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  • 1.
    Andersson, Jonas
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Mellberg, Caroline
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Otten, Julia
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Ryberg, Mats
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Rinnström, Daniel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Larsson, Christel
    Lindahl, Bernt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Hauksson, Jon
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper. d Department of Radiography and Biomedical Science, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Olsson, Tommy
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Left ventricular remodelling changes without concomitant loss of myocardial fat after long-term dietary intervention2016Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 216, s. 92-96Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Accumulation of myocardial triglycerides (MTG) is associated with impaired left ventricular (LV) remodelling and function in obese and diabetic subjects. The role of MTG accumulation in development of heart failure in this group of patients is unknown. Short-term studies suggest that diets that lead to weight loss could mobilize MTG, with a favourable effect on cardiac remodelling. In a 24-month, randomized, investigator-blinded study, we assessed the effect of two different diets and subsequent weight loss on cardiac function and MTG in postmenopausal women. Methods: Sixty-eight healthy postmenopausal women with body mass index [BMI] >= 27 kg/m(2) were randomized to an ad libitum Palaeolithic diet (PD) or a Nordic Nutrition Recommendation (NNR) diet for 24 months. Morphology, cardiac function, and MTG levels were measured using magnetic resonance (MR) scanning, including proton spectroscopy at baseline and 6 and 24 months. Results: Despite mean weight losses of 4.9 (1.0) kg (NNR) and 7.8 (1.1) kg (PD), the MTG content did not change over time (p = 0.98 in the NNR and p = 0.11 in the PD group at 24 months). Reduced left ventricular mass was observed in both diet groups over 24 months. Blood pressure was reduced at 6 months, but returned to baseline levels at 24 months. End diastolic volume, stroke volume, and cardiac output decreased over time. No differences between diet groups were observed. Conclusions: Diet intervention and moderate weight loss over 24 months improved LV remodelling but did not alter MTG levels in overweight/obese postmenopausal women.

  • 2. Apers, Silke
    et al.
    Kovacs, Adrienne H.
    Luyckx, Koen
    Alday, Luis
    Berghammer, Malin
    Budts, Werner
    Callus, Edward
    Caruana, Maryanne
    Chidambarathanu, Shanthi
    Cook, Stephen C.
    Dellborg, Mikael
    Enomoto, Junko
    Eriksen, Katrine
    Fernandes, Susan M.
    Jackson, Jamie L.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Khairy, Paul
    Kutty, Shelby
    Menahem, Samuel
    Rempel, Gwen
    Sluman, Maayke A.
    Soufi, Alexandra
    Thomet, Corina
    Veldtman, Gruschen
    Wang, Jou-Kou
    White, Kamila
    Moons, Philip
    Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease - International Study (APPROACH-IS): Rationale, design, and methods2015Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 179, s. 334-342Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Data on patient-reported outcomes (PROs) in adults with congenital heart disease (CHD) are inconsistent and vary across the world. Better understanding of PROs and their differences across cultural and geographic barriers can best be accomplished via international studies using uniform research methods. The APPROACH-IS consortium (Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease - International Study) was created for this purpose and investigates PROs in adults with CHD worldwide. This paper outlines the project rationale, design, and methods. Methods/design: APPROACH-IS is a cross-sectional study. The goal is to recruit 3500-4000 adults with CHD from 15 countries in five major regions of the world (Asia, Australia, Europe, North and South America). Self-report questionnaires are administered to capture information on PRO domains: (i) perceived health status (12-item Short-form Health Survey & EuroQOL-5D); (ii) psychological functioning (Hospital Anxiety and Depression Scale); (iii) health behaviors (Health-Behavior Scale-Congenital Heart Disease); and (iv) quality of life (Linear Analog Scale & Satisfaction With Life Scale). Additionally, potential explanatory variables are assessed: (i) socio-demographic variables; (ii) medical history (chart review); (iii) sense of coherence (Orientation to Life Questionnaire); and (iv) illness perceptions (Brief Illness Perception Questionnaire). Descriptive analyses and multilevel models will examine differences in PROs and investigate potential explanatory variables. Discussion: APPROACH-IS represents a global effort to increase research understanding and capacity in the field of CHD, and will have major implications for patient care. Results will generate valuable information for developing interventions to optimize patients' health and well-being. 

  • 3.
    Backman, Christer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Klinisk fysiologi.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Tossavainen, Erik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Henein, Michael Y
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Unusual arrhythmogenic myocardial disease2014Ingår i: International Cardiovascular Forum Journal, ISSN 2410-2636, Vol. 1, nr 4, s. 195-196Artikel i tidskrift (Refereegranskat)
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  • 4.
    Bay, Annika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Berghammer, M.
    Lämås, Kristina
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Sandberg, Camilla
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Facilitators and barriers for physical activity in adults with congenital heart disease2018Ingår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, s. 1120-1121Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Background: A majority of adults with congenital heart disease (CHD) have reduced exercise capacity and do not reach the recommended level of physical activity. A physically active lifestyle is essential to maintain health and counteract acquired cardiovascular disease. This study illuminates aspects that may be relevant for performing physical activity.

    Purpose: To describe facilitators and barriers for physical activity in adults with CHD.

    Methods: Semi-structured interviews were performed individually with fourteen adults (age 19–68 years, women=7) with complex CHD. The interviews were analyzed using qualitative content analysis.

    Results: Aspects that may enable or inhibit physical activity were found in two domains; Facilitators and Barriers, which both consisted of four categories physical, psychological, psychosocial and environmental aspects (Table 1).

