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  • 401.
    Verhoeven, E. L. G.
    et al.
    Dept Vasc & Endovasc Surg, Paracelsus Med Univ, Nürnberg, Germany.
    Katsargyris, A.
    Dept Vasc & Endovasc Surg, Paracelsus Med Univ, Nürnberg, Germany.
    Bachoo, P.
    Dept Vasc Surg, Aberdeen Royal Infirm, Aberdeen, UK.
    Larzon, Thomas
    Örebro University Hospital. Dept Cardiothorac & Vasc Surg, Örebro University Hospital, Örebro, Sweden.
    Fisher, R.
    Liverpool Vasc & Endovasc Serv, Royal Liverpool Univ Hosp, Liverpool, England.
    Ettles, D.
    Dept Radiol, Hull Royal Infirm, Kingston Upon Hull, England.
    Boyle, J. R.
    Dept Vasc Surg, Cambridge Univ Hosp NHS Fdn Trust, Cambridge, England.
    Brunkwall, J.
    Univ Clin, Dept Vasc & Endovasc Surg, Univ Cologne, Cologne, Germany.
    Boeckler, D.
    Dept Vasc & Endovasc Surg, Univ Heidelberg Hosp, Heidelberg, Germany.
    Florek, H-J
    Dept Vasc & Endovasc Surg, Weisseritztal Kliniken, Freital, Germany.
    Stella, A.
    Dept Vasc Surg, Policlin S Orsola Malpighi, Univ Bologna, Bologna, Italy.
    Kasprzak, P.
    Dept Surg Vasc Surg & Endovasc Surg, Univ Hosp, Univ Regensburg, Regensburg, Germany.
    Verhagen, H.
    Med Ctr, Dept Vasc Surg, Erasmus Univ, Rotterdam, Netherlands.
    Riambau, V.
    Hosp Clin, Thorax Inst, Vasc Surg Div,Dept Cardiovasc Surg, Univ Barcelona, Barcelona, Spain.
    Real-world Performance of the New C3 Gore Excluder Stent-Graft: 1-year Results from the European C3 Module of the Global Registry for Endovascular Aortic Treatment (GREAT)2014In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 48, no 2, p. 131-137Article in journal (Refereed)
    Abstract [en]

    Objectives: The European C3 module of the Global Registry for Endovascular Aortic Treatment (GREAT) provides "real-world" outcomes for the new C3 Gore Excluder stent-graft, and evaluates the new deployment mechanism. This report presents the 1-year results from 400 patients enrolled in this registry. Methods: Between August 2010 and December 2012, 400 patients (86.8% male, mean age 73.9 +/- 7.8 years) from 13 European sites were enrolled in this registry. Patient demographics, treatment indication, case planning, operative details including repositioning and technical results, and clinical outcome were analyzed. Results: Technical success was achieved in 396/400 (99%) patients. Two patients needed intraoperative open conversion, one for iliac rupture, the second because the stent-graft was pulled down during a cross-over catheterization in an angulated anatomy. Two patients required an unplanned chimney renal stent to treat partial coverage of the left renal artery because of upward displacement of the stent-graft. Graft repositioning occurred in 192/399 (48.1%) patients, most frequently for level readjustment with regard to the renal arteries, and less commonly for contralateral gate reorientation. Final intended position of the stent-graft below the renal arteries was achieved in 96.2% of patients. Thirty-day mortality was two (0.5%) patients. Early reintervention (<= 30 days) was required in two (0.5%) patients. Mean follow-up duration was 15.9 +/- 8.8 months (range 0-37 months). Late reintervention (>30 days) was required in 26 (6.5%) patients. Estimated freedom from reintervention at 1 year was 95.2% (95% CI 92.3-97%), and at 2 years 91.5% (95% CI 86.8-94.5%). Estimated patient survival at 1 year was 96% (95% CI 93.3-97.6%) and at 2 years 90.6% (95% CI 85.6-93.9%). Conclusions: Early real-world experience shows that the new C3 delivery system offers advantages in terms of device repositioning resulting in high deployment accuracy. Longer follow-up is required to confirm that this high deployment accuracy results in improved long-term durability.

  • 402.
    Verma, Subodh
    et al.
    Li Ka Shing Knowledge Inst, Keenan Res Ctr, Div Cardiac Surg, St Michaels Hosp, Toronto ON, Canada; Dept Surg, Univ Toronto, Toronto ON, Canada.
    Lovren, Fina
    Li Ka Shing Knowledge Inst, Keenan Res Ctr, Div Cardiac Surg, St Michaels Hosp, Toronto ON, Canada.
    Pan, Yi
    Li Ka Shing Knowledge Inst, Keenan Res Ctr, Div Cardiac Surg, St Michaels Hosp, Toronto ON, Canada.
    Yanagawa, Bobby
    Li Ka Shing Knowledge Inst, Keenan Res Ctr, Div Cardiac Surg, St Michaels Hosp, Toronto ON, Canada; Dept Surg, Univ Toronto, Toronto ON, Canada.
    Deb, Saswata
    Dept Surg, Univ Toronto, Toronto ON, Canada; Schulich Heart Ctr, Div Cardiac Surg, Sunnybrook Hlth Sci Ctr, Toronto ON, Canada.
    Karkhanis, Reena
    Schulich Heart Ctr, Div Cardiac Surg, Sunnybrook Hlth Sci Ctr, Toronto ON, Canada.
    Quan, Adrian
    Li Ka Shing Knowledge Inst, Keenan Res Ctr, Div Cardiac Surg, St Michaels Hosp, Toronto ON, Canada.
    Teoh, Hwee
    Li Ka Shing Knowledge Inst, Keenan Res Ctr, Div Cardiac Surg, St Michaels Hosp, Toronto ON, Canada; Li Ka Shing Knowledge Inst, Keenan Res Ctr, Div Endocrinol & Metab, St Michaels Hosp, Toronto ON, Canada.
    Feder-Elituv, Randi
    Li Ka Shing Knowledge Inst, Keenan Res Ctr, Div Cardiac Surg, St Michaels Hosp, Toronto ON, Canada.
    Moussa, Fuad
    Dept Surg, Univ Toronto, Toronto ON, Canada; Schulich Heart Ctr, Div Cardiac Surg, Sunnybrook Hlth Sci Ctr, Toronto ON, Canada.
    Souza, Domingos S. R.
    Örebro University Hospital. Dept Cardiovasc & Thorac Surg, Örebro University Hospital, Örebro, Sweden.
    Fremes, Stephen E.
    Dept Surg, Univ Toronto, Toronto ON, Canada; Schulich Heart Ctr, Div Cardiac Surg, SunnybrookHlth Sci Ctr, Toronto ON, Canada.
    Pedicled no-touch saphenous vein graft harvest limits vascular smooth muscle cell activation: the PATENT saphenous vein graft study2014In: European Journal of Cardio-Thoracic Surgery, ISSN 1010-7940, E-ISSN 1873-734X, Vol. 45, no 4, p. 717-725Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Neointimal hyperplasia secondary to vascular smooth muscle cell (VSMC) activation limits the long-term patency of saphenous vein grafts (SVGs). We compared markers of vascular injury and VSMC activation in SVGs harvested using the pedicled 'no-touch' (NT) vs the conventional (CON) technique. METHODS: Patients undergoing coronary artery bypass surgery were enrolled in the PATENT SVG trial (clinicaltrials.gov NCT01488084). Patients were randomly allocated to have SVGs harvested with the NT technique from one leg and the CON method from the other. SVG segments underwent morphometry, histological and electron microscopy assessments and transcript measurements of VSMC activation and differentiation markers. Leg wound functional recovery and harvest site complications were assessed using a quality-of-life questionnaire. RESULTS: A total of 17 patients (65.3 +/- 7.3 years) were enrolled. SVGs harvested using the NT vs CON technique exhibited preserved intimal, medial and adventitial architecture. CON harvest was associated with greater medial Kruppel-like factor 4 transcript levels (0.26 +/- 0.05 vs 0.11 +/- 0.02, P < 0.05). CON samples had significantly lower medial serum response factor (0.53 +/- 0.11 vs 1.44 +/- 0.50, P < 0.05) and myocardin (0.59 +/- 0.08 vs 1.33 +/- 0.33, P < 0.05) transcript levels. MicroRNA-145, an inhibitor of VSMC activation and differentiation, was higher in the NT vs CON samples (1.84 +/- 1.03 vs 0.50 +/- 0.19, P < 0.05). Leg assessment scores were worse in the NT legs at 3 months, but similar to CON scores at 12 months. CONCLUSIONS: SVGs harvested using the 'NT' technique exhibit an early molecular and morphological pattern consistent with decreased VSMC activation compared with CON harvesting. Functional leg recovery was similar in both groups at 12 months. Larger studies are required to corroborate these findings.

