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  • 1. Ahlsson, Anders
    et al.
    Jideus, Lena
    Albage, Anders
    Kallner, Goran
    Holmgren, Anders
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Boano, Gabriella
    Hermansson, Ulf
    Kimblad, Per-Ola
    Schersten, Henrik
    Sjogren, Johan
    Stahle, Elisabeth
    Aberg, Bengt
    Berglin, Eva
    A Swedish consensus on the surgical treatment of concomitant atrial fibrillation2012In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 46, no 4, p. 212-218Article, review/survey (Refereed)
    Abstract [en]

    Atrial fibrillation (AF) is a common arrhythmia among patients scheduled for open heart surgery and is associated with increased morbidity and mortality. According to international guidelines, symptomatic and selected asymptomatic patients should be offered concomitant surgical AF ablation in conjunction with valvular or coronary surgery. The gold standard in AF surgery is the Cox Maze III ("cut-and-sew") procedure, with surgical incisions in both atria according to a specified pattern, in order to prevent AF reentry circuits from developing. Over 90% of patients treated with the Cox Maze III procedure are free of AF after 1 year. Recent developments in ablation technology have introduced several energy sources capable of creating nonconducting atrial wall lesions. In addition, simplified lesion patterns have been suggested, but results with these techniques have been unsatisfactory. There is a clear need for standardization in AF surgery. The Swedish Arrhythmia Surgery Group, represented by surgeons from all Swedish units for cardiothoracic surgery, has therefore reached a consensus on surgical treatment of concomitant AF. This consensus emphasizes adherence to the lesion pattern in the Cox Maze III procedure and the use of biatrial lesions in nonparoxysmal AF.

  • 2.
    Bajraktari, Gani
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Rönn, Folke
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Ibrahimi, Pranvera
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Jashari, Fisnik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Lindmark, Krister
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Jensen, Steen M
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Henein, Michael Y
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Combined electrical and global markers of dyssynchrony predict clinical response to Cardiac Resynchronization Therapy2014In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 48, no 5, p. 304-310Article in journal (Refereed)
    Abstract [en]

    AIM: To assess potential additional value of global left ventricular (LV) dyssynchrony markers in predicting cardiac resynchronization therapy (CRT) response in heart failure (HF) patients. METHODS: We included 103 HF patients (mean age 67 +/- 12 years, 83% male) who fulfilled the guidelines criteria for CRT treatment. All patients had undergone full clinical assessment, NT-proBNP and echocardiographic examination. Global LV dyssynchrony was assessed using total isovolumic time (t-IVT) and Tei index. On the basis of reduction in the NYHA class after CRT, patients were divided into responders and non-responders. RESULTS: Prolonged t-IVT [0.878 (range, 0.802-0.962), p = 0.005], long QRS duration [0.978 (range, 0.960-0.996), p = 0.02] and high tricuspid regurgitation pressure drop [1.047 (range, 1.001-1.096), p = 0.046] independently predicted response to CRT. A t-IVT >= 11.6 s/min was 67% sensitive and 62% specifi c (AUC 0.69, p = 0.001) in predicting CRT response. Respective values for a QRS >= 151 ms were 66% and 62% (AUC 0.65, p = 0.01). Combining the two variables had higher specifi city (88%) in predicting CRT response. In atrial fibrillation (AF) patients, only prolonged t-IVT [0.690 (range, 0.509 -0.937), p = 0.03] independently predicted CRT response. CONCLUSION: Combining prolonged t-IVT and the conventionally used broad QRS duration has a significantly higher specifi city in identifying patients likely to respond to CRT. Moreover, in AF patients, only prolonged t-IVT independently predicted CRT response.

  • 3. Blyme, Adam
    et al.
    Asferg, Camilla
    Nielsen, Olav W.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Gohlke-Baerwolf, Christa
    Wachtell, Kristian
    Olsen, Michael H.
    Increased hsCRP is associated with higher risk of aortic valve replacement in patients with aortic stenosis2016In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 50, no 3, p. 138-145Article in journal (Refereed)
    Abstract [en]

