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Holmgren, Anders
Publications (10 of 24) Show all publications
Holmgren, A. (2019). Metabolic risk markers and relative survival in patients with aortic stenosis requiring surgery. (Doctoral dissertation). Umeå: Umeå universitet
Open this publication in new window or tab >>Metabolic risk markers and relative survival in patients with aortic stenosis requiring surgery
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Aortic stenosis (AS) is the most common valve disorder requiring surgery in developed countries. The etiology of AS is only partly known.  Identification of new biomarkers in prospective studies could lead to novel insights in the etiology of AS, and possibly lead to improved clinical management. Long term observed survival after aortic valve surgery has improved over the last decades despite an ageing population presenting with more comorbidities. Whether this is reflected in improved relative survival is not known. We evaluated if biomarkers associated prospectively with AS requiring surgery, and if these associations differed between genders, time to surgery and the presence of coronary artery disease (CAD). We also assessed long term observed and relative survival after aortic valve surgery with and without concomitant coronary artery by-pass surgery (CABG).

Methods and results: Study I: We prospectively studied the impact of lipoprotein (a)(Lp[a]) and apolipoproteins (Apo) in subgroups of AS. During a 20-year period, 336 patients with prior participation in large population-based surveys in northern Sweden were operated due to AS plus CABG when indicated. For each case two referents were matched. Data from the baseline survey were collected and included data on cardiovascular risk factors, health history, measurements of anthropometry, blood pressure, blood glucose and blood lipid levels were retrieved. Data from pre- and perioperative assessments were also collected. The presence of CAD was determined from the coronary angiogram. Elevated levels of Lp(a) and an elevated Apo B/Apo A 1 ratio were independently associated with future surgery for AS, but only in patients with concomitant CAD (OR 1.29, 95 % CI 1.07-1.55 and 1.43, 95 % CI 1.16-1.76 respectively). Study II: The same patient cohort as in study I was used. A panel of 92 cardiovascular candidate proteins were analysed with the multiplex proximity extension assay in samples obtained at baseline. Six circulating proteins (growth differentiation factor 15[GDF-15], galectin-4, von Willebrand factor [vWF], interleukin 17 receptor A, transferrin receptor protein 1, and proprotein convertase subtilisin/kexin type 9, [PCSK9]) were associated with future surgery for AS in patients with concurrent CAD (ORs ranged from 1.25 to 1.37 per SD increase in the protein signal). In the validation study with 106 additional cases, the association of all but one, (interleukin 17 receptor A), of these proteins were replicated in patients with AS and concurrent CAD but not in those without concurrent CAD. Study III: In the same patient cohort as in study I and II we evaluated if troponin T (TnT) and C-reactive protein (CRP) associated prospectively with future surgery for AS. TnT was independently associated with surgery for AS in patients both with (OR 1.22, 95 % CI 1.02-1.46) and without concomitant CAD (1.39, 95% CI 1.05-1.84). CRP was not associated with surgery for AS (OR 1.06, 95 % CI 0.92-1.23). Study IV: 4970 patients between 2005 and 2016 from three Swedish heart surgery centres, undergoing aortic valve replacement (AVR) due to either AS or aortic regurgitation in conjunction with CABG when indicated, were followed up. All-cause mortality, as well as both observed and relative survival, was analysed with focus on age, sex, type of valve prosthesis and the impact of concomitant CABG. Median follow-up was 4.7 years (2.3-7.6). 30-day mortality was 2.3 %. Long-term survival with 30-day mortality excluded was 96.6 %, 82.7 %, 57.6 % after 1, 5 and 10 years respectively. Relative survival rates (adjusting for the background mortality in the general Swedish population based on age, sex and year) were 99.6 %, 99.5 % and 90.6 % after 1, 5 and 10 years respectively. Age had a negative influence on observed survival (p<0.001) but was associated with better relative survival (relative mortality rate [RMR] 0.74, 95 % CI 0.71 - 0.77). Women had a lower observed mortality than men (p<0.001) but a lower relative survival (RMR 1.17, 95 % CI 1.02-1.35). Combined surgery (AVR+CABG) was not significantly associated with higher mortality (p=0.43) in a multivariable adjusted analysis. The presence of bicuspid morphology was associated with lower observed mortality compared with tricuspid valve, and a relative survival matching that in the general population.

