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Häggmark, Sören
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Publications (10 of 53) Show all publications
Axelsson, B., Häggmark, S., Svenmarker, S., Johansson, G., Gupta, A., Tyden, H., . . . Haney, M. (2016). Effects of Combined Milrinone and Levosimendan Treatment on Systolic and Diastolic Function During Postischemic Myocardial Dysfunction in a Porcine Model. Journal of Cardiovascular Pharmacology and Therapeutics, 21(5), 495-503
Open this publication in new window or tab >>Effects of Combined Milrinone and Levosimendan Treatment on Systolic and Diastolic Function During Postischemic Myocardial Dysfunction in a Porcine Model
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2016 (English)In: Journal of Cardiovascular Pharmacology and Therapeutics, ISSN 1074-2484, E-ISSN 1940-4034, Vol. 21, no 5, p. 495-503Article in journal (Refereed) Published
Abstract [en]

It is not known whether there are positive or negative interactions on ventricular function when a calcium-sensitizing inotrope is added to a phosphodiesterase inhibitor in the clinical setting of acute left ventricular (LV) dysfunction. We hypothesized that when levosimendan is added to milrinone treatment, there will be synergetic inotropic and lusitropic effects. This was tested in an anesthetized porcine postischemic global LV injury model, where ventricular pressures and volumes (conductance volumetry) were measured. A global ischemic injury was induced by repetitive left main stem coronary artery occlusions. Load-independent indices of LV function were assessed before and after ventricular injury, after milrinone treatment, and finally after addition of levosimendan to the milrinone treatment. Nonparametric, within-group comparisons were made. The protocol was completed in 12 pigs, 7 of which received the inotrope treatment and 5 of which served as controls. Milrinone led to positive lusitropic effects seen by improvement in tau after myocardial stunning. The addition of levosimendan to milrinone further increased lusitropic state. The latter effect could however not be attributed solely to levosimendan, since lusitropic state also improved spontaneously in time-matched controls at the same rate during the corresponding period. When levosimendan was added to milrinone infusion, there was no increase in systolic function (preload recruitable stroke work) compared to milrinone treatment alone. We conclude that in this model of postischemic LV dysfunction, there appears to be no clear improvement in systolic or diastolic function after addition of levosimendan to established milrinone treatment but also no negative effects of levosimendan in this context.

Place, publisher, year, edition, pages
Sage Publications, 2016
Keywords
cardiac pharmacology, cardioactive agents, experimental and clinical heart failure, ischemia-reperfusion injury
National Category
Anesthesiology and Intensive Care Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-116180 (URN)10.1177/1074248416628675 (DOI)000382567800008 ()26837238 (PubMedID)1940-4034 (Electronic) 1074-2484 (Linking) (ISBN)
Available from: 2016-02-09 Created: 2016-02-09 Last updated: 2019-05-22Bibliographically approved
Svenmarker, S., Häggmark, S., Östman, M., Holmgren, A. & Näslund, U. (2013). Central venous oxygen saturation during cardiopulmonary bypass predicts 3-year survival. Interactive Cardiovascular and Thoracic Surgery, 16(1), 21-26
Open this publication in new window or tab >>Central venous oxygen saturation during cardiopulmonary bypass predicts 3-year survival
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2013 (English)In: Interactive Cardiovascular and Thoracic Surgery, ISSN 1569-9293, E-ISSN 1569-9285, Vol. 16, no 1, p. 21-26Article in journal (Refereed) Published
Abstract [en]

Long-term survival after cardiac surgery is determined by a number of different risk factors. Central venous oxygen saturation (SvO2) measures the balance between oxygen delivery and demand. SvO2 levels in the intensive care situation are reported to be associated with patient outcome. The present report explores the connection between SvO2 during cardiopulmonary bypass (CPB) and survival after cardiac surgery. Retrospective analysis of one thousand consecutive cardiac surgical patients was undertaken. SvO2 during CPB was monitored online. Registry data combining specific risk factors with SvO2 were selected for Kaplan-Meier and Cox regression analysis to examine the influence on 30-day and 3-year survivals. Nine-hundred and thirty-two patient records were eligible for analysis. SvO2 below 75% during CPB was associated with significantly shorter 30-day and 3-year survivals. Based on Kaplan-Meier statistics, the survival rate decreased by 3.1% (98.1-95.0), P = 0.011 and 6.1% (92.7-86.6), P = 0.003, respectively. The influence of SvO2 on 3-year survival remained statistically significant after controlling for a series of risk factors in the Cox regression analysis. Patients with SvO2 < 75% carried a 2-fold (odds ratio 2.1) increased relative risk of shortened 3-year survival (P = 0.003). Other risk factors statistically significantly associated with 3-year survival were age, gender, duration of CPB, blood temperature, hypertension, haematocrit and type of surgical procedure. We report decreased 30-day and 3-year survival expectancy for patients experiencing SvO2 lower than 75% during CPB.

