västmanlands Sjukhus, Västerås, Sweden.
    Jensen, Jens
    Department of Cardiology, Capio St. Görans Hospital, Karolinska Institutet, Stockholm, Sweden.
    Aasa, Mikael
    Department of Cardiology, Södersjukhuset AB, Stockholm, Sweden.
    Robertsson, Lotta
    Department of Internal Medicine, Västmanlands Sjukhus, Västerås, Sweden.
    Lindroos, Pontus
    Department of Cardiology, Capio St. Görans Hospital, Karolinska Institutet, Stockholm, Sweden.
    Haupt, Jan
    Department of Cardiology, Sunderby Sjukhus, Luleå, Sweden.
    Wikström, Helena
    Department of Cardiology, Kristianstad Hospital, Kristianstad, Sweden.
    Ulvenstam, Anders
    Department of Cardiology, Östersund Hospital, Östersund, Sweden.
    Bhiladvala, Pallonji
    Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
    Lindvall, Bo
    Department of Cardiology, Sundsvall Hospital, Sundsvall, Sweden.
    Lundin, Anders
    Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
    Tödt, Tim
    Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
    Ioanes, Dan
    Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Råmunddal, Truls
    Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Kellerth, Thomas
    Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden.
    Zagozdzon, Leszek
    Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden.
    Götberg, Matthias
    Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
    Andersson, Jonas
    Department of Cardiology, Umeå University, Umeå, Sweden.
    Angerås, Oskar
    Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Östlund, Ollie
    Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Lagerqvist, Bo
    Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Held, Claes
    Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Wallentin, Lars
    Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Scherstén, Fredrik
    Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
    Eriksson, Peter
    Department of Cardiology, Umeå University, Umeå, Sweden.
    Koul, Sasha
    Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
    James, Stefan
    Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Bivalirudin versus Heparin Monotherapy in Myocardial Infarction2017In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 377, no 12, p. 1132-1142Article in journal (Refereed)
    Abstract [en]

    Background The comparative efficacy of various anticoagulation strategies has not been clearly established in patients with acute myocardial infarction who are undergoing percutaneous coronary intervention (PCI) according to current practice, which includes the use of radial-artery access for PCI and administration of potent P2Y12 inhibitors without the planned use of glycoprotein IIb/IIIa inhibitors. Methods In this multicenter, randomized, registry-based, open-label clinical trial, we enrolled patients with either ST-segment elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI) who were undergoing PCI and receiving treatment with a potent P2Y12 inhibitor (ticagrelor, prasugrel, or cangrelor) without the planned use of glycoprotein IIb/IIIa inhibitors. The patients were randomly assigned to receive bivalirudin or heparin during PCI, which was performed predominantly with the use of radial-artery access. The primary end point was a composite of death from any cause, myocardial infarction, or major bleeding during 180 days of follow-up. Results A total of 6006 patients (3005 with STEMI and 3001 with NSTEMI) were enrolled in the trial. At 180 days, a primary end-point event had occurred in 12.3% of the patients (369 of 3004) in the bivalirudin group and in 12.8% (383 of 3002) in the heparin group (hazard ratio, 0.96; 95% confidence interval [CI], 0.83 to 1.10; P=0.54). The results were consistent between patients with STEMI and those with NSTEMI and across other major subgroups. Myocardial infarction occurred in 2.0% of the patients in the bivalirudin group and in 2.4% in the heparin group (hazard ratio, 0.84; 95% CI, 0.60 to 1.19; P=0.33), major bleeding in 8.6% and 8.6%, respectively (hazard ratio, 1.00; 95% CI, 0.84 to 1.19; P=0.98), definite stent thrombosis in 0.4% and 0.7%, respectively (hazard ratio, 0.54; 95% CI, 0.27 to 1.10; P=0.09), and death in 2.9% and 2.8%, respectively (hazard ratio, 1.05; 95% CI, 0.78 to 1.41; P=0.76). Conclusions Among patients undergoing PCI for myocardial infarction, the rate of the composite of death from any cause, myocardial infarction, or major bleeding was not lower among those who received bivalirudin than among those who received heparin monotherapy. (Funded by the Swedish Heart-Lung Foundation and others; VALIDATE-SWEDEHEART ClinicalTrialsRegister.eu number, 2012-005260-10 ; ClinicalTrials.gov number, NCT02311231 .).

  • 124.
    Escaned, Javier
    et al.
    Hospital Clínico San Carlos, IDISSC, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain.
    Calais, Fredrik
    Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden.
    Fröbert, Ole
    Örebro University, School of Medical Sciences.
    Davies, Justin E.
    Hammersmith Hospital, Imperial College London, London, United Kingdom.
    Götberg, Matthias
    Skåne University Hospital, Lund University, Lund, Sweden.
    Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes2018In: JACC: Cardiovascular Interventions, ISSN 1936-8798, E-ISSN 1876-7605, Vol. 11, no 15, p. 1437-1449Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS).

    BACKGROUND: Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization.

    METHODS: The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year.

    RESULTS: Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p < 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04).

    CONCLUSIONS: Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used to assess physiological significance. In deferred patients presenting with ACS, the event rate was significantly increased compared with SAP at 1 year.

  • 125.
    Fengsrud, Espen
    et al.
    Örebro University, School of Health Sciences. Departments of Cardiology and Cardiothoracic Surgery, Örebro University Hospital, Örebro, Sweden.
    Englund, Anders
    Department of Clinical Sciences, South Hospital and Arrhythmia Center, Karolinska Institute, Stockholm, Sweden.
    Ahlsson, Anders
    Örebro University, School of Medical Sciences. Departments of Cardiology and Cardiothoracic Surgery, Örebro University Hospital, Örebro, Sweden.
    Pre- and postoperative atrial fibrillation in CABG patients have similar prognostic impact2017In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 51, no 1, p. 21-27Article in journal (Refereed)
    Abstract [en]

    Objectives: To study pre- and postoperative atrial fibrillation and its long-term effects in a cohort of aortocoronary bypass surgery patients.

    Design: Altogether 615 patients undergoing aortocoronary bypass graft surgery in 1999-2000 were studied. Forty-four (7%) had preoperative atrial fibrillation. Postoperative atrial fibrillation occurred in 165/615 patients (27%) while 406/615 patients (66%) had no atrial fibrillation. After a median follow-up of 15 years, symptoms and medication in survivors were recorded, and cause of death in the deceased was obtained.

    Results: Death due to cerebral ischaemia was most common in the pre- and postoperative atrial fibrillation groups (7% and 5%, respectively, v. 2% among those without atrial fibrillation, p = 0.038), as were death due to heart failure (18% and 14%, v. 7%, p = 0.007) and sudden death (9% and 5%, v. 2%, p = 0.029). The presence of pre- or postoperative atrial fibrillation was an independent risk factor for late mortality (hazard ratios 1.47 (1.02-2.12) and 1.28 (1.01-1.63), respectively).

    Conclusions: Patients with pre- or postoperative atrial fibrillation undergoing aortocoronary bypass surgery have increased long-term mortality and risk of cerebral ischemic and cardiovascular death compared with patients in sinus rhythm.

  • 126.
    Fengsrud, Espen
    et al.
    Örebro University, School of Medical Sciences. Department of Cardiology.
    Wickbom, Anders
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Almroth, Henrik
    Department of Cardiology, Örebro University, Örebro, Sweden; Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Englund, Anders
    Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Arrhythmia Centre, South General Hospital, Stockholm, Sweden.
    Ahlsson, Anders
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Total endoscopic ablation of patients with long-standing persistent atrial fibrillation: a randomized controlled study2016In: Interactive Cardiovascular and Thoracic Surgery, ISSN 1569-9293, E-ISSN 1569-9285, Vol. 23, no 2, p. 292-298Article in journal (Refereed)
    Abstract [en]

    Objectives: Total endoscopic ablation of atrial fibrillation is an alternative to catheter ablation, but its clinical role needs further evaluation. The aim of this study was to compare total endoscopic ablation with rate control in patients with long-standing persistent atrial fibrillation and to examine the effect of endoscopic ablation on heart rhythm, symptoms, physical working capacity and myocardial function during 1 year of follow-up.

