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  • 1.
    Erelund, Sofia
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Karp, Kjell
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Arvidsson, Sandra
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Johansson, Bengt
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Sundström, Nina
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Wiklund, Urban
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Pulmonary function in a cohort of heart-healthy individuals from Northern Sweden: a comparison with discordant reference values2023In: BMC Pulmonary Medicine, E-ISSN 1471-2466, Vol. 23, no 1, article id 110Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Dynamic spirometry is an important investigation to differentiate between impaired and normal lung function. This study aimed to evaluate the results of lung function testing in a cohort of subjects from Northern Sweden without any known heart or pulmonary disease. Our focus was to compare with two reference materials that have showed differences in the age-dependency of lung function in Swedish subjects.

    METHODS: The study population consisted of 285 healthy adults (148 males, 52%) between 20-90 years of age. The subjects had been randomly selected from the population register for inclusion in a study investigating cardiac function in heart-healthy subjects, but were also assessed with dynamic spirometry. At least seven percent reported smoking. Sixteen subjects presented with pulmonary functional impairments and were excluded from the current study. The sex-specific age-dependency in lung volumes was estimated using the LMS model, where non-linear equations were derived for the mean value (M), the location (L) or skewness, and the scatter (S) or coefficient of variation. This model of the observed lung function data was compared with reference values given by the original LMS model published by the Global Lung Initiative (GLI), and with the model from the recent Obstructive Lung Disease In Norrbotten (OLIN) study, where higher reference values were presented for Swedish subjects than those given by the GLI model.

    RESULTS: No differences were found in the age-dependency of pulmonary function between the LMS model developed in the study and the OLIN model. Although the study group included smokers, the original GLI reference values suggested significantly lower normal values of FEV1 (forced expiratory volume) and FVC (forced vital capacity), and consequently fewer subjects below the lower limit of normality, than both the rederived LMS and OLIN models.

    CONCLUSIONS: Our results are in line with previous reports and support that the original GLI reference values underestimate pulmonary function in the adult Swedish population. This underestimation could be reduced by updating the coefficients in the underlying LMS model based on a larger cohort of Swedish citizens than was available in this study.

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  • 2.
    Erelund, Sofia
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Karp, Kjell
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Wiklund, Urban
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Hörnsten, Rolf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Arvidsson, Sandra
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Are ECG changes in heart-healthy individuals of various ages related to cardiac disease 20 years later?2021In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 126, no 1, article id e6064Article in journal (Refereed)
    Abstract [en]

    Background: This research study aimed at assessing the electrocardiographic (ECG) changes caused by ageing in a cohort of healthy subjects with normal echocardiographic examinations.

    Methods: A total of 219 healthy individuals (119 males and 100 females) were evaluated for possible arrhythmias with a standard 12-lead resting ECG and 24-h Holter ECG. As the recordings were performed between 1998 and 2000, a 20-year follow-up study was carried out by assessing the local medical records to investigate whether the subjects had experienced any cardiovascular health complications or disease since the baseline assessment.

    Results: Eighty-three subjects (45 males and 38 females) presented with pathological ECG findings at baseline. The most common finding on analysis of Holter ECG recordings was premature atrial contractions, and the most severe pathological finding was episodes of ventricular tachycardia (eight subjects). Regarding the analysis of the standard 12-lead ECG, the most common finding was left ventricular hypertrophy, and the most severe pathological findings were ST-T changes and prolongation of the QT interval. Despite other cardiac examinations performed on these patients showing normal results, in combination with a strict inclusion criterion, this study showed that 28% of all subjects had pathological resting 12-lead ECGs at rest and 35% had pathological heart rhythms when assessed by 24-h Holter ECG. At follow-up, 21% of females and 43% of males had presented with ECG abnormalities, and 30% of females and 36% of males had cardiovascular disease. There was hypertension in 45% of females and in 58% of males. However, no association was found between the follow-up findings and ECG changes seen at baseline.

    Conclusion: Although most ECG changes found at baseline could be considered as a normal variation, they may progress to more severe heart complications as the subject ages. The results of this study also validate ECG findings of previous studies and underline that diagnostic criteria should be based on gender and age.

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  • 3.
    Gref, Margareta
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Karp, Kjell
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    99mTc-diethylenetriamine penta-acetate plasma clearance in advanced renal failure by the mean sojourn time approach2009In: Nuclear medicine communications, ISSN 0143-3636, E-ISSN 1473-5628, Vol. 30, no 3, p. 202-205Article in journal (Refereed)
    Abstract [en]

    Objectives: The single-sample 99mTc-diethylenetriamine penta-acetate (DTPA) clearance method by Christensen and Groth is recommended by the Radionuclides in Nephrourology Committee on Renal Clearance for use in adults with an estimated glomerular filtration rate (GFR) ≥30 ml/min. The purpose of this study was to test a new 99mTc-DTPA single-sample low clearance formula for GFR lesser than 30 ml/min.

