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  • 1.
    Bajraktari, Gani
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Berisha, G.
    Bytyci, I.
    Haliti, E.
    Ibrahimi, Pranvera
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Ahmeti, A.
    Poniku, A.
    Henein, Michael Y.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    The presence of metabolic syndrome predicts long-term outcome in heart failure patients2015Ingår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 36, s. 831-831Artikel i tidskrift (Övrigt vetenskapligt)
  • 2.
    Bajraktari, Gani
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Bytyci, I.
    Ahmeti, A.
    Ibrahimi, Pranvera
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Poniku, A.
    Haliti, E.
    Batalli, A.
    Henein, Michael Y
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Left atrial emptying function predicts long-term outcome in HFpEF patients2015Ingår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 36, s. 1183-1183Artikel i tidskrift (Övrigt vetenskapligt)
  • 3.
    Bajraktari, Gani
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Bytyci, I.
    Ibrahimi, Pranvera
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Hyseni, V.
    Berisha, G.
    Rexhepaj, N.
    Henein, Michael Y
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    The relationship between left atrial emptying function and exercise capacity in heart failure2014Ingår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 35, nr Supplement 1, Meeting abstract P2776, s. 510-510Artikel i tidskrift (Övrigt vetenskapligt)
  • 4.
    Bajraktari, Gani
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Clinic of Cardiology and Angiology, University Clinical Centre of Kosova, Prishtina, Republic of Kosovo.
    Kurtishi, Ilir
    Rexhepaj, Nehat
    Tafarshiku, Rina
    Ibrahimi, Pranvera
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Jashari, Fisnik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Alihajdari, Rrezarta
    Batalli, Arlind
    Elezi, Shpend
    Henein, Michael Y
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Gender related predictors of limited exercise capacity in heart failure2013Ingår i: IJC Heart & Vessels, ISSN 2214-7632, Vol. 1, s. 11-16Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Aim The aim of this study was to investigate the impact of gender on the prediction of limited exercise capacity in heart failure (HF) patients assessed by 6 minute walk test (6-MWT).

    Methods In 147 HF patients (mean age 61 ± 11 years, 50.3% male), a 6-MWT and a Doppler echocardiographic study were performed in the same day. Conventional cardiac measurements were obtained and global LV dyssynchrony was indirectly assessed using total isovolumic time − t-IVT [in s/min; calculated as: 60 − (total ejection time − total filling time)] and Tei index (t-IVT/ejection time). Patients were divided into two groups according to gender, which were again divided into two subgroups based on the 6-MWT distance (Group I: ≤ 300 m, and Group II: > 300 m).

    Results Female patients were younger (p = 0.02), and had higher left ventricular (LV) ejection fraction — EF (p = 0.007) but with similar 6-MWT distance to male patients (p = 68). Group I male patients had lower hemoglobin level (p = 0.02) and lower EF (p = 0.03), compared with Group II, but none of the clinical or echocardiographic variables differed between groups in female patients. In multivariate analysis, only t-IVT [0.699 (0.552–0.886), p = 0.003], and LV EF [0.908 (0.835–0.987), p = 0.02] in males, and NYHA functional class [4.439 (2.213–16.24), p = 0.02] in females independently predicted poor 6-MWT distance (< 300 m).

    Conclusion Despite similar limited exercise capacity, gender determines the pattern of underlying cardiac disturbances; ventricular dysfunction in males and subjective NYHA class in female heart failure patients.

  • 5.
    Bajraktari, Gani
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Clinic of Cardiology and Angiology, University Clinical Centre of Kosova, Prishtina, Republic of Kosovo.
    Nicoll, Rachel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Ibrahimi, Pranvera
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Clinic of Cardiology and Angiology, University Clinical Centre of Kosova, Prishtina, Republic of Kosovo.
    Jashari, Fisnik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Clinic of Cardiology and Angiology, University Clinical Centre of Kosova, Prishtina, Republic of Kosovo.
    Schmermund, Axel
    Henein, Michael Y.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Coronary calcium score correlates with estimate of total plaque burden2013Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 167, nr 3, s. 1050-1052Artikel i tidskrift (Refereegranskat)
  • 6.
    Bajraktari, Gani
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Rönn, Folke
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Ibrahimi, Pranvera
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Jashari, Fisnik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Jensen, Steen M
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Henein, Michael Y
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Combining electrical and global mechanical markers of LV dyssynchrony optimizes patient selection for cardiac resynchronization therapy2014Artikel i tidskrift (Refereegranskat)
  • 7.
    Bajraktari, Gani
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Rönn, Folke
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Ibrahimi, Pranvera
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Jashari, Fisnik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Jensen, Steen M.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Henein, Michael Y.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Total isovolumic time, a marker of global left ventricular dyssynchrony, predicts response to Cardiac Resynchronization Therapy in heart failure patients2014Ingår i: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 16, nr Sup. 2, s. 154-154Artikel i tidskrift (Övrigt vetenskapligt)
  • 8.
    Bajraktari, Gani
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Rönn, Folke
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Ibrahimi, Pranvera
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Jashari, Fisnik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Jensen, Steen M.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Henein, Michael Y.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Total isovolumic time, a marker of global left ventricular dyssynchrony, predicts response to Cardiac Resynchronization Therapy in heart failure patients with atrial fibrillation2014Ingår i: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 16, s. 56-56Artikel i tidskrift (Övrigt vetenskapligt)
  • 9.
    Bajraktari, Gani
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Rönn, Folke
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Ibrahimi, Pranvera
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Jashari, Fisnik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Lindmark, Krister
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Jensen, Steen M
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Henein, Michael Y
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Combined electrical and global markers of dyssynchrony predict clinical response to Cardiac Resynchronization Therapy2014Ingår i: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 48, nr 5, s. 304-310Artikel i tidskrift (Refereegranskat)
    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.