    Methods: In a prospective controlled study, 36 patients aged >50 years with symptomatic long-standing persistent atrial fibrillation were randomized to either total endoscopic ablation (n = 17, after two drop-outs before ablation n = 15) or rate control therapy (n = 19). In the ablation group, a box lesion encircling the pulmonary veins was performed, using temperature-controlled radiofrequency energy. Loop recorders were implanted in all patients. Echocardiography and quality-of-life assessment were performed at 6 and 12 months, and physical working capacity assessment at 6 months.

    Results: There was no mortality or thromboembolic event. In the control group, all patients were in permanent atrial fibrillation during 12 months of follow-up. In the ablation group, the proportion of patients in sinus rhythm without antiarrhythmic drugs was 12/15 (80%) at 12 months. The median freedom of atrial fibrillation at 3-12 months was 95% in the ablation group and the proportion of patients with an atrial fibrillation burden of <5% at 3-12 months was 8/15 (53%). The left ventricular ejection fraction increased during follow-up in the ablation group compared with the control group (from 53.7 ± 8.6 to 58.8 ± 6.5%, P = 0.003), combined with a reduction in the left atrial area (from 29.2 ± 5.5 to 27.2 ± 6.3 cm(2), P = 0.002). The physical working capacity increased in the ablation group compared with the control group (from 94 ± 21.4 to 102.9 ± 14.4%, P = 0.011). The subjective physical and mental capacity scale also improved during follow-up in the ablation group, but not in the control group (P =0.003 and 0.018, respectively).

    Conclusions: Total endoscopic ablation in patients with long-standing persistent atrial fibrillation significantly reduced atrial fibrillation burden 12 months after intervention compared with controls. The left ventricular function, physical working capacity and subjective physical and mental health were improved. These results need to be confirmed in larger randomized trials.

  • 127.
    Fernberg, Ulrika
    et al.
    Örebro University, School of Medical Sciences.
    Fernström, Maria
    Örebro University, School of Health Sciences. Åstrand Laboratory of Work Physiology, The Swedish School of Sport and Health Sciences, Stockholm, Sweden.
    Hurtig-Wennlöf, Anita
    Örebro University, School of Health Sciences.
    Arterial stiffness is associated to cardiorespiratory fitness and body mass index in young Swedish adults: The Lifestyle, Biomarkers, and Atherosclerosis study2017In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 24, no 17, p. 1809-1818Article in journal (Refereed)
    Abstract [en]

    Background: Early changes in the large muscular arteries are already associated with risk factors as hypertension and obesity in adolescence and young adulthood. The present study examines the association between arterial stiffness measurements, pulse wave velocity and augmentation index and lifestyle-related factors, body composition and cardiorespiratory fitness, in young, healthy, Swedish adults.

    Design: This study used a population-based cross-sectional sample.

    Methods: The 834 participants in the study were self-reported healthy, non-smoking, age 18-25 years. Augmentation index and pulse wave velocity were measured with applanation tonometry. Cardiorespiratory fitness was measured by ergometer bike test to estimate maximal oxygen uptake. Body mass index (kg/m(2)) was calculated and categorised according to classification by the World Health Organisation.

    Results: Young Swedish adults with obesity and low cardiorespiratory fitness have significantly higher pulse wave velocity and augmentation index than non-obese young adults with medium or high cardiorespiratory fitness. The observed U-shaped association between pulse wave velocity and body mass index categories in women indicates that it might be more beneficial to be normal weight than underweight when assessing the arterial stiffness with pulse wave velocity. The highest mean pulse wave velocity was found in overweight/obese individuals with low cardiorespiratory fitness. The lowest mean pulse wave velocity was found in normal weight individuals with high cardiorespiratory fitness. Cardiorespiratory fitness had a stronger effect than body mass index on arterial stiffness in multiple regression analyses.

    Conclusions: The inverse association between cardiorespiratory fitness and arterial stiffness is observed already in young adults. The study result highlights the importance of high cardiorespiratory fitness, but also that underweight individuals may be a possible risk group that needs to be further studied.

  • 128.
    Fernberg, Ulrika
    et al.
    Örebro University, School of Health Sciences.
    Op't Roodt, Jos
    Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands; CARIM, School for Cardiovascular Diseases, Maastricht, The Netherlands.
    Fernström, Maria
    Åstrand Laboratory of Work Physiology, Swedish School of Sport and Health Sciences, GIH, Stockholm, Sweden.
    Hurtig-Wennlöf, Anita
    Örebro University, School of Health Sciences.
    Body composition is a strong predictor of local carotid stiffness in Swedish, young adults: the cross sectional Lifestyle, biomarkers, and atherosclerosis study2019In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 19, no 1, article id 205Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Obesity has nearly tripled worldwide during the last four decades, especially in young adults, and is of growing concern since it is a risk factor for cardiovascular diseases (CVD). We explored how different body composition measurements are associated with intima media thickness (cIMT) and local stiffness in the common carotid artery, in a subsample of healthy, young women and men, from the Swedish Lifestyle, Biomarkers, and Atherosclerosis (LBA) Study.

    METHODS: From the LBA study, a subsample of 220 randomly selected, self-reported healthy individuals, 18-25 years old, were collected for the automatized local stiffness measurements; arterial distensibility, Young's elastic modulus, and β stiffness index. Blood pressure and mean arterial pressure (MAP) was measured using automatic blood pressure equipment. Body mass index (BMI) was calculated, waist circumference was measured, and percentage of body fat assessed using an impedance body composition analyzer. The carotid artery was scanned by ultrasound and analyzed using B-mode edge wall tracking. cIMT was measured and local stiffness measurements were calculated with carotid blood pressure, measured with applanation tonometry.

    RESULTS: No association was found between cIMT and body composition. Local carotid stiffness was associated with body composition, and women had less stiff arteries than men (p < 0.001). Of the local stiffness measurements, arterial distensibility had the strongest associations with body composition measurements in both women and men (p < 0.05). Multiple regression analyses showed that BMI in women and BMI and percentage of body fat in men had the highest impact on arterial distensibility (p < 0.01 in both women and men).

    CONCLUSIONS: Arterial distensibility was the local stiffness measurement with the strongest associations to different body composition measurements, in both women and men. In this age group, body composition measurements seem to be stronger predictors of common carotid arterial stiffness than MAP, and is a convenient way of detecting young adults who need cardiovascular risk follow-up and lifestyle counseling.

  • 129.
    Fernström, Maria
    et al.
    Örebro University, School of Health Sciences. Department of Medical Diagnostics.
    Fernberg, Ulrika
    Örebro University, School of Medical Sciences.
    Eliason, Gabriella
    Örebro University, School of Health Sciences. Department of Medical Diagnostics.
    Hurtig-Wennlöf, Anita
    Örebro University, School of Health Sciences. Department of Medical Diagnostics.
    Aerobic fitness is associated with low cardiovascular disease risk: the impact of lifestyle on early risk factors for atherosclerosis in young healthy Swedish individuals - the Lifestyle, Biomarker, and Atherosclerosis study2017In: Vascular Health and Risk Management, ISSN 1176-6344, E-ISSN 1178-2048, Vol. 13, p. 91-99Article in journal (Refereed)
    Abstract [en]

    Background: The progression of cardiovascular disease (CVD) and atherosclerosis is slow and develops over decades. In the cross-sectional Swedish Lifestyle, Biomarker, and Atherosclerosis study, 834 young, self-reported healthy adults aged 18.0-25.9 years have been studied to identify early risk factors for atherosclerosis.

    Purpose: The aims of this study were to 1) assess selected cardiometabolic biomarkers, carotid intima-media thickness (cIMT) as a marker of subclinical atherosclerosis, and lifestyle-related indicators (food habits, handgrip strength, and oxygen uptake, VO(2)max);2) analyze the associations between cIMT and lifestyle factors; and 3) identify subjects at risk of CVD using a risk score and to compare the characteristics of subjects with and without risk of CVD.

    Method: Blood samples were taken in a fasting state, and food habits were reported through a questionnaire. cIMT was measured by ultrasound, and VO2 max was measured by ergometer bike test. The risk score was calculated according to Wildman.