    Objective To investigate relations between inflammation and aortic valve stenosis (AS) by measuring high-sensitivity C-reactive protein, at baseline (hsCRP(0)) and after 1year (hsCRP(1)) and exploring associations with aortic valve replacement (AVR). Design We examined 1423 patients from the Simvastatin and Ezetimibe in Aortic Stenosis study. Results During first year of treatment, hsCRP was reduced both in patients later receiving AVR (2.3 [0.9-4.9] to 1.8 [0.8-5.4] mg/l, p<0.001) and not receiving AVR (1.90 [0.90-4.10] to 1.3 [0.6-2.9] mg/l, p<0.001). In Cox-regression analyses, hsCRP(1) predicted later AVR (HR=1.17, p<0.001) independently of hsCRP(0) (HR=0.96, p=0.33), aortic valve area (AVA) and other risk factors. A higher rate of AVR was observed in the group with high hsCRP(0) and an increase during the first year (AVR(highCRP0CRP1inc)=47.3% versus AVR(highCRP0CRP1dec)=27.5%, p<0.01). The prognostic benefit of a 1-year reduction in hsCRP was larger in patients with high versus low hsCRP(0) eliminating the difference in incidence of AVR between high versus low hsCRP(0) (AVR(highCRP0CRP1dec)=27.5% versus AVR(lowCRP0CRP1dec)=25.8%, p=0.66) in patients with reduced hsCRP during the first year. Conclusions High hsCRP(1) or an increase in hsCRP during the first year of follow-up predicted later AVR independently of AVA, age, gender and other risk factors, although no significant improvement in C-statistics was observed.

  • 4.
    Boivie, Patrik
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Hansson, Magnus
    Engström, Karl Gunnar
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Aortic plaque distribution in relation to cross-clamp and cannulation procedures during cardiac surgery2007In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 41, no 2, p. 120-125Article in journal (Other academic)
  • 5.
    Boivie, Patrik
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Hand Surgery.
    Hedberg, Magnus
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Engström, Karl Gunnar
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Size distribution of embolic material produced at aortic cross-clamp manipulation2010In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 44, no 6, p. 367-372Article in journal (Refereed)
    Abstract [en]

    Objectives: The association between aortic atherosclerosis and neurological damage during cardiac surgery is well recognized. The purpose was here to analyze the size distribution of particles produced at cross-clamp manipulation of the ascending aorta.

    Design: A human cadaveric aortic perfusion model of retrograde design was applied (n 27). With this model, washout samples were collected from the pressurized ascending aorta during cross clamp manipulation. Before the experiment, the aorta was flushed to remove debris and with a baseline sample collected. The cross-clamp was opened to collect ten repeated aliquots with dislodged particles. Collected washout samples were evaluated by digital image analysis and microscopy.

    Results: Cross-clamping produced a significant output of particles, which was seen for size intervals of 1 mm and smaller (p 0.002 to p 0.022). In all size intervals the particle output correlated with the degree of overall aortic calcification(p 0.002 to p 0.025). The model generated substantially more small-size particles than large debris (p 0.010).

    Conclusions: Aortic clamping was here verified to dislodge aortic debris which correlated with the degree of observed calcification. Macroscopic particles were few. In contrast, cross-clamping produced substantial numbers of small-size particles. These findings emphasize microembolic risks associated with cross-clamping of atherosclerotic vessels.

  • 6.
    Boles, Usama
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Zhao, Ying
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Rakhit, Roby
    Shiu, Man Fi
    Papachristidis, Alexandros
    David, Santosh
    Koganti, Sudheer
    Gilbert, Timothy
    Henein, Michael Y.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Patterns of coronary artery ectasia and short-term outcome in acute myocardial infarction2014In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 48, no 3, p. 161-166Article in journal (Refereed)
    Abstract [en]

    Objective. To assess the relationship between hematological inflammatory signs, cardiovascular risk (CV) factors and prognosis in patients presenting with acute myocardial infarction (AMI) and coronary artery ectasia (CAE). Design. We investigated 3321 AMI patients who required urgent primary percutaneous intervention in two centres in the United Kingdom between January 2009 and August 2012. Thirty patients with CAE were compared with 60 age-and gender-matched controls. Blood was collected within 2 h of the onset of chest pain. CV risk factors were assessed from the records. Major acute cardiac events and/or mortality (MACE) over 2 years were documented. Results. CAE occurred in 2.7% and more often affected the right (RCA) (p = 0.001) and left circumflex artery (LCx) (0.0001). Culprit lesions were more frequently related to atherosclerosis in non-CAE patients (p = 0.001). Yet, CV risk factors failed to differentiate between the groups, except diabetes, which was less frequent in CAE (p = 0.02). CRP was higher in CAE (p = 0.006), whereas total leucocyte, neutrophil counts and neutrophil/lymphocyte ratio (N/L ratio) were lower (p = 0.002, 0.002 and 0.032, respectively) than among non-CAE. This also was the case in diffuse versus localised CAE (p = 0.02, 0.008 and 0.03, respectively). The MACE incidence did not differ between CAE and non-CAE (p = 0.083) patients, and clinical management and MACE were unrelated to the inflammatory markers. Conclusion. In AMI, patients with CAE commonly have aneurysmal changes in RCA and LCx, and their inflammatory responses differ from those with non-CAE. These differences did not have prognostic relevance, and do not suggest different management.

