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Holmgren, Anders
Publications (10 of 28) Show all publications
Sasao, T., Holmgren, A. & Eklund, P. (2023). A logical method to predict outcomes after coronary artery bypass grafting. In: 2023 IEEE 53rd International Symposium on Multiple-Valued Logic (ISMVL): . Paper presented at 53rd IEEE International Symposium on Multiple-Valued Logic, ISMVL 2023, Matsue, Japan, May 22-24, 2023 (pp. 202-208). IEEE
Open this publication in new window or tab >>A logical method to predict outcomes after coronary artery bypass grafting
2023 (English)In: 2023 IEEE 53rd International Symposium on Multiple-Valued Logic (ISMVL), IEEE, 2023, p. 202-208Conference paper, Published paper (Refereed)
Abstract [en]

This paper analyzes data from coronary artery bypass grafting (CABG) using decision functions to represent rules. The data was collected at the University Hospital in Umeå, Sweden. The data contains pre-, intra-, and postoperative detail from 2975 heart operations during 1993-96. Each instance is represented by 14 preoperative variables, 4 intraoperative variables, and 9 postoperative variables. A logical method is used to predict the postoperative variables using preoperative variables. First, each postoperative variable is represented as a decision functions of preoperative variables. Then, for each postoperative variable, a minimal set of preoperative variables is derived. And finally, each postoperative variable is represented by a minimum set of rules using preoperative variables. With this method we can predict postoperative outcome, where prediction using preoperative data only is of particular interest e.g. for surgery scheduling.

Place, publisher, year, edition, pages
IEEE, 2023
Series
Proceedings - International Symposium on Multiple-Valued Logic, ISSN 0195-623X, E-ISSN 2378-2226
Keywords
classification, decision tree, discretization, domain reduction, imbalanced data set, multi-valued logic, partially defined function, rule reduction, variable minimization
National Category
Surgery Computer and Information Sciences
Identifiers
urn:nbn:se:umu:diva-212254 (URN)10.1109/ISMVL57333.2023.00046 (DOI)2-s2.0-85164601193 (Scopus ID)9781665464161 (ISBN)
Conference
53rd IEEE International Symposium on Multiple-Valued Logic, ISMVL 2023, Matsue, Japan, May 22-24, 2023
Available from: 2023-07-20 Created: 2023-07-20 Last updated: 2023-07-20Bibliographically approved
Holm, J., Ferrari, G., Holmgren, A., Vanky, F., Friberg, Ö., Vidlund, M. & Svedjeholm, R. (2022). Effect of glutamate infusion on NT-proBNP after coronary artery bypass grafting in highrisk patients (GLUTAMICS II): a randomized controlled trial. PLoS Medicine, 19(5), Article ID e1003997.
Open this publication in new window or tab >>Effect of glutamate infusion on NT-proBNP after coronary artery bypass grafting in highrisk patients (GLUTAMICS II): a randomized controlled trial
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2022 (English)In: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 19, no 5, article id e1003997Article in journal (Refereed) Published
Abstract [en]

Background: Animal and human data suggest that glutamate can enhance recovery of myocardial metabolism and function after ischemia. N-terminal pro-brain natriuretic peptide (NT-proBNP) reflects myocardial dysfunction after coronary artery bypass surgery (CABG). We investigated whether glutamate infusion can reduce rises of NT-proBNP in moderate- to high-risk patients after CABG.