Keywords
Survival, Cardiopulmonary bypass, Venous oxygen saturation, Systemic blood flow
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-64238 (URN)10.1093/icvts/ivs363 (DOI)000312652900007 ()
Available from: 2013-01-29 Created: 2013-01-21 Last updated: 2018-06-08Bibliographically approved
Svenmarker, S., Häggmark, S., Holmgren, A. & Näslund, U. (2011). Serum markers are not reliable measures of renal function in conjunction with cardiopulmonary bypass. Interactive Cardiovascular and Thoracic Surgery, 12(5), 713-717
Open this publication in new window or tab >>Serum markers are not reliable measures of renal function in conjunction with cardiopulmonary bypass
2011 (English)In: Interactive Cardiovascular and Thoracic Surgery, ISSN 1569-9293, E-ISSN 1569-9285, Vol. 12, no 5, p. 713-717Article in journal (Refereed) Published
Abstract [en]

The present study explored the influence of haemodilution on estimates of the glomerular filtration rate (GFR) in conjunction with cardiopulmonary bypass (CPB) and cardiac surgery. Ninety-eight patients (n = 98) undergoing coronary artery bypass grafting with the aid of CPB were examined. The serum concentration of cystatin C and creatinine was analysed prior to surgery, after completion of CPB and in the intensive care the day after surgery. The estimated GFR was calculated using standard equations based on the serum concentration of cystatin C and creatinine. It was found that haemodilution induced by CPB had significant effects on the estimated GFR. For cystatin C, the GFR increased by 50.5 ± 2.5 ml/min (P = 0.000) and for creatinine based GFR with 22.5 ± 0.9 ml/min (P = 0.000) using the 4-variable modification of diet renal disease formula and with 22.1 ± 0.93 ml/min (P = 0.000) for the Cockcroft-Gault formula, respectively. Similar effects of haemodilution on GFR were also detected postoperatively. Haemodilution induced by CPB may therefore significantly overestimate the renal function as indicated by GFR based on serum markers.

Keywords
Renal function; Creatinine; Cystatin C; Cardiopulmonary bypass; Haemodilution
Identifiers
urn:nbn:se:umu:diva-45882 (URN)10.1510/icvts.2010.259432 (DOI)21297138 (PubMedID)
Available from: 2011-08-19 Created: 2011-08-19 Last updated: 2018-06-08Bibliographically approved
Haney, M. F., Häggmark, S., Johansson, G. & Näslund, U. (2009). ST changes and temporal relation to the J point during heart rate increase and myocardial ischemia.. Journal of electrocardiology, 42(1), 6-11
Open this publication in new window or tab >>ST changes and temporal relation to the J point during heart rate increase and myocardial ischemia.
2009 (English)In: Journal of electrocardiology, ISSN 1532-8430, Vol. 42, no 1, p. 6-11Article in journal (Refereed) Published
Abstract [en]

There is no concensus concerning where in the ST segment to measure. We studied the relation between different J point intervals to ST results during tachycardia and ischemia. Symptomatic (anesthetized) patients with coronary artery disease were paced at ascending incremental levels until they became ischemic. ST vector magnitude and ST vector change from baseline (STC-VM) as well as the sum of ST changes from all 12 electrocardiogram (ECG) leads (ECG ST sum) were measured at J point 0 millisecond, J + 20, J + 60, and J + 80 milliseconds for 34 patients. ST segments increased in similar fashion during pacing and ischemia. There was no difference in ST results when measurement was performed at different time intervals for both STC-VM and ECG ST sum. We conclude that ST assessment by ST change from baseline is not affected by different J point intervals during increased heart rate and ischemia in this clinical model of pacing-induced ischemia and vectorcardiographic ST analysis.