Conclusion: I. Plasma levels of Lp(a) and the Apo B/Apo A 1 ratio were independently associated with future surgery for AS but only in patients with concomitant CAD. This finding suggests that patients with AS have different phenotypes and may open a new avenue of research on targeted risk factor interventions in this population. II. Five circulating proteins – GDF-15, galectin-4, vWF, transferrin receptor protein 1, and PCSK9 – were associated with the need for aortic valve surgery several years later. The role of these proteins should be investigated in future studies. III. Elevated plasma levels of TnT were independently associated with future surgery for AS, irrespective of the presence of concomitant CAD, which could indicate that the myocardium is subject to mechanical stress already in the subclinical stage of AS. This may be used as a clinical tool for identification of patients with subclinical AS who could benefit from early intervention. Elevated CRP levels did not associate with future AVR. IV. Relative survival following AVR was particularly good in the elderly matching that in the general population underlining the benefits of aortic valve surgery in properly selected patients. Women had decreased relative survival compared to men. This should be explored in future studies. Adding CABG to an AVR procedure was not associated with increased risk. Bicuspid valve morphology was associated with lower observed mortality compared with tricuspid valve morphology, and with a relative survival matching that of the general population.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2019. p. 85
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2028
Keywords
aortic stenosis, aortic valve surgery, coronary artery disease, prospective cohort study, risk markers, lipoprotein (a), apolipoproteins, proteomics, troponin T, C-reactive protein, relative survival, observed survival
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:umu:diva-159032 (URN)978-91-7855-051-7 (ISBN)
Public defence
2019-06-14, Sal B, Unod T, 9 tr, Norrlands Universitetssjukhus, 13:00 (English)
Opponent
Supervisors
Available from: 2019-05-24 Created: 2019-05-16 Last updated: 2019-05-24Bibliographically approved
Ljungberg, J., Johansson, B., Bergdahl, I., Holmgren, A., Näslund, U., Hultdin, J. & Söderberg, S. (2019). Mild impairment of renal function (shrunken pore syndrome) is associated with increased risk for future surgery for aortic stenosis. Scandinavian Journal of Clinical and Laboratory Investigation, 79(7), 524-530
Open this publication in new window or tab >>Mild impairment of renal function (shrunken pore syndrome) is associated with increased risk for future surgery for aortic stenosis
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2019 (English)In: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 79, no 7, p. 524-530Article in journal (Refereed) Published
Abstract [en]

Recently, a new approach was proposed to detect mild impairment in renal function: a reduced ratio between estimated glomerular filtration rate (eGFR) calculated by cystatin C and eGFR calculated by creatinine. We aimed to evaluate if this ratio is associated with aortic stenosis (AS) requiring surgery. We identified 336 patients that first participated in population surveys and later underwent surgery for AS (median age [interquartile range] 59.8 [10.3] years at survey and 68.3 [12.7] at surgery, 48% females). For each patient, two matched referents were allocated. Cystatin C and creatinine were determined in stored plasma. eGFR(cystatin C) and eGFR(creatinine) and their ratio were estimated. Conditional logistic regression analyses were used to estimate the risk (odds ratio (OR) with [95% confidence interval (CI)]) related to one (ln) standard deviation increase in the ratio between eGFR(cystatin C) and eGFR(creatinine). A high ratio was associated with lower risk for AS requiring surgery (OR [95% CI]) (OR 0.84 [0.73-0.97]), especially in women (0.74 [0.60-0.92] vs. 0.93 [0.76-1.13] in men). After further stratification for coronary artery disease (CAD), the association remained in women with CAD but not in women without CAD (0.60 [0.44-0.83] and 0.89 [0.65-1.23], respectively). In conclusion, a high ratio between eGFR(cystatin C) and eGFR(creatinine) was associated with lower risk for surgery for AS, especially in women. Mild impairment of renal function is thus associated with future risk for AS requiring surgery.