    This can be exemplified by the category physical aspects; where persons expressed being limited by the CHD to perform physical activity, but also that improved aerobic fitness allows for being more active, and in the category psychosocial aspects; the person's previous negative experiences and lack of support constituted barriers while encouragement from others and being active as a child facilitated an active lifestyle in adult age.

    Conclusion: The present study identifies barriers and facilitators for being physically active in adults living with CHD. It is essential to identify prerequisites for supporting and promoting physical activity and thereby hopefully prevent long-term adverse outcomes. Barriers can potentially be transformed to facilitators through increased knowledge in both the adult with CHD and the healthcare provider.

  • 5.
    Bay, Annika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Berghammer, Malin
    Institute of Health Sciences, University West and Queen Silvia Children Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Burström, Åsa
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Holstad, Ylva
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Christersson, Christina
    Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.
    Dellborg, Mikael
    Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Trzebiatowska-Krzynska, Aleksandra
    Department of Cardiology and Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
    Sörensson, Peder
    Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
    Thilén, Ulf
    Department of Clinical Sciences, Cardiology, Lund University, Lund, Sweden.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Symptoms during pregnancy in primiparous women with congenital heart disease2024Ingår i: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 58, nr 1, artikel-id 2302135Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: As more women with congenital heart disease (CHD) are reaching childbearing age, it becomes more common for their symptoms to be evaluated during pregnancy. However, pregnancy-related symptoms are similar to those caused by heart disease. This study investigated the prevalence of factors associated with symptoms during pregnancy in women with CHD.

    Methods: The national birth register was searched for primiparous women with CHD who were registered in the national quality register for patients with CHD.

    Results: Symptoms during the third trimester were reported in 104 of 465 evaluated women. The most common symptom was palpitations followed by dyspnea. Factors associated with symptoms were tested in a univariable model; higher NYHA classification (>1) (OR 11.3, 95%CI 5.5–23.2), low physical activity (≤3 h/week) (OR 2.1 95%CI 1.3–3.6) and educational level ≤ 12 years (OR 1.9 95%CI 1.2–3.0) were associated with having symptoms. In multivariable analysis, low physical activity level (OR 2.4 95%CI 1.2–5.0) and higher NYHA class (OR 11.3 95%CI 5.0–25.6) remained associated with symptoms during pregnancy. There were no cases with new onset of impaired systemic ventricular function during pregnancy.

    Conclusion: Symptoms during pregnancy are common in women with CHD but are often already present before pregnancy. Because ordinary symptoms during pregnancy often overlap with symptoms of heart disease, it is important to know if symptoms were present before pregnancy and if they became worse during pregnancy. These results should be included in pre-pregnancy counselling and considered in the monitoring during pregnancy.

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  • 6.
    Bay, Annika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Berghammer, Malin
    Lämås, Kristina
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Sandberg, Camilla
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Facilitators and barriers for physical activity in adults with congenital heart disease2018Ingår i: European Heart Journal: ESC Congress 2018 25 - 29 August Munich, Germany, Oxford University Press, 2018, Vol. 39, artikel-id P5433Konferensbidrag (Refereegranskat)
  • 7.
    Bay, Annika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Dellborg, Mikael
    Berghammer, Malin
    Sandberg, Camilla
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Engström, Gunnar
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Moons, Philip
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Patient reported outcomes are associated with physical activity level in adults with congenital heart disease2017Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 243, s. 174-179Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: In general, adults with congenital heart disease (CHD) have impaired exercise capacity, and approximately 50% do not reach current recommendations on physical activity. Herein we analysed factors associated with physical activity level (PAL) in adults with CHD by using patient-reported outcomes (PRO). Methods: Patients with CHD (n = 471) were randomly selected from the national register on CHD and categorized according to complexity of lesions -simple (n = 172, 39.1 +/- 14.6 years), moderate (n = 212, 39 +/- 14.1 years), and severe (n = 87, 31.7 +/- 10.7 years). Participants completed a standardized questionnaire measuring PRO-domains including PAL. Variables associated with PAL were tested in multivariate logistic regression. Results: PAL was categorized into high (>= 3 METs = 2.5 h/week, n = 192) and low (>= 3 METs <2.5 h/week, n = 279). Patients with low PAL were older (42.6 vs. 35.8 years, p = 0.001), had more prescribed medications (51% vs. 39%, p = 0.009), more symptoms (25% vs. 16%, p = 0.02) and comorbidity (45% vs. 34% p= 0.02). Patients with low PAL rated a lower quality of life (76.6 vs. 83.4, p < 0.001), satisfaction with life (25.6 vs. 27.3, p = 0.003), a lower Physical Component Summary score (PCS) (78.1 vs. 90.5, p < 0.001) andMental Component Summary score (MCS) (73.5 vs. 79.5, p < 0.001). Complexity of heart lesion was not associated with PAL. The included PROs-separately tested in the model, together with age were associated with PAL. Conclusions: PCS and MCS are stronger associated with PAL than age and medical factors. The use of these PROs could therefore provide valuable information of benefit for individualized advice regarding physical activity to patients with CHD.

  • 8.
    Bay, Annika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Lämås, Kristina
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Berghammer, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Department of Paediatrics, The Queen Silvia Children’s Hospital, Sweden.
    Sandberg, Camilla
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Enablers and barriers for being physically active: experiences from adults with congenital heart disease2021Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 20, nr 2, s. 276-284Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: In general, adults with congenital heart disease have reduced exercise capacity and many do not reach the recommended level of physical activity. A physically active lifestyle is essential to maintain health and to counteract acquired cardiovascular disease, therefore enablers and barriers for being physically active are important to identify.