  • 7. Engström, Karin
    et al.
    Engström, Karl Gunnar
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Hazards with electrocautery-induced decomposition of fatty acids: in view of lipid embolization2010In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 44, no 5, p. 307-312Article in journal (Refereed)
    Abstract [en]

    Electrocautery induces a profound fatty-acid fragmentation to form short-chained compounds. The chemical and toxic nature of these compounds remains to be determined, including their clinical implications at blood recycling in cardiac surgery.

  • 8. Hambraeus, Kristina
    et al.
    Held, Claes
    Johansson, Per
    Svennberg, Lars
    Cider, Asa
    James, Stefan
    Lagerqvist, Bo
    Friberg, Orjan
    Nilsson, Johan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    From-Attebring, Mona
    Harnek, Jan
    Jernberg, Tomas
    SWEDEHEART Annual Report 20122014In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 48, no S63, p. 1-129Article in journal (Refereed)
    Abstract [en]

    The Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART) supports continuous monitoring and improvement of care for coronary artery disease, catheter-based and surgical coronary interventions, secondary prevention as well as catheter based and surgical valve intervention, by providing extensive data on base-line, diagnostic, procedural and outcome variables. Design. This national quality registry collects information from all Swedish hospitals treating patients with acute coronary artery disease and all patients undergoing coronary angiography, catheter-based interventions or heart surgery. Combination with other national mandatory official registries enables complete follow-up of all individuals regarding myocardial infarction, new interventional procedures, death and all-cause hospitalizations. The registry is governed by an independent steering committee and funded by the Swedish National Health care provider. The software is developed by Uppsala Clinical Research Center. Results. The SWEDEHEART Quality Index reflects overall quality of care for coronary artery disease including secondary prevention. In comparison with 2011, an improvement of the index occurred in 2012 overall. There was however, still a wide range in performance between individual centers, emphasizing the need for continuous monitoring of quality of care at a national as well as on a center level.

  • 9.
    Hannuksela, Matias
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Johansson, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Aortic stiffness in families with inherited non-syndromic thoracic aortic disease2018In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 52, no 6, p. 301-307Article in journal (Refereed)
    Abstract [en]

    Background. In families with an inherited form of non-syndromic thoracic aortic disease (TAAD), aortic diameter alone is not a reliable marker for disease occurrence or progression. To identify other parameters of aortic function, we studied aortic stiffness in families with TAAD. We also compared diameter measurements obtained by transthoracic echocardiography (TTE) and magnetic resonance imaging (MRI).

    Methods. Seven families, including 116 individuals, with non-syndromic TAAD, were studied. The aortic diameter was measured by TTE and MRI. Aortic stiffness was assessed as local distensibility in the ascending aorta and as regional and global pulse wave velocity (PWV). Individuals with a dilated thoracic aorta (n = 21) were compared with those without aortic dilatation (n = 95).

    Results. Ascending aortic diameter measured by TTE strongly correlated with the diameter measured by MRI (r2 = 0.93). The individuals with dilated aortas were older than those without dilatation (49 vs 37 years old). Ascending aortic diameter increased and distensibility decreased with increasing age; while, PWV increased with age and diameter. Some young subjects without aortic dilatation showed increased aortic stiffness. Individuals with a dilated thoracic aorta had significantly higher PWV and lower distensibility, measured by MRI than individuals without dilatation.

    Conclusions. Diameters measured with TTE agree with those measured by MRI. Aortic stiffness might be a complementary marker for aortic disease and progression when used with aortic diameter, especially in young individuals.

  • 10.
    Hannuksela, Matias
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Lundqvist, Stefan
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Thoracic aorta: dilated or not?2006In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 40, no 3, p. 175-178Article in journal (Refereed)
    Abstract [en]

    Objectives: Knowledge of normal aortic diameters is important in the assessment of aortic disease. The aim of this study was to determine normal thoracic aortic diameters.

    Design: 77 patients undergoing computed tomography of the thorax were studied. The diameter of the thoracic aorta was measured at three levels in the ascending aorta and at three levels in the descending aorta. The diameter was studied in relation to age, sex, weight and height.

    Results: We found that aortic diameter is increasing with increasing age. Even sex and BMI influence the aortic diameter but to a lesser extent than age. The upper normal limit for ascending aorta can be calculated with the formula D(mm) = 31 + 0.16*age and for descending aorta with the formula D(mm) = 21 + 0.16*age. Thus a 20-year-old person has an upper normal limit for ascending aorta of 34 mm and an 80-year-old person has a limit of 44 m.

    Conclusions: The thoracic aortic diameter varies with age, sex and body weight and height. The strongest correlation can be seen with age. Age should therefore be taken into consideration when determining whether the thoracic aorta is dilated or not.