    Result: cIMT (mean +/- standard deviation) was 0.50 +/- 0.06 mm, and VO2 max values were 37.8 +/- 8.5 and 42.9 +/- 9.9 mL/kg/min, in women and men, respectively. No correlation was found between aerobic fitness expressed as VO2 max (mL/kg/min) and cIMT. Using Wildman's definition, 12% of the subjects were classified as being at risk of CVD, and 15% had homeostasis model assessment of insulin resistance. A total of 35% of women and 25% of men had lower high-density lipoprotein cholesterol than recommended. Food habits did not differ between those at risk and those not at risk. However, aerobic fitness measured as VO2 max (mL/kg/min) differed; 47% of the subjects at risk had low aerobic fitness compared to 23% of the nonrisk subjects (P<0.001).

    Conclusion: High aerobic fitness is associated with low CVD risk in Swedish young adults. The high prevalence of young adults observed with unfavorable levels of high-density lipoprotein cholesterol and homeostasis model assessment of insulin resistance raises concerns about future CVD risk.

  • 130.
    Finckenberg, Piet
    et al.
    Institute of Biomedicine, University of Helsinki, Helsinki, Finland.
    Eriksson, Ove
    Institute of Biomedicine, University of Helsinki, Helsinki, Finland.
    Baumann, Marc
    Institute of Biomedicine, University of Helsinki, Helsinki, Finland.
    Merasto, Saara
    Institute of Biomedicine, University of Helsinki, Helsinki, Finland.
    Lalowski, Maciej M.
    Institute of Biomedicine, University of Helsinki, Helsinki, Finland.
    Levijoki, Jouko
    Orion Pharma Ltd, Espoo, Finland.
    Haasio, Kristiina
    Orion Pharma Ltd, Espoo, Finland.
    Kytö, Ville
    Department of Medicine, Turku University Hospital, Turku, Finland.
    Muller, Dominik N.
    Experimental and Clinical Research Center, Max Delbrück Center, Berlin, Germany.
    Luft, Friedrich C.
    Experimental and Clinical Research Center, Max Delbrück Center, Berlin, Germany.
    Oresic, Matej
    Örebro University, School of Medical Sciences. VTT Technical Research Centre of Finland, Espoo, Finland.
    Mervaala, Eero
    Institute of Biomedicine, University of Helsinki, Helsinki, Finland.
    Caloric restriction ameliorates angiotensin II-induced mitochondrial remodeling and cardiac hypertrophy2012In: Hypertension, ISSN 0194-911X, E-ISSN 1524-4563, Vol. 59, no 1, p. 76-84Article in journal (Refereed)
    Abstract [en]

    Angiotensin II-induced cardiac damage is associated with oxidative stress-dependent mitochondrial dysfunction. Caloric restriction (CR), a dietary regimen that increases mitochondrial activity and cellular stress resistance, could provide protection. We tested that hypothesis in double transgenic rats harboring human renin and angiotensinogen genes (dTGRs). CR (60% of energy intake for 4 weeks) decreased mortality in dTGRs. CR ameliorated angiotensin II-induced cardiomyocyte hypertrophy, vascular inflammation, cardiac damage and fibrosis, cardiomyocyte apoptosis, and cardiac atrial natriuretic peptide mRNA overexpression. The effects were blood pressure independent and were linked to increased endoplasmic reticulum stress, autophagy, serum adiponectin level, and 5' AMP-activated protein kinase phosphorylation. CR decreased cardiac p38 phosphorylation, nitrotyrosine expression, and serum insulin-like growth factor 1 levels. Mitochondria from dTGR hearts showed clustered mitochondrial patterns, decreased numbers, and volume fractions but increased trans-sectional areas. All of these effects were reduced in CR dTGRs. Mitochondrial proteomic profiling identified 43 dTGR proteins and 42 Sprague-Dawley proteins, of which 29 proteins were in common in response to CR. We identified 7 proteins in CR dTGRs that were not found in control dTGRs. In contrast, 6 mitochondrial proteins were identified from dTGRs that were not detected in any other group. Gene ontology annotations with the Panther protein classification system revealed downregulation of cytoskeletal proteins and enzyme modulators and upregulation of oxidoreductase activity in dTGRs. CR provides powerful, blood pressure-independent, protection against angiotensin II-induced mitochondrial remodeling and cardiac hypertrophy. The findings support the notion of modulating cardiac bioenergetics to ameliorate angiotensin II-induced cardiovascular complications.

  • 131.
    Fokkema, Marieke L.
    et al.
    Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands; Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    James, Stefan K.
    Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Albertsson, Per
    Department of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden.
    Aasa, Mikael
    Department of Cardiology, Södersjukhuset, Stockholm, Sweden.
    Åkerblom, Axel
    Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Calais, Fredrik
    Örebro University, School of Medical Sciences. Department of Cardiology.
    Eriksson, Peter
    Department of Cardiology, Umeå University Hospital, Umeå, Sweden.
    Jensen, Jens
    Department of Medicine, Sundsvall-Härnösand County Hospital, Karolinska Institutet, Stockholm, Sweden.
    Schersten, Fredrik
    Department of Cardiology, Skåne University Hospital, Lund University, Lund, Sweden.
    de Smet, Bart J.
    Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands; Department of Cardiology, Meander Medisch Centrum, Amersfoort, Netherlands.
    Sjögren, Iwar
    Department of Cardiology, Falun Lasarett, Falun, Sweden.
    Tornvall, Per
    Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
    Lagerqvist, Bo
    Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Outcome after percutaneous coronary intervention for different indications: long-term results from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR)2016In: EuroIntervention, ISSN 1774-024X, E-ISSN 1969-6213, Vol. 12, no 3, p. 303-311Article in journal (Refereed)
    Abstract [en]

    Aims: The aim of this study was to evaluate clinical outcome for different indications for PCI in an unselected, nationwide PCI population at short- and long-term follow-up.

    Methods and results: We evaluated clinical outcome up to six years after PCI in all patients undergoing a PCI procedure for different indications in Sweden between 2006 and 2010. A total of 70,479 patients were treated for stable coronary artery disease (CAD) (21.0%), unstable angina (11.0%), non-ST-elevation myocardial infarction (NSTEMI) (36.6%) and ST-elevation myocardial infarction (STEMI) (31.4%). Mortality was higher in STEMI patients at one year after PCI (9.6%) compared to NSTEMI (4.7%), unstable angina (2.2%) and stable CAD (2.0%). At one year after PCI until the end of follow-up, the adjusted mortality risk (one to six years after PCI) and the risk of myocardial infarction were comparable between NSTEMI and STEMI patients and lower in patients with unstable angina and stable CAD. The adjusted risk of stent thrombosis and heart failure was highest in STEMI patients.

    Conclusions: The risk of short-term mortality, heart failure and stent thrombosis is highest for STEMI patients after PCI. Therapies to reduce stent thrombosis and heart failure appear to be most important in decreasing mortality in patients with STEMI or NSTEMI undergoing PCI.

  • 132.
    Forslund, Tomas
    et al.
    Karolinska Institutet, Department of Medicine Solna, Clinical Pharmacology Unit, Karolinska University Hospital, Stockholm, Sweden.
    Wettermark, Björn
    Karolinska Institutet, Department of Medicine Solna, Clinical Pharmacology Unit, Karolinska University Hospital, Stockholm, Sweden.
    Wändell, Per
    Karolinska Institutet, Department of Medicine Solna, Clinical Pharmacology Unit, Karolinska University Hospital, Stockholm, Sweden.
    von Euler, Mia
    Karolinska Institutet, Department of Medicine Solna, Clinical Pharmacology Unit, Karolinska University Hospital, Stockholm, Sweden.
    Hasselström, Jan
    Karolinska Institutet, Department of Medicine Solna, Clinical Pharmacology Unit, Karolinska University Hospital, Stockholm, Sweden.
    Hjemdahl, Paul
    Karolinska Institutet, Department of Medicine Solna, Clinical Pharmacology Unit, Karolinska University Hospital, Stockholm, Sweden.
    Risk scoring and thromboprophylactic treatment of patients with atrial fibrillation with and without access to primary healthcare data: experience from the Stockholm health care system2013In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 170, no 2, p. 208-214Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Earlier validation studies of risk scoring by CHA2DS2VASc for assessments of appropriateness of warfarin treatment in patients with atrial fibrillation have been performed solely with diagnoses recorded in hospital based care, even though many patients to a large extent are managed in primary care.