    Aim: To describe what adults with complex congenital heart diseases consider as physical activity, and what they experience as enablers and barriers for being physically active.

    Methods: A qualitative study using semi-structured interviews in which 14 adults with complex congenital heart disease (seven women) participated. The interviews were analysed using qualitative content analysis.

    Results: The analysis revealed four categories considered enablers and barriers – encouragement, energy level, approach and environment. The following is exemplified by the category encouragement as an enabler: if one had experienced support and encouragement to be physically active as a child, they were more positive to be physically active as an adult. In contrast, as a barrier, if the child lacked support and encouragement from others, they had never had the opportunity to learn to be physically active.

    Conclusion: It is important for adults with congenital heart disease to have the opportunity to identify barriers and enablers for being physically active. They need knowledge about their own exercise capacity and need to feel safe that physical activity is not harmful. This knowledge can be used by healthcare professionals to promote, support and eliminate misconceptions about physical activity. Barriers can potentially be transformed into enablers through increased knowledge about attitudes and prerequisites.

  • 9.
    Bay, Annika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Lämås, Kristina
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Berghammer, Malin
    Sandberg, Camilla
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Enablers and barriers for physical activity in adults with congenital heart disease2019Konferensbidrag (Refereegranskat)
  • 10.
    Bay, Annika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Lämås, Kristina
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Berghammer, Malin
    Sandberg, Camilla
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    It ́s like balancing on a slackline: A description from adults living with congenital heart disease2018Ingår i: Cardiology in the Young, ISSN 1047-9511, E-ISSN 1467-1107, Vol. 28, nr Suppl. S1, s. S37-S37Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Several studies have shown that adults with congenital heart disease have reduced exercise capacity and do not reach the recommended daily level of physical activity. With this in view, it is of great importance to investigate how this population experiences physical activity. The aim of the study is to illuminate how adults with congenital heart disease describes themselves in relation to physical activity.

    Methods: Semi-structured interviews with fourteen adults with complex congenital heart disease were performed. Patients were recruited from the clinic waiting list, based on their scheduled follow up and diagnosis. Interviews were analysed by qualitative content analysis.

    Results: The overall theme It´s like balancing on a slackline illustrates how adults with congenital heart disease described themselves in relation to physical activity. The overall theme consists of four themes: Being an adventurer- enjoying the challenges of physical activity, Being a realist- adapting to physical ability, Beinga non-doer- lacking prerequisites for physical activity and Being an outsider- feeling excluded depending on physical ability.

    Conclusions: The descriptions on themselves as a physically active were not constant or one-dimensional and the descriptions varied during the interviews, related to different time periods in life. It meant that they could described themselves as being an adventurer liking tough challenges, but at the same time describing themselves as being a non-doer with uncertainty over their physical strength. The findings point out specific factors for adults with CHD that might constitute as obstacles, but also possibilities for being physically active.

  • 11.
    Bay, Annika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Lämås, Kristina
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Berghammer, Malin
    Sandberg, Camilla
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    It's like balancing on a slackline: a description of how adults with congenital heart disease describe themselves in relation to physical activity2018Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, nr 15-16, s. 3131-3138Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS AND OBJECTIVES: To illuminate how adults with CHD describe themselves in relation to physical activity.

    BACKGROUND: Several studies have shown that adults with congenital heart disease (CHD) have reduced exercise capacity and do not reach the recommended daily level of physical activity. With this in view, it is of immense importance to investigate how this population experiences physical activity.

    DESIGN: Qualitative study with semi-structured interviews analysed with qualitative content analysis.

    METHODS: Semi-structured interviews were individually performed with fourteen adults (women=7, age 19-68 years) with complex CHD. Patients were purposively recruited from the clinic waiting list, based on a scheduled follow-up and diagnosis.

    RESULTS: The overall theme, It's like balancing on a slackline, illustrates how adults with CHD described themselves in relation to physical activity. This overall theme consisted of four subthemes: (1) Being an adventurer- enjoying the challenges of physical activity; (2) Being a realist- adapting to physical ability; (3) Being a non-doer- lacking prerequisites for physical activity; and (4) Being an outsider- feeling excluded depending on physical ability.

    CONCLUSIONS: Adults with CHD seem to have a diverse relationship to physical activity and it involves various aspects throughout the lifespan. The findings point out factors that might constitute as obstacles for being physically active, specific for people with chronic conditions like CHD. This highlights the importance of further exploring the hindering and facilitating factors for being physically active in order to get a deeper understanding of how to support adults with CHD to be physically active.

    RELEVANCE TO CLINICAL PRACTICE: Given the diverse relationship to physical activity, nurses have to further investigate the patients' relationship to physical activity, in order to support a healthy lifestyle. Nurses and allied health professionals should offer individualized exercise prescriptions and education about suitable physical activities in relation to physical ability. This article is protected by copyright. All rights reserved.

  • 12.
    Bay, Annika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Sandberg, Camilla
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Thilen, U.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Exercise self-efficacy (ESE) in adults with congential heart disease2017Ingår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 38, nr Suppl. 1, artikel-id ehx501.P618Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Many adults with congenital heart disease (CHD) have reduced aerobic exercise capacity and impaired muscle function. However, it is largely unknown which factors have influence on the confidence to perform exercise training, i.e. Exercise Self-Efficacy (ESE).