  • 10. Batalli-Këpuska, Arbnora
    et al.
    Bajraktari, Gani
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Umeå Heart Centre and Internal Medicine Clinic, University Clinical Centre of Kosova, Prishtinë, Republic of Kosovo.
    Zejnullahu, Murat
    Azemi, Mehmedali
    Shala, Mujë
    Batalli, Arlind
    Ibrahimi, Pranvera
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Umeå Heart Centre.
    Jashari, Fisnik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Umeå Heart Centre.
    Henein, Michael Y.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Umeå Heart Centre.
    Abnormal systolic and diastolic myocardial function in obese asymptomatic adolescents2013Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 168, nr 3, s. 2347-2351Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Structural and functional cardiac changes are known in obese adults. We aimed to assess the relationship between body mass index (BMI) and cardiac function in overweight and obese asymptomatic adolescents. Ninety three healthy adolescents, aged 12.6±1.2years, received weight, height, BMI, waist, hips, waist/hips ratio assessment, hematology and biochemistry tests and an echocardiogram. Based on BMI, subjects were divided into: lean (L, n=32), overweight (Ov, n=33) and obese (Ob, n=32). Interventricular septal and LV posterior wall thickness were increased parallel to the BMI (L: 0.84±0.1cm, Ov: 0.88±0.1cm, Ob: 0.96±0.1cm, p<0.001, and L: 0.78±0.1cm, Ov: 0.8±0.1cm, Ob: 0.94±0.1cm, p<0.001, respectively) as were relative wall thickness (RWT) and mass index (LVMI) (L: 0.34±0.05, Ov: 0.34±0.05, Ob: 0.40±0.04, p<0.001, and L: 47.7±8.4g/m(2), Ov: 51.9±8.3g/m(2), Ob: 65.2±13.3g/m(2), p=0<001, respectively). LV early diastolic (E') lateral and septal velocities (L: 15.3±3.9cm/s, Ov: 13.6±4cm/s, Ob: 10.5±3.4cm/s, p<0.001, and L: 12.2±2.3cm/s, Ov: 11.1±2.4cm/s, Ob: 9.8±3.1cm/s, p=0.003, respectively), and systolic (S') velocities (L: 9.2±1.4cm/s, Ov: 9.3±2.3cm/s, Ob: 8.04±1.5cm/s, p=0.018, and L: 9.05±2.3cm/s, Ov: 9±2.4cm/s, Ob: 7.6±1.1cm/s, p=0.014, respectively) were all reduced, only in obese adolescents. LV lateral E' (r=-0.44, p<0.001) and S' (r=-0.29, p=0.005) correlated with BMI. In asymptomatic adolescents, LV wall is thicker and diastolic function impaired and correlate with BMI. These findings demonstrate early cardiac functional disturbances which might explain the known obesity risk for cardiac disease.

  • 11. Berisha, Gëzim
    et al.
    Bajraktari, Gani
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Clinic of cardiology University Clinical Centre of Kosovo.
    Ibrahimi, Pranvera
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Clinic of cardiology University Clinical Centre of Kosovo.
    Bytyci, Ibadete
    Rexhepaj, Nehat
    Elezi, Shpend
    Henein, Michael
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Impaired left atrial reservoir function in metbolic syndrome predicts symptoms in HFpEF patients2015Ingår i: International Cardiovascular Forum Journal, ISSN 2410-2636, Vol. 4, s. 37-42Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and Aim. The Metabolic Syndrome (MetS) has been shown to be independently associated with increased risk for incident heart failure (HF) and coronary artery disease. The aim of this study was to investigate the additional effect of MetS on LA dysfunction in a group of patients with HF and preserved ejection fraction (HFpEF) and its relationship with symptoms.

    Methods. This study included 194 consecutive patients (age 62 ± 9 years) with stable HFpEF. LV dimensions, ejection fraction (EF), mitral annulus peak systolic excursion (MAPSE), myocardial velocities (s’, e’ and a’), LA dimensions and volumes were measured. Total LA emptying fraction (LA EF) was measured by Simpson rule volumes. Based on the NCEP-ATP III criteria, patients were divided into two groups; MetS (n=95) and non-MetS (n=108) and were compared with 34 age and gender matched controls.

    Results. Age and gender were not different between patients and control neither between MetS and non-Met. LV dimensions, EF and longitudinal function indices were also not different. The MetS patients had higher LV mass index (p=0.038), lower septal and lateral e’ (p=0.003 and p=0.001, respectively) velocities, larger LA minimal volume (p=0.007) and lower LA EF (p<0.001) compared with the non-MetS patients. Age, LA EF and MetS independently predicted the NYHA class.

    Conclusions. Despite no difference in LV systolic function, patients with HFpEF and MetS have worse LA emptying fraction, compared with HFpEF and non-MetS patients. In addition, LA reservoir function impairment and MetS independently predict patients limiting symptoms, thus add to a better understanding of HFpEF.