Identifiers
urn:nbn:se:umu:diva-23131 (URN)10.1016/j.jelectrocard.2008.08.039 (DOI)18976774 (PubMedID)
Available from: 2009-06-01 Created: 2009-06-01 Last updated: 2018-06-08
Svenmarker, S., Häggmark, S., Hultin, M. & Holmgren, A. (2009). Static blood-flow control during cardiopulmonary bypass is a compromise of oxygen delivery. European Journal of Cardio-Thoracic Surgery, 37(1), 218-222
Open this publication in new window or tab >>Static blood-flow control during cardiopulmonary bypass is a compromise of oxygen delivery
2009 (English)In: European Journal of Cardio-Thoracic Surgery, ISSN 1010-7940, E-ISSN 1873-734X, Vol. 37, no 1, p. 218-222Article in journal (Refereed) Published
Abstract [en]

Background: Blood-flow control during cardiopulmonary bypass (CPB) is by tradition based on the patient's body surface area. Emergence of new techniques enables dynamic blood-flow control based on online measurement of venous oxygen saturation and oxygen consumption. Present investigation aimed to compare static versus dynamic blood-flow control with respect to use of oxygen and effects upon organ function. Methods: In this study, 100 coronary-artery-bypass surgical patients were prospectively randomised to static or dynamic hypothermic blood-flow control during CPB. In the static group, pump flow was set to 2.4 (litres per minute) times the patient's body surface area (m(2)) throughout the procedure. Pump flow in the dynamic group was varied according to the reading of the venous oxygen saturation and maintained at >75%. CPB-specific information was collected online. Blood samples were collected for analysis of haemoglobin, lactate, amylase, creatinine and C-reactive protein: pre-CPB, at weaning from CPB and on day 1 postoperatively. Results: Randomisation formed two uniform groups. Choice of static or dynamic blood-flow control during CPB had no significant effects on organ function as judged by lactate, amylase or creatinine levels. On increasing oxygen demand, oxygen balance was maintained by increasing venous oxygen extraction rates in the static flow mode and by increasing the pump flow rate in the dynamic group. Conclusions: Independent of the blood-flow control mode, oxygen balance remained preserved. However, the dynamic mode provided higher oxygen delivery, which may increase margins of safety and protection of organ function.

National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-31399 (URN)10.1016/j.ejcts.2009.05.019 (DOI)1873-734X (Electronic) 1010-7940 (Linking) (ISBN)
Note
Journal article European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery Eur J Cardiothorac Surg. 2010 Jan;37(1):218-222. Epub 2009 Jul 29.Available from: 2010-02-10 Created: 2010-02-10 Last updated: 2018-06-08Bibliographically approved
Häggmark, S., Haney, M., Johansson, G., Reiz, S. & Näslund, U. (2008). Contributions of myocardial ischemia and heart rate to ST segment changes in patients with or without coronary artery disease.. Acta Anaesthesiologica Scandinavica, 52(2), 219-228
Open this publication in new window or tab >>Contributions of myocardial ischemia and heart rate to ST segment changes in patients with or without coronary artery disease.
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2008 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 52, no 2, p. 219-228Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: ST changes related to ischemia at different heart rates (HRs) have not been well described. We aimed to analyze ST dynamic changes by vectorcardiography (VCG) during pacing-induced HR changes for subjects with proven coronary artery disease (CAD) and without (non-CAD). METHODS: Symptomatic CAD patients scheduled for elective surgery were enrolled along with a non-CAD group. During anesthesia, both groups were placed at multiple ascending levels. VCG ST data, and in particular in ST change vector magnitude (STC-VM) from baseline, along with arterial and great coronary artery vein (GCV) blood samples were collected to determine regional myocardial lactate production. RESULTS: A total of 35 CAD and 10 non-CAD patients were studied over six incremental 10 beat/min HR increases. STC-VM mean levels increased in the CAD group from 9+/-5 to 131+/-37 microV (standard deviation) compared with non-CAD subjects with 8+/-3-76+/-34 microV. Myocardial ischemia (lactate production) was noted at higher HRs and the positive predictive value for STC-VM to detect ischemia was 58% with the negative predictive value being 88%. STC-VM at 54 microV showed a sensitivity of 88% and a specificity of 75% for identification of ischemia. CONCLUSIONS: Both HR and ischemia at higher HRs contribute to VCG ST elevation. Established ST ischemia detection concerning HR levels is suboptimal, and further attention to the effects of HR on ST segments is needed to improve electrocardiographic ischemia criteria.