    Methods: Twenty-one adult patients (29 investigations) were included. Reference clearance was calculated with both 51Cr-EDTA and 99mTc-DTPA according to Brøchner-Mortensen with samples drawn between 3 and 24 h. Single-sample clearance was calculated from a 24 h sample using the low clearance formula

    Equation (Uncited)Image Tools

    C(t) is the activity of the tracer in the plasma sample t minutes after the injection and Q0 is the injected amount. ECV is the extracellular volume in ml defined as the distribution volume of the tracer. ECV is estimated from the body surface area as ECV=8116.6×body surface area-28.2.

    Results: The mean difference between reference and 99mTc-DTPA single-sample clearance was -0.5 ml/min (SD 1.0 ml/min) for 99mTc-DTPA and -0.8 ml/min (SD 1.2 ml/min) for 51Cr-EDTA as reference clearance.

    Conclusion: In adult patients it is possible, even with GFR lesser than 30 ml/min, to get an accurate determination of 99mTc-DTPA plasma clearance from a single sample using the mean sojourn time approach. The blood sample should be obtained about 24 h after injection of the GFR tracer.

  • 4.
    Gref, Margareta
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Karp, Kjell
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    GFR determination in adults with a single-sample iohexol plasma clearance method based on the mean sojourn time2007In: Nephrology, Dialysis and Transplantation, ISSN 0931-0509, E-ISSN 1460-2385, Vol. 22, no 11, p. 3166-3173Article in journal (Refereed)
    Abstract [en]

    Background. Glomerular filtration rate is a key parameter in kidney disease. The Radionuclides in Nephrourology Committee has recommended a single-sample method with 99mTc-DTPA based on the mean sojourn time. This study was done to develop the method for use with iohexol making the method more available.

    Methods. The single-sample formula was derived for group I (n = 48, Cl = 8–188 ml/min) and applied on group II (n = 47) and on group III (n = 123). In groups I and II, reference clearance was determined according to Sapirstein and in group III according to Brøchner-Mortensen.

    Results. The formula (a = (−6.49 × 10−6×t + 8.85 × 10−4)×t, b = 1.143 × t and c = ln[(C(t))×(ECV/Q0)](ECV) was derived for patients with estimated Cl > 30 ml/min with the best result if the single sample was obtained between 4 and 5 h. Extracellular volume was estimated as ECV =9985 × BSA − 3431.

    The formula ClS(24 h) = −ln[(C(t))×(ECV/Q0)](ECV)/(t) was developed for patients with estimated Cl <30 ml/min with a single sample at 24 h. With this combined approach SDdiff was 2.7 ml/min in group II and 3.1 ml/min in group III.

    Conclusions. An accurate determination of iohexol clearance can be obtained from a single plasma sample applying the mean sojourn time approach. A separate formula must be used for patients with low clearance values. Body surface area (BSA), injected amount of iohexol (Q0), time when the single sample is drawn (t) and the concentration of iohexol [C(t)] in the sample are needed for the calculations.

  • 5.
    Gref, Margaretha
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Karp, Kjell
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Single-sample 99mTc-diethylenetriamine penta-acetate plasma clearance in advances renal failure by the mean sojourn time approach2009In: Nuclear medicine communications, ISSN 0143-3636, E-ISSN 1473-5628, Vol. 30, no 3, p. 202-205Article in journal (Refereed)
    Abstract [en]

    AB Objectives: The single-sample 99mTc-diethylenetriamine penta-acetate (DTPA) clearance method by Christensen and Groth is recommended by the Radionuclides in Nephrourology Committee on Renal Clearance for use in adults with an estimated glomerular filtration rate (GFR) >=30 ml/min. The purpose of this study was to test a new 99mTc-DTPA single-sample low clearance formula for GFR lesser than 30 ml/min. Methods: Twenty-one adult patients (29 investigations) were included. Reference clearance was calculated with both 51Cr-EDTA and 99mTc-DTPA according to Brochner-Mortensen with samples drawn between 3 and 24 h. Single-sample clearance was calculated from a 24 h sample using the low clearance formula C(t) is the activity of the tracer in the plasma sample t minutes after the injection and Q0 is the injected amount. ECV is the extracellular volume in ml defined as the distribution volume of the tracer. ECV is estimated from the body surface area as ECV=8116.6xbody surface area-28.2. Results: The mean difference between reference and 99mTc-DTPA single-sample clearance was -0.5 ml/min (SD 1.0 ml/min) for 99mTc-DTPA and -0.8 ml/min (SD 1.2 ml/min) for 51Cr-EDTA as reference clearance. Conclusion: In adult patients it is possible, even with GFR lesser than 30 ml/min, to get an accurate determination of 99mTc-DTPA plasma clearance from a single sample using the mean sojourn time approach. The blood sample should be obtained about 24 h after injection of the GFR tracer.