    Aims: To identify factors related to low ESE, and thus identify potential targets for rehabilitation and thereby enhance the potential for being physically active.

    Methods: Seventy-nine adults with CHD; simple lesions n=38 (women n=16), complex lesions n=41 (women n=17) (mean age 36.7±14.6 years) and 42 age and sex matched controls were recruited. All participants completed questionnaires on ESE, quality of life (EQ-5D), and physical activity (international physical activity questionnaire, IPAQ), and performed muscle endurance tests.

    Results: ESE was categorised into low (<26 points, n=24) and high (≥26 points, n=55). Patients with low ESE were older (45.2±15.4 vs. 32.6±12.5 years, p=0.002), more often had prescribed medication (67% vs. 44%, p=0.06), higher New York Heart Association functional class (NYHA) (≥ III) (25% vs. 7%, p=0.03) and performed fewer shoulder flexions (30.9±16.1 vs. 45.9±23.9, p=0.01) compared with those with high ESE. In the high ESE group, ESE did not differ from controls (33.8±3.9 vs. 33.4±6.1, p=0.74). In linear multivariate analysis age (B;-0.18, 95% CI -0.28- -0.08), smoking (B;-3.73, 95% CI -7.17- -0.28), EQ-5Dindex <1 (B;-3.33, 95% CI -6.08- -0.57) and number of shoulder flexions (B; 0.09, 95% CI 0.03–0.16) were independently associated with ESE.

    Conclusion: Many adults with CHD have low ESE. Rehabilitation targeting quality of life, smoking cessation and muscle training may improve ESE, and thus enhance the potential for being physically active in this population.

  • 13.
    Bay, Annika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Sandberg, Camilla
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Thilén, Ulf
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Exercise self-efficacy in adults with congenital heart disease2018Ingår i: International Journal of Cardiology: Heart and vasculature, E-ISSN 2352-9067, Vol. 18, s. 7-11Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Physical activity improves health, exercise tolerance and quality of life in adults with congenital heart disease (CHD), and exercise training is in most patients a high-benefit low risk intervention. However, factors that influence the confidence to perform exercise training, i.e. exercise self-efficacy (ESE), in CHD patients are virtually unknown. We aimed to identify factors related to low ESE in adults with CHD, and potential strategies for being physically active.

    Methods: Seventy-nine adults with CHD; 38 with simple lesions (16 women) and 41 with complex lesions (17 women) with mean age 36.7 ± 14.6 years and 42 matched controls were recruited. All participants completed questionnaires on ESE and quality of life, carried an activity monitor (Actiheart) during four consecutive days and performed muscle endurance tests.

    Results: ESE in patients was categorised into low, based on the lowest quartile within controls, (≤ 29 points, n = 34) and high (> 29 points, n = 45). Patients with low ESE were older (42.9 ± 15.1 vs. 32.0 ± 12.4 years, p = 0.001), had more complex lesions (65% vs. 42%, p = 0.05) more often had New York Heart Association functional class III (24% vs. 4%, p = 0.01) and performed fewer shoulder flexions (32.5 ± 15.5 vs. 47.7 ± 25.0, p = 0.001) compared with those with high ESE. In a logistic multivariate model age (OR; 1.06, 95% CI 1.02-1.10), and number of shoulder flexions (OR; 0.96, 95% CI 0.93-0.99) were associated with ESE.

    Conclusion: In this study we show that many adults with CHD have low ESE. Age is an important predictor of low ESE and should, therefore, be considered in counselling patients with CHD. In addition, muscle endurance training may improve ESE, and thus enhance the potential for being physically active in this population.

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  • 14. Behndig, A
    et al.
    Karlsson, K
    Johansson, B O
    Brännström, T
    Marklund, S L
    Superoxide dismutase isoenzymes in the normal and diseased human cornea.2001Ingår i: Investigative Ophthalmology and Visual Science, ISSN 0146-0404, E-ISSN 1552-5783, Vol. 42, nr 10, s. 2293-6Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: The human cornea, a tissue much exposed to oxidative stress, is rich in extracellular superoxide dismutase (SOD). In this study, the contents and distributions of the SOD isoenzymes in the normal human cornea were compared with those in corneas affected by keratoconus and bullous keratopathy.

    METHODS: The central and peripheral parts of normal human corneas were analyzed separately. Central corneal buttons were obtained from patients with keratoconus and bullous keratopathy who were undergoing primary keratoplasty or retransplantation. SOD enzymatic activities were determined by a direct spectrophotometric method, and extracellular SOD and the cytosolic Cu- and Zn-containing SOD (CuZn-SOD) proteins were determined with ELISA and studied with immunohistochemistry.

    RESULTS: The total SOD content, and particularly the extracellular SOD content, was lower in the central than in the peripheral normal cornea. CuZn-SOD and extracellular SOD were demonstrated in all three corneal layers. CuZn-SOD was found in cells, whereas extracellular SOD appeared to be localized on cell surfaces, in basal membranes, and in the stroma. In keratoconus, corneal levels of extracellular SOD were half those in the control corneas, whereas CuZn-SOD and the mitochondrial Mn-containing SOD levels were normal. In bullous keratopathy, apart from edematous dilution, SOD isoenzyme levels were essentially normal. In a remarkable finding, the same pattern in SOD isoenzyme levels as in the original disease was also found at retransplantation.