Methods and findings: A prospective, randomized, double-blind study enrolled patients from November 15, 2015 to September 30, 2020, with a 30-day follow-up at 4 academic cardiac surgery centers in Sweden. Patients underwent CABG ± valve procedure and had left ventricular ejection fraction ≤0.30 or EuroSCORE II ≥3.0. Intravenous infusion of 0.125 M L-glutamic acid or saline at 1.65 mL/kg/h started 10 to 20 minutes before releasing the aortic cross-clamp, then continued for another 150 minutes. Patients, staff, and investigators were blinded to the treatment. The primary endpoint was the difference between preoperative and day-3 postoperative NT-proBNP levels. Analysis was intention to treat. We studied 303 patients (age 74 ± 7 years; females 26%, diabetes 47%), 148 receiving glutamate group and 155 controls. There was no significant difference in the primary endpoint associated with glutamate administration (5,390 ± 5,396 ng/L versus 6,452 ± 5,215 ng/L; p = 0.086). One patient died ≤30 days in the glutamate group compared to 6 controls (0.7% versus 3.9%; p = 0.12). No adverse events linked to glutamate were observed. A significant interaction between glutamate and diabetes was found (p = 0.03). Among patients without diabetes the primary endpoint (mean 4,503 ± 4,846 ng/L versus 6,824 ± 5,671 ng/L; p = 0.007), and the incidence of acute kidney injury (11% versus 29%; p = 0.005) was reduced in the glutamate group. These associations remained significant after adjusting for differences in baseline data. The main limitations of the study are: (i) it relies on a surrogate marker for heart failure; and (ii) the proportion of patients with diabetes had almost doubled compared to the cohort used for the sample size estimation.

Conclusions: Infusion of glutamate did not significantly reduce postoperative rises of NT-proBNP. Diverging results in patients with and without diabetes agree with previous observations and suggest that the concept of enhancing postischemic myocardial recovery with glutamate merits further evaluation.

Place, publisher, year, edition, pages
Public Library of Science (PLoS), 2022
National Category
Cardiac and Cardiovascular Systems Surgery
Identifiers
urn:nbn:se:umu:diva-203142 (URN)10.1371/journal.pmed.1003997 (DOI)000836909800001 ()35533197 (PubMedID)2-s2.0-85130486899 (Scopus ID)
Funder
Swedish Heart Lung Foundation, 20140633Region Östergötland, RO 796412Region Östergötland, RO 693091Region Östergötland, RO 610951
Available from: 2023-01-16 Created: 2023-01-16 Last updated: 2023-03-20Bibliographically approved
Holmgren, A., Enger, T. B., Näslund, U., Videm, V., Valle, S., Evjemo, K. J., . . . Wahba, A. (2021). Long-term results after aortic valve replacement for bicuspid or tricuspid valve morphology in a Swedish population. European Journal of Cardio-Thoracic Surgery, 59(3), 570-576
Open this publication in new window or tab >>Long-term results after aortic valve replacement for bicuspid or tricuspid valve morphology in a Swedish population
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2021 (English)In: European Journal of Cardio-Thoracic Surgery, ISSN 1010-7940, E-ISSN 1873-734X, Vol. 59, no 3, p. 570-576Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Our goal was to study long-term observed and relative survival after first-time aortic valve replacement surgery with or without concomitant coronary artery bypass surgery with reference to valve morphology (i.e. bicuspid vs tricuspid).

METHODS: Consecutive patients (n = 5086) from 3 Swedish hospitals, operated on between 1 January 2005 and 31 December 2016, were included. The 30-day mortality (n = 116, 2.3%) was excluded from the analysis of long-term observed and relative survival (n = 4970). Observed survival was analysed using Cox regression. Relative survival was calculated as the ratio between observed and expected survival based on data from the general Swedish population, matched for age, sex and calendar year. Risk factors for death were explored using multivariable analysis.

RESULTS: During the follow-up (median 4.7 years) period, 1157 (23%) patients died. Observed survival excluding 30-day mortality was 96.6%, 82.7% and 57.6% after 1, 5 and 10 years. Compared with the general Swedish population, the relative 1-, 5- and 10-year survival rates were 99.0%, 97.5% and 89.0%. Bicuspid morphology was independently associated with higher observed and relative long-term survival. Renal dysfunction, diabetes, chronic obstructive pulmonary disease, heart failure, smoking and atrial fibrillation were associated with higher long-term mortality. Combined surgery was not associated with higher observed or relative mortality.

CONCLUSIONS: Patients with a bicuspid morphology had better prognosis, matching that of the general population. With increased age, long-term relative survival compared favourably with survival in the general Swedish population. Adding coronary artery bypass surgery to an aortic valve replacement procedure did not affect long-term outcome.