  • 11. Harnek, Jan
    et al.
    Nilsson, Johan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Friberg, Örjan
    James, Stefan
    Lagerqvist, Bo
    Hambraeus, Kristina
    Cider, Åsa
    Svennberg, Lars
    Attebring, Mona From
    Held, Claes
    Johansson, Per
    Jernberg, Tomas
    The 2011 outcome from the Swedish Health Care Registry on Heart Disease (SWEDEHEART)2013In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 47, no S62, p. 1-10Article in journal (Refereed)
  • 12.
    Hedberg, Magnus
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Boivie, Patrik
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Edström, Cecilia
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Engström, Karl Gunnar
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Cerebrovascular accidents after cardiac surgery: an analysis of CT scans in relation to clinical symptoms2005In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 39, no 5, p. 299-305Article in journal (Refereed)
    Abstract [en]

    There is a link between aortic manipulation, particle embolization, and cerebrovascular accidents (CVA) in cardiac surgery. The present aim was to study hemispheric side differences of CVA. Cardiac-surgery patients with CVA and with computer tomography (CT) performed (n = 77) were analyzed within a total group of 2641 consecutive cases. CT data were reviewed for hemispheric and vascular distribution, and compared with CVA-symptom data of immediate and delayed type. Of the included patients, 66% had positive CT. In the group of 'cardiac-type' operations (e.g., routine clamping and cannulation) and having immediate CVA, right-hemispheric lesions were more frequent than of the contra-lateral side (p = 0.005). Patients with aortic dissections had strong dominance of bilateral findings, which was different from the unilateral pattern of 'cardiac-type' operations (p = 0.001). The middle-cerebral artery territory dominated, and when involved showed a significant (p = 0.022) right-sided distribution. Both CT and clinical symptoms confirmed that CVA after cardiac surgery has a right-hemispheric predominance. These observations may imply that aortic manipulation directs embolic material towards the brachiocephalic trunk.

  • 13.
    Hedberg, Magnus
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Engström, Karl Gunnar
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Stroke after cardiac surgery - hemispheric distribution and survival2013In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 47, no 3, p. 136-144Article in journal (Refereed)
    Abstract [en]

    Objectives. Stroke following cardiac surgery may occur either in association with surgery (early) or occur postoperatively (delayed). The hemispheric distribution of lesions may provide information about embolic routes, which was analyzed here. Design. In 10,809 patients undergoing cardiac surgery, early (n = 223) and delayed stroke (n = 116) were explored. Symptoms and computed tomography findings were evaluated to categorize hemispheric distributions. This was compared with pre- and intra-operative characteristics and survival, using logistic regression and Kaplan-Meier statistics. Results. Early stroke had preponderance for the right rather than the left hemisphere (P = 0.009), whereas delayed stroke had a uniform distribution. Several intraoperative variables predicted the development of bilateral stroke compared with its unilateral counterpart. At multivariable analysis, the use of tranexamic acid was associated with bilateral stroke (P = 0.017), but was also associated with right rather than left-hemispheric stroke (P = 0.001). Bilateral lesions dramatically impaired survival versus those with unilateral lesions (P < 0.001). There was no survival difference between left and right-hemispheric stroke. Conclusions. When stroke, after cardiac surgery, is subdivided into early and delayed forms, it becomes evident that early, but not delayed stroke, demonstrates a hemispheric side difference. The preponderance for right-hemispheric lesions may indicate embolic mechanisms routed via the brachiocephalic trunk.

  • 14.
    Jallow, Tim
    et al.
    Sunderby Hospital , Luleå , Sweden..
    Wennberg, Patrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Forslund, Ann-Sofie
    Department of Research, Region Norrbotten , The Northern Sweden MONICA Myocardial Registry , Luleå , Sweden..
    Temporal variation in out-of-hospital cardiac arrest with validated cardiac cause2018In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 52, no 3, p. 149-155Article in journal (Refereed)
    Abstract [en]

    Objective: Temporal variations in the occurrence of out-of-hospital cardiac arrest (OHCA) have been shown. Most previous studies have in common that they include individuals whom have received cardiopulmonary resuscitation (CPR) and thus excluding a great number of all the actual cases of OHCA when conducting a study. Therefore the aim of this study was to describe temporal variations of OHCA, regardless of whether CPR was performed or not.

    Design: All individuals aged 25-74 years in northern Sweden, 1989-2009, who suffered an out-of-hospital cardiac arrest with validated myocardial infarction aetiology (OHCA-V), regardless of whether CPR was performed or not, were included in this study, which resulted in 3357 individuals.