    CONCLUSIONS: Extracellular SOD and CuZn-SOD show markedly different distribution patterns within the human cornea. Extracellular SOD activity in the central cornea is halved in keratoconus, compared with that in normal control corneas. The finding of a similar reduction at retransplantation in keratoconus suggests reduced corneal extracellular SOD synthesis in cells of the host as a cause of the low enzyme levels.

  • 15. Berghammer, M.
    et al.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Mattson, E.
    Moons, P.
    Dellborg, M.
    Exploration of disagreement between the patient's self reported limitations and limitations assessed by caregivers in adults with congenital heart disease2018Ingår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, s. 468-468Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Background: The New York Heart Association (NYHA) classification is applied in a wide spectrum of heart diseases including adult patients with congenital heart disease (ACHD). The NYHA-class assessment is often based on the evaluation by the caregiver, but to what extent it correlates with the patient's view of their function is not fully known.

    Purpose: To investigate the relation between the patient's self-reported physical limitations, symptoms, other heart defect related factors and NYHA-class assessed by the caregiver.

    Methods: Eligible patients (n=333, age 39.2±13.6 years) were identified and randomly selected from the national registry for CHD. All of the patients completed a standardized questionnaire measuring different PRO-domains. By combing self-reported data with registry data including NYHA-class, analyses of agreement of physical limitations were performed.

    Results: Almost 30% of the patients rated their limitations higher compared to the NYHA-class estimated by the caregiver. Patients with self-reported limitations and their NYHA-class underestimated by caregivers, more often reported symptoms, anxiety, lower health and worked fewer hours/week compared to other patients with CHD. There were no differences regarding sex, type of symptoms, prescribed medications, or complexity of cardiac lesion. In patients without self-reported limitations agreement with NYHA-class estimated by caregivers was 97%.

    Conclusion: Adult patients with CHD and self-reported limitations may not be correctly identified by the care-giver. Instruments for patient reported outcomes might improve the assessment of physical limitations and could further improve the correctness in evaluating the patient's status.

  • 16. Berghammer, Malin C.
    et al.
    Mattsson, Eva
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Moons, Philip
    Dellborg, Mikael
    Comparison of participants and non-participants in patient-reported outcome surveys: the case of Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease - International Study2017Ingår i: Cardiology in the Young, ISSN 1047-9511, E-ISSN 1467-1107, Vol. 27, nr 3, s. 427-434Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The last decade has seen a vast increase in the use of patient-reported outcomes. As patientreported outcomes are used in order to capture patients' perspectives of their health and illness, it is a prerequisite for accurate patient-reported outcome evaluations to use representative samples. In order to evaluate representativeness, the present study focussed on the comparison between participants and non-participants in the Swedish branch of the international study APPROACH-IS (Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease - International Study), regarding demographic, clinical, and health status characteristics. Methods: Eligible patients for APPROACH-IS were identified and selected from SWEDCON, the Swedish registry for congenital heart disease (CHD). Overall, 912 eligible patients were identified, of whom 471 participated, 398 did not participate, and 43 were either unreachable or declined to participate in APPROACH-IS. The participants and nonparticipants were compared in terms of statistical significance and effect sizes. Results: Significant differences were observed between participants and non-participants for sex, age, primary diagnosis, number of cardiac operations, and fatigue; however, the effect sizes were in general small, except for the difference in primary diagnosis. No differences between the two groups were found in number of catheterisations, implanted device, the distribution of NYHA functional class, or health status and symptoms. Conclusions: This study shows that participants and non-participants are relatively comparable groups, which confirms the representativeness of the participants. The Swedish data from APPROACH-IS can therefore be reliably generalised to the population of adults with CHD in Sweden.

  • 17.
    Berglund, Elisabeth
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Dellborg, Mikael
    Sörensson, Peder
    Christersson, Christina
    Nielsen, Niels-Eric
    Rinnström, Daniel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Thilén, Ulf
    High incidence of infective endocarditis in adults with congenital ventricular septal defect2016Ingår i: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 102, nr 22, s. 1835-1839Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Ventricular septal defects (VSDs), if haemodynamically important, are closed whereas small shunts are left without intervention. The long-term prognosis in congenital VSD is good but patients are still at risk for long-term complications. The aim of this study was to clarify the incidence of infective endocarditis (IE) in adults with VSD. Methods: The Swedish registry for congenital heart disease (SWEDCON) was searched for adults with VSD. 779 patients were identified, 531 with small shunts and 248 who had the VSD previously closed. The National Patient Register was then searched for hospitalisations due to IE in adults during a 10-year period. Results: Sixteen (2%) patients were treated for IE, 6 men and 10 women, with a mean age of 46.3 +/- 12.2 years. The incidence of IE was 1.7-2.7/1000 years in patients without previous intervention, 20-30 times the risk in the general population. Thirteen had small shunts without previous intervention. There was no mortality in these 13 cases. Two patients had undergone repair of their VSD and also aortic valve replacement before the episode of endocarditis and a third patient with repaired VSD had a bicuspid aortic valve, all of these three patients needed reoperation because of their IE and one patient died. No patient with isolated and operated VSD was diagnosed with IE. Conclusions: A small unoperated VSD in adults carries a substantially increased risk of IE but is associated with a low risk of mortality.