    METHODS: Cross-sectional registry study of all 43 353 patients with a diagnosis of non-valvular atrial fibrillation recorded in inpatient care, specialist ambulatory care or primary care in the Stockholm County during 2006-2010.

    RESULTS: The mean CHA2DS2VASc score was 3.82 (4.67 for women and 3.14 for men). 64% of the entire cohort of patients with atrial fibrillation had the diagnosis in primary care (12% only there). The mean CHA2DS2VASc score of patients with a diagnosis only in inpatient care or specialist ambulatory care increased from 3.63 to 3.83 when comorbidities registered in primary care were added. In 2010 warfarin prescriptions were claimed by 47.2%, and ASA by 41.6% of the entire cohort. 34% of patients with CHA2DS2VASc=1 and 20% with CHA2DS2VASc=0 had warfarin treatment. ASA was more frequently used instead of warfarin among women and elderly patients.

    CONCLUSIONS: Registry CHA2DS2VASc scores were underestimated without co-morbidity data from primary care. Many individuals with scores 0 and 1 were treated with warfarin, despite poor documentation of clinical benefit. In contrast, warfarin appears to be underused and ASA overused among high risk atrial fibrillation patients. Lack of diagnoses from primary care underestimated CHA2DS2VASc scores and may thereby have overestimated treatment benefits in low-risk patients in earlier studies.

  • 133.
    Fransén, Karin
    et al.
    Örebro University, School of Medical Sciences.
    Paramel Varghese, Geena
    Örebro University, School of Medical Sciences.
    Jansson, J.H.
    Skellefteå Hospital, Skellefteå, Sweden; Umeå University Hospital, Umeå, Sweden.
    Eriksson, P.
    Karolinska University Hospital , Karolinska Institutet, Stockholm, Sweden.
    Sirsjö, Allan
    Örebro University, School of Medical Sciences.
    Molecular genetic aspects of the NLRP3 inflammasome in cardiovascular disease2016Conference paper (Refereed)
  • 134.
    Friberg, Örjan
    et al.
    Dept Cardiovasc, Örebro University Hospital, Örebro, Sweden; Thorac Surg, Örebro University Hospital, Örebro, Sweden.
    Bodin, Lennart
    Inst Environm Med, Unit Intervention & Implementation Research, Karolinska Institute, Stockholm, Sweden.
    Collagen Gentamicin for Prevention of Sternal Wound Infection: Effective or Not?2013In: The thoracic and cardiovascular surgeon, ISSN 0171-6425, E-ISSN 1439-1902, Vol. 61, no 3, p. 185-193Article in journal (Refereed)
    Abstract [en]

    Background Prophylactic local application of collagen-gentamicin sponges for prevention of sternal wound infections (SWI) after cardiac surgery has been used routinely in risk patients for several years at our center. However, a recent US study failed to show a significant reduction in SWI with the prophylaxis. Therefore, a systematic reevaluation of the effect of local collagen gentamicin was conducted. Methods A complete follow-up of all cardiac surgery patients 2 months postoperatively was achieved. All SWIs were recorded. The effect of the prophylaxis was analyzed, and differences in risk factors were compensated for using multiple logistic regression analyses and Coarsened Exact Matching (CEM). Results A total of 950 patients were included. Established risk factors for SWI were confirmed. The use of collagen-gentamicin prophylaxis was independently associated with a highly significant reduction in SWI (odds ratio [OR] 0.30, 95% confidence interval 0.16 to 0.57; p < 0.001). Applying the more advanced statistical method, CEM indicated that the effect of the prophylaxis may be even greater. Conclusions The use of local collagen-gentamicin prophylaxis was associated with an approximately 70% reduction in the rate of SWI compared with standard intravenous antibiotic prophylaxis alone.

  • 135. Friberg, Örjan
    et al.
    Svedjeholm, Rolf
    Källman, Jan
    Söderquist, Bo
    Örebro University, School of Health and Medical Sciences.
    Incidence, microbiological findings, and clinical presentation of sternal wound infections after cardiac surgery with and without local gentamicin prophylaxis2007In: European Journal of Clinical Microbiology and Infectious Diseases, ISSN 0934-9723, E-ISSN 1435-4373, Vol. 26, no 2, p. 91-97Article in journal (Refereed)
    Abstract [en]

    Sternal wound infection (SWI) is a serious complication after cardiac surgery. In a previous randomized controlled trial, the addition of local collagen-gentamicin in the sternal wound before wound closure was found to significantly reduce the incidence of postoperative wound infections compared with the routine intravenous prophylaxis of isoxazolyl-penicillin only. The aims of the present study were to analyse the microbiological findings of the SWIs from the previous trial as well as to correlate these findings with the clinical presentation of SWI. Differences in clinical presentation of SWIs, depending on the causative agent, could be identified. Most infections had a late, insidious onset, and the majority of these were caused by staphylococci, predominantly coagulase-negative staphylococci. The clinically most fulminant infections were caused by gram-negative bacteria and presented early after surgery. Local administration of gentamicin reduced the incidence of SWIs caused by all major, clinically important bacterial species. Propionibacterium acnes was identified as a possible cause of SWI and may be linked to instability in the sternal fixation. There was no indication of an increase in the occurrence of gentamicin-resistant bacterial isolates in the treatment group. Furthermore, the addition of local collagen-gentamicin reduced the incidence of SWIs caused by methicillin-resistant coagulase-negative staphylococci. This technique warrants further evaluation as an alternative to prophylactic vancomycin in settings with a high prevalence of methicillin-resistant Staphylococcus aureus.

  • 136.
    Fröbert, Ole
    et al.
    Faculty of Health, Department of Cardiology, Örebro University, Örebro, Sweden.
    Arevström, Lilith
    Faculty of Health, Department of Cardiology, Örebro University, Örebro, Sweden.
    Calais, Fredrik
    Örebro University, School of Medical Sciences.
    James, Stefan K.
    Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical research center, Uppsala University, Uppsala, Sweden.
    Lagerqvist, Bo
    Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical research center, Uppsala University, Uppsala, Sweden.
    Height and prognosis following percutaneous coronary intervention2016In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 224, p. 188-190Article in journal (Refereed)
  • 137.
    Fröbert, Ole
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Calais, Fredrik
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    James, Stefan K.
    Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Lagerqvist, Bo
    Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    ST-Elevation Myocardial Infarction, Thrombus Aspiration, and Different Invasive Strategies: A TASTE Trial Substudy2015In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 4, no 6, article id e001755Article in journal (Refereed)
    Abstract [en]

    Background: The clinical effect of thrombus aspiration in ST-elevation myocardial infarction may depend on the type of aspiration catheter and stenting technique.

    Methods and Results: The multicenter, prospective, randomized, open-label trial Thrombus Aspiration in ST-Elevation myocardial infarction in Scandinavia (TASTE) did not demonstrate a clinical benefit of thrombus aspiration compared to percutaneous coronary intervention alone. We assessed the effect of type of aspiration device, stent type, direct stenting, and postdilatation on outcomes at 1 year. There was no difference in all-cause mortality, between the 3 most frequently used aspiration catheters (Eliminate [Terumo] 5.4%, Export [Medtronic] 5.0%, Pronto [Vascular Solutions] 4.5%) in patients randomized to thrombus aspiration. There was no difference in mortality between directly stented patients randomized to thrombus aspiration compared to patients randomized to percutaneous coronary intervention only (risk ratio 1.08, 95% CI 0.70 to 1.67, P=0.73). Similarly, there was no difference in mortality between the 2 randomized groups for patients receiving drug-eluting stents (risk ratio 0.89, 95% CI 0.63 to 1.26, P=0.50) or for those treated with postdilation (risk ratio 0.72, 95% CI 0.49 to 1.07, P=0.11). Furthermore, there was no difference in rehospitalization for myocardial infarction or stent thrombosis between the randomized arms in any of the subgroups.