  • 403.
    Völz, Sebastian
    et al.
    Department of Cardiology, Sahlgrenska University Hospital, Sweden.
    Angerås, Oskar
    Department of Cardiology, Sahlgrenska University Hospital, Sweden.
    Koul, Sasha
    Department of Cardiology, Lund University, Sweden.
    Haraldsson, Inger
    Department of Cardiology, Sahlgrenska University Hospital, Sweden.
    Sarno, Giovanna
    Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden.
    Venetsanos, Dimitrios
    Department of Cardiology, Karolinska University Hospital, Sweden.
    Grimfärd, Per
    Department of Internal Medicine, Västmanlands Sjukhus, Sweden.
    Ulvenstam, Anders
    Department of Cardiology, Östersund Hospital, Sweden.
    Hofmann, Robin
    Department of Clinical Science and Education, Karolinska Institutet, Sweden.
    Hamid, Mehmet
    Department of Cardiology, Mälarsjukhuset, Sweden.
    Henareh, Loghman
    Department of Cardiology, Karolinska University Hospital, Sweden.
    Wagner, Henrik
    Department of Cardiology, Helsingborg Lasarett, Sweden.
    Jensen, Jens
    Unit of Cardiology, Capio S:t Görans Sjukhus, Sweden.
    Danielewicz, Mikael
    Department of Cardiology, Karlstad Hospital, Sweden.
    Östlund, Ollie
    Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden.
    Eriksson, Peter
    Department of Cardiology, Umeå University, Sweden.
    Scherstén, Fredrik
    Department of Cardiology, Lund University, Sweden.
    Linder, Rickard
    Department of Cardiology, Danderyd Hospital, Sweden.
    Råmunddal, Truls
    Department of Cardiology, Århus University Hospital, Sweden.
    Pétursson, Pétur
    Department of Cardiology, Sahlgrenska University Hospital, Sweden.
    Fröbert, Ole
    Örebro University, School of Medical Sciences. Department of Cardiology.
    James, Stefan
    Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden.
    Erlinge, David
    Department of Cardiology, Lund University, Sweden.
    Omerovic, Elmir
    Department of Cardiology, Sahlgrenska University Hospital, Sweden.
    Radial versus femoral access in patients with acute coronary syndrome undergoing invasive management: A prespecified subgroup analysis from VALIDATE-SWEDEHEART2019In: European heart journal. Acute cardiovascular care., ISSN 2048-8726, Vol. 8, no 6, p. 510-519Article in journal (Refereed)
    Abstract [en]

    Aims: In the Bivalirudin versus Heparin in ST-Segment and Non-ST-Segment Elevation Myocardial Infarction in Patients on Modern Antiplatelet Therapy in the Swedish Web System for Enhancement and Development of Evidence-based Care in Heart Disease Evaluated according to Recommended Therapies Registry Trial (VALIDATE-SWEDEHEART), bivalirudin was not superior to unfractionated heparin in patients with acute coronary syndrome undergoing invasive management. We assessed whether the access site had an impact on the primary endpoint of death, myocardial infarction or major bleeding at 180 days and whether it interacted with bivalirudin/unfractionated heparin.

    Methods and results: A total of 6006 patients with acute coronary syndrome planned for percutaneous coronary intervention were randomised to either bivalirudin or unfractionated heparin. Arterial access was left to the operator discretion. Overall, 90.5% of patients underwent transradial access and 9.5% transfemoral access. Baseline risk was higher in transfemoral access. The unadjusted hazard ratio for the primary outcome was lower with transradial access (hazard ratio 0.53, 95% confidence interval 0.43-0.67, p<0.001) and remained lower after multivariable adjustment (hazard ratio 0.56, 95% confidence interval 0.52-0.84, p<0.001). Transradial access was associated with lower risk of death (hazard ratio 0.41, 95% confidence interval 0.28-0.60, p<0.001) and major bleeding (hazard ratio 0.57, 95% confidence interval 0.44-0.75, p<0.001). There was no interaction between treatment with bivalirudin and access site for the primary endpoint (p=0.976) or major bleeding (p=0.801).

    Conclusions: Transradial access was associated with lower risk of death, myocardial infarction or major bleeding at 180 days. Bivalirudin was not associated with less bleeding, irrespective of access site.