  • 12.
    Bytyci, Ibadete
    et al.
    Clinic of Cardiology and Angiology, University Clinical Centre of Kosova, Pishtinë, Republic of Kosovo.
    Bajraktari, Gani
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Clinic of Cardiology and Angiology, University Clinical Centre of Kosova, Pishtinë, Republic of Kosovo.
    Pranvera, Ibrahimi
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Clinic of Cardiology and Angiology, University Clinical Centre of Kosova, Pishtinë, Republic of Kosovo.
    Berisha, Gezim
    Clinic of Cardiology and Angiology, University Clinical Centre of Kosova, Pishtinë, Republic of Kosovo.
    Rexhepaj, Nehat
    Clinic of Cardiology and Angiology, University Clinical Centre of Kosova, Pishtinë, Republic of Kosovo.
    Henein, Michael Y
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Left atrial emptying fraction predicts limited exercise performance in heart failure patients2014Ingår i: IJC Heart and Vessels, ISSN 2214-7632, Vol. 4, s. 203-207Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: We aimed in this study to assess the role of left atrial (LA), in addition to left ventricular (LV) indices, in predicting exercise capacity in patients with heart failure (HF). Methods: This study included 88 consecutive patients (60 ± 10 years) with stable HF. LV end-diastolic and end-systolic dimensions, ejection fraction (EF), mitral and tricuspid annulus peak systolic excursion (MAPSE and TAPSE), myocardial velocities (s′, e′ and a′), LA dimensions, LA volume and LA emptying fraction were measured. A 6-min walking test (6-MWT) distance was performed on the same day of the echocardiographic examination. Results: Patients with limited exercise performance (≤ 300 m) were older (p = 0.01), had higher NYHA functional class (p = 0.004), higher LV mass index (p = 0.003), larger LA (p = 0.002), lower LV EF (p = 0.009), larger LV end-systolic dimension (p = 0.007), higher E/A ratio (p = 0.03), reduced septal MAPSE (p < 0.001), larger LA end-systolic volume (p = 0.03), larger LA end-diastolic volume (p = 0.005) and lower LA emptying fraction (p < 0.001) compared with good performance patients. In multivariate analysis, only the LA emptying fraction [0.944 (0.898–0.993), p = 0.025] independently predicted poor exercise performance. An LA emptying fraction < 60% was 68% sensitive and 73% specific (AUC 0.73, p < 0.001) in predicting poor exercise performance. Conclusion: In heart failure patients, the impaired LA emptying function is the best predictor of poor exercise capacity. This finding highlights the need for routine LA size and function monitoring for better optimization of medical therapy in HF.

  • 13.
    Henein, Michael
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Hällgren, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Holmgren, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Sörensen, Karen
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Diagnostisk radiologi.
    Ibrahimi, Pranvera
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Kofoed, Klaus Fuglsang
    Larsen, Linnea Hornbech
    Hassager, Christian
    Aortic root, not valve, calcification correlates with coronary artery calcification in patients with severe aortic stenosis: a two-center study2015Ingår i: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 243, nr 2, s. 631-637Artikel i tidskrift (Refereegranskat)
    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.

  • 14.
    Ibrahimi, Pranvera
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Patterns of non-invasive imaging of carotid atherosclerosis2015Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Atherosclerosis is an inflammatory disease that can be generalized, affecting more than one arterial bed simultaneously, or localized, manifested in one system. Ultrasound based measurements of plaque textural features, such as low grey scale median (GSM), echolucent (hypoechoic) plaque types and juxtaluminal black (hypoechoic) area (JBA) are manifestation of potentially unstable lesions. Conventional carotid IMT (intima media thickness) and the recently introduced IM-GSM (echogenicity of the intima media complex) are important measures of subclinical atherosclerosis and are used to predict future ischemic events.

    The aims of this thesis were to study, in detail, the systemic nature of atherosclerosis by evaluating the carotid disease burden contralateral to symptomatic arteries, determining the relationship between proximal (subclinical atherosclerosis) and distal segments (well established disease) of the same artery and comparing local plaque features with systemic burden of atherosclerosis disease. In addition, the effect of statins on carotid plaque echogenicity was evaluated in a systematic review and meta-analysis.

    Methods:

    We have measured ultrasound-based textural carotid plaque features (GSM, JBA, entropy, coarseness), surface morphology, as well as IMT and IM-GSM. An in-house custom developed research software package was used for plaque feature extraction. For the meta-analysis we used Comprehensive Meta-Analysis version 3 software.

    Results:

    Study 1. In 39 patients, the carotid plaques contralateral to symptomatic arteries had similar morphological and textural features to those in the symptomatic arteries and are more vulnerable than those in asymptomatic arteries; more often mildly or markedly irregular with more vulnerable textural plaque features (lower GSM and larger JBA).

    Study 2. In 87 asymptomatic patients, an increased IMT in CCA correlated with plaque irregularities in the bifurcation and ICA while IM-GSM was closely related to plaque echogenicity (GSM), and other textural plaque features.

    Study 3. In the same cohort in study 2, patients with previous disease in the coronary arteries had higher IMT and lower IM-GSM and those with prior stroke had lower IM-GSM. Neither IMT nor IM-GSM was different between patients with and without previous lower extremity disease. IM-GSM decreases significantly with increasing number of arterial territories p<0.001 (asymptomatic vs symptoms in one vs multiple arterial systems) but conventional IMT was not different between groups p=0.49.

    Study 4. In a meta-analysis of 9/580 identified studies including 566 patients with 7.2 months follow-up, a consistent increase in the carotid plaques echogenicity after statin therapy, was reported. The perpetual (over 12 months) effects of which were shown in a meta-regression analysis to be related to changes in hsCRP.

    Conclusion:

    Symptomatic patients have similar plaque morphology and textural features of vulnerability in the contralateral carotid system, compared with asymptomatic ones. In the latter, measurements of proximal disease reflect distal pathology and the number of affected arteries. Finally, statin therapy and the drop of LDL cholesterol result in better plaque stability and optimum control of arterial inflammation, shown by arterial wall echogenicity and hsCRP changes, respectively.