Identifiers
urn:nbn:se:umu:diva-8755 (URN)10.1111/j.1399-6576.2007.01507.x (DOI)17999710 (PubMedID)
Available from: 2008-02-08 Created: 2008-02-08 Last updated: 2018-06-09Bibliographically approved
Häggmark, S., Haney, M. F., Johansson, G., Biber, B. & Näslund, U. (2006). Vectorcardiographic ST deviations related to increased heart rate in the absence of ischemia in an experimental pig model.. Journal of Electrocardiology, 39(2), 169-176
Open this publication in new window or tab >>Vectorcardiographic ST deviations related to increased heart rate in the absence of ischemia in an experimental pig model.
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2006 (English)In: Journal of Electrocardiology, ISSN 0022-0736, E-ISSN 1532-8430, Vol. 39, no 2, p. 169-176Article in journal (Refereed) Published
Abstract [en]

The electrocardiographic ST segment may change when heart rate (HR) increases. We aimed to analyze vectorcardiographic ST relation and myocardial conditions during controlled HR increases in anesthetized pigs. The relative parameters ST change vector magnitude and ST change vector angle were calculated at paced HRs ranging from 85 to 175 beats per minute. ST change vector magnitude increased from baseline 6.3 +/- 1.3 to 26.0 +/- 3.1 microV (P < .01; range, 4-50 microV) at HR 175 beats per minute with similar changes in ST change vector angle, whereas the absolute parameter ST vector magnitude demonstrated a heterogeneous pattern without any systematic relation to HR changes. Microdialysis results from left ventricular wall, with analysis of glucose, lactate, and pyruvate, showed no sign of ischemia during pacing. Potassium concentrations did not change during pacing. We conclude that significant HR-related ST vector changes can occur in the absence of myocardial ischemia.

Keywords
Animals, Cardiac Pacing; Artificial, Female, Heart Rate/physiology, Myocardial Ischemia/*physiopathology, Swine, Tachycardia/physiopathology, Vectorcardiography
Identifiers
urn:nbn:se:umu:diva-15346 (URN)10.1016/j.jelectrocard.2005.08.014 (DOI)16580414 (PubMedID)
Available from: 2007-12-18 Created: 2007-12-18 Last updated: 2018-06-09Bibliographically approved
Svenmarker, S., Häggmark, S. & Ostman, M. (2006). What is a normal lactate level during cardiopulmonary bypass?. Scand Cardiovasc J, 40(5), 305-11
Open this publication in new window or tab >>What is a normal lactate level during cardiopulmonary bypass?
2006 (English)In: Scand Cardiovasc J, ISSN 1401-7431, Vol. 40, no 5, p. 305-11Article in journal (Refereed) Published
Keywords
Adolescent, Adult, Cardiopulmonary Bypass/*methods, Female, Humans, Lactates/*blood, Male, Middle Aged, Postoperative Period, Predictive Value of Tests, Retrospective Studies, Sensitivity and Specificity
Identifiers
urn:nbn:se:umu:diva-6828 (URN)17012142 (PubMedID)
Available from: 2007-12-18 Created: 2007-12-18 Last updated: 2018-06-09Bibliographically approved
Haney, M. F., Johansson, G., Häggmark, S. & Biber, B. (2005). Myocardial systolic function increases during positive pressure lung inflation.. Anesthesia and Analgesia, 101(5), 1269-74
Open this publication in new window or tab >>Myocardial systolic function increases during positive pressure lung inflation.
2005 (English)In: Anesthesia and Analgesia, ISSN 0003-2999, Vol. 101, no 5, p. 1269-74Article in journal (Refereed) Published
Abstract [en]

