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Lundström, A., Wiklund, U., Winbo, A., Eliasson, H., Karlsson, M. & Rydberg, A. (2023). Cardiac response to water activities in children with Long QT syndrome type 1. PLOS ONE, 18(12), Article ID e0295431.
Open this publication in new window or tab >>Cardiac response to water activities in children with Long QT syndrome type 1
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2023 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 18, no 12, article id e0295431Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Swimming is a genotype-specific trigger in long QT syndrome type 1 (LQT1).

OBJECTIVE: To examine the autonomic response to water activities in children and adolescents with LQT1.

METHODS: In this cross-sectional study, LQT1 patients were age and sex matched to one healthy control subject. Electrocardiograms (ECGs) were recorded during face immersion (FI), swimming, diving, and whole-body submersion (WBS). Heart rate (HR) and heart rate variability (HRV) was measured. The high frequency (HF) component of HRV was interpreted to reflect parasympathetic activity, while the low frequency (LF) component was interpreted as reflecting the combined influence of sympathetic and parasympathetic activity on autonomic nervous modulation of the heart.

RESULTS: Fifteen LQT1 patients (aged 7-19 years, all on beta-blocker therapy) and fifteen age and sex matched non-medicated controls were included. No significant ventricular arrhythmias were observed in the LQT1 population during the water activities. Out of these 15 matched pairs, 12 pairs managed to complete FI and WBS for more than 10 seconds and were subsequently included in HR and HRV analyses. In response to FI, the LQT1 group experienced a drop in HR of 48 bpm, compared to 67 bpm in the control group (p = 0.006). In response to WBS, HR decreased by 48 bpm in the LQT1 group and 70 bpm in the control group (p = 0.007). A significantly lower PTOT (p < 0.001) and HF (p = 0.011) component was observed before, during and after FI in LQT1 patients compared with the controls. Before, during and after WBS, a significantly lower total power (p < 0.001), LF (p = 0.002) and HF (p = 0.006) component was observed in the LQT1 patients.

CONCLUSION: A significantly lower HR decrease in response to water activities was observed in LQT1 subjects on beta-blocker therapy, compared to matched non-medicated controls. The data suggests an impaired parasympathetic response in LQT1 children and adolescents. An aberrant autonomic nervous system (ANS) response may cause an autonomic imbalance in this patient group.

Place, publisher, year, edition, pages
Public Library of Science (PLoS), 2023
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-218679 (URN)10.1371/journal.pone.0295431 (DOI)38060596 (PubMedID)2-s2.0-85179900660 (Scopus ID)
Available from: 2023-12-27 Created: 2023-12-27 Last updated: 2024-03-27Bibliographically approved
Erelund, S., Södergren, A., Wiklund, U. & Sundström, N. (2023). Heart rate variability and cardiovascular risk factors in patients with rheumatoid arthritis: a longitudinal study. Autonomic Neuroscience: Basic & Clinical, 249, Article ID 103119.
Open this publication in new window or tab >>Heart rate variability and cardiovascular risk factors in patients with rheumatoid arthritis: a longitudinal study
2023 (English)In: Autonomic Neuroscience: Basic & Clinical, ISSN 1566-0702, E-ISSN 1872-7484, Vol. 249, article id 103119Article in journal (Refereed) Published
Abstract [en]

Background: It is established that the risk of cardiovascular disease (CVD) is increased in patients with Rheumatoid Arthritis (RA). Heart rate variability (HRV) is a method for evaluating the activity in the cardiac autonomic nervous system. Our aim was to assess the longitudinal development of HRV in patients with RA and compare with healthy controls. Furthermore, we wanted to investigate associations between HRV, inflammatory disease activity and cardiovascular complications in patients with RA over time.

Method: HRV was assessed with frequency-domain analysis at baseline and after five years in 50 patients with early RA, all being younger than 60 years. HRV indices were age-adjusted based on the estimated age-dependency in 100 age and sex matched healthy controls. Additionally, clinical data including serological markers, disease activity, and blood pressure were collected from the patients. Eleven years after inclusion CVD was assessed.