  • 6.
    Hagström, Linn
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Henein, Michael Y
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Karp, Kjell
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Waldenström, Anders
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Lindqvist, Per
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Impact of age and sex on normal left heart structure and function2017In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 37, no 6, p. 759-766Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Accurate age- and sex-related normal reference values of ventricular structure and function are important to determine the level of dysfunction in patients. The aim of this study therefore was to document normal age range sex-related measurements of LV structural and functional measurements to serve such purpose.

    METHODS: We evaluated left ventricular structure and function in 293 healthy subjects between 20 and 90 years with equally distributed gender. Doppler echocardiography was used including measure of both systolic and diastolic functions.

    RESULTS: Due to systolic LV function, only long axis function correlated with age (r = 0·55, P<0·01) and the correlation was stronger in females. Concerning diastolic function, there was a strong age correlation in all parameters used (r = 0·40-0·74, P<0·001). Due to LV structural changes over age, females showed a larger reduction in end-diastolic volumes, but no or trivial difference in wall thickness after the age of 60 years.

    CONCLUSION: Age is associated with significant normal changes in left ventricular structure and function, which should be considered when deciding on normality. These changes are related to systemic arterial changes as well as body stature, thus reflecting overall body ageing process. Furthermore, normal cardiac ageing in females might partly explain the higher prevalence of heart failure with preserved ejection in females.

  • 7.
    Johansson, Elias P
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Ahlqvist, Jan
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Garoff, Maria
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Karp, Kjell
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Ultrasound screening for asymptomatic carotid stenosis in subjects with calcifications in the area of the carotid arteries on panoramic radiographs: a cross-sectional study2011In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 11, no 44, p. 1-9Article in journal (Refereed)
    Abstract [en]

    Background: Directed ultrasonic screening for carotid stenosis is cost-effective in populations with > 5% prevalence of the diagnosis. Occasionally, calcifications in the area of the carotid arteries are incidentally detected on odontological panoramic radiographs. We aimed to determine if directed screening for carotid stenosis with ultrasound is indicated in individuals with such calcifications. Methods: This was a cross-sectional study. Carotid ultrasound examinations were performed on consecutive persons, with findings of calcifications in the area of the carotid arteries on panoramic radiography that were otherwise eligible for asymptomatic carotid endarterectomy. Results: Calcification in the area of the carotid arteries was seen in 176 of 1182 persons undergoing panoramic radiography. Of these, 117 fulfilled the inclusion criterion and were examined with carotid ultrasound. Eight persons (6.8%; 95% CI 2.2-11.5%) had a carotid stenosis - not significant over the 5% pre-specified threshold (p = 0.232, Binomial test). However, there was a significant sex difference (p = 0.008), as all stenoses were found in men. Among men, 12.5% (95% CI 4.2-20.8%) had carotid stenosis - significantly over the 5% pre-specified threshold (p = 0.014, Binomial test). Conclusions: The incidental finding of calcification in the area of the carotid arteries on panoramic radiographs should be followed up with carotid screening in men that are otherwise eligible for asymptomatic carotid endarterectomy.

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  • 8.
    Leijon-Sundqvist, K.
    et al.
    Division of Medical Sciences, Department of Health Sciences, Luleå University of Technology, Luleå, Sweden.
    Lehto, N.
    Division of Medical Sciences, Department of Health Sciences, Luleå University of Technology, Luleå, Sweden.
    Juntti, U.
    Performance in Cold AB, Luleå, Sweden.
    Karp, Kjell
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Andersson, S.
    Division of Medical Sciences, Department of Health Sciences, Luleå University of Technology, Luleå, Sweden.
    Tegner, Y.
    Division of Medical Sciences, Department of Health Sciences, Luleå University of Technology, Luleå, Sweden.
    Thermal response after cold-water provocation of hands in healthy young men2015In: Thermology International, ISSN 1560-604X, Vol. 25, no 2, p. 48-53Article in journal (Refereed)
    Abstract [en]