  • 18.
    Bäckstrom, Björn
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rättsmedicin. Department of Forensic Medicine, National Board of Forensic Medicine, PO Box 7616, SE-907 12, Umeå.
    Johansson, Bengt
    Eriksson, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rättsmedicin.
    Death from Nitrous Oxide2015Ingår i: Journal of Forensic Sciences, ISSN 0022-1198, E-ISSN 1556-4029, Vol. 60, nr 6, s. 1662-1665Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Nitrous oxide is an inflammable gas that gives no smell or taste. It has a history of abuse as long as its clinical use, and deaths, although rare, have been reported. We describe two cases of accidental deaths related to voluntary inhalation of nitrous oxide, both found dead with a gas mask covering the face. In an attempt to find an explanation to why the victims did not react properly to oncoming hypoxia, we performed experiments where a test person was allowed to breath in a closed system, with or without nitrous oxide added. Vital signs and gas concentrations as well as subjective symptoms were recorded. The experiments indicated that the explanation to the fact that neither of the descendents had reacted to oncoming hypoxia and hypercapnia was due to the inhalation of nitrous oxide. This study raises the question whether nitrous oxide really should be easily, commercially available.

  • 19. Callus, Edward
    et al.
    Pagliuca, Silvana
    Boveri, Sara
    Ambrogi, Federico
    Luyckx, Koen
    Kovacs, Adrienne H.
    Apers, Silke
    Budts, Werner
    Enomoto, Junko
    Sluman, Maayke A.
    Wang, Jou-Kou
    Jackson, Jamie L.
    Khairy, Paul
    Cook, Stephen C.
    Chidambarathanu, Shanthi
    Alday, Luis
    Eriksen, Katrine
    Dellborg, Mikael
    Berghammer, Malin
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Mackie, Andrew S.
    Menahem, Samuel
    Caruana, Maryanne
    Veldtman, Gruschen
    Soufi, Alexandra
    Fernandes, Susan M.
    White, Kamila
    Kutty, Shelby
    Moons, Philip
    Phenotypes of adults with congenital heart disease around the globe: a cluster analysis2021Ingår i: Health and Quality of Life Outcomes, ISSN 1477-7525, E-ISSN 1477-7525, Vol. 19, nr 1, artikel-id 53Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To derive cluster analysis-based groupings for adults with congenital heart disease (ACHD) when it comes to perceived health, psychological functioning, health behaviours and quality of life (QoL).

    METHODS: This study was part of a larger worldwide multicentre study called APPROACH-IS; a cross sectional study which recruited 4028 patients (2013-2015) from 15 participating countries. A hierarchical cluster analysis was performed using Ward's method in order to group patients with similar psychological characteristics, which were defined by taking into consideration the scores of the following tests: Sense Of Coherence, Health Behavior Scale (physical exercise score), Hospital Anxiety Depression Scale, Illness Perception Questionnaire, Satisfaction with Life Scale and the Visual Analogue Scale scores of the EQ-5D perceived health scale and a linear analogue scale (0-100) measuring QoL.

    RESULTS: 3768 patients with complete data were divided into 3 clusters. The first and second clusters represented 89.6% of patients in the analysis who reported a good health perception, QoL, psychological functioning and the greatest amount of exercise. Patients in the third cluster reported substantially lower scores in all PROs. This cluster was characterised by a significantly higher proportion of females, a higher average age the lowest education level, more complex forms of congenital heart disease and more medical comorbidities.

    CONCLUSIONS: This study suggests that certain demographic and clinical characteristics may be linked to less favourable health perception, quality of life, psychological functioning, and health behaviours in ACHD. This information may be used to improve psychosocial screening and the timely provision of psychosocial care.

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  • 20.
    Camilla, Sandberg
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Pomeroy, Jeremy
    Thilén, Ulf
    Gradmark, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Habitual Physical Activity in Adults with Congenital Heart Disease Compared with Age- and Sex- Matched Controls2016Ingår i: Canadian Journal of Cardiology, ISSN 0828-282X, E-ISSN 1916-7075, Vol. 32, nr 4, s. 547-553Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Most adult patients with congenital heart disease (CHD) have reduced aerobic exercise capacity. Their habitual physical activity (PA) level is, however, less well studied. In this study habitual PA level in a cohort of adults with CHD compared to healthy age and gender matched controls was investigated.

    Methods: Eighty adults with CHD, classed as either “complex” (n=40) or “simple” (n=40), and 42 healthy controls were studied with a combined uniaxial accelerometer and heart rate monitor worn during 4 consecutive days. We analysed 1) the time spent during ≥ moderate/vigorous PA, 2) accelerometer counts/day and 3) to what extent the World Health Organization recommendations on PA were reached.

    Results: Patients with simple lesions had higher total accelerometer counts/day compared to both patients with complex lesions and controls (simple lesions; median (IQR) 107.7(63.4) vs. complex lesions; 72.8(53.5) and controls; 78.3(49.6), p≤0.001 and p=0.002). Furthermore, no differences in time spent during ≥ moderate-to-vigorous PA was found between patients and controls. In addition 46% of the patients with simple lesions, 55% of the patients with complex lesions and 44% of the controls did not reach the W.H.O.-recommended level of daily PA, but no significant differences between groups were found. There were no differences in achieving recommended PA level between patients in NYHA I vs. NYHA II+III.

    Conclusions: Patients with CHD follow the same PA-level pattern as the general population. Broad strategies promoting an active lifestyle are needed across the population and especially for patients with complex CHD and impaired NYHA class.