Results: At baseline, patients with RA presented with lower HRV compared to controls during deep breathing (6 breaths/min), paced normal breathing (12 breaths/min) and after passive tilt to the upright position. No significant change in HRV was observed at the five-year follow-up. A significant negative correlation was found between HRV parameters and systolic blood pressure (SBP) at baseline. A significant positive correlation was found between heart rate and inflammatory markers at baseline but not after five years. Nine patients had developed CVD after 11 years, but no significant association was found with baseline HRV data.

Conclusion: This study showed that patients with RA have autonomic imbalance both at an early stage of the disease and after five years, despite anti-rheumatic medication, but no correlation between HRV and inflammation markers were observed. Reduced HRV was also significantly negatively correlated with increased SBP. Hypertension is a common finding in patients with RA. Thus, significant decline of HRV could be a useful early marker for development of hypertension in patients with RA.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Autonomic nervous system, Clinical physiology, Heart rate variability, Rheumatoid arthritis
National Category
Cardiac and Cardiovascular Systems Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:umu:diva-214502 (URN)10.1016/j.autneu.2023.103119 (DOI)37703773 (PubMedID)2-s2.0-85170415207 (Scopus ID)
Funder
Region VästerbottenSwedish Research CouncilKnut and Alice Wallenberg FoundationSwedish Rheumatism AssociationVisare NorrSwedish Heart Lung FoundationStiftelsen Konung Gustaf V:s 80-årsfondSwedish Society of Medicine
Available from: 2023-09-21 Created: 2023-09-21 Last updated: 2023-11-02Bibliographically approved
Wikner, A., Sandström, A., Rinnström, D., Wiklund, U., Christersson, C., Dellborg, M., . . . Sandberg, C. (2023). Impaired exercise capacity and mortality risk in adults with congenital heart disease. JACC: Advances, 2(5), 100422-100422, Article ID 100422.
Open this publication in new window or tab >>Impaired exercise capacity and mortality risk in adults with congenital heart disease
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2023 (English)In: JACC: Advances, ISSN 2772-963X, Vol. 2, no 5, p. 100422-100422, article id 100422Article in journal (Refereed) Published
Abstract [en]

Background: An association between impaired exercise capacity and risk of mortality has been reported among adults with congenital heart disease (CHD). Over the years, treatment methods have improved and may influence outcome. Hence, we report data from a national cohort reflecting a contemporary population.

Objectives: The purpose of this study was to investigate the association between exercise capacity (workload) and mortality in a large registry-based cohort.

Methods: Data on exercise capacity using cycle ergometer were retrieved from the national registry of CHD. The association between predicted exercise capacity (%ECpred) and mortality was analyzed using Cox regression.

Results: In total, 3,721 adults (>18 years, 44.6% women) with CHD were included. The median age was 27.0 years (IQR: 20.8-41.0 years) and mean %ECpred was 77% ± 20%. Over a mean follow-up of 9.4 ± 6.0 years, there were 214 (5.8%) deaths. The Multivariable Cox regression model showed that moderately and severely impaired exercise capacity (50-<70 %ECpred: HR: 2.1, 95% CI: 1.4-3.2, P < 0.001, and <50 %ECpred: HR: 3.5, 95% CI: 2.1-6.0, P < 0.001) and CHD complexity were associated with higher mortality (moderate complexity: HR: 1.9 95% CI: 1.2-3.0, P = 0.003, great complexity: HR: 2.3 95% CI: 1.3-4.2, P = 0.008) when adjusted for New York Heart Association class, physical activity, cardiovascular medication, sex, impaired systemic ventricular function, and age.