    The thermal response in hands provoked by cold water was investigated with infrared thermography. In 26 healthy young men, the response of hand skin temperature to cold water provocation was measured twice on consecutive days. An infrared thermographic camera was used and data were processed in real time. The software divides each hand into 18 predefined regions of interest (ROI). The average temperature in each ROI was stored every 10th second. Baseline hand skin temperature was recorded for two minutes. The bare hands were then immersed for 30 seconds in water at 10°C × 0.5°C and carefully dried. Thereafter, the cooled and final hand skin temperature was measured. The baseline showed a higher average temperature of 0.3°C on day 2 and the 95% limits of agreement (LOA) were - 5.2-5.8, the cooled average temperatures showed no significant difference between the two days (LOA: - 4.8-4.6) and the average final hand skin temperature was 0.8°C higher on day 2 (LOA: - 5.2-6.4). In conclusion, there was variability between the two measurements, small differences in the temperature response to the reaction to cold-water provocation - probably due to Day 1 stress factor.

  • 9.
    Leijon-Sundqvist, K.
    et al.
    Division of Medical Sciences, Department of Health Sciences, Luleå University of Technology, Luleå, Sweden.
    Tegner, Y.
    Division of Medical Sciences, Department of Health Sciences, Luleå University of Technology, Luleå, Sweden.
    Juntti, U.
    Performance in Cold AB, Luleå, Sweden.
    Karp, Kjell
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Lehto, N.
    Division of Medical Sciences, Department of Health Sciences, Luleå University of Technology, Luleå, Sweden.
    Hand skin temperature - Are there warm and cold rewarming patterns after cold stress test?2016In: Thermology International, ISSN 1560-604X, Vol. 26, no 3, p. 81-87Article in journal (Refereed)
    Abstract [en]

    In 116 thermographic measurements of 66 healthy male participants, 44 of whom were measured at least twice, hand skin temperature distributions before and after a cold stress test (CST) were examined to identify any typical characteristics of hand skin rewarming. On each hand, measurements from 18 regions of interest recorded every 10 s were used to calculate the surface average temperature. Temperatures at baseline (Tb), directly after cooling (Tc), and after 15 min of rewarming (Tf) were used for comparison and the averages of each finger, palm, and hand were analyzed. Using fits of normal distribution for the measured data, final hand skin temperatures were divided into two groups, A and B, with a calculated boundary at 25.4 °C. Digital analyses of all thermograms were performed to describe the process, and each group's rewarming patterns were observed. Group A was considered to demonstrate warm rewarming, since the whole hands reached a Tf approximately equal to the Tb. By contrast, Group B demonstrated cold rewarming and had whole hand Tf less than Tb. The predictive value of Tc was lower than that of Tb in Group A, whereas the opposite occurred in Group B. Altogether, the findings suggest different hand skin temperature rewarming patterns in healthy males.

  • 10. Leijon-Sundqvist, K.
    et al.
    Tegner, Y.
    Olsson, F.
    Karp, Kjell
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Lehto, N.
    Relation between dorsal and palmar hand skin temperatures during a cold stress test2017In: Journal of Thermal Biology, ISSN 0306-4565, E-ISSN 1879-0992, Vol. 66, p. 87-92Article in journal (Refereed)
    Abstract [en]

    Hand skin temperature measurements have previously been performed on either dorsal or palmar sides and it is possible to find arguments for the advantage of both locations. Therefore, the aim of this study was to use dynamic infrared (IR) imaging to examine the relationship between dorsal and palmar hand skin temperature. The palmar and dorsal hand skin temperature before and after a cold stress test was measured with IR thermography in 112 healthy participants. Calculation of surface average temperature was made from nine regions of interest on each hand's dorsal and palmar side. Temperature values were recorded at baseline, directly after immersion of hands in vinyl gloves for one minute in water at 20 +/- 0.5 degrees C (gloves removed), and after eight minutes rewarming. Results showed that: a) the skin temperatures on the dorsal and palmar sides of the hand are strongly correlated; b) the correlation is stronger on the fingers than on the carpometacarpal (CMC) area; c) the palmar side of the CMC area is warmer than the dorsal side, but this is reversed in the fingers so that the nail bed is warmer than the finger pad; and d) the temperature difference Delta T between the dorsal and palmar sides of the fingers is independent of the skin temperature, though Delta T on the CMC area of the hand is temperature dependent. Such differences can be important in detailed investigations of thermal phenomena in the hand. In conclusion, results showed a strong correlation between the dorsal and palmar temperatures. If both sides cannot be measured, the purpose of the investigation should determine which side of the hand should be measured.