Place, publisher, year, edition, pages
Taylor & Francis, 2019
Keywords
Aortic stenosis, valvular replacement, renal insufficiency, creatinine, cystatin C
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-164404 (URN)10.1080/00365513.2019.1664761 (DOI)000486559100001 ()31522562 (PubMedID)
Available from: 2019-11-05 Created: 2019-11-05 Last updated: 2019-11-05Bibliographically approved
Ljungberg, J., Janiec, M., Bergdahl, I., Holmgren, A., Hultdin, J., Johansson, B., . . . Söderberg, S. (2018). Proteomic Biomarkers for Incident Aortic Stenosis Requiring Valvular Replacement. Circulation, 138(6)
Open this publication in new window or tab >>Proteomic Biomarkers for Incident Aortic Stenosis Requiring Valvular Replacement
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2018 (English)In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 138, no 6Article in journal (Refereed) Published
Abstract [en]

Background: Aortic valve stenosis (AS) is the most common indication for cardiac valve surgery; untreated AS is linked to high mortality. The etiological background of AS is unknown. Previous human studies were typically based on case-control studies. Biomarkers identified in prospective studies could lead to novel mechanistic insights. Methods: Within a large population survey with blood samples obtained at baseline, 334 patients were identified who later underwent surgery for AS (median age [interquartile range], 59.9 [10.4] years at survey and 68.3 [12.7] at surgery; 48% female). For each case, 2 matched referents were allocated. Plasma was analyzed with the multiplex proximity extension assay for screening of 92 cardiovascular candidate proteins. Conditional logistic regression models were used to assess associations between each protein and AS, with correction for multiple testing. A separate set of 106 additional cases with 212 matched referents was used in a validation study. Results: Six proteins (growth differentiation factor 15, galectin-4, von Willebrand factor, interleukin 17 receptor A, transferrin receptor protein 1, and proprotein convertase subtilisin/kexin type 9) were associated with case status in the discovery cohort; odds ratios ranged from 1.25 to 1.37 per SD increase in the protein signal. Adjusting the multivariable models for classical cardiovascular risk factors at baseline yielded similar results. Subanalyses of case-referent triplets (n=133) who showed no visible coronary artery disease at the time of surgery in the index person supported associations between AS and growth differentiation factor 15 (odds ratio, 1.40; 95% confidence interval, 1.10-1.78) and galectin-4 (odds ratio, 1.27; 95% confidence interval, 1.02-1.59), but these associations were attenuated after excluding individuals who donated blood samples within 5 years before surgery. In triplets (n=201), which included index individuals with concurrent coronary artery disease at the time of surgery, all 6 proteins were robustly associated with case status in all sensitivity analyses. In the validation study, the association of all but 1 (interleukin 17 receptor A) of these proteins were replicated in patients with AS with concurrent coronary artery disease but not in patients with AS without coronary artery disease. Conclusions: We provide evidence that 5 proteins were altered years before AS surgery and that the associations seem to be driven by concurrent atherosclerotic disease.

Keywords
aortic stenosis, aortic valve surgery, prospective study, proteomics, risk markers
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:umu:diva-145712 (URN)10.1161/CIRCULATIONAHA.117.030414 (DOI)000440866500011 ()29487139 (PubMedID)
Available from: 2018-04-09 Created: 2018-04-09 Last updated: 2019-05-24Bibliographically approved
Bagge, L., Probst, J., Jensen, S. M., Blomström, P., Thelin, S., Holmgren, A. & Blomström-Lundqvist, C. (2018). Quality of life is not improved aftermitral valve surgery combined with epicardial left atrial cryoablation as compared with mitral valve surgery alone: a substudy of the double blind randomized SWEDish Multicentre Atrial Fibrillation study (SWEDMAF). Europace, 20, F343-F350
Open this publication in new window or tab >>Quality of life is not improved aftermitral valve surgery combined with epicardial left atrial cryoablation as compared with mitral valve surgery alone: a substudy of the double blind randomized SWEDish Multicentre Atrial Fibrillation study (SWEDMAF)
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2018 (English)In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 20, p. F343-F350Article in journal (Refereed) Published
Abstract [en]