    Results: Regarding the diurnal variation, a daytime excess of OHCA-V was seen, with most occurring between 12:00-17:59 (29%) closely followed by the 06:00-11:59 time block (27%). In terms of the weekly variation, most OHCA-V was seen on Saturdays (17%), while January (11%), followed by December (9%), saw the highest incidence of the months.

    Conclusion: A temporal variation in OHCA-V is seen even when including cases where no CPR is attempted. However, this variation differs in some aspects to what some previous studies have shown, in that no clear morning or Monday peaks were seen. In order to explore potential triggers and underlying factors that influence OHCA, more studies like these are needed, preferably following standardized inclusion criteria and definitions of OHCA to better be able to compare results, all in order to develop the best possible preventive strategies.

  • 15.
    Jashari, Fisnik
    et al.
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Ibrahimi, Pranvera
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Johansson, Elias
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Grönlund, Christer
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine. Department of Clinical Sciences, Danderyds Hospital, Karolinska Institute, Stockholm, Sweden.
    Henein, Michael Y.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Carotid IM-GSM is better than IMT for identifying patients with multiple arterial disease2018In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 52, no 2, p. 93-99Article in journal (Refereed)
    Abstract [en]

    Objective. Atherosclerosis is a systemic inflammatory disease that can affect more than one arterial bed simultaneously. The aim of this study was to determine the relationship between ultrasound markers of atherosclerosis and multiple arterial disease. Design. We have included 87 currently asymptomatic carotid disease patients (mean age 69 +/- 6 year, 34% females) in this study. Intima media thickness (IMT) and intima media-grey scale median (IM-GSM) were measured in the common carotid artery (CCA), and correlated with previous and/or current atherosclerotic vascular disease in the coronary, carotid and lower extremities. Patients were divided into three groups: (1) asymptomatic, (2) previous symptoms in one arterial territory and (3) previous symptoms in multiple arterial territories. Results. Patients with previous disease in the coronary arteries had higher IMT (p=.034) and lower IM-GSM (p<.001), and those with prior stroke had lower IM-GSM (p=.007). Neither IMT nor IM-GSM was different between patients with and without previous lower extremity vascular disease. IM-GSM was significantly different between groups, it decreased significantly with increasing number of arterial territories affected (37.7 +/- 15.4 vs. 29.3 +/- 16.4 vs. 20.7 +/- 12.9) p<.001, for asymptomatic, symptoms in one and in multiple arterial systems, respectively. Conventional IMT was not significantly different between groups p=.49. Conclusion. Carotid IMT was higher and IM-GSM lower in patients with symptomatic nearby arterial territories but not in those with peripheral disease. In contrast to conventional IMT, IM-GSM can differentiate between numbers of arterial territories affected by atherosclerosis, suggesting that it is a better surrogate for monitoring multiple arterial territory disease.

  • 16. Karlström, Patric
    et al.
    Dahlström, Ulf
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Alehagen, Urban
    Responder to BNP-guided treatment in heart failure. The process of defining a responder Results from the Use of PeptideS in Tailoring hEart failure Project or UPSTEP study2015In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 49, no 6, p. 316-324Article in journal (Refereed)
    Abstract [en]

    Objectives. B-type natriuretic peptide (BNP) levels predict prognosis and outcome in heart failure (HF) patients. To evaluate the optimal cut-off level of BNP to predict death, need for hospitalization, and worsening HF, and also to determine the optimal time to apply the chosen cut-off value. Design. In a sub-study from the Use of PeptideS in Tailoring hEart failure Project or UPSTEP study where tailoring treatment of HF by BNP level was evaluated, we assessed the change in percentage between levels of BNP at study start versus a specific week (2, 6, 10, 16, 24, 36, or 48) during the follow-up period. Results. The optimum cut-off percentage levels were obtained using a Cox proportional regression analysis of death, hospitalization, and worsening HF. A decrease in BNP by less than 40% in week 16 compared with study start and/or a BNP > 300 ng/L presented the highest hazard ratio (HR) for a non-responder to reach a combined endpoint (HR: 2.43; 95% confidence interval or CI: 1.61-3.65; p < 0.00003). This definition gave a 78% risk reduction of cardiovascular (CV) mortality (p > 0.0005) and an 89% risk reduction of HF mortality (p > 0.004), and reduced risk of CV and HF hospitalization for the responders. Conclusions. Patients with a decrease in BNP of more than 40% compared with that at study start and/or a BNP level below 300 ng/L at week 16 had a significantly reduced risk of CV and HF mortality and hospitalization.