  • 404.
    Waldenborg, Micael
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Lidén, Mats
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Kähäri, Anders
    Department of Radiology, School of Health and Medical Sciences, Örebro University, Örebro, Sweden .
    Emilsson, Kent
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Effect on left ventricular mass and geometry in patients with takotsubo cardiomyopathy2015In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 49, no 1, p. 27-38Article in journal (Refereed)
    Abstract [en]

    Objectives: Takotsubo cardiomyopathy (TTC) is a condition of transient left ventricular (LV) dysfunction. The effects on LV mass (LVM) and geometry have not been studied enough in TTC. Retrospectively, we analyzed our TTC cohort both by transthoracic echocardiography (TTE) and magnetic resonance imaging (MRI), for comparative purposes.

    Design: Thirteen women undergoing TTE and MRI, at onset and three months later, were included. LVM was estimated by MRI, and two TTE-methods. Segmental wall thickness (SWT) was measured, whilst radial strain was assessed by TTE. Data analysis included Wilcoxon's test (between phases), Mann Whitney U- and McNemar's tests (between and within groups). Bland-Altman analyzes were used for intertechnique coherence, whilst interactions regarding TTE were tested using Spearman's coefficient.

    Results: LVM decreased during recovery (p<0.05), by MRI and one of the TTE-methods; truncated ellipsoid formula (TEF), which also showed relatively better coherence compared to MRI. SWT decreased in two of three sites, by both modalities, but with ambiguous coherence therebetween. The TEF-data interacted partially with a demonstrated increase in radial strain.

    Conclusions: TTC associates with acute increase in LVM, which appears to be an apical effect, tending to follow the changes in concentric wall motion. MRI and TTE show adequate coherence; primarily for the TEF-method regarding LVM.

  • 405.
    Waldenborg, Micael
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Clinical Physiology, Örebro University Hospital, Örebro, Sweden.
    Lidén, Mats
    Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Kähäri, Anders
    Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Emilsson, Kent
    Department of Clinical Physiology, Örebro University Hospital, Örebro, Sweden.
    Effect on left ventricular mass and geometry in patients with takotsubo cardiomyopathyManuscript (preprint) (Other academic)
    Abstract [en]

    Aims: Takotsubo cardiomyopathy (TTC) is a condition of reversible left ventricular (LV) dysfunction. The effects, from acute to recovery phase, on LV mass (LVM) and the LV geometry are not thoroughly enough studied at TTC, which were the main aims of the present study. Retrospectively, we analyzed our cohort of TTC-patients, both with transthoracic echocardiography (TTE) and magnetic resonance imaging (MRI), to further investigate these changes, including intertechnique comparison.

    Methods: We studied 13 female TTC-patients, undergoing TTE and MRI acutely, and three months later at follow-up. LVM was measured with MRI- and five different TTE-methods. Segmental wall thickness (SWT) was assessed, and used for LV hypertrophy (LVH) geometry categorization. Radial strain was measured at TTE. Data analysis included Wilcoxon signed-test (between phases), Mann Whitney U- and McNemar’s tests (between and within groups). Spearman’s coefficient was used for intertechnique coherence (with BlandAltman plots) and for correlations of simultaneous TTE changes.

    Results: LVM decreased significantly between phases (p<0.05), by MRI and with two TTE-methods. Two of three SWT-sites became significantly thinner, with adequate correlation (rs≥0.69) between techniques, while LVH categories remained unchanged. Relatively better consistency, compared with MRI, was shown for one of the TTE-methods used to estimate LVM (truncated ellipsoid (TE)). Radial strain improved significantly, with partial correlation towards the TE-method.

    Conclusions: TTC associates with acute increase in LVM, which seems to be a local effect, tending to occur in parallel with changes in concentric wall motion. MRI and TTE shows adequate consistency, primarily for the TE-method regarding LVM.

  • 406.
    Waldenborg, Micael
    et al.
    Department of Clinical Physiology, Örebro University Hospital, Örebro, Sweden.
    Soholat, Mona
    Department of Psychiatry, Örebro University Hospital, Örebro, Sweden.
    Kähäri, Anders
    Department of Radiology, Orebro University Hospital, Orebro, Sweden.
    Emilsson, Kent
    Department of Clinical Physiology, Örebro University Hospital, Örebro, Sweden.
    Fröbert, Ole
    Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
    Multidisciplinary assessment of takotsubo cardiomyopathy: a prospective case study2011In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 11, p. 14-Article in journal (Refereed)
    Abstract [en]

    Background: The cause of tako tsubo cardiomyopathy remains unclear. We used a multidisciplinary approach to investigate if a common pathophysiological denominator could be outlined.

    Methods: Within 3 days following symptom presentation and again after 3 months we investigated all patients coming to our institution and diagnosed with tako-tsubo cardiomyopathy. Patients underwent extensive biochemical screening. Left ventricular function was evaluated by echocardiography and contrast-enhanced cardiac magnetic resonance imaging. Cardiac autonomic function was studied by heart rate variability and signal-averaged electrocardiogram and posttraumatic stress and depression were investigated by questionnaires (the Posttraumatic Stress Syndrome 10-Questions Inventory, PTSS-10 and the Montgomery-Asberg depression rating scale, self rated version, MADRS-S).

    Results: During 2 years, 13 consecutive patients were included. Markers of myocardial damage and heart failure were slightly to moderately elevated and ejection fraction (echocardiography and MRi) was moderately reduced at hospitalization and improved to normal values in all patients. Signal averaged ECG demonstrated a statistically significant shorter duration of the filtered QRS complex in the acute phase as compared to follow-up. In heart rate variability analysis, SDNN and SDANN were shorter acutely compared to follow-up. Two patients fulfilled criteria for posttraumatic stress syndrome while 7 patients were in the borderline zone. There was a statistically significant inverse correlation between PTSS-10 score and QRS duration in the signal-averaged ECG (r = -0.66, P = 0.01).

    Conclusions: Patients with tako tsubo cardiomyopathy have altered cardiac autonomic function and a high incidence rate of borderline or definite posttraumatic stress syndrome acutely. This is in line with findings in patients with myocardial infarction and does not allow conclusions on cause and effect.