    Conclusions: In patients with ST-elevation myocardial infarction randomized to thrombus aspiration, the type of aspiration catheter did not affect outcome. Stent type, direct stenting, or postdilation did not affect outcome irrespective of treatment with thrombus aspiration and percutaneous coronary intervention or percutaneous coronary intervention alone.

  • 138.
    Fröbert, Ole
    et al.
    Örebro University, School of Medical Sciences. Department of Cardiology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Götberg, Matthias
    Department of Cardiology, University Hospital Lund, Lund, Sweden.
    Angerås, Oskar
    Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Jonasson, Lena
    Department of Cardiology, University Hospital Linkoping, Linköping, Sweden.
    Erlinge, David
    Department of Cardiology, University Hospital Lund, Lund, Sweden.
    Engström, Thomas
    Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
    Persson, Jonas
    Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Jensen, Svend E.
    Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
    Omerovic, Elmir
    Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    James, Stefan K.
    Department of Cardiology, University Hospital Uppsala, Uppsala, Sweden.
    Lagerqvist, Bo
    Department of Cardiology, University Hospital Uppsala, Uppsala, Sweden.
    Nilsson, Johan
    Cardiology, Heart Centre, department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Kåregren, Amra
    Department of Cardiology, Västerås County Hospital, Västerås, Sweden.
    Moer, Rasmus
    The Feiring Clinic, Feiring, Norway.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital. Unit of Biostatistics, Institute of Evironmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Agus, David B.
    Lawrence J. Ellison Institute for Transformative Medicine, University of Southern California, Los Angeles, United States.
    Erglis, Andrejs
    Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia.
    Jensen, Lisette O.
    Department of Cardiology, Odense University Hospital, Odense, Denmark.
    Jakobsen, Lars
    Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
    Christiansen, Evald H.
    Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
    Pernow, John
    Cardiology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Design and rationale for the Influenza vaccination After Myocardial Infarction (IAMI) trial: A registry-based randomized clinical trial2017In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 189, p. 94-102Article in journal (Refereed)
    Abstract [en]

    Background: Registry studies and case-control studies have demonstrated that the risk of acute myocardial infarction (AMI) is increased following influenza infection. Small randomized trials, underpowered for clinical end points, indicate that future cardiovascular events can be reduced following influenza vaccination in patients with established cardiovascular disease. Influenza vaccination is recommended by international guidelines for patients with cardiovascular disease, but uptake is varying and vaccination is rarely prioritized during hospitalization for AMI.

    Methods/design: The Influenza vaccination After Myocardial Infarction (IAMI) trial is a double-blind, multicenter, prospective, registry-based, randomized, placebo-controlled, clinical trial. A total of 4,400 patients with ST-segment elevation myocardial infarction (STEMI) or non-STEMI undergoing coronary angiography will randomly be assigned either to in-hospital influenza vaccination or to placebo. Baseline information is collected from national heart disease registries, and follow-up will be performed using both registries and a structured telephone interview. The primary end point is a composite of time to all cause death, a new AMI, or stent thrombosis at 1 year.

    Implications: The IAMI trial is the largest randomized trial to date to evaluate the effect of in-hospital influenza vaccination on death and cardiovascular outcomes in patients with STEMI or non-STEMI. The trial is expected to provide highly relevant clinical data on the efficacy of influenza vaccine as secondary prevention after AMI.

  • 139.
    Fröbert, Ole
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    James, Stefan K.
    Uppsala Clin Res Ctr, Dept Med Sci, Uppsala Univ, Uppsala, Sweden; Uppsala Clin Res Ctr, Dept Cardiol, Uppsala Univ, Uppsala, Sweden.
    Coronary thrombus aspiration: a lesson for clinical medicine2016In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 387, no 10014, p. 97-98Article in journal (Refereed)
  • 140.
    Fröbert, Ole
    et al.
    Örebro University Hospital. Dept Cardiol.
    Lagerqvist, Bo
    Dept Med Sci, Uppsala University, Uppsala, Sweden; Uppsala Clin Res Ctr, Uppsala University, Uppsala, Sweden.
    Olivecrona, Goran K.
    Dept Cardiol, Lund University Hosp, Lund, Sweden.
    Omerovic, Elmir
    Dept Cardiol, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Gudnason, Thorarinn
    Dept Cardiol, Landspitali University Hospital Iceland, Reykjavik, Iceland; Cardiovasc Res Ctr, Landspitali Univ Hosp Iceland, Reykjavik, Iceland.
    Maeng, Michael
    Dept Cardiol, Aarhus University Hospital, Aarhus, Denmark.
    Aasa, Mikael
    Dept Cardiol, Södersjukhuset, Karolinska Institute, Stockholm, Sweden.
    Angeras, Oskar
    Dept Cardiol, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Calais, Fredrik
    Dept Cardiol, Örebro University Hospital, Örebro, Sweden.
    Danielewicz, Mikael
    Dept Cardiol, Karlstad Hospital, Karlstad, Sweden.
    Erlinge, David
    Dept Cardiol, Lund University Hospital, Lund, Sweden.
    Hellsten, Lars
    Dept Cardiol, Gävle Central Hospital, Gävle, Sweden.
    Jensen, Ulf
    Dept Med, Cardiol Unit, Karolinska University Hospital, Stockholm, Sweden.
    Johansson, Agneta C.
    PCI Unit, Sunderby Hospital, Sunderby, Sweden.
    Karegren, Amra
    Dept Cardiol, Västerås Hospital, Västerås, Sweden.
    Nilsson, Johan
    Dept Cardiol, Ctr Heart, Umeå University, Umeå, Sweden.
    Robertson, Lotta
    Dept Cardiol, Borås Hospital, Borås, Sweden.
    Sandhall, Lennart
    Dept Radiol, Helsingborg Hospital, Helsingborg, Sweden.
    Sjogren, Iwar
    Dept Cardiol, Falun Central Hospital, Falun, Sweden.
    Ostlund, Ollie
    Dept Med Sci, Uppsala University, Uppsala, Sweden; Clin Res Ctr, Uppsala University, Uppsala, Sweden.
    Harnek, Jan
    Dept Cardiol, Lund University Hospital, Lund, Sweden.
    James, Stefan K.
    Dept Med Sci, Uppsala University, Uppsala, Sweden; Clin Res Ctr, Uppsala University, Uppsala, Sweden.
    Thrombus Aspiration during ST-Segment Elevation Myocardial Infarction2013In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 369, no 17, p. 1587-1597Article in journal (Refereed)
    Abstract [en]

    Background:The clinical effect of routine intracoronary thrombus aspiration before primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) is uncertain. We aimed to evaluate whether thrombus aspiration reduces mortality. Methods: We conducted a multicenter, prospective, randomized, controlled, open-label clinical trial, with enrollment of patients from the national comprehensive Swedish Coronary Angiography and Angioplasty Registry (SCAAR) and end points evaluated through national registries. A total of 7244 patients with STEMI undergoing PCI were randomly assigned to manual thrombus aspiration followed by PCI or to PCI only. The primary end point was all-cause mortality at 30 days. ResultsNo patients were lost to follow-up. Death from any cause occurred in 2.8% of the patients in the thrombus-aspiration group (103 of 3621), as compared with 3.0% in the PCI-only group (110 of 3623) (hazard ratio, 0.94; 95% confidence interval [CI], 0.72 to 1.22; P=0.63). The rates of hospitalization for recurrent myocardial infarction at 30 days were 0.5% and 0.9% in the two groups, respectively (hazard ratio, 0.61; 95% CI, 0.34 to 1.07; P=0.09), and the rates of stent thrombosis were 0.2% and 0.5%, respectively (hazard ratio, 0.47; 95% CI, 0.20 to 1.02; P=0.06). There were no significant differences between the groups with respect to the rate of stroke or neurologic complications at the time of discharge (P=0.87). The results were consistent across all major prespecified subgroups, including subgroups defined according to thrombus burden and coronary flow before PCI. ConclusionsRoutine thrombus aspiration before PCI as compared with PCI alone did not reduce 30-day mortality among patients with STEMI. (Funded by the Swedish Research Council and others; ClinicalTrials.gov number, NCT01093404.)