Aims: Concomitant surgical ablation of atrial fibrillation (AF) in patients undergoing mitral valve surgery (MVS) has almost become routine despite lack of convincing information about improved quality-of-life (QOL) and clinical benefit. Quality-of-life was therefore assessed after MVS with or without epicardial left atrial cryoablation. Methods and results: Sixty-five patients with permanent AF randomized to MVS with or without left atrial cryoablation, in the doubleblinded multicentre SWEDMAF trial, replied to the Short Form 36 QOL survey at 6 and 12 months follow-up. The QOL scores at 12month follow-up did not differ significantly between patients undergoing MVS combined with cryoablation vs. those undergoing MVS alone regarding Physical Component Summary mean 42.8 (95% confidence interval 38.3-47.3) vs. mean 44.0 (40.1-47.7), P =0.700 or Mental Component Summary mean 53.1 (49.7-56.4) vs. mean 48.4 (44.6-52.2), P=0.075. All patients, irrespective of allocated procedure, reached the same QOL after surgery as an age-matched Swedish general population. The Physical Component Summary in patients with sinus rhythm did also not differ from those in AF at 12months; mean 45.4 (42.0-48.7) vs. mean 40.5 (35.5-45.6), P=0.096) nor was there a difference in Mental Component Summary; mean 51.0 (48.0-54.1) vs. mean 49.6 (44.6-54.5), P=0.581). Conclusion: Left atrial cryoablation added to MVS does not improve health-related QOL in patients with permanent AF, a finding that raises concerns regarding recommendations made for this combined procedure.

Place, publisher, year, edition, pages
Oxford University Press, 2018
Keywords
Quality-of-life, Ablation, Atrial fibrillation, Mitral valve surgery, Concomitant surgical ablation
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-155246 (URN)10.1093/europace/eux253 (DOI)000454047100014 ()29016835 (PubMedID)
Note

Special Issue: 3

Available from: 2019-01-14 Created: 2019-01-14 Last updated: 2019-05-20Bibliographically approved
Ljungberg, J., Holmgren, A., Bergdahl, I. A., Hultdin, J., Norberg, M., Näslund, U., . . . Söderberg, S. (2017). Lipoprotein(a) and the Apolipoprotein B/A1 Ratio Independently Associate With Surgery for Aortic Stenosis Only in Patients With Concomitant Coronary Artery Disease. Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, 6(12), Article ID e007160.
Open this publication in new window or tab >>Lipoprotein(a) and the Apolipoprotein B/A1 Ratio Independently Associate With Surgery for Aortic Stenosis Only in Patients With Concomitant Coronary Artery Disease
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2017 (English)In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 6, no 12, article id e007160Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Aortic stenosis (AS) has different clinical phenotypes, including AS with or without concomitant coronary artery disease (CAD). It is unknown whether these phenotypes share the same risk factors. In particular, lipoprotein(a) [Lp(a)] and apolipoproteins (Apo) are associated with AS, but it is unknown whether these associations differ among phenotypes. In this prospective analysis we examined the impact of Lp(a) and Apo in subgroups of patients with AS.

METHODS AND RESULTS: We identified 336 patients (mean age at survey 56.7 years, 48% female) who underwent surgery for AS after a median 10.9 years (interquartile range 9.3 years), participants in 1 of 3 large population surveys. For each patient, 2 matched referents were allocated. Lp(a) and Apo were analyzed in the baseline samples. Uni- and multivariable logistic regression analyses were used to estimate risks related to a 1 (ln) standard deviation increase in Lp(a) and the ratio of Apo B to Apo A1 (Apo B/A1 ratio). High levels of Lp(a) predicted surgery for AS in 203 patients with concomitant CAD (odds ratio [95% confidence intervals]) (1.29 [1.07-1.55]), but not in 132 patients without CAD (1.04 [0.83-1.29]) in the fully adjusted model. Similarly, a high Apo B/A1 ratio predicted surgery in patients with concomitant CAD (1.43 [1.16-1.76]) but not in those without CAD (0.87 [0.69-1.10]).