  • 407.
    Walfridsson, Ulla
    et al.
    Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Hansen, Peter Steen
    Private Hospital Molholm, Vejle, Denmark.
    Charitakis, Emmanouil
    Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Almroth, Henrik
    Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Jönsson, Anders
    Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Karlsson, Lars O.
    Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Liuba, Ioan
    Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Ayou, Romeo Samo
    Department of Cardiology, Skaraborgs Hospital, Skövde, Sweden.
    Poçi, Dritan
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiology.
    Holmqvist, Fredrik
    Deptartment of Cardiology, Skåne University Hospital, Lund, Sweden.
    Kongstad, Ole
    Deptartment of Cardiology, Skåne University Hospital, Lund, Sweden.
    Walfridsson, Håkan
    Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Gender and age differences in symptoms and health-related quality of life in patients with atrial fibrillation referred for catheter ablation2019In: Pacing and Clinical Electrophysiology, ISSN 0147-8389, E-ISSN 1540-8159, Vol. 42, no 11, p. 1431-1439Article in journal (Refereed)
    Abstract [en]

    Background: Primary indication for catheter ablation of atrial fibrillation (AF) is to reduce symptoms and improve health-related quality of life (HRQoL). There are data showing differences between the genders and between younger and older patients. To evaluate this, we studied a large Scandinavian cohort of patients referred for catheter ablation of AF.

    Methods: Consecutive patients filled out the ASTA questionnaire, assessing symptoms, HRQoL, and perception of arrhythmia, prior to ablation. Patients were recruited from four Swedish and one Danish tertiary center.

    Results: A total of 2493 patients (72% men) filled out the ASTA questionnaire. Women experienced eight of the nine ASTA scale symptoms more often than men. Patients <65 years reported four symptoms more often, only tiredness was more frequent in those >= 65 years (P = .007). Women and patients <65 years experienced more often palpitations and regarding close to fainting and this was more common among women, no age differences were seen. Women and men scored differently in 10 of the 13 HRQoL items. Only negative impact on sexual life was more common in men (P < .001). Older patients reported more negative influence in four of the HRQoL items and the younger in one; ability to concentrate.

    Conclusions: Women experienced a more pronounced symptom burden and were more negatively affected in all HRQoL concerns, except for the negative impact on sexual life, where men reported more influence of AF. Differences between age groups were less pronounced. Disease-specific patient-reported outcomes measures (PROMs) add important information where gender differences should be considered in the care.

  • 408.
    Walker, Alex J.
    et al.
    Div Epidemiol & Publ Hlth, City Hosp Nottingham, Univ Nottingham, Nottingham, England; Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Biomed Res Unit, Nottingham, England.
    Grainge, Matthew J.
    Div Epidemiol & Publ Hlth, City Hosp Nottingham, Univ Nottingham, Nottingham, England; Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Biomed Res Unit, Nottingham, England.
    Card, Tim R.
    Div Epidemiol & Publ Hlth, City Hosp Nottingham, Univ Nottingham, Nottingham, England; Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Biomed Res Unit, Nottingham, England.
    West, Joe
    Div Epidemiol & Publ Hlth, City Hosp Nottingham, Univ Nottingham, Nottingham, England; Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Biomed Res Unit, Nottingham, England.
    Ranta, Susanna
    Childhood Canc Res Unit, Karolinska Inst, Stockholm, Sweden.
    Ludvigsson, Jonas F.
    Örebro University Hospital. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet Sockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden.
    Venous thromboembolism in children with cancer: A population-based cohort study2014In: Thrombosis Research, ISSN 0049-3848, E-ISSN 1879-2472, Vol. 133, no 3, p. 340-344Article in journal (Refereed)
    Abstract [en]

    Introduction: Cancer is a known risk factor for venous thromboembolism (VTE) in adults, but population-based data in children are scarce.

    Materials and methods: We conducted a cohort study utilising linkage of the Clinical Practice Research Database (primary care), Hospital Episodes Statistics (secondary care), UK Cancer Registry data and Office for National Statistics cause of death data. From these databases, we selected 498 children with cancer diagnosed between 1997 and 2006 and 20,810 controls without cancer. We calculated VTE incidence rates in children with cancer vs. controls, and hazard ratios (HRs) using Cox regression.

    Results: We identified four VTE events in children with cancer compared with four events in the larger control population corresponding to absolute risks of 1.52 and 0.06 per 1000 person-years respectively. The four children with VTE and cancer were diagnosed with hematological, bone or non-specified cancer. Childhood cancer was hence associated with a highly increased risk of VTE (HR adjusted for age and sex: 28.3; 95% CI = 7.0-114.5).

    Conclusions: Children with cancer are at increased relative risk of VTE compared to those without cancer. Physicians could consider thromboprophylaxis in children with cancer to reduce their excess risk of VTE however the absolute risk is extremely small and the benefit gained therefore would need to be balanced against the risk invoked of implementing such a strategy.

    Novelty & Impact Statements: While there is a reasonable level of knowledge about the risk of VTE in adult populations, it is not well known whether this risk is reflected in paediatric patients. We found a substantial increase in risk of VTE in children with cancer compared to a child population without cancer. While this finding is important, the absolute risk of VTE is still low and must be balanced with the risks of anticoagulation. (C) 2014 The Authors. Published by Elsevier Ltd. All rights reserved.

  • 409. Wall, Kent
    et al.
    Oddsson, Hjörtur
    Ternestedt, Britt-Marie
    Jonzon, Anders
    Nylander, Eva
    Schollin, Jens
    Örebro University, School of Health and Medical Sciences.
    Thirty-year electrocardiographic follow-up after repair of tetralogy of Fallot or atrial septal defect2007In: Journal of Electrocardiology, ISSN 0022-0736, E-ISSN 1532-8430, Vol. 40, no 2, p. 214-217Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE: Knowledge about long-term electrocardiographic changes after surgery for congenital heart disease is limited. METHODS: Eleven patients with corrected tetralogy of Fallot (ToF) and 14 with corrected atrial septal defect (ASD) were followed up at 20 and 30 years after surgery. RESULTS: Approximately 50% of the ASD group developed prolonged QRS duration. In the ToF group, 7 increased QRS duration by more than 20 milliseconds. Nearly all had right bundle-branch block, and 30% of them also had bifascicular block. Two in the ASD group developed first grade atrioventricular block. Five ASD and 6 ToF had prolonged corrected QT duration in the late postoperative phase. CONCLUSIONS: Even after primarily good results of surgery in congenital heart disease, unknown late effects may occur not only in complex lesions such as ToF but also after ASD correction. Regular medical checkups are important after surgical correction in congenital heart disease.