Place, publisher, year, edition, pages
Oxford University Press, 2021
Keywords
Aortic stenosis, Aortic valve replacement, Bicuspid valve, Observed survival, Relative survival
National Category
Surgery Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-182758 (URN)10.1093/ejcts/ezaa348 (DOI)000646254500007 ()33179723 (PubMedID)2-s2.0-85104275889 (Scopus ID)
Available from: 2021-05-24 Created: 2021-05-24 Last updated: 2023-09-05Bibliographically approved
Holmgren, A., Ljungberg, J., Hultdin, J., Johansson, B., Bergdahl, I., Näslund, U. & Söderberg, S. (2020). Troponin T but not C-reactive protein is associated with future surgery for aortic stenosis: a population based nested case-referent study. Open heart, 7(2), Article ID e001325.
Open this publication in new window or tab >>Troponin T but not C-reactive protein is associated with future surgery for aortic stenosis: a population based nested case-referent study
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2020 (English)In: Open heart, E-ISSN 2053-3624, Vol. 7, no 2, article id e001325Article in journal (Refereed) Published
Abstract [en]

Aims: High-sensitivity troponin T (hs-TnT) and high-sensitivity C reactive protein (hs-CRP) may convey prognostic information in patients with aortic stenosis (AS). This study evaluated if hs-TnT and hs-CRP associate with myocardial mass, and risk of future surgery for AS.

Methods: In total, 336 patients (48% women) with surgery for AS with previous participation in large population surveys were identified. Preoperatively, myocardial mass and the presence of coronary artery disease (CAD) were assessed. Two matched referents were allocated for each case, and hs-TnT and hs-CRP were determined in stored plasma from the baseline survey. Conditional logistic regression analysis was used to estimate the risk (OR (95% CI)) related to one (natural logarithm) SD increase in hs-TnT and hs-CRP. Kaplan-Mayer and Cox regression analyses were used to evaluate time to surgery.

Results: Median age (IQR) was 59.8 (10.3) years at survey, and median time between survey and surgery was 10.9 (9.3) years. Hs-TnT was independently associated with surgery for AS (1.24 (1.06–1.44)) irrespective of CAD, whereas Hs-CRP was not (1.05 (0.90–1.22)). Elevated hs-TnT levels at survey associated with shorter time to surgery (p<0.001), and with increased myocardial mass (p=0.002). Hs-CRP did not associate with time to surgery or with myocardial mass.

Conclusions: Hs-TnT—but not hs-CRP—was associated with increased risk of—and shorter time to—future surgery for AS. Hs-TnT associated with myocardial mass at surgery which indicates that hs-TnT could be a potential biomarker for determining intervention.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2020
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-159019 (URN)10.1136/openhrt-2020-001325 (DOI)000583257500001 ()33051334 (PubMedID)2-s2.0-85093503026 (Scopus ID)
Funder
Swedish Heart Lung Foundation, 20140799Swedish Heart Lung Foundation, 20 120 631Swedish Heart Lung Foundation, 20100635Region Västerbotten, VLL-548791
Note

Previously included in thesis in manuscript form

Available from: 2019-05-16 Created: 2019-05-16 Last updated: 2023-03-24Bibliographically approved
Söderberg, S., Holmgren, A., Ljungberg, J., Hultdin, J., Bergdahl, I., Näslund, U. & Johansson, B. (2020). Troponin T but not C-reactive protein is associated with myocardial mass and risk for, and time to future surgery for aortic stenosis: a population-based study. European Heart Journal, 41, 1884-1884
Open this publication in new window or tab >>Troponin T but not C-reactive protein is associated with myocardial mass and risk for, and time to future surgery for aortic stenosis: a population-based study
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2020 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 41, p. 1884-1884Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Oxford University Press, 2020
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-180149 (URN)10.1093/ehjci/ehaa946.1884 (DOI)000606106301887 ()
Note