  • 21. Caruana, Maryanne
    et al.
    Apers, Silke
    Kovacs, Adrienne H.
    Luyckx, Koen
    Thomet, Corina
    Budts, Werner
    Sluman, Maayke
    Eriksen, Katrine
    Dellborg, Mikael
    Berghammer, Malin
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Soufi, Alexandra
    Callus, Edward
    Moons, Philip
    Grech, Victor
    Red Flags for Maltese Adults with Congenital Heart Disease: Poorer Dental Care and Less Sports Participation Compared to Other European Patients-An APPROACH-IS Substudy2017Ingår i: Pediatric Cardiology, ISSN 0172-0643, E-ISSN 1432-1971, Vol. 38, nr 5, s. 965-973Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Studies in recent years have explored lifestyle habits and health-risk behaviours in adult congenital heart disease (ACHD) patients when compared to controls. The aim of this study was to investigate differences in lifestyle habits between Maltese and other European ACHD patients. Data on alcohol consumption, cigarette smoking, substance misuse, dental care and physical activity collected in 2013-2015 during "Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease-International Study" (APPROACH-IS) were analysed. Responses from 119 Maltese participants were compared to those of 1616 participants from Belgium, France, Italy, Norway, Sweden, Switzerland and the Netherlands. Significantly fewer Maltese patients with simple (Maltese 84.1% vs. European 97.5%, p < 0.001) and moderately complex CHD (Maltese 83.6% vs. European 97.4%, p < 0.001) brushed their teeth daily. Only 67.2% of Maltese with moderately complex disease had dental reviews in the previous year compared to 80.3% of Europeans (p = 0.02). Maltese patients with simple (Maltese 31.8% vs. European 56.1%, p = 0.002) and moderately complex lesions (Maltese 30.0% vs. European 59.2%, p < 0.001) performed less regular sport activities. Comparison by country showed Maltese patients to have significantly poorer tooth brushing and sports participation than patients from any other participating country. Alcohol consumption, cigarette smoking and substance misuse were not significantly different. This study highlights lifestyle aspects that Maltese ACHD patients need to improve on, which might not be evident upon comparing patients to non-CHD controls. These findings should also caution researchers against considering behaviours among patients in one country as necessarily representative of patients on the larger scale.

  • 22.
    Casteigt, Benjamin
    et al.
    Montreal Heart Institute, Université de Montréal, Montreal, Canada.
    Samuel, Michelle
    Montreal Heart Institute, Université de Montréal, Montreal, Canada.
    Laplante, Laurence
    Montreal Heart Institute, Université de Montréal, Montreal, Canada.
    Shohoudi, Azadeh
    Montreal Heart Institute, Université de Montréal, Montreal, Canada.
    Apers, Silke
    KU Leuven Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium.
    Kovacs, Adrienne H.
    Knight Cardiovascular Institute, Oregon Health & Science University, OR, Portland, United States.
    Luyckx, Koen
    KU Leuven—University of Leuven, Psychology and Development in Context, Leuven, Belgium and UNIBS, University of the Free State, Bloemfontein, South Africa.
    Thomet, Corina
    Center for Congenital Heart Disease, Inselspital—Bern University Hospital, University of Bern, Bern, Switzerland.
    Budts, Werner
    Division of Congenital and Structural Cardiology, University Hospitals Leuven and Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.
    Enomoto, Junko
    Department of Adult Congenital Heart Disease, Chiba Cardiovascular Center, Chiba, Japan.
    Sluman, Maayke A.
    Department of Cardiology, Jeroen Bosch Hospital, ‘s Hertogenbosch, the Netherlands and Coronel Institute for Occupational Health, Academic Medical Centre, Amsterdam, Netherlands.
    Lu, Chun-Wei
    Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
    Jackson, Jamie L.
    Center for Biobehavioral Health, Nationwide Children's Hospital, OH, Columbus, United States.
    Cook, Stephen C.
    Adult Congenital Heart Disease Center, Helen DeVos Children's Hospital, MI, Grand Rapids, United States.
    Chidambarathanu, Shanthi
    Frontier Lifeline Hospital (Dr. K.M. Cherian Heart Foundation), Chennai, India.
    Alday, Luis
    Division of Cardiology, Hospital de Niños, Córdoba, Argentina.
    Eriksen, Katrine
    Department of Cardiology, Oslo University Hospital—Rikshospitalet, Oslo, Norway.
    Dellborg, Mikael
    Adult Congenital Heart Unit, Sahlgrenska University Hospital/Östra, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Berghammer, Malin
    Centre for Person-Centred Care (GPCC), University of Gothenburg and Department of Health Sciences, University West, Trollhättan, Sweden.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Mackie, Andrew S.
    Division of Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Canada.
    Menahem, Samuel
    Monash Medical Centre, Monash University, Melbourne, Australia.
    Caruana, Maryanne
    Department of Cardiology, Mater Dei Hospital, Birkirkara Bypass, Malta.
    Veldtman, Gruschen
    Adult Congenital Heart Disease Center, Cincinnati Children's Hospital, OH, Cincinnati, United States.
    Soufi, Alexandra
    Department of Congenital Heart Disease, Louis Pradel Hospital, Lyon, France.
    Fernandes, Susan M.
    Department of Pediatrics and Medicine, Stanford University School of Medicine, CA, Palo Alto, United States.
    White, Kamila
    Adult Congenital Heart Disease Center, Washington University and Barnes Jewish Heart & Vascular Center and University of Missouri, MO, Saint Louis, United States.
    Callus, Edward
    Clinical Psychology Service, IRCCS Policlinico San Donato, Milan, Italy and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.
    Kutty, Shelby
    Adult Congenital Heart Disease Center, University of Nebraska Medical Center/Children's Hospital & Medical Center, NE, Omaha, United States.
    Brouillette, Judith
    Montreal Heart Institute, Université de Montréal, Montreal, Canada.
    Moons, Philip
    KU Leuven—University of Leuven, Department of Public Health and Primary Care, Leuven, Belgium Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden and Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
    Khairy, Paul
    Montreal Heart Institute, Université de Montréal, Montreal, Canada.
    Atrial arrhythmias and patient-reported outcomes in adults with congenital heart disease: An international study2021Ingår i: Heart Rhythm, ISSN 1547-5271, E-ISSN 1556-3871, Vol. 18, nr 5, s. 793-800Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Atrial arrhythmias (ie, intra-atrial reentrant tachycardia and atrial fibrillation) are a leading cause of morbidity and hospitalization in adults with congenital heart disease (CHD). Little is known about their effect on quality of life and other patient-reported outcomes (PROs) in adults with CHD. Objective: The purpose of this study was to assess the impact of atrial arrhythmias on PROs in adults with CHD and explore geographic variations.