Lung inflation with positive airway pressure may have rapid and dynamic effects on myocardial contractile function. We designed this study to assess the magnitude and time to onset of myocardial function changes during the initiation of single positive pressure lung inflation at clinically relevant inflation pressures. In 8 anesthetized 40-kg pigs, left ventricular pressures and volumes were measured directly (conductance volumetry). A 15 cm H2O airway pressure plateau with lung inflation (PPLI-15) was performed, and 2 single beats from that sequence, one from resting apnea at zero airway pressure and the second from the point when the lungs were first maximally inflated, were selected for analysis. Systolic function variables for zero airway pressure and PPLI-15 were analyzed. Systolic elastance, derived from bilinear time-varying elastance curves, increased approximately 15% during PPLI-15 from zero airway pressure. This agreed with other systolic function variables that identified an increase in left ventricular contractile function for the lung inflation beat. Serial measurements of myocardial function should be conducted with constant airway pressure and lung inflation conditions.

Keywords
Animals, Lung/physiopathology, Positive-Pressure Respiration, Swine, Systole, Ventricular Function; Left
Identifiers
urn:nbn:se:umu:diva-6810 (URN)16243979 (PubMedID)
Available from: 2007-12-18 Created: 2007-12-18 Last updated: 2018-06-09Bibliographically approved
Konrad, D., Oldner, A., Wanecek, M., Rudehill, A., Weitzberg, E., Biber, B., . . . Haney, M. (2005). Positive inotropic and negative lusitropic effects of endothelin receptor agonism in vivo.. American Journal of Physiology, Heart and Circulatory Physiology, 289(4), H1702-9
Open this publication in new window or tab >>Positive inotropic and negative lusitropic effects of endothelin receptor agonism in vivo.
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2005 (English)In: American Journal of Physiology, Heart and Circulatory Physiology, ISSN 0363-6135, Vol. 289, no 4, p. H1702-9Article in journal (Refereed) Published
Abstract [en]

The endothelin (ET) system is involved in the regulation of myocardial function in health as well as in several diseases, such as congestive heart failure, myocardial infarction, and septic myocardial depression. Conflicting results have been reported regarding the acute contractile properties of ET-1. We therefore investigated the effects of intracoronary infusions of ET-1 and of the selective ET(B) receptor-selective agonist sarafotoxin 6c with increasing doses in anesthetized pigs. Myocardial effects were measured through analysis of the left ventricular pressure-volume relationship. ET-1 elicited increases in the myocardial contractile status (end-systolic elastance value of 0.94 +/- 0.11 to 1.48 +/- 0.23 and preload recruitable stroke work value of 68.7 +/- 4.7 to 83.4 +/- 7.2) that appear to be mediated through ET(A) receptors, whereas impairment in left ventricular isovolumic relaxation (tau = 41.5 +/- 1.4 to 58.1 +/- 5.0 and t(1/2) = 23.0 +/- 0.7 to 30.9 +/- 2.6, where tau is the time constant for pressure decay and t(1/2) is the half-time for pressure decay) was ET(B) receptor dependent. In addition, intravenous administration of ET-1 impaired ventricular relaxation but had no effect on contractility. Intracoronary sarafotoxin 6c administration caused impairments in left ventricular relaxation (tau from 43.3 +/- 1.8 to 54.4 +/- 3.4) as well as coronary vasoconstriction. In conclusion, ET-1 elicits positive inotropic and negative lusitropic myocardial effects in a pig model, possibly resulting from ET(A) and ET(B) receptor activation, respectively.

Keywords
Anesthesia, Animals, Cardiotonic Agents/*pharmacology, Coronary Circulation/drug effects, Diastole/drug effects, Endothelin-1/blood/*pharmacology, Female, Heart/*drug effects/physiology, Injections; Intravenous, Myocardial Contraction/drug effects, Oxygen/metabolism, Receptor; Endothelin B/antagonists & inhibitors, Receptors; Endothelin/*agonists, Sus scrofa, Vasoconstrictor Agents/pharmacology, Ventricular Pressure/drug effects, Viper Venoms/pharmacology
Identifiers
urn:nbn:se:umu:diva-6820 (URN)15951343 (PubMedID)
Available from: 2007-12-18 Created: 2007-12-18 Last updated: 2018-06-09Bibliographically approved
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