  • 11.
    Lindqvist, Per
    et al.
    Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences, Clinical Physiology.
    Mörner, Stellan
    Karp, Kjell
    Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences, Clinical Physiology.
    Waldenström, Anders
    New aspects of septal function by using 1-dimensional strain and strain rate imaging.2006In: Journal of the American Society of Echocardiography, ISSN 0894-7317, E-ISSN 1097-6795, Vol. 19, no 11, p. 1345-1349Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The interventricular septum is a complex structure, both anatomically and functionally, which limits the use of Doppler tissue imaging in the assessment of radial septal function. In this study we investigated whether strain (epsilon) and epsilon rate (SR) imaging can improve the measurement of the septal function. METHODS: Thirty healthy participants (18 women; age 60 +/- 11 years, range 42-72) were randomly selected from the population. Systolic epsilon and SR measurements were made of the radial motion from right endocardial layer (RE), left endocardial layer (LE), and middle layer of septum. Furthermore, we also compared RE and longitudinal right ventricular free wall and left ventricular longitudinal and LE septal motion. RESULTS: In both the endocardial sampling sites, LE and RE, we found negative radial epsilon (myocardial shortening), -20.1 +/- 11.5% for RE and -25.0 +/- 14.1% for LE during systole. However, in the middle layer we found a positive radial epsilon (myocardial lengthening), +11.5 +/- 13.2%, significantly different from the two endocardial layers (P < .001 for both). SR was negative in the two endocardial layers and significantly higher for LE, (-2.9 +/- 1.8 1/s) than for RE (-1.2 +/- 1.8 1/s, P < .001) and positive for the middle layer (+1.1 +/- 1.0 1/s), significantly different in comparison with the two endocardial layers (P < .001). Finally, there was a higher longitudinal epsilon compared with radial endocardial epsilon for right ventricle (-26.5 +/- 11.5 vs -20.1 +/- 11.5, P < .05) whereas there was significantly higher left ventricular radial epsilon and SR compared with the longitudinal epsilon and SR (-25.0 +/- 14.1 vs -16.8 +/- 9.5, P < .05; and -2.9 +/- 1.8 vs -1.1 +/- 0.4, P < .001). CONCLUSION: Systolic epsilon and SR imaging indicate differences in the radial deformation in different layers of the interventricular septum, which might be explained by the complexity of the septal fiber arrays and function. It might also explain why using Doppler tissue imaging technique is limited in assessing radial myocardial septal velocities. Furthermore, these results suggest that longitudinal shortening dominates in the right ventricle whereas the radial shortening dominates in the left ventricle.

  • 12.
    Ljung, Lotta
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Bergholm, Robert
    Brink, Mikael
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Söderström, Ingegerd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Karp, Kjell
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Leirisalo-Repo, Marjatta
    Yki-Järvinen, Hannele
    Rantapää-Dahlqvist, Solbritt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Inflammatory markers in serum and adipose tissue in relation to markers of sub-clinical atherosclerosis in rheumatoid arthritis patientsManuscript (preprint) (Other academic)
  • 13.
    Rönn, Folke
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Kesek, Milos
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Karp, Kjell
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Henein, Michael
    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.
    Right ventricular lead positioning does not influence the benefits of cardiac resynchronization therapy in patients with heart failure and atrial fibrillation.2011In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 13, no 12, p. 1747-1752Article in journal (Refereed)
    Abstract [en]

    Aims Little is known about the optimal right ventricular (RV) pacing site in cardiac resynchronization therapy (CRT). This study compares bi-ventricular pacing at the left ventricular (LV) free wall combined with two different RV stimulation sites: RV outflow tract (RVOT+LV) vs. RV-apex (RVA+LV). Methods and results Thirty-three patients (32 males) with chronic heart failure, NYHA class III-IV, optimal drug therapy, QRS-duration ≥150 ms, and chronic atrial fibrillation (AF) received CRT with two different RV leads, in the apex (RVA) or outflow tract (RVOT), together with an LV lead, all connected to a bi-ventricular pacemaker. Randomization to pacing in RVOT+LV or RVA+LV was made 1 month after implantation and cross-over to the alternate pacing configuration occurred after 3 months. The median age of patients was 69 ± 10 years, the mean QRS was 179 ± 23 ms, and 58% of patients had ischaemic heart disease. Seven patients had pacemaker rhythm at inclusion and 60% were treated with atrioventricular-junctional ablation before randomization. In the RVA+LV and RVOT+LV pacing modes, 67 and 63% (nonsignificant) responded symptomatically with a decrease of at least 10 points in the Minnesota Living with Heart Failure score. The secondary end-points (6-min walk test, peak oxygen uptake, N-Terminal fragment of B-type Natriuretic Peptide, and left ventricular ejection fraction) showed significant improvement between baseline and CRT, but not between RVOT+LV and RVA+LV. Conclusion In this randomized controlled study, the exact RV pacing site, either apex or outflow tract, did not influence the benefits of CRT in a group of patients with chronic heart failure and AF. ClinicalTrials.gov ID: NCT00457834.