  • 141.
    Fröbert, Ole
    et al.
    Örebro University, School of Medical Sciences. Department of Cardiology.
    Reitan, Christian
    Faculty of Medicine, Department of Cardiology, Lund University, Lund, Sweden.
    Hatsukami, Dorothy K.
    Department of Psychiatry, Tobacco Research Programs, University of Minnesota, Minneapolis Minnesota, USA.
    Pernow, John
    Unit of Cardiology, Department of Medicine, Heart and Vascular Division, Karolinska Institutet, Stockholm, Sweden.
    Omerovic, Elmir
    Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Andell, Pontus
    Unit of Cardiology, Department of Medicine, Heart and Vascular Division, Karolinska Institutet, Stockholm, Sweden.
    Smokeless tobacco, snus, at admission for percutaneous coronary intervention and future risk for cardiac events2019In: Open heart, E-ISSN 2053-3624, Vol. 6, no 2, article id UNSP e001109Article in journal (Refereed)
    Abstract [en]

    Objective: To assess the risk of future death and cardiac events following percutaneous coronary intervention (PCI) in patients using smokeless tobacco, snus, compared with patients not using snus at admission for a first PCI.

    Methods: The Swedish Coronary Angiography and Angioplasty Registry is a prospective registry on coronary diagnostic procedures and interventions. A total of 74 958 patients admitted for a first PCI were enrolled between 2009 and 2018, 6790 snus users and 68 168 not using snus. We used Cox proportional hazards regression for statistical modelling on imputed datasets as well as complete-case datasets.

    Results: Patients using snus were younger (mean (SD) age 61.0 (+/- 10.2) years) than patients not using snus (67.6 (+/- 11.1), p<0.001) and more often male (95.4% vs 67.4%, p<0.001). After multivariable adjustment, snus use was not associated with the primary composite outcome of all-cause mortality, new coronary revascularisation or new hospitalisation for heart failure at 1 year (HR 0.98, 95% CI 0.91 to 1.05). In patients using snus at baseline who underwent a second PCI (n=1443), the duration from the index intervention was shorter for subjects who continued using snus (n=921, 63.8%) compared with subjects who had stopped (mean number of days 285 vs 406, p value=0.001).

    Conclusions: Snus use at admission for a first PCI was not associated with a higher occurrence of all-cause mortality, new revascularisation or heart failure hospitalisation. Discontinuing snus after a first PCI was associated with a significantly longer duration to a subsequent PCI.

  • 142.
    Fröbert, Ole
    et al.
    Örebro University Hospital. Dept Cardiol.
    Sarno, Giovanna
    Inst Med Sci, Uppsala University, Uppsala, Sweden.
    James, Stefan K.
    Inst Med Sci, Uppsala University, Uppsala, Sweden.
    Saleh, Nawsad
    Dept Cardiol, Karolinska Hosp, Stockholm, Sweden.
    Lagerqvist, Bo
    Inst Med Sci, Uppsala University, Uppsala, Sweden.
    Effect of Stent Inflation Pressure and Post-Dilatation on the Outcome of Coronary Artery Intervention. A Report of More than 90 000 Stent Implantations2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 2, article id e56348Article in journal (Refereed)
    Abstract [en]

    Background: Percutaneous coronary intervention (PCI) stent inflation pressure correlates to angiographic lumen improvement and stent expansion but the relation to outcome is not clarified. Using comprehensive registry data our aim was to evaluate how stent inflation pressure influences restenosis, stent thrombosis and death following PCI. Methods: We evaluated all consecutive coronary stent implantations in Sweden during 46 months from 2008 using data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). We used logistic regression and Cox proportional hazard modeling to estimate risk of outcomes with different balloon pressures. Results: In total, 93 697 stents were eligible for analysis and divided into five different pressure interval groups: <= 15 atm, 16-17 atm, 18-19 atm, 20-21 atm and >= 22 atm. The risks of stent thrombosis and restenosis were significantly higher in the <= 15 atm, 18-19 atm and >= 22 atm groups (but not in the 16-17 atm group) compared to the 20-21 atm group. There were no differences in mortality. Post-dilatation was associated with a higher restenosis risk ratio (RR) of 1.22 (95% confidence interval (CI) 1.14-1.32, P < 0.001) but stent thrombosis did not differ statistically between procedures with or without post-dilatation. The risk of death was lower following post-dilatation (RR 0.81 (CI 0.71-0.93) P = 0.003) and the difference compared to no post-dilatation was seen immediately after PCI. Conclusion: Our retrospective study of stent inflation pressure identified a possible biological pattern-the risks of stent thrombosis and of restenosis appeared to be higher with low and very high pressures. Post-dilatation might increase restenosis risk.

  • 143.
    Fröbert, Ole
    et al.
    Örebro University Hospital. Department of Cardiology.
    Scherstén, Fredrik
    Department of Cardiology, Skåne University Hospital, Lund, Sweden.
    James, Stefan K.
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Carlsson, Jorg
    Department of Cardiology, Kalmar Hospital, Kalmar, Sweden.
    Lagerqvist, Bo
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Long-term safety and efficacy of drug-eluting and bare metal stents in saphenous vein grafts2012In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 164, no 1, p. 87-93Article in journal (Refereed)
    Abstract [en]

    Background: Long-term safety and efficacy data of drug-eluting stents (DESs) in saphenous vein grafts (SVGs) are lacking. This study sought to compare the clinical outcomes of DES versus bare metal stents (BMS) in SVGs.

    Methods: We studied all stent implantations in SVGs in Sweden during 74 months between 2005 and 2011 registered in the Swedish Coronary Angiography and Angioplasty Registry. We evaluated outcome in patients who received DES compared with those who received BMS after adjustments for differences in clinical, vessel, and lesion characteristics.

    Results: Mean follow-up time was 3 years and 4 months. A total of 4,576 stents, implanted at 3,063 procedures, were included in the analysis of which 2,499 stents (54.6 %) were BMS and 2,077 (45.4%) were DES. The outcome analysis was based on 190 stent thromboses, 898 restenoses, and 523 deaths. The incidence of stent thrombosis did not differ between groups. When adjusted for baseline characteristics, including a propensity score for receiving DES, the incidence of restenosis was significantly lower with DES as compared with BMS (risk ratio 0.83, 95% CI 0.70-0.97, P = .019). There was a difference in mortality in the crude analysis between DES and BMS, and after multivariable adjustment, this difference remained statistically significant (risk ratio 0.80, CI 0.65-0.99, P = .038).

    Conclusions: The use of DES compared with BMS in SVGs was associated with a significantly lower adjusted incidence of restenosis and death in this large, national, all-encompassing propensity adjusted observational study. (Am Heart J 2012;164:87-93.)

  • 144.
    Gannedahl, Per E.
    et al.
    Departments of Anaesthesiology and Intensive Care, Karolinska Hospital and Institute, Stockholm, Sweden.
    Edner, Magnus M.
    Departments of Cardiology, Karolinska Hospital and Institute, Stockholm, Sweden.
    Lindahl, Sten
    Departments of Anaesthesiology and Intensive Care, Karolinska Hospital and Institute, Stockholm, Sweden.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Departments of Anaesthesiology and Intensive Care, Karolinska Hospital and Institute, Stockholm, Sweden.
    Minimal influence of anaesthesia and abdominal surgery on computerized vectorcardiography recordings1995In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 39, no 1, p. 71-78Article in journal (Refereed)
    Abstract [en]

    Myocardial infarction still represents a major cause of morbidity and mortality following surgical procedures. Continuous computerized on‐line vector‐ECG has previously been shown to be useful in the detection of myocardial ischaemia, in acute myocardial infarction and unstable angina pectoris and for ischaemia monitoring after PTCA procedures. This method was presently tested for the possible influence of anaesthesia and surgery during cholecystectomy under general anaesthesia (n = 9), and during inguinal hernia repairs using a spinal block (n = 5). The patients had no history, symptoms or signs of ischaemic heart disease. Analyses of vectorcardiographic changes were made in relation to predefined standardized anaesthetic and surgical procedures, all of which potentially could influence the vector‐ECG. Three vectorcardiographic trend parameters were studied: QRS‐vector difference, ST‐vector magnitude and ST‐change vector magnitude. The overall vectorcardiographic changes were minimal and smaller than vectorcardiographic changes previously reported during myocardial ischaemia and infarction. Since anaesthetic and surgical procedures per se had only minor effects on the vector ECG recordings, it is concluded that continuous computerized on‐line vectorcardiography will not be skewed by these procedures. Hence, vectorcardiography has the potential of becoming a new monitor for the detection of perioperative myocardial ischaemia. 