  • 15.
    Ibrahimi, Pranvera
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Clinic of Cardiology and Angiology, University Clinical Centre of Kosova, Pishtinë, Republic of Kosovo.
    Bajraktari, Gani
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Clinic of Cardiology and Angiology, University Clinical Centre of Kosova, Pishtinë, Republic of Kosovo.
    Bytyci, Ibadete
    Clinic of Cardiology and Angiology, University Clinical Centre of Kosova, Pishtinë, Republic of Kosovo.
    Ahmeti, Artan
    Clinic of Cardiology and Angiology, University Clinical Centre of Kosova, Pishtinë, Republic of Kosovo.
    Batalli, Arlind
    Clinic of Cardiology and Angiology, University Clinical Centre of Kosova, Pishtinë, Republic of Kosovo.
    Jashari, Haki
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Elezi, Shpend
    Clinic of Cardiology and Angiology, University Clinical Centre of Kosova, Pishtinë, Republic of Kosovo.
    Henein, Michael Y
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Global dyssynchrony correlates with compromised left ventricular filling and stroke volume but not with ejection fraction or QRS duration in HFpEF2014Ingår i: International Cardiovascular Forum Journal, ISSN 2410-2636, Vol. 1, nr 3, s. 147-151Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and Aim: Mechanical global left ventricular (LV) dyssynchrony reflected as prolonged total isovolumic time(t-IVT) has been introduced as a potential mechanism behind compromised stroke volume in heart failure (HF). It has alsobeen shown to be superior to other markers of dyssynchrony in predicting response to cardiac resynchronization therapy(CRT), but its application in HF with preserved ejection fraction (HFpEF) remains unknown. The aim of this study was toassess the role of t-IVT in explaining symptoms in HFpEF.Methods: In 55 symptomatic HFpEF patients (age 60±9 years, NYHA class II-IV; LV EF ≥45%) and 24 age and gendermatched controls, a complete Doppler echocardiographic study was performed including mitral annulus peak systolicexcursion (MAPSE) and myocardial velocities as well as LV filling, outflow tract velocity time integral (VTI) and stroke volumemeasurements. Global LV dyssynchrony was assessed by t-IVT [in s/min; calculated as: 60 - (total ejection time + total fillingtime)], Tei index (t-IVT/ejection time) and pre-ejection time difference between LV and RV.Results: Patients had reduced lateral and septal MAPSE (p=0.009 and p=0.01, respectively) lower lateral and septal s’(p=0.002 and p=0.04, respectively) and e’ (p<0.001, for both) velocities and higher E/e’ ratio (p=0.01) compared to controls.They also had longer t-IVT (p<0.001), higher Tei index (p=0.04), but similar pre-ejection time difference and LVEF to controls.T-IVT correlated with LV filling time (r=0.44, p<0.001), stroke volume (r=-0.41; p=0.002), MAPSE (lateral: r=-0.36, p=0.007 andseptal: r=-0.31; p=0.02), but not with LV mass index, LVEF, E/e’ ratio or QRS duration.Conclusion: Patients with HFpEF have exaggerated global mechanical dyssynchrony shown by prolonged t-IVT, comparedwith healthy age and gender matched controls. The relationship between t-IVT, LV filling and stroke volume suggests anassociation, more important than with ejection fraction or electrical dyssynchrony. These results support the importance ofthe individualistic approach for optimum HFpEF patient management.

  • 16.
    Ibrahimi, Pranvera
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Jashari, Fisnik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Ahlqvist, Jan
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Tandläkarutbildning.
    Arnerlöv, Conny
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Garoff, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Tandläkarutbildning.
    Johansson, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Levring Jäghagen, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi.
    Wester, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Henein, Michael Y
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Carotid ultrasound accurately detects arterial calcification quantified by cone beam computed tomography2014Ingår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 35, nr Supplement 1, Meeting abstract P3519, s. 636-636Artikel i tidskrift (Övrigt vetenskapligt)
  • 17.
    Ibrahimi, Pranvera
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Jashari, Fisnik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Bajraktari, Gani
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Wester, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Henein, Michael Y
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Ultrasound assessment of carotid plaque echogenicity response to statin therapy: a systematic review and meta-analysis2015Ingår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 36, nr Suppl 1, s. 993-993Artikel i tidskrift (Övrigt vetenskapligt)
  • 18.
    Ibrahimi, Pranvera
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Jashari, Fisnik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Bajraktari, Gani
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Wester, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Henein, Michael Y
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Ultrasound assessment of carotid plaque echogenicity response to statin therapy: a systematic review and meta-analysis2015Ingår i: International Journal of Molecular Sciences, ISSN 1422-0067, E-ISSN 1422-0067, Vol. 16, nr 5, s. 10734-10747Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To evaluate in a systematic review and meta-analysis model the effect of statin therapy on carotid plaque echogenicity assessed by ultrasound.

    METHODS: We have systematically searched electronic databases (PubMed, MEDLINE, EMBASE and Cochrane Center Register) up to April, 2015, for studies evaluating the effect of statins on plaque echogenicity. Two researchers independently determined the eligibility of studies evaluating the effect of statin therapy on carotid plaque echogenicity that used ultrasound and grey scale median (GSM) or integrated back scatter (IBS).