CONCLUSIONS: High levels of Lp(a) and a high Apo B/A1 ratio were associated with surgery for AS in patients with concomitant CAD but not in those with isolated AS. This finding may lead to a new avenue of research for targeted risk factor interventions in this population.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
Keywords
aortic stenosis, aortic valve surgery, apolipoproteins, lipoprotein(a), prospective cohort study, risk markers
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-143323 (URN)10.1161/JAHA.117.007160 (DOI)000418951100046 ()29246959 (PubMedID)
Available from: 2017-12-20 Created: 2017-12-20 Last updated: 2019-05-21Bibliographically approved
Henein, M., Holmgren, A., Holmner, F., Mörner, S. & Lindqvist, P. (2016). Long anterior mitral leaflet causing outflow tract obstruction in a symptomatic patient with hypertrophic cardiomyopathy: the role of mitral valve surgical correction [Letter to the editor]. International Journal of Cardiology, 204, 86-87
Open this publication in new window or tab >>Long anterior mitral leaflet causing outflow tract obstruction in a symptomatic patient with hypertrophic cardiomyopathy: the role of mitral valve surgical correction
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2016 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 204, p. 86-87Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
Elsevier, 2016
Keywords
Hypertrophic cardiomyopathy, Anterior mitral leaflet, Obstruction, Exercise echocardiography
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-114604 (URN)10.1016/j.ijcard.2015.11.153 (DOI)000367008200027 ()26655547 (PubMedID)
Available from: 2016-02-11 Created: 2016-01-25 Last updated: 2018-06-07Bibliographically approved
Henein, M., Hällgren, P., Holmgren, A., Sörensen, K., Ibrahimi, P., Kofoed, K. F., . . . Hassager, C. (2015). Aortic root, not valve, calcification correlates with coronary artery calcification in patients with severe aortic stenosis: a two-center study. Atherosclerosis, 243(2), 631-637
Open this publication in new window or tab >>Aortic root, not valve, calcification correlates with coronary artery calcification in patients with severe aortic stenosis: a two-center study
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2015 (English)In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 243, no 2, p. 631-637Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The underlying pathology in aortic stenosis (AS) and coronary artery stenosis (CAS) is similar including atherosclerosis and calcification. We hypothesize that coronary artery calcification (CAC) is likely to correlate with aortic root calcification (ARC) rather than with aortic valve calcification (AVC), due to tissue similarity between the two types of vessel rather than with the valve leaflet tissue.

MATERIAL AND METHODS: We studied 212 consecutive patients (age 72.5 ± 7.9 years, 91 females) with AS requiring aortic valve replacement (AVR) in two Heart Centers, who underwent multidetector cardiac CT preoperatively. CAC, AVC and ARC were quantified using Agatston scoring. Correlations were tested by Spearman's test and Mann-Whitney U-test was used for comparing different subgroups; bicuspid (BAV) vs tricuspid (TAV) aortic valve.

RESULTS: CAC was present in 92%, AVC in 100% and ARC in 82% of patients. CAC correlated with ARC (rho = 0.51, p < 0.001) but not with AVC. The number of calcified coronary arteries correlated with ARC (rho = 0.45, p < 0.001) but not with AVC. 29/152 patients had echocardiographic evidence of BAV and 123 TAV, who were older (p < 0.001) but CAC was associated with TAV even after adjusting for age (p = 0.01). AVC score was associated with BAV after adjusting for age (p = 0.03) but ARC was not. Of the total cohort, 82 patients (39%) had significant coronary stenosis (>50%), but these were not different in the pattern of calcification from those without CAS. CAC was consistently higher in patients with risk factors for atherosclerosis compared to those without.

CONCLUSION: The observed relationship between coronary and aortic root calcification suggests a diffuse arterial disease. The lack of relationship between coronary and aortic valve calcification suggests a different pathology.