  • 17.
    Ljungberg, Johan
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Johansson, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Engström, Karl Gunnar
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Norberg, Margareta
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Bergdahl, Ingvar A
    Umeå University, Faculty of Medicine, Department of Biobank Research.
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Arterial hypertension and diastolic blood pressure associate with aortic stenosis2019In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 53, no 2, p. 91-97Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Due to age-related differences in aortic valve structure, it is likely that the pathophysiology of aortic stenosis (AS) and associated risk factors differ between age groups. Here we prospectively studied the influence of traditional cardiovascular risk factors on AS development requiring surgery among patients without concomitant coronary artery disease (CAD) and stratified for age.

    DESIGN: This study included 322 patients, who had prior to surgery for AS participated in population-based surveys, and 131 of them had no visible CAD upon preoperative coronary angiogram. For each case, we selected four referents matched for age, gender, and geographic area. To identify predictors for surgery, we used multivariable conditional logistic regression with a model including arterial hypertension (or measured blood pressure and antihypertensive medication), cholesterol levels, diabetes, body mass index (BMI), and smoking.

    RESULTS: In patients without CAD, future surgery for AS was associated with arterial hypertension and elevated levels of diastolic blood pressure in patients younger than 60 years at surgery (odds ratio [95% confidence interval]), (3.40 [1.45-7.93] and 1.60 [1.09-2.37], respectively), and with only impaired fasting glucose tolerance in patients 60 years or older at surgery (3.22 [1.19-8.76]).

    CONCLUSION: Arterial hypertension and elevated diastolic blood pressure are associated with a risk for AS requiring surgery in subjects below 60 years of age. Strict blood pressure control in this group is strongly advocated to avoid other cardiovascular diseases correlated to hypertension. If hypertension and elevated diastolic blood pressure are risk factors for developing AS requiring surgery need further investigations. Notably, elevated fasting glucose levels were related to AS requiring surgery in older adults without concomitant CAD.

  • 18. Lundgren, Jakob
    et al.
    Sandqvist, Anna
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Pharmacology.
    Hedeland, Mikael
    Bondesson, Ulf
    Wikström, Gerhard
    Rådegran, Göran
    Alterations in plasma L-arginine and methylarginines in heart failure and after heart transplantation2018In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 52, no 4, p. 196-204Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Endothelial function, including the nitric oxide (NO)-pathway, has previously been extensively investigated in heart failure (HF). In contrast, studies are lacking on the NO pathway after heart transplantation (HT). We therefore investigated substances in the NO pathway prior to and after HT in relation to hemodynamic parameters.

    DESIGN: 12 patients (median age 50.0 yrs, 2 females), heart transplanted between June 2012 and February 2014, evaluated at our hemodynamic lab, at rest, prior to HT, as well as four weeks and six months after HT were included. All patients had normal left ventricular function post-operatively and none had post-operative pulmonary hypertension or acute cellular rejection requiring therapy at the evaluations. Plasma concentrations of ADMA, SDMA, L-Arginine, L-Ornithine and L-Citrulline were analyzed at each evaluation.

    RESULTS: In comparison to controls, the plasma L-Arginine concentration was low and ADMA high in HF patients, resulting in low L-Arginine/ADMA-ratio pre-HT. Already four weeks after HT L-Arginine was normalized whereas ADMA remained high. Consequently the L-Arginine/ADMA-ratio improved, but did not normalize. The biomarkers remained unchanged at the six-month evaluation and the L-Arginine/ADMA-ratio correlated inversely to pulmonary vascular resistance (PVR) six months post-HT.

    CONCLUSIONS: Plasma L-Arginine concentrations normalize after HT. However, as ADMA is unchanged, the L-Arginine/ADMA-ratio remained low and correlated inversely to PVR. Together these findings suggest that (i) the L-Arginine/ADMA-ratio may be an indicator of pulmonary vascular tone after HT, and that (ii) NO-dependent endothelial function is partly restored after HT. Considering the good postoperative outcome, the biomarker levels may be considered "normal" after HT.

  • 19.
    Nilsson, Johan
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Jensen, Steen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Ottander, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Näslund, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    The electrocardiographic reperfusion peak in patients with ST-elevation myocardial infarction.2007In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 41, no 1, p. 25-31Article in journal (Refereed)
  • 20. Ruge, Toralph
    et al.
    Carlsson, Axel C.
    Jansson, Jan-Håkan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Larsson, Anders
    Ärnlöv, Johan
    The association between circulating endostatin levels and incident myocardial infarction2018In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 52, no 6, p. 315-319Article in journal (Refereed)
    Abstract [en]

    Objective. Increased levels of circulating endostatin have been observed in patients with prevalent ischemic heart disease. However, the association between circulating endostatin, and incident myocardial infarction (MI) is less studied. Our main aim was to study the association between circulating endostatin and incident MI in the community adjusted for established cardiovascular risk factors in men and women.