    RESULTS: Nine out of 580 identified studies including 566 patients' carotid artery data were meta-analyzed for a mean follow up of 7.2 months. A consistent increase in the echogenicity of carotid artery plaques, after statin therapy, was reported. Pooled weighted mean difference % (WMD) on plaque echogenicity after statin therapy was 29% (95% CI 22%-36%), p < 0.001, I2 = 92.1%. In a meta-regression analysis using % mean changes of LDL, HDL and hsCRP as moderators, it was shown that the effects of statins on plaque echogenicity were related to changes in hsCRP, but not to LDL and HDL changes from the baseline. The effect of statins on the plaque was progressive; it showed significance after the first month of treatment, and the echogenicity continued to increase in the following six and 12 months.

    CONCLUSIONS: Statin therapy is associated with a favorable increase of carotid plaque echogenicity. This effect seems to be dependent on the period of treatment and hsCRP change from the baseline, independent of changes in LDL and HDL.

  • 19.
    Ibrahimi, Pranvera
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Jashari, Fisnik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Johansson, Elias
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin. Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk neurovetenskap.
    Grönlund, Christer
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Bajraktari, Gani
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Wester, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Henein, Michael Y.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Common carotid intima-media features determine distal disease phenotype and vulnerability in asymptomatic patients2015Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 196, s. 22-28Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: There is a growing awareness of the importance of carotid plaque features evaluation in stroke prediction. Carotid intima-media thickness (IMT) and recently its echogenicity were used for stroke prediction, although their clinical relevance was not well determined. The aim of this study was to assess the relationship between common carotid artery (CCA) ultrasound markers of atherosclerosis and distal, bifurcation and internal carotid artery (ICA), plaque features. Methods: We analyzed 137 carotid arteries in 87 asymptomatic patients with known carotid disease (mean age 69 +/- 6 year, 34.5% females). Intima media thickness (IMT) and its gray scale median (IM-GSM) were measured at the CCA. Plaque textural features including gray scale median (GSM), juxtaluminal black area (JBA-mm(2)) without a visible cap, and plaque coarseness, at bifurcation and ICA were also determined. CCA measurements were correlated with those of the distal plaques. Results: An increased IMT in CCA correlated with plaque irregularities in the bifurcation and ICA (r = 0.53, p < 0.001), while IM-GSM was closely related to plaque echogenicity (GSM) (r = 0.76, p < 0.001), and other textural plaque features. Both, IMT and IM-GSM correlated weakly with stenosis severity (r = 0.27, p = 0.001 and r = -0.18, p = 0.026) respectively. Conclusion: In asymptomatic patients, measurements of CCA reflect distal, bifurcation and ICA disease, with IMT reflecting plaque irregularities and IM-GSM as markers of textural plaque abnormalities. Integrating measurements of both IMT and IM-GSM in a model could be used as a better marker of disease vulnerability over and above each measure individually. 

  • 20.
    Ibrahimi, Pranvera
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Jashari, Fisnik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Johansson, Elias
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk neurovetenskap. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Grönlund, Christer
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.
    Bajraktari, Gani
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Wester, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Henein, Michael Y
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Vulnerable plaques in the contralateral carotid arteries in symptomatic patients: a detailed ultrasound analysis2014Ingår i: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 235, nr 2, s. 526-531Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND AND AIM: Carotid plaques may represent a generalized atherosclerotic syndrome or a localized disease. The aim of this study was to assess the morphological and textural features of carotid plaques located contralateral to the symptomatic side and compare them with the symptomatic side and with plaques from asymptomatic patients. METHODS: We studied 66 arteries in 39 patients (mean age 70 ± 7 year, 33% females). Arterial plaques were classified as either symptomatic (n = 30), contralateral to symptomatic (n = 25) or asymptomatic (n = 11). We compared several plaque features between these groups including the mean values of the grey scale median (GSM), entropy, juxtaluminal black area (JBA) without visible echogenic cap, GSM of the JBA and surface irregularity. RESULTS: The plaques contralateral to symptomatic arteries had similar morphological and textural features to those in the symptomatic arteries. In contrast, they had more vulnerable morphological and textural features than those in asymptomatic arteries: less smooth plaques (12% vs. 55%) and instead more often mildly irregular (60% vs 36%) or markedly irregular (28% vs. 9%; p = 0.03), lower GSM (26.2 ± 8 vs. 49.4 ± 14, p < 0.001) and lower GSM of the JBA (5.0 ± 3.6 vs. 11.4 ± 2.1, p = 0.008). The frequency of entropy and plaque calcification was similar in all groups. CONCLUSION: Symptomatic patients with carotid artery disease seem to have similar morphological and textural features of vulnerability in the symptomatic and the contralateral carotid arteries, which are profound compared with asymptomatic carotid arteries. These findings support the concept of generalized carotid atherosclerotic pathology rather than incidental unilateral disease, and also emphasize a need for aggressive measures for plaque stabilization, particularly in symptomatic patients.

  • 21.
    Ibrahimi, Pranvera
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Jashari, Fisnik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Johansson, Elias
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk neurovetenskap.
    Grönlund, Christer
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Wester, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Henein, Michael Y.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Common carotid intima-media measurements determine distal disease structure and vulnerability in asymptomatic patients2015Ingår i: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 241, nr 1, s. E164-E164Artikel i tidskrift (Övrigt vetenskapligt)
  • 22.
    Ibrahimi, Pranvera
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Jashari, Fisnik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Nicoll, Rachel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Bajraktari, Gani
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Wester, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Henein, Michael Y
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Coronary and carotid atherosclerosis: how useful is the imaging?2013Ingår i: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 231, nr 2, s. 323-333Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The recent advancement of imaging modalities has made possible visualization of atherosclerosis disease in all phases of its development. Markers of subclinical atherosclerosis or even the most advanced plaque features are acquired by invasive (IVUS, OCT) and non-invasive imaging modalities (US, MRI, CTA). Determining plaques prone to rupture (vulnerable plaques) might help to identify patients at risk for myocardial infarction or stroke. The most accepted features of plaque vulnerability include: thin cap fibroatheroma, large lipid core, intimal spotty calcification, positive remodeling and intraplaque neovascularizations. Today, research is focusing on finding imaging techniques that are less invasive, less radiation and can detect most of the vulnerable plaque features. While, carotid atherosclerosis can be visualized using noninvasive imaging, such as US, MRI and CT, imaging plaque feature in coronary arteries needs invasive imaging modalities. However, atherosclerosis is a systemic disease with plaque development simultaneously in different arteries and data acquisition in carotid arteries can add useful information for prediction of coronary events.