Conclusions: Impaired exercise capacity and CHD complexity are independently associated with all-cause mortality in patients with CHD. Exercise capacity is an easily accessible variable that may be a useful tool for risk assessment in adult patients with CHD, but this needs confirmation in prospective studies.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
aerobic exercise capacity, congenital heart disease, exercise test, mortality, outcome
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:umu:diva-215208 (URN)10.1016/j.jacadv.2023.100422 (DOI)2-s2.0-85179944904 (Scopus ID)
Funder
Swedish Heart Lung Foundation, 20200493Swedish Heart Lung Foundation, 20190525Swedish Heart Lung Foundation, 20170483Swedish Heart Lung Foundation, 20130472Swedish Heart Lung Foundation, 20100355Umeå UniversityRegion VästerbottenVisare Norr
Available from: 2023-10-11 Created: 2023-10-11 Last updated: 2024-01-12Bibliographically approved
Andersen, L., Appelblad, M., Wiklund, U., Sundström, N. & Svenmarker, S. (2023). Our initial experience of monitoring the autoregulation of cerebral blood flow during cardiopulmonary bypass. The journal of extra-corporeal technology, 55(4), 209-217
Open this publication in new window or tab >>Our initial experience of monitoring the autoregulation of cerebral blood flow during cardiopulmonary bypass
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2023 (English)In: The journal of extra-corporeal technology, ISSN 0022-1058, Vol. 55, no 4, p. 209-217Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Cerebral blood flow (CBF) is believed to be relatively constant within an upper and lower blood pressure limit. Different methods are available to monitor CBF autoregulation during surgery. This study aims to critically analyze the application of the cerebral oxygenation index (COx), one of the commonly used techniques, using a reference to data from a series of clinical registrations.

METHOD: CBF was monitored using near-infrared spectroscopy, while cerebral blood pressure was estimated by recordings obtained from either the radial or femoral artery in 10 patients undergoing cardiopulmonary bypass. The association between CBF and blood pressure was calculated as a moving continuous correlation coefficient. A COx index > 0.4 was regarded as a sign of abnormal cerebral autoregulation (CA). Recordings were examined to discuss reliability measures and clinical feasibility of the measurements, followed by interpretation of individual results, identification of possible pitfalls, and suggestions of alternative methods.

RESULTS AND CONCLUSION: Monitoring of CA during cardiopulmonary bypass is intriguing and complex. A series of challenges and limitations should be considered before introducing this method into clinical practice.

Place, publisher, year, edition, pages
EDP Sciences, 2023
Keywords
Autoregulation, Cardiopulmonary bypass, Cerebral blood flow, Monitoring, Near-infrared spectroscopy
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-218633 (URN)10.1051/ject/2023032 (DOI)38099638 (PubMedID)2-s2.0-85179772071 (Scopus ID)
Available from: 2023-12-27 Created: 2023-12-27 Last updated: 2023-12-27Bibliographically approved
Erelund, S., Karp, K., Arvidsson, S., Johansson, B., Sundström, N. & Wiklund, U. (2023). Pulmonary function in a cohort of heart-healthy individuals from Northern Sweden: a comparison with discordant reference values. BMC Pulmonary Medicine, 23(1), Article ID 110.
Open this publication in new window or tab >>Pulmonary function in a cohort of heart-healthy individuals from Northern Sweden: a comparison with discordant reference values
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2023 (English)In: BMC Pulmonary Medicine, E-ISSN 1471-2466, Vol. 23, no 1, article id 110Article in journal (Refereed) Published
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.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Clinical physiology, Linear regression, Lung function, Reference values, Spirometry
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-206770 (URN)10.1186/s12890-023-02403-w (DOI)000963360400001 ()37020237 (PubMedID)2-s2.0-85151789612 (Scopus ID)
Available from: 2023-04-26 Created: 2023-04-26 Last updated: 2024-01-17Bibliographically approved
Sundström, E., Jensen, S. M., Diamant, U.-B., Wiklund, U. & Rydberg, A. (2022). ICD harm and benefit: risk scores applied to the Swedish ICD-treated LQTS population. Scandinavian Cardiovascular Journal, 56(1), 48-55
Open this publication in new window or tab >>ICD harm and benefit: risk scores applied to the Swedish ICD-treated LQTS population
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2022 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 56, no 1, p. 48-55Article in journal (Refereed) Published
Abstract [en]