    Design. Circulating endostatin was measured in a nested case control study based on three large community-based Swedish cohorts, including 533 MI cases, and 1003 age-, sex- and cohort-matched controls. Odds ratios (OR) with 95% confidence intervals (CI) were calculated with adjustments for established cardiovascular risk factors.

    Results. Higher endostatin was associated with a higher incidence of MI independently of established cardiovascular risk factors (OR 1.19, 95% CI 1.03–1.37, p = .02), but this association was abolished after additional adjustment for C-reactive protein. Sex-stratified analyses suggest that the association was substantially stronger in women as compared to men.

    Conclusions. In our community based sample, higher endostatin predicted incident myocardial infarction predominantly in women but not independently of CRP. Thus, our findings do not support a broad utility of endostatin measurements for the prediction of incident myocardial infarction in clinical practice.

  • 21. Rådegran, Göran
    et al.
    Kjellström, Barbro
    Ekmehag, Björn
    Larsen, Flemming
    Rundqvist, Bengt
    Berg Blomquist, Sofia
    Gustafsson, Carola
    Hesselstrand, Roger
    Karlsson, Monica
    Kornhall, Björn
    Nisell, Magnus
    Persson, Liselotte
    Ryftenius, Henrik
    Selin, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Ullman, Bengt
    Wall, Kent
    Wikström, Gerhard
    Willehadson, Maria
    Jansson, Kjell
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Characteristics and survival of adult Swedish PAH and CTEPH patients 2000-20142016In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 50, no 4, p. 243-250Article in journal (Refereed)
    Abstract [en]

    Objectives: The Swedish Pulmonary Arterial Hypertension Register (SPAHR) is an open continuous register, including pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) patients from 2000 and onwards. We hereby launch the first data from SPAHR, defining baseline characteristics and survival of Swedish PAH and CTEPH patients.Design: Incident PAH and CTEPH patients 2008-2014 from all seven Swedish PAH-centres were specifically reviewed.Results: There were 457 PAH (median age: 67 years, 64% female) and 183 CTEPH (median age: 70 years, 50% female) patients, whereof 77 and 81%, respectively, were in functional class III-IV at diagnosis. Systemic hypertension, diabetes, ischaemic heart disease and atrial fibrillation were common comorbidities, particularly in those >65 years. One-, 3- and 5-year survival was 85%, 71% and 59% for PAH patients. Corresponding numbers for CTEPH patients with versus without pulmonary endarterectomy were 96%, 89% and 86% versus 91%, 75% and 69%, respectively. In 2014, the incidence of IPAH/HPAH, associated PAH and CTEPH was 5, 3 and 2 per million inhabitants and year, and the prevalence was 25, 24 and 19 per million inhabitants.Conclusion: The majority of the PAH and CTEPH patients were diagnosed at age >65 years, in functional class III-IV, and exhibiting several comorbidities. PAH survival in SPAHR was similar to other registers.

  • 22.
    Rönn, Folke
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Kesek, Milos
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Höglund, Niklas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Jensen, Steen M
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Long-term follow-up of patients treated with ICD: benefit in patients with preserved left ventricular function.2008In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 42, no 2, p. 125-9Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Most major defibrillator trials have short follow-up and may neither capture the benefit for those with preserved function nor the progressive nature of advanced heart disease. We intended to investigate the long-term outcome in an unselected population of patients treated with ICD. DESIGN: We followed 124 consecutive patients that received an ICD during 1993-2002 at our institution for a median of 6.1 years. Information about heart disease, index arrhythmia, follow-up and death was extracted from medical records. RESULTS: The crude mortality was 26% (32/124). One- and two-year mortality was 6% and 12%, estimated 5- and 10-year mortality 20% and 33%. The cause of death was heart failure in 75% of deaths. The ejection fraction was below 35% in 91% of the 32 patients who died. We estimated that 28% of the patients received lifesaving therapy. The relative number of saved lives and complications was not related to the ejection fraction. CONCLUSION: Patients with preserved left ventricular function are excellent candidates for ICD, with life-saving ICD therapies in a substantial proportion, low mortality and good quality of life.