  • 145.
    Gannerdahl, Per E.
    et al.
    Dept. of Anesth. and Intensive Care, Karolinska Institute, Karolinska, Sweden; .
    Edner, Magnus M.
    Department of Cardiology, Karolinska Institute, Karolinska, Sweden; Danderyd Hospitals, Stockholm, Sweden.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Department of Surgery, Karolinska Institute, Karolinska, Sweden.
    Computerizedvectorcardio-graphy for improved perioperative cardiac monitoring in vascularsurgery1996In: Journal of the American College of Surgeons, ISSN 1072-7515, E-ISSN 1879-1190, Vol. 182, no 6, p. 530-536Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Postoperative cardiac complications occur frequently after noncardiac operations in high-risk patients. Routine cardiac monitoring is usually done by electrocardiographic (ECG) methods. The present analysis shows that computerizedvectorcardiography (VCG) is superior to traditional ECG monitoring in predicting postoperative cardiac complications.

    STUDY DESIGN:

    Thirty-eight patients scheduled for abdominal aortic operations were monitored intraoperatively and for 48 hours postoperatively using VCG. These data were analyzed in a blinded fashion, and compared to cardiac outcome and regularly calculated 12-lead ECGs.

    RESULTS:

    Thirteen patients suffered from cardiac events: myocardial infarction (n = 3), cardiac death (n = 1), recurrent myocardial ischemia (n = 1), arrhythmias (n = 2), congestive heart failure (n = 2), and arrhythmias combined with congestive heart failure (n = 4). Thirty of 38 patients had ischemia recorded on their VCG, including all 13 patients with cardiac events. Only seven of the 13 patients had ischemic changes on the V5-lead alone and ten on the three leads II, V4, V5, yielding a sensitivity of 54 percent (V5), 77 percent (II, V4, V5) and 100 percent (VCG). Signs of ischemia appeared 400 +/- 690 (mean plus or minus standard deviation) minutes earlier (median 78 minutes, with a range of zero to 2,284 minutes), and never later on the VCG compared to the three leads II, V4, V5.

    CONCLUSIONS:

    Vectorcardiography in this risk group shows increased sensitivity in predicting perioperative cardiac complications and earlier ischemia detection than the most sensitive scalar leads. Vectorcardiography substantially improves the possibility of earlier intervention, potentially reducing the incidence of postoperative cardiac complications.

  • 146.
    Geirsson, Arnar
    et al.
    Faculty of Medicine, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland.
    Ahlsson, Anders
    Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden; School of Health and Medicine, Örebro University, Örebro, Sweden.
    Franco-Cereceda, Anders
    Department of Thoracic and Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Fuglsang, Simon
    Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Denmark.
    Gunn, Jarmo
    Department of Surgery, Heart Center, Turku University Hospital, University of Turku, Turku, Finland.
    Hansson, Emma C.
    Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Hjortdal, Vibeke
    Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Denmark.
    Jarvela, Kati
    Department of Cardiothoracic Surgery, Heart Center Tampere University Hospital, Tampere, Finland.
    Jeppsson, Anders
    Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Mennander, Ari
    Department of Cardiothoracic Surgery, Heart Center Tampere University Hospital, Tampere, Finland.
    Nozohoor, Shahab
    Department of Cardiothoracic Surgery, Skåne University Hospital, Lund, Sweden.
    Olsson, Christian
    Department of Thoracic and Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Pan, Emily
    Department of Surgery, Heart Center, Turku University Hospital, University of Turku, Turku, Finland.
    Wickbom, Anders
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Zindovic, Igor
    Department of Cardiothoracic Surgery, Skåne University Hospital, Lund, Sweden.
    Gudbjartsson, Tomas
    Faculty of Medicine, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland.
    Hospital volumes and later year of operation correlates with better outcomes in acute Type A aortic dissection2018In: European Journal of Cardio-Thoracic Surgery, ISSN 1010-7940, E-ISSN 1873-734X, Vol. 53, no 1, p. 276-281Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Acute Type A aortic dissection remains a life-threatening disease, but there are indications that its surgical mortality is decreasing. The aim of this report was to study how surgical mortality has changed and what influences those changes.

    METHODS: Nordic Consortium for Acute Type A Aortic Dissection is a retrospective database comprising 1159 patients (mean age 61.6 ± 12.2 years, 68% male) treated for acute Type A aortic dissection at 8 centres in Denmark, Finland, Iceland and Sweden from 2005 to 2014. Data gathered included demographics, symptoms, type of procedure, complications and 30-day mortality.

    RESULTS: The annual number of operations increased significantly from 85 in 2005 to 150 in 2014 (P < 0.001). Chest pain was present in 85% of patients, 24% were hypotensive on presentation and 28% had malperfusion syndrome. Open distal anastomosis technique under hypothermic circulatory arrest was used in 85% of cases and its use increased significantly throughout the study. The 30-day mortality decreased from 24% in 2005 to 13% in 2014 (P = 0.003). Independent predictors for 30-day mortality were preoperative cardiac arrest, malperfusion syndrome, Penn Class C, Penn Class B and C and cardiopulmonary bypass time, whereas later calendar year and higher hospital operative volumes predicted improved survival.

    CONCLUSIONS: Surgical mortality for acute Type A aortic dissection remains high but has decreased significantly over the last decade. This correlated with later year of operation and increased the number of operations performed per year, indicating that cumulative surgical experience contributes significantly to improved surgical outcomes.

  • 147.
    Geirsson, Arnar
    et al.
    Faculty of Medicine, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland.
    Ahlsson, Anders
    Örebro University, School of Medical Sciences. Örebro University Hospital, Örebro, Sweden.
    Franco-Cereceda, Anders
    Karolinska University Hospital, Stockholm, Sweden.
    Fuglsang, Simon
    Aarhus University Hospital, Skejby, Denmark.
    Gunn, Jarmo
    Turku University Hospital, Turku, Finland.
    Hansson, Emma C.
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Hjortdal, Vibeke
    Aarhus University Hospital, Skejby, Denmark.
    Jarvela, Kati
    Tampere University Hospital, Tampere, Finland.
    Jeppsson, Anders
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Mennander, Ari
    Tampere University Hospital, Tampere, Finland.
    Nozohoor, Shahab
    Skåne University Hospital, Lund, Sweden.
    Olsson, Christian
    Karolinska University Hospital, Stockholm, Sweden.
    Wickbom, Anders
    Karolinska University Hospital, Stockholm, Sweden.
    Zindovic, Igor
    Skåne University Hospital, Lund, Sweden.
    Gudbjartsson, Tomas
    Faculty of Medicine, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland.
    The Nordic Consortium for Acute type A Aortic Dissection (NORCAAD): objectives and design2016In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 50, no 5-6, p. 334-340Article in journal (Refereed)
    Abstract [en]

    Objectives: The Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD) is a collaborative effort of Nordic cardiac surgery centers to study acute type A aortic dissection (ATAAD). Here, we outline the overall objectives and the design of NORCAAD.

    Design: NORCAAD currently consists of eight centers in Denmark, Finland, Iceland and Sweden. Data was collected for patients undergoing surgery for ATAAD from 2005 to 2014. A total of 194 variables were retrospectively collected including demographics, past medical history, preoperative medications, symptoms at presentation, operative variables, complications, bleeding and blood transfusions, need for late reoperations, 30-day mortality and long-term survival.