The use of implantable cardioverter defibrillators (ICDs) in long QT syndrome (LQTS) patients is essential in high-risk patients. However, it is sometimes used in patients without high-risk profiles for whom the expected benefit may be lower than the risk of ICD harm. Here, we evaluated ICD benefit and harm by assessing risk according to risk scores and pre-ICD clinical characteristics. Design. We studied 109 Swedish LQTS patients drawn from the Swedish ICD and Pacemaker Registry with data collected from medical records. In addition to clinical characteristics, we used two risk scores to assess pre-ICD risk, and evaluated ICD benefit and harm. Results. Twenty percent of all patients received ≥1 appropriate shock with a first appropriate shock incidence rate of 4.3 per 100 person-years. A long QTc (≥550 ms) and double mutations were significantly associated with appropriate shock. Low risk scores among patients without pre-ICD aborted cardiac arrest were not significantly associated with low risk of first appropriate shock. The incidence rates of a first inappropriate shock and first complication were 3.0 and 7.6 per 100 person-years, respectively. Conclusion. Our findings on ICD harm emphasize the importance of careful individual pre-ICD consideration. When we applied two risk scores to patients without pre-ICD aborted cardiac arrest, we could not validate their ability to identify patients with low risk of appropriate shocks and patients who were assessed as having a low risk still received appropriate shocks. This further supports the complexity of risk stratification and the difficulty of using risk scores.

Place, publisher, year, edition, pages
Taylor & Francis, 2022
Keywords
benefit, harm, implantable cardioverter defibrillator, Long QT syndrome, risk, Sweden
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-194538 (URN)10.1080/14017431.2022.2060524 (DOI)000788341300001 ()35481393 (PubMedID)2-s2.0-85128932257 (Scopus ID)
Funder
Swedish Heart Lung Foundation, 20150482Region Västerbotten, 7002996
Available from: 2022-05-09 Created: 2022-05-09 Last updated: 2024-04-24Bibliographically approved
Hansson, L., Sandberg, C., Öhlund, I., Lind, T., Sthen Bergdahl, M., Wiklund, U., . . . Rydberg, A. (2022). Vitamin D, liver-related biomarkers, and distribution of fat and lean mass in young patients with Fontan circulation. Cardiology in the Young, 32(6), 861-868
Open this publication in new window or tab >>Vitamin D, liver-related biomarkers, and distribution of fat and lean mass in young patients with Fontan circulation
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2022 (English)In: Cardiology in the Young, ISSN 1047-9511, E-ISSN 1467-1107, Vol. 32, no 6, p. 861-868Article in journal (Refereed) Published
Abstract [en]

Introduction/aim: Young patients with Fontan circulation may have low serum 25-hydroxyvitamin D levels, an affected liver, and unhealthy body compositions. This study aimed to explore the association between vitamin D intake/levels, liver biomarkers, and body composition in young Fontan patients.

Method: We collected prospective data in 2017 to 2018, obtained with food-frequency questionnaires, biochemical analyses of liver biomarkers, and dual-energy X-ray absorptiometry scans in 44 children with Fontan circulation. Body compositions were compared to matched controls (n = 38). Linear regression analyses were used to investigate associations of biomarkers, leg pain, and lean mass on serum levels of 25-hydroxyvitamin D. Biomarkers were converted to z scores and differences were evaluated within the Fontan patients.

Results: Our Fontan patients had a daily mean vitamin D intake of 9.9 µg and a mean serum 25-hydroxyvitamin D of 56 nmol/L. These factors were not associated with fat or lean mass, leg pain, or biomarkers of liver status. The Fontan patients had significantly less lean mass, but higher fat mass than controls. Male adolescents with Fontan circulation had a greater mean abdominal fat mass than male controls and higher cholesterol levels than females with Fontan circulation.

Conclusion: Vitamin D intake and serum levels were not associated with body composition or liver biomarkers in the Fontan group, but the Fontan group had lower lean mass and higher fat mass than controls. The more pronounced abdominal fat mass in male adolescents with Fontan circulation might increase metabolic risks later in life.

Place, publisher, year, edition, pages
Cambridge University Press, 2022
Keywords
CHD, Fontan circulation, vitamin D, micronutrient intake, body composition
National Category
Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:umu:diva-176573 (URN)10.1017/S1047951121003115 (DOI)000752691600001 ()34338624 (PubMedID)2-s2.0-85112065396 (Scopus ID)
Funder
Swedish Heart Lung Foundation, 20160496
Note

Originally included in thesis in manuscript form.