  • 410.
    Waltenberger, Johannes
    et al.
    Department of Cardiovascular Medicine, Medical Faculty, University of Münster, Münster, Germany.
    Brachmann, Johannes
    II. Medizinische Klinik, Klinikum Coburg, Coburg, Germany.
    van der Heyden, Jan
    Department of Cardiology, St. Antionius Ziekenhuis, Nieuwegein, the Netherlands.
    Richardt, Gert
    Department of Cardiology and Angiology, Herzzentrum Segeberger Kliniken GmbH, Bad Segeberg, Germany.
    Fröbert, Ole
    Örebro University, School of Medical Sciences. Department of Cardiology.
    Seige, Markus
    I. Medizinische Klinik, Krankenhaus Martha Maria gGmbH, Halle-Dölau, Germany.
    Friedrich, Guy
    Innere Medizin III, Kardiologie, University Hospital Innsbruck, Innsbruck, Austria.
    Erglis, Andrejs
    Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia.
    Winkens, Mark
    Department of Cardiology, Elisabeth-Tweesteden Ziekenhuis (ETZ), AD Tilburg, the Netherlands.
    Hegeler-Molkewehrum, Christian
    Kardiologisch-Angiologische Praxis Hegeler, Bremen, Germany.
    Neef, Martin
    Department of Cardiology, University Leipzig, Leipzig, Germany.
    Hoffmann, Stefan
    Department Internal Medicine and Cardiology, Vivantes Klinikum im Friedrichshain, Berlin, Germany.
    Five-Year Results of the Bioflow-III Registry: Real-World Experience with a Biodegradable Polymer Sirolimus-Eluting Stent2020In: Cardiovascular Revascularization Medicine, ISSN 1553-8389, E-ISSN 1878-0938, Vol. 21, no 1, p. 63-69Article in journal (Refereed)
    Abstract [en]

    Purpose: We aimed to assess long-term safety and performance of the Orsiro sirolimus-eluting coronary stent with biodegradable polymer in a large unselected population and in pre-specified subgroups.

    Methods: BIOFLOW-III is a prospective, multicenter, international, observational registry with follow-up visits scheduled at 6 and 12 months, and at 3 and 5 years (NCT01553526).

    Results: 1356 patients with 1738 lesions were enrolled. Of those, 392 (28.9%) declined to participate in the study extension from 18 months to 5 years, 37 (2.7%) withdrew consent, and 89 (6.6%) were lost to follow-up. At 5-years, Kaplan-Meier estimates of target lesion failure, defined as a composite of cardiac death, target-vessel myocardial infarction, coronary artery bypass grafting and clinically driven target lesion revascularization was 10.0% [95% confidence interval (CI): 8.4; 12.0] in the overall population, and 14.0% [95% CI: 10.5; 18.6], 10.3% [95% CI: 7.8; 13.5], 1.8% [95% CI: 0.3; 12.0], and 11.3% [95% CI: 8.5; 15.1] in the pre-defined risk groups of patients with diabetes mellitus, small vessels <= 2.75 mm, chronic total occlusion, and acute myocardial infarction. Definite stent thrombosis was observed in 0.3% [95% CI: 0.1; 0.9] of patients.

    Conclusion: These long-term outcomes provide further evidence on the safety and performance of a sirolimus-eluting biodegradable polymer stent within daily clinical practice. The very lowdefinite stent thrombosis rate affirms biodegradable polymer safety and performance.

  • 411.
    Warensjö, Eva
    et al.
    Clinical Nutrition and Metabolism, Department of Public health and Caring sciences, Uppsala University, Sweden.
    Risérus, Ulf
    Clinical Nutrition and Metabolism, Department of Public health and Caring sciences, Uppsala University, Sweden.
    Gustafsson, Inga-Britt
    Örebro University, School of Hospitality, Culinary Arts & Meal Science.
    Mohsen, Rawya
    Clinical Nutrition and Metabolism, Department of Public health and Caring sciences, Uppsala University, Sweden.
    Cederholm, Tommy
    Clinical Nutrition and Metabolism, Department of Public health and Caring sciences, Uppsala University, Sweden.
    Vessby, Bengt
    Clinical Nutrition and Metabolism, Department of Public health and Caring sciences, Uppsala University, Sweden.
    Effects of saturated and unsaturated fatty acids on estimated desaturase activities during a controlled dietary intervention2008In: NMCD. Nutrition Metabolism and Cardiovascular Diseases, ISSN 0939-4753, E-ISSN 1590-3729, Vol. 18, no 10, p. 683-690Article in journal (Refereed)
    Abstract [en]

    Background and aims

    Direct measurement of desaturase activities are difficult to obtain in humans. Consequently, surrogate measures of desaturase activity (estimated desaturase activities) have been frequently used in observational studies, and estimated Δ9- (or stearoyl-CoA-desaturase (SCD)), Δ6- and Δ5-desaturase activities have been associated with cardiometabolic disease. Data on how the markers of desaturase activities are modified by changes in dietary fat quality are lacking and therefore warrant examination.

    Methods and results

    In a two-period (three weeks) strictly controlled cross-over study, 20 subjects (six women and 14 men) consumed a diet high in saturated fat (SAT-diet) and a rapeseed oil diet (RO-diet), rich in oleic acid (OA), linoleic acid (LA) and α-linolenic acid (ALA). Estimated desaturase activities were calculated as precursor to product FA ratios in serum cholesteryl esters and phospholipids. The estimated SCD [16:1 n-7/16:0] and Δ6-desaturase [20:3 n-6/18:2 n-6] was significantly higher while Δ5-desaturase [20:4 n-6/20:3 n-6] was significantly lower in the SAT-diet (P < 0.001 for all), compared to the RO-diet. The serum proportions of palmitic, stearic, palmitoleic and dihomo-γ-linolenic acids were significantly higher in the SAT-diet while the proportions of LA and ALA were significantly higher in the RO-diet.

    Conclusion

    This is the first study to demonstrate that surrogate measures of desaturase activities change as a consequence of an alteration in dietary fat quality. Both the [16:1/16:0]-ratio and 16:1 seem to reflect changes in saturated fat intake and may be useful markers of saturated fat intake in Western countries.

  • 412.
    Westerdahl, Elisabeth
    et al.
    Örebro University, School of Health Sciences.
    Jonsson, Marcus
    Örebro University, School of Medical Sciences.
    Emtner, Margareta
    Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden.
    Pulmonary function and health-related quality of life 1-year follow up after cardiac surgery2016In: Journal of Cardiothoracic Surgery, ISSN 1749-8090, E-ISSN 1749-8090, Vol. 11, no 1, article id 99Article in journal (Refereed)
    Abstract [en]

    Background: Pulmonary function is severely reduced in the early period after cardiac surgery, and impairments have been described up to 4-6 months after surgery. Evaluation of pulmonary function in a longer perspective is lacking. In this prospective study pulmonary function and health-related quality of life were investigated 1 year after cardiac surgery.