Place, publisher, year, edition, pages
Elsevier, 2015
Keywords
coronary artery calcification, family history of premature coronary heart disease, Parents, Siblings, ronary calcium score
National Category
Cardiac and Cardiovascular Systems
Research subject
Medicine, cardiovascular disease
Identifiers
urn:nbn:se:umu:diva-112216 (URN)10.1016/j.atherosclerosis.2015.10.014 (DOI)000366534100041 ()26551591 (PubMedID)
Available from: 2015-12-04 Created: 2015-12-04 Last updated: 2018-06-07Bibliographically approved
Ramzy, I. S., Gustafsson, S., Holmgren, A. & Henein, M. Y. (2015). Early effect of surgical revascularisation on left ventricular twist function. International Cardiovascular Forum Journal, 4, 16-23
Open this publication in new window or tab >>Early effect of surgical revascularisation on left ventricular twist function
2015 (English)In: International Cardiovascular Forum Journal, ISSN 2410-2636, Vol. 4, p. 16-23Article in journal (Refereed) Published
Place, publisher, year, edition, pages
Barcaray Publishing, 2015
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-55469 (URN)10.17987/icfj.v4i0.125 (DOI)
Available from: 2012-05-16 Created: 2012-05-16 Last updated: 2018-11-28Bibliographically approved
Vanoli, D., Backman, C. & Holmgren, A. (2015). Inferior infarction complicated by ruptured interventricular septum [Letter to the editor]. International Cardiovascular Forum Journal, 2(1), 44-45
Open this publication in new window or tab >>Inferior infarction complicated by ruptured interventricular septum
2015 (English)In: International Cardiovascular Forum Journal, ISSN 2410-2636, Vol. 2, no 1, p. 44-45Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
Barcaray International Publishing, 2015
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-107644 (URN)10.17987/icfj.v2i1.80 (DOI)
Available from: 2015-08-25 Created: 2015-08-25 Last updated: 2018-06-07Bibliographically approved
Henein, M. Y., Holmgren, A. & Lindqvist, P. (2015). Left atrial function in volume versus pressure overloaded left atrium. The International Journal of Cardiovascular Imaging, 31(5), 959-965
Open this publication in new window or tab >>Left atrial function in volume versus pressure overloaded left atrium
2015 (English)In: The International Journal of Cardiovascular Imaging, ISSN 1569-5794, E-ISSN 1875-8312, Vol. 31, no 5, p. 959-965Article in journal (Refereed) Published
Abstract [en]

Left atrial (LA) pressure and volume overload both result in cavity enlargement and complications. LA volume has been shown to predict such complications, but it does not reflect myocardial function, which can be accurately assessed using myocardial deformation measurements. We hypothesized that volume overloaded LA have maintained myocardial function compared to pressure overloaded ones. We tested this hypothesis in 44 patient (mean age 62 ± 12 years) with LA volume overload (LAVOL) due to severe mitral regurgitation (MR) with no indirect signs of elevated left ventricular (LV) filling pressures based on Doppler measured isovolumic relaxation time >60 ms. We compared them with 24 (mean age 64 ± 12 years) patient with LA pressure overload (LAPOL) who proved to have PCWP >15 mmHg on right heart catheterization. Twenty-seven healthy controls (mean age 57 ± 10 years) constituted a control group. Patients with LAVOL had larger LA volumes, higher LV ejection fraction, global LV strain (LVGLS) and transmitral and pulmonary veins flow velocities (p < 0.05) and better LA atrial strain rate (LASR) function compared to LAPOL (p < 0.001). In LAVOL, the LASR during atrial contraction (LASRa) was lower than in controls (p < 0.05) indicating LA mechanical disturbances. LVGLS correlated with peak atrial longitudinal systolic strain in the whole group (r = -0.65, p < 0.001) and less so with LASRa (r = -0.43, p < 0.001) Conclusion: Irrespective of a smaller LA volume, LAVOL had less negative effect on LA myocardial function than LAPOL. Thus, monitoring atrial myocardial contraction might be useful in following patients with significant MR.

Place, publisher, year, edition, pages
Springer, 2015
Keywords
left atrial pressure overload, left atrial volume overload, strain, strain rate
National Category
Cardiac and Cardiovascular Systems Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:umu:diva-101973 (URN)10.1007/s10554-015-0638-6 (DOI)000355151300009 ()25759088 (PubMedID)
Available from: 2015-04-17 Created: 2015-04-17 Last updated: 2018-06-07Bibliographically approved
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