Available from: 2020-11-09 Created: 2020-11-09 Last updated: 2022-11-29Bibliographically approved
Lundström, A., Wiklund, U., Law, L., Jensen, S. M., Karlsson, M. & Rydberg, A. (2021). Aberrant autonomic pattern during the post-exercise recovery phase in long QT syndrome patients. Autonomic Neuroscience: Basic & Clinical, 236, Article ID 102897.
Open this publication in new window or tab >>Aberrant autonomic pattern during the post-exercise recovery phase in long QT syndrome patients
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2021 (English)In: Autonomic Neuroscience: Basic & Clinical, ISSN 1566-0702, E-ISSN 1872-7484, Vol. 236, article id 102897Article in journal (Refereed) Published
Abstract [en]

Objectives: It is well-established that the autonomic nervous system (ANS) plays a central role in arrhythmogenesis. During and after exercise the ANS is particularly active, and since long QT syndrome (LQTS) patients have an increased risk of lethal arrhythmias during physical activity, it is important to investigate the autonomic function in these patients. In this study we investigate the ANS response during and after exercise in LQTS patients and healthy age and sex matched controls.

Methods: Forty-four genotype-verified adult LQTS patients and forty-four healthy age- and sex-matched controls performed a submaximal bicycle exercise stress test. Heart rate recovery (HRR) and heart rate variability (HRV) were analyzed from registered electrocardiogram (ECG) and vector electrocardiogram (VCG) recordings collected throughout rest, exercise and in the post-exercise phase.

Results: LQTS patients had a slower HRR than controls at 1- and 4-min post-exercise (p < 0.001). During the post-exercise phase, LQTS patients had a lower total power (p < 0.001), low frequency power (p < 0.001) and high frequency power (p < 0.001) than controls. In the same phase, LQTS patients off betablocker (BB) treatment showed a lower high frequency power (p = 0.01) and different low frequency/high frequency ratio (p = 0.003) when comparing with LQTS patients on BB treatment.

Conclusions: The parasympathetic effect on both HRR and HRV after exercise appears depressed in this LQTS patient cohort compared to healthy controls. This indicates an aberrant ANS response during the post-exercise phase which might be compensated by BB treatment. Our findings emphasize the importance of performing further investigations to identify the role of the ANS in LQTS arrhythmogenesis.

Place, publisher, year, edition, pages
Elsevier, 2021
Keywords
Arrhythmia, Autonomic, Exercise, Heart rate recovery, Heart rate variability, Long QT syndrome
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-189666 (URN)10.1016/j.autneu.2021.102897 (DOI)000719914400003 ()2-s2.0-85118836483 (Scopus ID)
Funder
Swedish Heart Lung Foundation, 20150482Region Västerbotten
Note

Corrigendum: Anna Lundström, Urban Wiklund, Lucy Law, Steen Jensen, Marcus Karlsson, Annika Rydberg, Corrigendum to "Aberrant autonomic pattern during the post-exercise recovery phase in Long QT syndrome patients", Autonomic Neuroscience, 2022, 102931. DOI: 10.1016/j.autneu.2021.102931

Available from: 2021-11-19 Created: 2021-11-19 Last updated: 2024-03-27Bibliographically approved
Lundqvist, M. H., Almby, K., Wiklund, U., Abrahamsson, N., Kamble, P. G., Pereira, M. J. & Eriksson, J. W. (2021). Altered hormonal and autonomic nerve responses to hypo- and hyperglycaemia are found in overweight and insulin-resistant individuals and may contribute to the development of type 2 diabetes. Diabetologia, 64(3), 641-655
Open this publication in new window or tab >>Altered hormonal and autonomic nerve responses to hypo- and hyperglycaemia are found in overweight and insulin-resistant individuals and may contribute to the development of type 2 diabetes
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2021 (English)In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 64, no 3, p. 641-655Article in journal (Refereed) Published
Abstract [en]

Aims/hypothesis: Results from animal models and some clinical work suggest a role for the central nervous system (CNS) in glucose regulation and type 2 diabetes pathogenesis by modulation of glucoregulatory hormones and the autonomic nervous system (ANS). The aim of this study was to characterise the neuroendocrine response to various glucose concentrations in overweight and insulin-resistant individuals compared with lean individuals.