    Methods: Pulmonary function measurements, health-related quality of life (SF-36), dyspnoea, subjective breathing and coughing ability and pain were evaluated before and 1 year after surgery in 150 patients undergoing coronary artery bypass grafting, valve surgery or combined surgery.

    Results: One year after surgery the forced vital capacity and forced expiratory volume in 1 s were significantly decreased (by 4-5 %) compared to preoperative values (p < 0.05). Saturation of peripheral oxygen was unchanged 1 year postoperatively compared to baseline. A significantly improved health-related quality of life was found 1 year after surgery, with improvements in all eight aspects of SF-36 (p < 0.001). Sternotomy-related pain was low 1 year postoperatively at rest (median 0 [min-max; 0-7]), while taking a deep breath (0 [0-4]) and while coughing (0 [0-8]). A more pronounced decrease in pulmonary function was associated with dyspnoea limitations and impaired subjective breathing and coughing ability.

    Conclusions: One year after cardiac surgery static and dynamic lung function measurements were slightly decreased, while health-related quality of life was improved in comparison to preoperative values. Measured levels of pain were low and saturation of peripheral oxygen was same as preoperatively.

  • 413.
    Westerdahl, Elisabeth
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Medical Sciences, Clinical Physiology, University Hospital, Uppsala; Department of Physiotherapy and Thoracic Surgery, Örebro University Hospital, Örebro.
    Lindmark, B
    Department of Neuroscience, Section of Physiotherapy, University Hospital, Uppsala, Sweden .
    Bryngelsson, I
    Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro,Sweden.
    Tenling, A
    Department of Thoracic Anaesthesia, Huddinge Hospital, Huddinge, Sweden.
    Pulmonary function 4 months after coronary artery bypass graft surgery2003In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 97, no 4, p. 317-322Article in journal (Refereed)
    Abstract [en]

    The objective of this study was to describe the pulmonary function and pain 4 months after coronary artery bypass graft surgery. Twenty-five male patients performed pulmonary function tests before surgery, on the 4th postoperative day and 4 months after surgery. A severe reduction in pulmonary function was present after surgery. Four months postoperatively, the patients still showed a significant decrease (6-13% of preoperative values) in vital capacity (P<0.001), inspiratory capacity (P<0.001), forced expiratory volume in 1 s (P<0.001) peak expiratory flow rate (P<0.001), functional residual capacity (P=0.05) total lung capacity (P<0.001) and single-breath carbon monoxide diffusing capacity (P<0.01). Residual volume and single-breath carbon monoxide diffusing capacity per litre of alveolar volume had returned to the preoperative level. Four months postoperatively, the median values for sternotomy pain while taking a deep breath was 0.2 and while coughing 0.3 on a 10 cm visual analogue pain scale. In conclusion, a significant restrictive pulmonary impairment persisting up to 4 months into the postoperative period was found after CABG. Measured levels of pain were low and could not explain the impairment.

  • 414.
    Westerdahl, Elisabeth
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Medical Sciences, Clinical Physiology, University Hospital, Uppsala; Departments of Physiotherapy and Thoracic Surgery, Örebro University Hospital, Örebro,.
    Lindmark, Birgitta
    Department of Neuroscience, Section of Physiotherapy, University Hospital, Uppsala.
    Eriksson, Tomas
    Department of Radiology, Örebro University Hospital, Örebro.
    Hedenstierna, Göran
    Department of Medical Sciences, Clinical Physiology, University Hospital, Uppsala.
    Tenling, Arne
    Department of Medical Sciences, Clinical Physiology, University Hospital, Uppsala; Department of Thoracic Anaesthesia, Huddinge University Hospital, Huddinge, Sweden.
    The immediate effects of deep breathing exercises on atelectasis and oxygenation after cardiac surgery2003In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 37, no 6, p. 363-367Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the effects of deep breathing performed on the second postoperative day after coronary artery bypass graft surgery.

    Design: The immediate effects of 30 deep breaths performed without a mechanical device (n = 21), with a blow bottle device (n = 20) and with an inspiratory resistance-positive expiratory pressure mask (n = 20) were studied. Spiral computed tomography and arterial blood gas analyses were performed immediately before and after the intervention.

    Results: Deep breathing caused a significant decrease in atelectatic area from 12.3 +/- 7.3% to 10.2 +/- 6.7% (p < 0.0001) of total lung area 1 cm above the diaphragm and from 3.9 +/- 3.5% to 3.3 +/- 3.1% (p < 0.05) 5 cm above the diaphragm. No difference between the breathing techniques was found. The aerated lung area increased by 5% (p < 0.001). The PaO (2) increased by 0.2 kPa (p < 0.05), while PaCO (2) was unchanged in the three groups.

    Conclusion: A significant decrease of atelectatic area, increase in aerated lung area and a small increase in PaO (2) were found after performance of 30 deep breaths. No difference between the three breathing techniques was found.

  • 415.
    Westerdahl, Elisabeth
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Physiotherapy, Örebro University Hospital, Örebro, Sweden; Department of Cardiothoracic Surgery, Örebro University Hospital, Örebro, Sweden; Örebro University Hospital, Centre for Health Care Sciences, Örebro, Sweden .
    Urell, Charlotte
    Physiotherapy, Department of Neuroscience, Department of Medical Sciences, Uppsala University, Uppsala, Sweden .
    Jonsson, Marcus
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Physiotherapy, Örebro University Hospital, Örebro, Sweden; Department of Cardiothoracic Surgery, Örebro University Hospital, Örebro, Sweden.
    Bryngelsson, Ing-Liss
    Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden .
    Hedenström, Hans
    Department of Clinical Physiology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden .
    Emtner, Margareta
    Physiotherapy, Department of Neuroscience, Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Department of Respiratory Medicine and Allergology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden .
    Deep breathing exercises performed 2 months following cardiac surgery: a randomized controlled trial2014In: Journal of cardiopulmonary rehabilitation and prevention, ISSN 1932-7501, Vol. 34, no 1, p. 34-42Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Postoperative breathing exercises are recommended to cardiac surgery patients. Instructions concerning how long patients should continue exercises after discharge vary, and the significance of treatment needs to be determined. Our aim was to assess the effects of home-based deep breathing exercises performed with a positive expiratory pressure device for 2 months following cardiac surgery.