  • 23.
    Ibrahimi, Pranvera
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Clinic of Cardiology and Angiology, University Clinical Centre of Kosova, Pishtinë, Republic of Kosovo.
    Poniku, Afrim
    Clinic of Cardiology and Angiology, University Clinical Centre of Kosova, Pishtinë, Republic of Kosovo.
    Hysenaj, Violeta
    Clinic of Cardiology and Angiology, University Clinical Centre of Kosova, Pishtinë, Republic of Kosovo.
    Ahmeti, Artan
    Clinic of Cardiology and Angiology, University Clinical Centre of Kosova, Pishtinë, Republic of Kosovo.
    Jashari, Fisnik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Haliti, Edmond
    Clinic of Cardiology and Angiology, University Clinical Centre of Kosova, Pishtinë, Republic of Kosovo.
    Bajraktari, Gani
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Clinic of Cardiology and Angiology, University Clinical Centre of Kosova, Pishtinë, Republic of Kosovo.
    Predictors of exercise capacity in heart failure: combined right ventricular dysfunction and raised left ventricular filling pressures predict limited exercise capacity in heart failure with reduced ejection fraction (HFrEF)2013Ingår i: International Cardiovascular Forum Journal, ISSN 2410-2636, Vol. 1, nr 1, s. 37-42Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and Aim: Compromised exercise capacity is a major symptom in patients with heart failure (HF) and reduced left ventricular (LV) ejection fraction (EF). Six-minute walk test (6-MWT) is popular for the objective assessment of exercise capacity in these patients but is largely confined to major heart centres. The aim of this study was to prospectively examine functional parameters that predict 6-MWT in patients with HF and reduced LVEF.

    Methods: In 111 HF patients (mean age 60±12 years, 56% male), a 6-MWT and an echo-Doppler study were performed in the same day. In addition to conventional ventricular function measurements, global LV dyssynchrony was indirectly assessed by total isovolumic time - t-IVT [in s/min; calculated as: 60 – (total ejection time – total filling time)], and Tei index (t-IVT/ejection time). Also, LV and right ventricular function were assessed by mitral and tricuspid annular plane systolic excursion (MAPSE and TAPSE, respectively). Based on the 6-MWT distance, patients were divided into 2 groups: Group I: ≤300m and Group II: >300m.

    Results: The 6-MWT distance correlated with t-IVT and Tei index (r=-0.37, p<0.001, for both), lateral and septal e' velocities (r=0.41, p<0.001, and r=0.46, p<0.001, respectively), E/e' ratio (r=-0.37, p<0.001) and TAPSE (r=0.45, p<0.001), but not with the other clinical or echo parameters. Group I patients had longer t-IVT, lower E/e' ratio, TAPSE and lateral e' (p<0.001 for all) compared with Group II. In multivariate analysis, TAPSE [0.076 (0.017-0.335), p=0.001], E/e' [1.165 (1.017-1.334), p=0.027], t-IVT [1.178 (1.014-1.370), p=0.033] independently predicted poor 6-MWT performance (<300m). Sensitivity and specificity for TAPSE ≤1.9 cm were 66% and 77%, (AUC 0.78, p<0.001); E/e' ≥10.7 were 66% and 62% (AUC 0.67, p=0.002) and t-IVT ≥13 s/min were 64% and 60% (AUC 0.68, p=0.002) in predicting poor 6-MWT. Combined TAPSE and E/e' had a sensitivity of 68% but specificity of 92% in predicting 6-MWT. Respective values for combined TAPSE and t-IVT were 71% and 85%.

    Conclusion: In patients with HF, the limited exercise capacity assessed by 6-MWT, is multifactorial being related both to the severity of right ventricular systolic dysfunction as well as to raised LV filling pressures and global dyssynchrony.

  • 24.
    Jashari, Fisnik
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Ibrahimi, Pranvera
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Bajraktari, Gani
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Grönlund, Christer
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Wester, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin. Department of Clinical Sciences, Danderyds Hospital, Karolinska Institute, Stockholm, Sweden.
    Henein, Michael Y
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Carotid plaque echogenicity predicts cerebrovascular symptoms: a systematic review and meta-analysis2016Ingår i: European Journal of Neurology, ISSN 1351-5101, E-ISSN 1468-1331, Vol. 23, nr 7, s. 1241-1247Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and purpose: Many reports have shown an association between hypoechoic (echolucent) carotid atherosclerotic plaques and unstable features. In this meta-analysis our aim was to determine the role of carotid plaque echogenicity in predicting future cerebrovascular (CV) symptoms.

    Methods: Electronic databases (PubMed, MEDLINE, EMBASE and Cochrane Center Register) up to September 2015 were systematically searched. Studies with ultrasound-based characterization of carotid artery plaque echogenicity and its association with focal neurological symptoms of vascular origin were eligible for analysis. In the meta-analysis, heterogeneity was measured usingI2 statistics and publication bias was evaluated using the Begg–Mazumdar test. In addition several comparisons between subgroups were performed.