Methods: Overweight/obese (HI, n = 15, BMI ≥27.0 kg/m2) and lean (LO, n = 15, BMI <27.0 kg/m2) individuals without diabetes underwent hyperinsulinaemic euglycaemic–hypoglycaemic clamps and hyperglycaemic clamps on two separate occasions with measurements of hormones, Edinburgh Hypoglycaemic Symptom Scale (ESS) score and heart rate variability (HRV). Statistical methods included groupwise comparisons with Mann–Whitney U tests, multilinear regressions and linear mixed models between neuroendocrine responses and continuous metabolic variables.

Results: During hypoglycaemic clamps, there was an elevated cortisol response in HI vs LO (median ΔAUC 12,383 vs 4793 nmol/l × min; p = 0.050) and a significantly elevated adrenocorticotropic hormone (ACTH) response in HI vs LO (median ΔAUC 437.3 vs 162.0 nmol/l × min; p = 0.021). When adjusting for clamp glucose levels, obesity (p = 0.033) and insulin resistance (p = 0.009) were associated with elevated glucagon levels. By contrast, parasympathetic activity was less suppressed in overweight individuals at the last stage of hypoglycaemia compared with euglycaemia (high-frequency power of HRV, p = 0.024). M value was the strongest predictor for the ACTH and PHF responses, independent of BMI and other variables. There was a BMI-independent association between the cortisol response and ESS score response (p = 0.024). During hyperglycaemic clamps, overweight individuals displayed less suppression of glucagon levels (median ΔAUC −63.4% vs −73.0%; p = 0.010) and more suppression of sympathetic relative to parasympathetic activity (low-frequency/high-frequency power, p = 0.011).

Conclusions/interpretation: This study supports the hypothesis that altered responses of insulin-antagonistic hormones and the ANS to glucose fluctuations occur in overweight and insulin-resistant individuals, and that these responses are probably partly mediated by the CNS. Their potential role in development of type 2 diabetes needs to be addressed in future research.

Place, publisher, year, edition, pages
Springer, 2021
Keywords
ACTH, Central nervous system, Cortisol, Diabetes, Glucoregulatory hormones, Glucose, Insulin resistance, Obesity
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-177495 (URN)10.1007/s00125-020-05332-z (DOI)000592558000001 ()33241460 (PubMedID)2-s2.0-85096588761 (Scopus ID)
Funder
Swedish Diabetes AssociationErnfors FoundationNovo NordiskEXODIAB - Excellence of Diabetes Research in Sweden
Available from: 2020-12-29 Created: 2020-12-29 Last updated: 2023-03-24Bibliographically approved
Erelund, S., Karp, K., Wiklund, U., Hörnsten, R. & Arvidsson, S. (2021). Are ECG changes in heart-healthy individuals of various ages related to cardiac disease 20 years later?. Upsala Journal of Medical Sciences, 126(1), Article ID e6064.
Open this publication in new window or tab >>Are ECG changes in heart-healthy individuals of various ages related to cardiac disease 20 years later?
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2021 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 126, no 1, article id e6064Article in journal (Refereed) Published
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.

Place, publisher, year, edition, pages
Upsala Medical Society, 2021
Keywords
Arrhythmia, Clinical physiology, Electrocardiogram, Heart function test, Normal values
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-186419 (URN)10.48101/ujms.v126.6064 (DOI)000683141300001 ()2-s2.0-85110436769 (Scopus ID)
Funder
Region Västerbotten
Available from: 2021-07-29 Created: 2021-07-29 Last updated: 2023-11-02Bibliographically approved
Projects
State-space approach for analysis of the short-term interactions in systems with circular causality: Assessment of the autonomic control of heart rate and blood pressure variability [2008-03292_VR]; Umeå UniversityRealtime interactive cognitive architecture for prediction of autonomic cardiovascular dysregulation [2015-04677_VR]; Umeå University
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-1313-0934

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