    METHODS: The study design was a prospective, single-blinded, parallel-group, randomized trial. Patients performing breathing exercises 2 months after cardiac surgery (n = 159) were compared with a control group (n = 154) performing no breathing exercises after discharge. The intervention consisted of 30 slow deep breaths performed with a positive expiratory pressure device (10-15 cm H2O), 5 times a day, during the first 2 months after surgery. The outcomes were lung function measurements, oxygen saturation, thoracic excursion mobility, subjective perception of breathing and pain, patient-perceived quality of recovery (40-Item Quality of Recovery score), health-related quality of life (36-Item Short Form Health Survey), and self-reported respiratory tract infection/pneumonia and antibiotic treatment.

    RESULTS: Two months postoperatively, the patients had significantly reduced lung function, with a mean decrease in forced expiratory volume in 1 second to 93 ± 12% (P< .001) of preoperative values. Oxygenation had returned to preoperative values, and 5 of 8 aspects in the 36-Item Short Form Health Survey were improved compared with preoperative values (P< .01). There were no significant differences between the groups in any of the measured outcomes.

    CONCLUSION: No significant differences in lung function, subjective perceptions, or quality of life were found between patients performing home-based deep breathing exercises and control patients 2 months after cardiac surgery.

  • 416.
    Yetukuri, Laxman
    et al.
    Technical Research Centre of Finland, Espoo, Finland.
    Huopaniemi, Ilkka
    Aalto University School of Science, Department of Information and Computer Science, Helsinki Institute for Information Technology, Espoo, Finland.
    Koivuniemi, Artturi
    Technical Research Centre of Finland, Espoo, Finland.
    Maranghi, Marianna
    Department of Internal Medicine and Medical Specialties, Sapienza University, Rome, Italy; Division of Cardiology, Department of Medicine, University of Helsinki, Helsinki, Finland.
    Hiukka, Anne
    Division of Cardiology, Department of Medicine, University of Helsinki, Helsinki, Finland.
    Nygren, Heli
    Technical Research Centre of Finland, Espoo, Finland.
    Kaski, Samuel
    Aalto University School of Science, Department of Information and Computer Science, Helsinki Institute for Information Technology, Espoo, Finland.
    Taskinen, Marja-Riitta
    Division of Cardiology, Department of Medicine, University of Helsinki, Helsinki, Finland.
    Vattulainen, Ilpo
    Department of Physics, Tampere University of Technology, Tampere, Finland; Department of Applied Physics, Aalto University School of Science and Technology, Espoo, Finland; MEMPHYS - Center for Biomembrane Physics, University of Southern Denmark, Odense, Denmark.
    Jauhiainen, Matti
    National Institute for Health and Welfare, Helsinki, Finland; Institute for Molecular Medicine Finland, Helsinki, Finland.
    Oresic, Matej
    Örebro University, School of Medical Sciences. Technical Research Centre of Finland, Espoo, Finland; Institute for Molecular Medicine Finland, Helsinki, Finland.
    High density lipoprotein structural changes and drug response in lipidomic profiles following the long-term fenofibrate therapy in the FIELD substudy2011In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 6, no 8, article id e23589Article in journal (Refereed)
    Abstract [en]

    In a recent FIELD study the fenofibrate therapy surprisingly failed to achieve significant benefit over placebo in the primary endpoint of coronary heart disease events. Increased levels of atherogenic homocysteine were observed in some patients assigned to fenofibrate therapy but the molecular mechanisms behind this are poorly understood. Herein we investigated HDL lipidomic profiles associated with fenofibrate treatment and the drug-induced Hcy levels in the FIELD substudy. We found that fenofibrate leads to complex HDL compositional changes including increased apoA-II, diminishment of lysophosphatidylcholines and increase of sphingomyelins. Ethanolamine plasmalogens were diminished only in a subgroup of fenofibrate-treated patients with elevated homocysteine levels. Finally we performed molecular dynamics simulations to qualitatively reconstitute HDL particles in silico. We found that increased number of apoA-II excludes neutral lipids from HDL surface and apoA-II is more deeply buried in the lipid matrix than apoA-I. In conclusion, a detailed molecular characterization of HDL may provide surrogates for predictors of drug response and thus help identify the patients who might benefit from fenofibrate treatment.

  • 417.
    Zindovic, Igor
    et al.
    Department of Clinical Sciences and Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, Lund, Sweden.
    Gudbjartsson, Tomas
    Landspitali University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
    Ahlsson, Anders
    Department of Cardiothoracic and Vascular Surgery, Orebro University Hospital and School of Health and Medicine, Örebro University, Örebro, Sweden.
    Fuglsang, Simon
    Department of Thoracic and Cardiovascular Surgery, Aarhus University Hospital, Skejby, Denmark.
    Gunn, Jarmo
    Heart Center, Turku University Hospital and University of Turku, Turku, Finland.
    Hansson, Emma C.
    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.
    Järvelä, Kati
    Heart Center, Tampere University Hospital, Tampere, Finland.
    Jeppsson, Anders
    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.
    Olsson, Christian
    Department of Thoracic and Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Pan, Emily
    Heart Center, Turku University Hospital and University of Turku, Turku, Finland.
    Sjögren, Johan
    Department of Clinical Sciences and Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, Lund, Sweden.
    Wickbom, Anders
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Geirsson, Arnar
    Landspitali University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
    Nozohoor, Shahab
    Department of Clinical Sciences and Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, Lund, Sweden.
    Malperfusion in acute type A aortic dissection: An update from the Nordic Consortium for Acute Type A Aortic Dissection2019In: Journal of Thoracic and Cardiovascular Surgery, ISSN 0022-5223, E-ISSN 1097-685X, Vol. 157, no 4, p. 1324-1333Article in journal (Refereed)
    Abstract [en]

    Objectives: To evaluate the effect of preoperative malperfusion on 30-day and late mortality and postoperative complications using data from the Nordic Consortium for Acute Type A Aortic Dissection (ATAAD) registry.

    Methods: We studied 1159 patients who underwent ATAAD surgery between January 2005 and December 2014 at 8 Nordic centers. Multivariable logistic and Cox regression analyses were performed to identify independent predictors of 30-day and late mortality.