    Results: Of 1387 identified reports, eight studies with asymptomatic patients and three studies with symptomatic patients were meta-analyzed. Pooled analysis showed an association between echolucent carotid plaques and future CV events in asymptomatic patients [relative risk 2.72 (95% confidence interval 1.86–3.96)] and recurrent symptoms in symptomatic patients [relative risk 2.97 (95% confidence interval 1.85–4.78)]. The association was preserved for all stenosis degrees in asymptomatic patients, whilst patients with echolucent plaques and severe stenosis were at higher risk of future events. Also, computer-assisted methods for assessment of carotid plaque echogenicity and studies analyzing ultrasound data collected after the year 2000 showed better prediction.

    Conclusions: In asymptomatic and symptomatic patients, analysis of carotid plaque echogenicity could identify those at high risk of CV events.

  • 25.
    Jashari, Fisnik
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Ibrahimi, Pranvera
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Bajraktari, Gani
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Wester, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Henein, Michael Y.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Carotid plaque echogenicity predicts cerebrovascular symptoms: A systematic review and metaanalysisManuskript (preprint) (Övrigt vetenskapligt)
  • 26.
    Jashari, Fisnik
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Ibrahimi, Pranvera
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Henein, Michael
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Common carotid intima-media measurements determine distal disease structure and vulnerability2015Ingår i: European Journal of Neurology, ISSN 1351-5101, E-ISSN 1468-1331, Vol. 22, s. 600-601Artikel i tidskrift (Övrigt vetenskapligt)
  • 27.
    Jashari, Fisnik
    et al.
    Umeå universitet.
    Ibrahimi, Pranvera
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Johansson, E
    Grönlund, C
    Bajraktari, Gani
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Wester, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Henein, Michael Y
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Carotid IM-GSM is more accurate than conventional IMT for monitoring systemic burden of atherosclerosisManuskript (preprint) (Övrigt vetenskapligt)
  • 28.
    Jashari, Fisnik
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Ibrahimi, Pranvera
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Johansson, Elias
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin. Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk neurovetenskap.
    Ahlqvist, Jan
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi.
    Arnerlöv, Conny
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Garoff, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi.
    Jäghagen, Eva Levring
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi.
    Wester, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Henein, Michael Y
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Atherosclerotic Calcification Detection: A Comparative Study of Carotid Ultrasound and Cone Beam CT2015Ingår i: International Journal of Molecular Sciences, ISSN 1422-0067, E-ISSN 1422-0067, Vol. 16, nr 8, s. 19978-19988Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND AND AIM: Arterial calcification is often detected on ultrasound examination but its diagnostic accuracy is not well validated. The aim of this study was to determine the accuracy of carotid ultrasound B mode findings in detecting atherosclerotic calcification quantified by cone beam computed tomography (CBCT).

    METHODS: We analyzed 94 carotid arteries, from 88 patients (mean age 70 ± 7 years, 33% females), who underwent pre-endarterectomy ultrasound examination. Plaques with high echogenic nodules and posterior shadowing were considered calcified. After surgery, the excised plaques were examined using CBCT, from which the calcification volume (mm3) was calculated. In cases with multiple calcifications the largest calcification nodule volume was used to represent the plaque. Carotid artery calcification by the two imaging techniques was compared using conventional correlations.

    RESULTS: Carotid ultrasound was highly accurate in detecting the presence of calcification; with a sensitivity of 88.2%. Based on the quartile ranges of calcification volumes measured by CBCT we have divided plaque calcification into four groups: <8; 8-35; 36-70 and >70 mm3. Calcification volumes ≥8 were accurately detectable by ultrasound with a sensitivity of 96%. Of the 21 plaques with <8 mm3 calcification volume; only 13 were detected by ultrasound; resulting in a sensitivity of 62%. There was no difference in the volume of calcification between symptomatic and asymptomatic patients.

    CONCLUSION: Carotid ultrasound is highly accurate in detecting the presence of calcified atherosclerotic lesions of volume ≥8 mm3; but less accurate in detecting smaller volume calcified plaques. Further development of ultrasound techniques should allow better detection of early arterial calcification.

  • 29.
    Jashari, Fisnik
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Ibrahimi, Pranvera
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Johansson, Elias
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap.
    Grönlund, Christer
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Wester, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Henein, Michael Y.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Carotid im-gsm is related to multisite atherosclerosis disease2015Ingår i: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 241, nr 1, s. E164-E164Artikel i tidskrift (Övrigt vetenskapligt)
  • 30.
    Jashari, Fisnik
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Ibrahimi, Pranvera
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Nicoll, Rachel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Bajraktari, Gani
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Wester, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Henein, Michael Y.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Coronary and carotid atherosclerosis: similarities and differences2013Ingår i: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 227, nr 2, s. 193-200Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Although a relationship is commonly accepted between coronary and carotid arterial disease, suggesting that atherosclerosis is a systemic condition, the extent of this association and correspondence has not been fully elucidated. This review discusses recent research in this field and highlights areas for future study. The prevalence of severe carotid stenosis increases with prevalence of coronary stenosis, with the latter being found in a significant number of stroke patients, while those with carotid stenosis may be at higher risk of myocardial infarction than stroke. There also appear to be common risk factors (age, diabetes, hypertension, smoking and dyslipidemia), although the effects in both vascular systems may not be identical. Furthermore, while the degree of stenosis in the coronary artery has little ability to predict acute coronary syndrome, which is caused by local thrombosis from a ruptured or eroded plaque, severe carotid stenosis causing hypoperfusion is highly predictive of stroke, although this effect may be time-limited. This apparent difference in event mechanism in the two arteries is interesting as is the difference in the rate of development of collaterals. Overall, the evidence shows that a clear relationship exists between disease in the coronary and carotid arteries, since conventional risk factors and the extent of stenosis and/or previous events emanating from one artery have a strong bearing on the prevalence of events in the other artery. Nevertheless, the exact correspondence between the two arteries is unclear, with sometimes contradictory study results. More research is needed to identify the full extent of risk factors for severe stenosis and cardio- or cerebral vascular events, among which, inflammatory biomarkers such as hs-CRP and prior vascular events are likely to play a key role.