    Results: Information was gathered in the database for 1159 patients, of which 67.6% were male. The mean age was 61.5 +/- 12.1 years. The mean follow-up was 3.1 +/- 2.9 years with a total of 3535 patient years.

    Conclusions: NORCAAD provides a foundation for close collaboration between cardiac surgery centers in the Nordic countries. Substudies in progress include: short-term outcomes, long-term survival, time interval from diagnosis until operation, effects of surgical techniques, malperfusion syndrome, renal failure, bleeding and neurological complications on outcomes and the rate of late reoperations.

  • 148.
    Geirsson, Arnar
    et al.
    Section of Cardiac Surgery, Yale University School of Medicine, New Haven CT, USA.
    Shioda, Kayoko
    Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven CT, USA.
    Olsson, Christian
    Department of Thoracic and Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Ahlsson, Anders
    Department of Thoracic and Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Gunn, Jarmo
    Heart Center, Turku University Hospital and University of Turku, Turku, Finland.
    Hansson, Emma C.
    Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Hjortdal, Vibeke
    Department of Thoracic and Cardiovascular Surgery, Aarhus University Hospital, Skejby, Denmark.
    Jeppsson, Anders
    Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Mennander, Ari
    Heart Center Tampere University Hospital, Tampere, Finland.
    Wickbom, Anders
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Zindovic, Igor
    Department of Cardiothoracic Surgery, Skane University Hospital, Lund, Sweden.
    Gudbjartsson, Tomas
    Landspitali University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
    Differential outcomes of open and clamp-on distal anastomosis techniques in acute type A aortic dissection2019In: Journal of Thoracic and Cardiovascular Surgery, ISSN 0022-5223, E-ISSN 1097-685X, Vol. 157, no 5, p. 1750-1758Article in journal (Refereed)
    Abstract [en]

    Objectives: Open-distal anastomosis is the preferred technique over clamp-on technique for surgical repair of acute type A aortic dissection (ATAAD). The aim of this study was to define how outcomes of ATAAD were affected by the use of either technique.

    Methods: Nordic Consortium for Acute Type A Aortic Dissection includes 8 academic cardiothoracic hospitals in 4 Nordic countries. The cohort consisted of 1134 patients, 153 clamp-on and 981 open-distal, from 2005 to 2014.

    Results: Patients who underwent operation with the clamp-on were younger, more frequently had coronary artery disease, bicuspid aortic valve, hypotension/shock or syncope, and a greater PennClass than open-distal patients. Postoperative cerebral vascular accident occurred less frequently in clamp-on (14/153, 10%) compared with the open-distal group (190/981, 20%). Clamp-on had greater 30-day mortality (39/153, 25%) than the open-distal group (158/981, 16%), and 5-year survival was also worse in clamp-on (61.8% +/- 4.4%) compared with the open-distal group (73.0% +/- 1.6%). The open-distal technique was used more frequently in greater-volume hospitals but was not independently associated with 30-day mortality. Preoperative condition was an independent risk factor whereas hospital volume and later year of operation were beneficial in regard to short-term outcome. Open-distal was independently associated with improved mid-term survival.

    Conclusions: Patients who underwent operation with the clamp-on were sicker on presentation and had worse short-and mid-term survival compared with the open-distal group. Patients in the open-distal group had greater rates of cerebrovascular complications. The results support the routine use of open-distal anastomosis as the primary operative strategy for ATAAD, although clamp-on can be performed successfully in select cases.

  • 149.
    Giesecke, Peter
    et al.
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.
    Frykman, Viveka
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.
    Wallin, Göran K.
    Örebro University, School of Medical Sciences. Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Department of Surgery, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Lönn, Stefan
    Department of Research and Development, Region Halland, Halmstad, Sweden.
    Discacciati, Andrea
    Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
    Törring, Ove
    Department of Clinical Research and Education, Karolinska Institute, Stockholm, Sweden.
    Rosenqvist, Mårten
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.
    All-cause and cardiovascular mortality risk after surgery versus radioiodine treatment for hyperthyroidism2018In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 105, no 3, p. 279-286Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Little is known about the long-term side-effects of different treatments for hyperthyroidism. The few studies previously published on the subject either included only women or focused mainly on cancer outcomes. This register study compared the impact of surgery versus radioiodine on all-cause and cause-specific mortality in a cohort of men and women.

    METHODS: Healthcare registers were used to find hyperthyroid patients over 35 years of age who were treated with radioiodine or surgery between 1976 and 2000. Comparisons between treatments were made to assess all-cause and cause-specific deaths to 2013. Three different statistical methods were applied: Cox regression, propensity score matching and inverse probability weighting.

    RESULTS: Of the 10 992 patients included, 10 250 had been treated with radioiodine (mean age 65·1 years; 8668 women, 84·6 per cent) and 742 had been treated surgically (mean age 44·1 years; 633 women, 85·3 per cent). Mean duration of follow-up varied between 16·3 and 22·3 years, depending on the statistical method used. All-cause mortality was significantly lower among surgically treated patients, with a hazard ratio of 0·82 in the regression analysis, 0·80 in propensity score matching and 0·85 in inverse probability weighting. This was due mainly to lower cardiovascular mortality in the surgical group. Men in particular seemed to benefit from surgery compared with radioiodine treatment.

    CONCLUSION: Compared with treatment with radioiodine, surgery for hyperthyroidism is associated with a lower risk of all-cause and cardiovascular mortality in the long term. This finding was more evident among men.

  • 150.
    Giesecke, Peter
    et al.
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Rosenqvist, Mårten
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Frykman, Viveka
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Friberg, Leif
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Wallin, Göran
    Örebro University, School of Medical Sciences. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Höijer, Jonas
    Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Lönn, Stefan
    Research and Development, Region Halland, Halmstad, Sweden.
    Törring, Ove
    Department of Clinical Research and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Increased Cardiovascular Mortality and Morbidity in Patients Treated for Toxic Nodular Goiter Compared to Graves' Disease and Nontoxic Goiter2017In: Thyroid, ISSN 1050-7256, E-ISSN 1557-9077, Vol. 27, no 7, p. 878-885Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Previous research has suggested an increased risk of death and cardiovascular disease in patients treated for hyperthyroidism. However, studies on this subject are heterogeneous, often based on old data, or have not considered the impact that treatment for hyperthyroidism might have on cardiovascular risk. It is also unclear whether long-term prognosis differs between Graves' disease and toxic nodular goiter. The aim of this study was to use a very large cohort built on recent data to assess whether improvements in cardiovascular care might have changed the prognosis over time. The study also investigated the impact of different etiologies of hyperthyroidism.

    METHODS: This was an observational register study for the period 1976-2012, with subjects followed for a median period of 18.4 years. Study patients were Stockholm residents treated for Graves' disease or toxic nodular goiter with either radioactive iodine or surgery (N = 12,239). This group was compared to Stockholm residents treated for nontoxic goiter (N = 3685), with adjustments made for age, sex, comorbidities, and time of treatment. Comparisons were also made to the general population of Stockholm. Outcomes were assessed in terms of all-cause and cardiovascular mortality as well as cardiovascular morbidity.

    RESULTS: The hazard ratios (HR) for all-cause mortality and for cardiovascular mortality were 1.27 [confidence interval (CI) 1.20-1.35] and 1.29 [CI 1.17-1.42], respectively, for hyperthyroid patients compared to those with nontoxic goiter. For cardiovascular morbidity, the HR was 1.12 [CI 1.06-1.18]. Patients aged ≥45 years who were treated for toxic nodular goiter were generally at greater risk than others, and those included from the year 1990 and onwards were at greater risk than those included earlier. Increased all-cause mortality, as well as cardiovascular mortality and morbidity, were also seen in comparisons with the general population.

    CONCLUSIONS: This is the first large study to indicate that the long-term risk of death and cardiovascular disease in hyperthyroid subjects is due to the hyperthyroidism itself and not an effect of confounding introduced by its treatment. Much of the excess risk is confined to individuals treated for toxic nodular goiter. Despite advances in cardiovascular care during recent decades, hyperthyroidism is still a diagnosis associated with increased cardiovascular morbidity and mortality.

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