Supplement: 2

Available from: 2021-02-18 Created: 2021-02-18 Last updated: 2022-02-14Bibliographically approved
Holmgren, A. (2019). Metabolic risk markers and relative survival in patients with aortic stenosis requiring surgery. (Doctoral dissertation). Umeå: Umeå universitet
Open this publication in new window or tab >>Metabolic risk markers and relative survival in patients with aortic stenosis requiring surgery
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

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

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

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

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

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

Place, publisher, year, edition, pages
Taylor & Francis, 2019
Keywords
Aortic stenosis, valvular replacement, renal insufficiency, creatinine, cystatin C
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-164404 (URN)10.1080/00365513.2019.1664761 (DOI)000486559100001 ()31522562 (PubMedID)2-s2.0-85073124103 (Scopus ID)
Available from: 2019-11-05 Created: 2019-11-05 Last updated: 2023-03-24Bibliographically approved
Ljungberg, J., Janiec, M., Bergdahl, I., Holmgren, A., Hultdin, J., Johansson, B., . . . Söderberg, S. (2018). Proteomic Biomarkers for Incident Aortic Stenosis Requiring Valvular Replacement. Circulation, 138(6)
Open this publication in new window or tab >>Proteomic Biomarkers for Incident Aortic Stenosis Requiring Valvular Replacement
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2018 (English)In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 138, no 6Article in journal (Refereed) Published
Abstract [en]

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

Keywords
aortic stenosis, aortic valve surgery, prospective study, proteomics, risk markers
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:umu:diva-145712 (URN)10.1161/CIRCULATIONAHA.117.030414 (DOI)000440866500011 ()29487139 (PubMedID)2-s2.0-85049318490 (Scopus ID)
Available from: 2018-04-09 Created: 2018-04-09 Last updated: 2023-03-24Bibliographically approved
Bagge, L., Probst, J., Jensen, S. M., Blomström, P., Thelin, S., Holmgren, A. & Blomström-Lundqvist, C. (2018). Quality of life is not improved aftermitral valve surgery combined with epicardial left atrial cryoablation as compared with mitral valve surgery alone: a substudy of the double blind randomized SWEDish Multicentre Atrial Fibrillation study (SWEDMAF). Europace, 20, F343-F350
Open this publication in new window or tab >>Quality of life is not improved aftermitral valve surgery combined with epicardial left atrial cryoablation as compared with mitral valve surgery alone: a substudy of the double blind randomized SWEDish Multicentre Atrial Fibrillation study (SWEDMAF)
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2018 (English)In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 20, p. F343-F350Article in journal (Refereed) Published
Abstract [en]

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

Place, publisher, year, edition, pages
Oxford University Press, 2018
Keywords
Quality-of-life, Ablation, Atrial fibrillation, Mitral valve surgery, Concomitant surgical ablation
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-155246 (URN)10.1093/europace/eux253 (DOI)000454047100014 ()29016835 (PubMedID)2-s2.0-85057277931 (Scopus ID)
Note

Special Issue: 3

Available from: 2019-01-14 Created: 2019-01-14 Last updated: 2023-03-24Bibliographically approved
Ljungberg, J., Holmgren, A., Bergdahl, I. A., Hultdin, J., Norberg, M., Näslund, U., . . . Söderberg, S. (2017). Lipoprotein(a) and the Apolipoprotein B/A1 Ratio Independently Associate With Surgery for Aortic Stenosis Only in Patients With Concomitant Coronary Artery Disease. Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, 6(12), Article ID e007160.
Open this publication in new window or tab >>Lipoprotein(a) and the Apolipoprotein B/A1 Ratio Independently Associate With Surgery for Aortic Stenosis Only in Patients With Concomitant Coronary Artery Disease
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2017 (English)In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 6, no 12, article id e007160Article in journal (Refereed) Published
Abstract [en]

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

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

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

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
Keywords
aortic stenosis, aortic valve surgery, apolipoproteins, lipoprotein(a), prospective cohort study, risk markers
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-143323 (URN)10.1161/JAHA.117.007160 (DOI)000418951100046 ()29246959 (PubMedID)2-s2.0-85038819154 (Scopus ID)
Available from: 2017-12-20 Created: 2017-12-20 Last updated: 2023-03-24Bibliographically approved
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