  • 23.
    Sundström, Emilia
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Jensen, Steen M.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Diamant, Ulla-Britt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Rydberg, Annika
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Implantable cardioverter defibrillator treatment in long QT syndrome patients: a national study on adherence to international guidelines2017In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 51, no 2, p. 88-94Article in journal (Refereed)
    Abstract [en]

    Objectives. Implantable cardioverter defibrillator (ICD) treatment is effective among long QT syndrome (LQTS) patients at a high risk of sudden cardiac death. Previous studies show that the international guidelines are not always followed, and that risk stratification may be based on genotype rather than individual risk profile. We analysed data from the Swedish ICD & Pacemaker Registry and medical records to examine how international guidelines were followed with regards to phenotype and genotype. Methods and results. ICD treatment was used in 150 Swedish LQTS patients from 1989-2013. The annual number of implantations increased over the study period. A total of 109 patients were included in the analysis. Most patients (91%) were symptomatic before the implantation. Seventy percent of patients who received ICD treatment met the 2006 Class I or Class IIa recommendations for LQTS treatment. Thirty-one percent of the LQT3 patients received ICD treatment despite being asymptomatic. Among LQT1 patients, 45% received ICD treatment after syncope despite beta-blockers. Conclusions. Thirty percent of Swedish LQTS patients with ICD received the treatment without a strong indication based on international guidelines. LQT3 patients were over-represented among asymptomatic patients. Many LQT1 patients received ICD despite the known effect of beta-blockers in this group.

  • 24.
    Winbo, Annika
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Rydberg, Annika
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Vestibular dysfunction is a clinical feature of the Jervell and Lange-Nielsen Syndrome2015In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 49, no 1, p. 7-13Article in journal (Refereed)
    Abstract [en]

    Objectives. To investigate the possible association between Jervell and Lange-Nielsen Syndrome (JLNS) genotype and vestibular dysfunction. Design. In 15 cases with JLNS, clinical data obtained from a semi-structured interview and full medical records were reviewed and post-rotatory nystagmus testing was performed. Results. All genotyped cases (n = 14) had double KCNQ1 mutations. Symptoms of impaired balance were reported in 14/14 deaf JLNS cases. Gross motor developmental delay (not walking without support at 18 months of age) was seen in 11/12 cases with available data (mean age for walking: 24 months). A pathologic post-rotatory test was seen in 9/9 tested subjects, and in 3 subjects clinical testing had been performed showing complete lack of vestibular function. Vestibular dysfunction was seen in deaf JLNS cases with (n = 5) and without (n = 9) cochlear implants, including subjective symptoms (5/5 vs. 9/9) and gross motor developmental delay (5/5 vs. 6/8). Conclusions. We identified a high frequency of symptoms and signs associated with vestibular dysfunction in deaf JLNS cases, irrespective of previous cochlear implantation. Disruption of endolymph homeostasis in the inner ear, including cochlea and vestibular system, by profound KCNQ1 function loss is the proposed mechanism.

  • 25.
    Wisten, A
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine.
    Messner, T
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine.
    Young Swedish patients with sudden cardiac death have a lifestyle very similar to a control population2005In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 39, no 3, p. 137-142Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To study the association between lifestyle and sudden cardiac death (SCD) in the young with special respect to athletic activities. DESIGN: We compared lifestyle factors, collected from forensic and medical reports and from interviews with family members, in the Swedish cohort of individuals 15-35 years of age who had suffered an SCD during 1992-1999, with those of the control population of the same age group, obtained from national health registries. RESULTS: Physical activity and body mass index (BMI) in men were the same as in the controls, whilst women had a higher BMI and a lower level of physical activity in the SCD group. Twenty-three per cent (32/138) were competing athletes in the SCD group and 29% in the control group (622/2131). Death during physical activity was more common in athletes (20/32) than in non-athletes (18/106) (p<0.001). In coronary artery disease deaths, 11/15 (73%) were smokers and BMI was significantly higher than in the controls in both sexes. CONCLUSIONS: Young Swedish persons suffering SCD were very similar to the normal population with regard to lifestyle factors.

  • 26.
    Wisten, Aase
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine.
    Messner, Torbjörn
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine.
    Symptoms preceding sudden cardiac death in the young are common but often misinterpreted.2005In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 39, no 3, p. 143-149Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To identify patients at risk of sudden cardiac death (SCD) by analysis of clinical history. DESIGN: A retrospective study of the Swedish cohort of 15-35 year olds having suffered an SCD during 1992-1999 and having undergone a forensic autopsy (162 individuals). We sought information in forensic, police and medical records and from interviews with family members. RESULTS: Syncope/presyncope, chest pain, palpitations or dyspnoea were present in 92/162, unspecific symptoms such as fatigue, influenza, headache or nightmares in 35/162. Syncope/presyncope was most common (42/162). In 74 seeking medical attention, 32 had an ECG recorded (24 pathological). In 26 subjects there was a family history of SCD. CONCLUSIONS: The patient seeking medical advice before suffering an SCD is characterized by one to three of the following: 1) cardiac-related symptoms or non-specific symptoms often after an infectious disease, 2) a pathological ECG, 3) a family history of SCD. In 6 out of 10 a cardiac diagnosis was not considered. We conclude that symptoms preceding SCD were common but often misinterpreted.

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