  • 31.
    Jashari, Haki
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Rydberg, Annika
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Ibrahimi, Pranvera
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Bajraktari, Gani
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Henein, Michael Y.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Left ventricular response to pressure afterload in children: aortic stenosis and coarctation A systematic review of the current evidence2015Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 178, s. 203-209Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Congenital aortic stenosis (CAS) and Coarctation of Aorta (CoA) represent two forms of pressure afterload that affect the left ventricle (LV), hence require regular echocardiographic monitoring. Subclinical dysfunction of the LV exists even in asymptomatic patients with preserved left ventricular ejection fraction (EF), implying low sensitivity of EF in predicting optimum time for intervention. In this article we review patterns of LV myocardial deformation before and after correction of CAS and CoA in infants, children and adolescents, showing their important role in monitoring the course of LV dysfunction. A systematic search using PubMed was performed and suitable studies are presented on a narrative form. Normal EF and/or fractional shortening (FS), with subclinical myocardial dysfunction are reported in all studies before intervention. The short-term results, after intervention, were related to the type of procedure, with no improvement or further deterioration related to surgery but immediate improvement after balloon intervention. Long term follow-up showed further improvement but still subnormal function. Thus correction of CAS and CoA before irreversible LV dysfunction is vital, and requires longitudinal studies in order to identify the most accurate parameter for function prognostication. Until then, conventional echocardiographic parameters together with myocardial velocities and deformation parameters should continue to provide follow-up reproducible measures of ventricular function.

  • 32.
    Jashari, Haki
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Rydberg, Annika
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Ibrahimi, Pranvera
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Bajraktari, Gani
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Kryeziu, Lindita
    Jashari, Fisnik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Henein, Michael Y.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Normal ranges of left ventricular strain in children: a meta-analysis2015Ingår i: Cardiovascular Ultrasound, ISSN 1476-7120, E-ISSN 1476-7120, Vol. 13, artikel-id 37Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Aims: The definition of normal values of two-dimensional speckle-tracking echocardiography derived left ventricular (LV) deformation parameters, is of critical importance for the routine application of this modality in children. The objectives of this study were to perform a meta-analysis of normal ranges for longitudinal, circumferential and radial strain/strain rate values and to identify confounders that may contribute to differences in reported measures. Methods and Results: A systematic search was conducted. Studies describing normal healthy subjects and observational studies that used control groups as a comparison were included. Data were combined using a random-effect model. Effects of demographic, clinical and equipment variables were assessed through meta-regression. The search identified 1,192 subjects form 28 articles. Longitudinal strain (LS) normal mean values varied from -12.9 to -26.5 (mean, -20.5; 95 % CI, -20.0 to -21.0). Normal mean values of circumferential strain (CS) varied from -10.5 to -27.0 (mean, -22.06; 95 % CI, -21.5 to -22.5). Radial strain (RS) normal mean values varied from 24.9 to 62.1 (mean, 45.4; 95 % CI, 43.0 to 47.8). Meta-regression showed LV end diastolic diameter as a significant determinant of variation for LS. Longitudinal systolic strain rate (LSRs) was significantly determined by the age and RS by the type of vendor used. Conclusion: Variations among different normal ranges were dependent on the vendor used, LV end-diastolic diameter and age. Vendor-independent software for analyzing myocardial deformation in children, using images from different vendors would be the ideal solution for strain measurements or else using the same system for patient's follow up.

  • 33.
    Nicoll, Rachel
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Zhao, Ying
    Ibrahimi, Pranvera
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Olivecrona, Gunilla
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap.
    Henein, Michael
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Diabetes and Hypertension Consistently Predict the Presence and Extent of Coronary Artery Calcification in Symptomatic Patients: A Systematic Review and Meta-Analysis2016Ingår i: International Journal of Molecular Sciences, ISSN 1422-0067, E-ISSN 1422-0067, Vol. 17, nr 9, artikel-id 1481Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background: The relationship of conventional cardiovascular risk factors (age, gender, ethnicity, diabetes, dyslipidaemia, hypertension, obesity, exercise, and the number of risk factors) to coronary artery calcification (CAC) presence and extent has never before been assessed in a systematic review and meta-analysis.

    Methods: We included only English language studies that assessed at least three conventional risk factors apart from age, gender, and ethnicity, but excluded studies in which all patients had another confirmed condition such as renal disease.

    Results: In total, 10 studies, comprising 15,769 patients, were investigated in the systematic review and seven studies, comprising 12,682 patients, were included in the meta-analysis, which demonstrated the importance of diabetes and hypertension as predictors of CAC presence and extent, with age also predicting CAC presence. Male gender, dyslipidaemia, family history of coronary artery disease, obesity, and smoking were overall not predictive of either CAC presence or extent, despite dyslipidaemia being a key risk factor for coronary artery disease (CAD).

    Conclusion: Diabetes and hypertension consistently predict the presence and extent of CAC in symptomatic patients.

     

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