  • 14.
    Södergren, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Karp, Kjell
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Bengtsson, Christine
    Moller, Bozena
    Rantapää-Dahlqvist, Solbritt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Wållberg-Jonsson, Solveig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    The Extent of Subclinical Atherosclerosis Is Partially Predicted by the Inflammatory Load: A Prospective Study over 5 Years in Patients with Rheumatoid Arthritis and Matched Controls2015In: Journal of Rheumatology, ISSN 0315-162X, E-ISSN 1499-2752, Vol. 42, no 6, p. 935-942Article in journal (Refereed)
    Abstract [en]

    Objective. This prospective followup study investigated subclinical atherosclerosis in relation to traditional cardiovascular disease (CVD) risk factors and inflammation in patients with rheumatoid arthritis (RA) recruited at diagnosis compared with controls. Methods. Patients diagnosed with early RA were consecutively recruited into a prospective study. From these, a subgroup aged <= 60 years (n = 71) was consecutively included for ultrasound measurement of intima-media thickness (IMT) and flow-mediated dilation (FMD) at inclusion (T0) and after 5 years (T5). Age-and sex-matched controls (n = 40) were also included. Results. In the Wilcoxon signed-rank test, both IMT and FMD were significantly aggravated at T5 compared to baseline in patients with RA, whereas only IMT was significantly increased in controls. In univariate linear regression analyses among patients with RA, the IMT at T5 was significantly associated with age, systolic blood pressure (BP), cholesterol, triglycerides, Systematic Coronary Risk Evaluation (SCORE), and Reynolds Risk Score at baseline (p < 0.05). Similarly, FMD at T5 was significantly inversely associated with age, smoking, systolic BP, SCORE, and Reynolds Risk Score (p < 0.05). A model with standardized predictive value from multiple linear regression models including age, smoking, BP, and blood lipids at baseline significantly predicted the observed value of IMT after 5 years. When also including the area under the curve for the 28-joint Disease Activity Score over 5 years, the observed value of IMT was predicted to a large extent. Conclusion. This prospective study identified an increased subclinical atherosclerosis in patients with RA. In the patients with RA, several traditional CVD risk factors at baseline significantly predicted the extent of subclinical atherosclerosis 5 years later. The inflammatory load over time augmented this prediction.

  • 15.
    Södergren, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology. Umeå University, Faculty of Medicine, Wallenberg Centre for Molecular Medicine at Umeå University (WCMM).
    Karp, Kjell
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Bengtsson, Christine
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology. Department of Rheumatology, Kristianstad Hospital, Kristianstad, Sweden.
    Möller, Bozena
    Rantapää-Dahlqvist, Solbritt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    Wållberg-Jonsson, Solveig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    Biomarkers associated with cardiovascular disease in patients with early rheumatoid arthritis2019In: PLOS ONE, E-ISSN 1932-6203, Vol. 14, no 8, article id e0220531Article in journal (Refereed)
    Abstract [en]

    Objectives: Patients with rheumatoid arthritis (RA) have an increased mortality and morbidity due to cardiovascular disease (CVD). In this prospective 5-year follow up of patients with RA, we analysed several biomarkers, known to be associated with atherosclerosis and/or inflammation in the general population. The aim of this study was to find out whether the RA-disease per se affect these biomarkers and if those could be associated with the progression of atherosclerosis, as measured by intima media thickness (IMT) among patients with early RA.

    Methods: Patients from northern Sweden diagnosed with early RA, are consecutively recruited into an ongoing prospective study on CVD comorbidity. A subgroup of patients, aged ≤60 years (n = 71) was included for ultrasound measurements of IMT at inclusion (T0) and after 5 years (T5) together with age-sex-matched controls (n = 40). The patients were clinically assessed. Blood was analysed for lipids, ESR and CRP and several biomarkers known to be associated with atherosclerosis in the general population.