    Results: Preoperative malperfusion was identified in 381 of 1159 patients (33%) who underwent ATAAD surgery. Thirty-day mortality was 28.9% in patients with preoperative malperfusion and 12.1% in those without. Independent predictors of 30-day mortality included any malperfusion (odds ratio, 2.76; 95% confidence interval [CI], 1.94-3.93), cardiac malperfusion (odds ratio, 2.37; 95% CI, 1.34-4.17), renal malperfusion (odds ratio, 2.38; 95% CI, 1.23-4.61) and peripheral malperfusion (odds ratio, 1.95; 95% CI, 1.26-3.01). Any malperfusion (hazard ratio, 1.72; 95% CI, 1.21-2.43), cardiac malperfusion (hazard ratio, 1.89; 95% CI, 1.24-2.87) and gastrointestinal malperfusion (hazard ratio, 2.25; 95% CI, 1.18-4.26) were predictors of late mortality. Malperfusion was associated with significantly poorer survival at 1, 3, and 5 years (95.0% +/-0.9% vs 88.7% +/-1.9%, 90.1% +/-1.3% vs 84.0% +/-2.4%, and 85.4% +/-1.7% vs 80.8% +/-2.7%; log rank P = .009).

    Conclusions: Malperfusion has a significant influence on early and late outcomes in ATAAD surgery. Management of preoperative malperfusion remains a major challenge in reducing mortality associated with surgical treatment of ATAAD.

  • 418.
    Zupanic, Eva
    et al.
    Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Neurogeriatrics, Karolinska Institutet, Huddinge, Sweden; Department of Neurology, University Medical Centre, Ljubljana, Slovenia.
    von Euler, Mia
    Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, and Department of Medicine, Solna, Sweden; Karolinska University Hospital, Aging Research Center, Stockholm, Sweden.
    Kåreholt, Ingemar
    Department of Clinical Pharmacology; Karolinska Institutet and Stockholm University, Aging Research Center, Stockholm, Sweden; Institute of Gerontology, School of Health and Welfare, Aging Research Network-Jönköping, Jönköping University, Jönköping, Sweden.
    Contreras Escamez, Beatriz
    Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Huddinge, Sweden; Department of Geriatrics, Hospital Universitario de Getafe, Madrid, Spain.
    Fastbom, Johan
    Department of Clinical Pharmacology; Karolinska Institutet and Stockholm University, Aging Research Center, Stockholm, Sweden.
    Norrving, Bo
    Skane University Hospital, Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden.
    Religa, Dorota
    Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Neurogeriatrics, Karolinska Institutet, Huddinge, Sweden; Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden.
    Kramberger, Milica G
    Department of Neurology, University Medical Centre, Ljubljana, Slovenia.
    Winblad, Bengt
    Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Neurogeriatrics, Karolinska Institutet, Huddinge, Sweden.
    Johnell, Kristina
    Department of Clinical Pharmacology; Karolinska Institutet and Stockholm University, Aging Research Center, Stockholm, Sweden.
    Eriksdotter, Maria
    Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Huddinge, Sweden; Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden.
    Garcia-Ptacek, Sara
    Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Huddinge, Sweden; Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Internal Medicine, Section for Neurology, Södersjukhuset, Stockholm, Sweden.
    Thrombolysis in acute ischemic stroke in patients with dementia: A Swedish registry study2017In: Neurology, ISSN 0028-3878, E-ISSN 1526-632X, Vol. 89, no 18, p. 1860-1868Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To compare access to intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) and its outcomes in patients with and without dementia.

    METHODS: This was a longitudinal cohort study of the Swedish dementia and stroke registries. Patients with preexisting dementia who had AIS from 2010 to 2014 (n = 1,356) were compared with matched patients without dementia (n = 6,755). We examined access to thrombolysis and its outcomes at 3 months (death, residency, and modified Rankin Scale [mRS] score). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated with logistic and ordinal logistic regression.

    RESULTS: < 0.001). Unfavorable outcomes with an mRS score of 5 to 6 were doubled in patients with dementia (56.1% vs 28.1%).

    CONCLUSIONS: Younger patients with dementia and AIS are less likely to receive IVT. Among patients receiving thrombolysis, there are no differences in sICH or death, although patients with dementia have worse accommodation and functional outcomes at 3 months.

  • 419.
    Östman, Maja Eriksson
    et al.
    Department of Cardiology, , Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Calais, Fredrik
    Örebro University, School of Medical Sciences. Department of Cardiology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Rosenblad, Andreas
    Centre for Clinical Research, Västmanland County Hospital, Uppsala University, Västerås, Sweden.
    Fröbert, Ole
    Örebro University, School of Medical Sciences. Department of Cardiology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Leppert, Jerzy
    Centre for Clinical Research, Västmanland County Hospital, Uppsala University, Västerås, Sweden.
    Hedberg, Pär
    Centre for Clinical Research, Västmanland County Hospital, Uppsala University, Västerås, Sweden.
    Prognostic impact of subclinical or manifest extracoronary artery diseases after acute myocardial infarction2017In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 263, p. 53-59Article in journal (Refereed)
    Abstract [en]

    Background and aims: In patients with coronary artery disease (CAD), clinically overt extracoronary artery diseases (ECADs), including claudication or previous strokes, are associated with poor outcomes. Subclinical ECADs detected by screening are common among such patients. We aimed to evaluate the prognostic impact of subclinical versus symptomatic ECADs in patients with acute myocardial infarction (AMI).

    Methods: In a prospective observational study, 654 consecutive patients diagnosed with AMI underwent ankle brachial index (ABI) measurements and ultrasonographic screening of the carotid arteries and abdominal aorta. Clinical ECADs were defined as prior strokes, claudication, or extracoronary artery intervention. Subclinical ECADs were defined as the absence of a clinical ECAD in combination with an ABI <= 0.9 or >1.4, carotid artery stenosis, or an abdominal aortic aneurysm.

    Results: At baseline, subclinical and clinical ECADs were prevalent in 21.6% and 14.4% of the patients, respectively. Patients with ECADs received evidence-based medication more often at admission but similar medications at discharge compared with patients without ECADs. During a median follow-up of 5.2 years, 166 patients experienced endpoints of hospitalization for AMI, heart failure, stroke, or cardiovascular death. With ECAD-free cases as reference and after adjustment for risk factors, a clinical ECAD (hazard ratio [HR] 2.10, 95% confidence interval [CI] 1.34-3.27, p = 0.001), but not a subclinical ECAD (HR 1.35, 95% CI 0.89-2.05, p = 0.164), was significantly associated with worse outcomes.

    Conclusions: Despite receiving similar evidence-based medication at discharge, patients with clinical ECAD, but not patients with a subclinical ECAD, had worse long-term prognosis than patients without an ECAD after AMI. (C) 2017 The Authors. Published by Elsevier Ireland Ltd.

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