    Results: At T0, the patients with RA had significantly lower levels of MIF and significantly higher levels of interleukin (IL)-18 and MIC-1 compared with controls. At T5, the patients with RA had significantly higher levels of pentraxin3, MIC-1, TNF-R2, ICAM-1, VCAM-1 and endostatin compared with controls. At T0 the levels of MPO correlated with DAS28, sCD40L with CRP and IL-18 with systolic blood pressure and Reynolds risk score. Using PLSR on a CVD-panel analysed with multiplex immunoassay, the patients with RA could be correctly classified into those who had a worsening in their IMT over the five years or not. Here, MMP3 was identified as influential.

    Conclusions: This study indicates that the RA disease itself could affect several of the biomarkers in this study, and possibly also the processes involved in the development of atherosclerosis.

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  • 16.
    Södergren, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Karp, Kjell
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Bengtsson, Christine
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Möller, Bozena
    Department of Rheumatology, Sunderby Hospital, Luleå, Sweden.
    Rantapää-Dahlqvist, Solbritt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Wållberg-Jonsson, Solveig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Is Lipoprotein-Associated Phospholipase A2a Link between Inflammation and Subclinical Atherosclerosis inRheumatoid Arthritis?2015In: BioMed Research International, ISSN 2314-6133, E-ISSN 2314-6141, article id 673018Article in journal (Refereed)
    Abstract [en]

    Objective. Lipoprotein-associated phospholipase A2 (Lp-PLA2), a marker of vascular inflammation, is associated with cardiovascular disease. This prospective study of an inception cohort aimed to investigate whether the level of Lp-PLA2 is associated with subclinical atherosclerosis in patients with rheumatoid arthritis (RA). Methods. Patients from northern Sweden diagnosed with early RA were consecutively recruited into an ongoing prospective study. From these, all patients <= 60 years (n = 71) were included for measurements of subclinical atherosclerosis at inclusion (T0) and five years later (T5). Forty age-and sex-matched controls were included. The patients were clinically assessed, SCORE, Reynolds Risk Score, and Larsen score were calculated, and blood samples were drawn from all individuals at T0 and T5. Results. There was no significant difference in the level of Lp-PLA2 between patients with RA and controls (p > 0.05). In simple linear regression models among patients with RA, Lp-PLA2 at T0 was significantly associated with intima media thickness (IMT) at T0 and T5, flow mediated dilation (FMD) at T0 and T5, ever smoking, male sex, HDL-cholesterol (inversely), non-HDL-cholesterol, SCORE, Reynolds Risk Score, and Larsen score (p < 0.05). Conclusion. In this cohort of patients with early RA, the concentration of Lp-PLA2 was associated with both subclinical atherosclerosis and disease severity.

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  • 17.
    Södergren, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Karp, Kjell
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Boman, Kurt
    Department of Medicine, Skellefteå Hospital, Lasarettsvägen, Skellefteå.
    Eriksson, Catharina
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Clinical Immunology.
    Lundström, Elisabet
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Smedby, Torgny
    Department of Rheumatology, Östersund Hospital, Kyrkgatan, 831 83 Östersund, Sweden.
    Söderlund, Lisbet
    Department of Rheumatology, Sunderby Hospital, 971 80 Luleå, Sweden.
    Rantapää-Dahlqvist, Solbritt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Wållberg-Jonsson, Solveig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Atherosclerosis in early rheumatoid arthritis: very early endothelial activation and rapid progression of intima media thickness2010In: Arthritis Research & Therapy, ISSN 1478-6354, E-ISSN 1478-6362, Vol. 12, no 4, p. R158-Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION : In this study we aimed to investigate whether there are indications of premature atherosclerosis, as measured by endothelial dependent flow-mediated dilation (ED-FMD) and intima media thickness (IMT), in patients with very early RA, and to analyze its relation to biomarkers of endothelial dysfunction, taking inflammation and traditional cardiovascular disease (CVD) risk factors into account.

    METHODS : Patients from the three northern counties of Sweden diagnosed with early RA are followed in an ongoing prospective study of CVD co-morbidity. Of these, all patients aged ≤60 years were consecutively included in this survey of CVD risk factors (n = 79). Forty-four age and sex matched controls were included. IMT of common carotid artery and ED-FMD of brachial artery were measured using ultrasonography. Blood was drawn for analysis of lipids, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator (tPA)-mass, VonWillebrand factor (VWF), soluble intercellular adhesion molecule-1 (sICAM), soluble vascular cell adhesion molecule-1 (sVCAM), sE-selectin, sL-selectin and monocyte chemotactic protein-1 (MCP-1). In a subgroup of 27 RA patients and their controls the ultrasound measurements were reanalysed after 18 months.

    RESULTS : There were no significant differences between RA patients and controls in terms of IMT or ED-FMD at the first evaluation. However after 18 months there was a significant increase in the IMT among the patients with RA (P < 0.05). Patients with RA had higher levels of VWF, sICAM-1 (P < 0.05) and of MCP-1 (P = 0.001) compared with controls. In RA, IMT was related to some of the traditional CVD risk factors, tPA-mass, VWF (P < 0.01) and MCP-1 and inversely to sL-selectin (P < 0.05). In RA, ED-FMD related to sL-selectin (P < 0.01). DAS28 at baseline was related to PAI-1, tPA-mass and inversely to sVCAM-1 (P < 0.05) and sL-selectin (P = 0.001).

    CONCLUSIONS : We found no signs of atherosclerosis in patients with newly diagnosed RA compared with controls. However, in patients with early RA, IMT and ED-FMD were, to a greater extent than in controls, related to biomarkers known to be associated with endothelial dysfunction and atherosclerosis. After 18 months, IMT had increased significantly in RA patients but not in controls.

  • 18.
    Wahlin, Bengt
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    Fasth, A. E.
    Karp, Kjell
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Lejon, Kristina
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Immunology/Immunchemistry.
    Södergren, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    Wållberg-Jonsson, Solveig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    Cd8+cd28- t-lymphocytes are associated with subclinical atherosclerosis in patients with rheumatoid arthritis2017In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 76, p. 250-250Article in journal (Other academic)
  • 19.
    Wahlin, Bengt
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    Fasth, Andreas
    Karp, Kjell
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Lejon, Kristina
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Immunology/Immunchemistry.
    Malmström, Vivianne
    Rahbar, Afsar
    Wållberg-Jonsson, Solveig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    Södergren, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology. Umeå University, Faculty of Medicine, Wallenberg Centre for Molecular Medicine at Umeå University (WCMM).
    Atherosclerosis in rheumatoid arthritis: associations between anti-cytomegalovirus IgG antibodies, CD4+CD28null T-cells, CD8+CD28null T-cells and intima-media thickness2021In: Clinical and Experimental Rheumatology, ISSN 0392-856X, E-ISSN 1593-098X, Vol. 39, no 3, p. 578-586Article in journal (Refereed)
    Abstract [en]

    Objectives: Patients with rheumatoid arthritis (RA) have an accelerated progression of atherosclerosis. The aims of this study were to study the associations between subsets of T-cells, subclinical atherosclerosis assessed by intima-media thickness (IMT) and serological status for CMV in patients with RA.

    Methods: Patients with new-onset RA (n=79), aged ≤60 years at diagnosis, were included in a prospective study of atherosclerosis. Controls matched for age and sex were also included (n=44). Ultrasound measurement of IMT in the common carotid artery was undertaken at inclusion (T0), after 1.5 years (T1.5) and after 11 years (T11). At T11, flow-cytometry analysis was undertaken to investigate subsets of T-cells. Serological analysis for CMV was undertaken from samples collected at T0.

    Results: At T0, 66% of the patients and controls were CMV immunoglobulin G-positive. CMV-IgG positive patients had a significantly more rapid increase in IMT at T1.5, compared with controls and CMV-IgG negative patients. CMV-IgG positive patients had a significantly higher percentage of T-cells lacking CD28 (both CD4+CD28null and CD8+CD28null T-cells) than CMV-IgG negative patients. Increased levels of CD4+CD28null and CD8+CD28null T-cells were significantly associated with IMT at T11, adjusted for systolic blood pressure. CX3CR1 was expressed in CD4+ and CD8+ CD28null T-cells, but CX3CR1 per se was not associated with increased IMT.

    Conclusions: Presence of CMV IgG-antibodies in patients with RA is associated with altered T-cell-populations and an increased burden of atherosclerosis. A possible protective effect of antiviral treatment in CMV-positive patients with new-onset RA should be considered.

  • 20.
    Wahlin, Bengt
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Meedt, T.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Jonsson, F.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Karp, Kjell
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Henein, Michael
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Wållberg-Jonsson, Solveig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Prediction of coronary artery calcification and association with inflammation in rheumatoid arthritis: a follow-up study2014In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 73, p. 634-635Article in journal (Other academic)
  • 21.
    Wållberg-Jonsson, Solveig
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Karp, Kjell
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Boman, Kurt
    Eriksson, Catharina
    Lundstrom, Elisabet
    Smedby, Torgny
    Moller, Bozena
    Rantapää-Dahlqvist, Solbritt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Södergren, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Progression of subclinical atherosclerosis over 5 years in patients with early rheumatoid arthritis2012In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 71, p. A92-A92Article in journal (Other academic)
1 - 21 of 21
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