    Methods: Associations between atrial arrhythmias and PROs were assessed in a cross-sectional study of adults with CHD from 15 countries spanning 5 continents. A propensity-based matching weight analysis was performed to compare quality of life, perceived health status, psychological distress, sense of coherence, and illness perception in patients with and those without atrial arrhythmias.

    Results: A total of 4028 adults with CHD were enrolled, 707 (17.6%) of whom had atrial arrhythmias. After applying matching weights, patients with and those without atrial arrhythmias were comparable with regard to age (mean 40.1 vs 40.2 years), demographic variables (52.5% vs 52.2% women), and complexity of CHD (15.9% simple, 44.8% moderate, and 39.2% complex in both groups). Patients with atrial arrhythmias had significantly worse PRO scores with respect to quality of life, perceived health status, psychological distress (ie, depression), and illness perception. A summary score that combines all PRO measures was significantly lower in patients with atrial arrhythmias (–3.3%; P = .0006). Differences in PROs were consistent across geographic regions.

    Conclusion: Atrial arrhythmias in adults with CHD are associated with an adverse impact on a broad range of PROs consistently across various geographic regions.

  • 23. Chen, Hao Yu
    et al.
    Cairns, Benjamin J.
    Small, Aeron M.
    Burr, Hannah A.
    Ambikkumar, Athithan
    Martinsson, Andreas
    Thériault, Sébastien
    Munter, Hans Markus
    Steffen, Brian
    Zhang, Richard
    Levinson, Rebecca T.
    Shaffer, Christian M.
    Rong, Jian
    Sonestedt, Emily
    Dufresne, Line
    Ljungberg, Johan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Näslund, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Ranatunga, Dilrini K.
    Whitmer, Rachel A.
    Budoff, Matthew J.
    Nguyen, Albert
    Vasan, Ramachandran S.
    Larson, Martin G.
    Harris, William S.
    Damrauer, Scott M.
    Stark, Ken D.
    Boekholdt, S. Matthijs
    Wareham, Nicholas J.
    Pibarot, Philippe
    Arsenault, Benoit J.
    Mathieu, Patrick
    Gudnason, Vilmundur
    O'Donnell, Christopher J.
    Rotter, Jerome I.
    Tsai, Michael Y.
    Post, Wendy S.
    Clarke, Robert
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Bossé, Yohan
    Wells, Quinn S.
    Smith, J. Gustav
    Rader, Daniel J.
    Lathrop, Mark
    Engert, James C.
    Thanassoulis, George
    Association of FADS1/2 Locus Variants and Polyunsaturated Fatty Acids With Aortic Stenosis2020Ingår i: JAMA cardiology, ISSN 2380-6583, E-ISSN 2380-6591, Vol. 5, nr 6, s. 694-702Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Importance: Aortic stenosis (AS) has no approved medical treatment. Identifying etiological pathways for AS could identify pharmacological targets.

    Objective: To identify novel genetic loci and pathways associated with AS.

    Design, Setting, and Participants: This genome-wide association study used a case-control design to evaluate 44 703 participants (3469 cases of AS) of self-reported European ancestry from the Genetic Epidemiology Research on Adult Health and Aging (GERA) cohort (from January 1, 1996, to December 31, 2015). Replication was performed in 7 other cohorts totaling 256 926 participants (5926 cases of AS), with additional analyses performed in 6942 participants from the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) Consortium. Follow-up biomarker analyses with aortic valve calcium (AVC) were also performed. Data were analyzed from May 1, 2017, to December 5, 2019.

    Exposures: Genetic variants (615 643 variants) and polyunsaturated fatty acids (ω-6 and ω-3) measured in blood samples.

    Main Outcomes and Measures: Aortic stenosis and aortic valve replacement defined by electronic health records, surgical records, or echocardiography and the presence of AVC measured by computed tomography.

    Results: The mean (SD) age of the 44 703 GERA participants was 69.7 (8.4) years, and 22 019 (49.3%) were men. The rs174547 variant at the FADS1/2 locus was associated with AS (odds ratio [OR] per C allele, 0.88; 95% CI, 0.83-0.93; P = 3.0 × 10-6), with genome-wide significance after meta-analysis with 7 replication cohorts totaling 312 118 individuals (9395 cases of AS) (OR, 0.91; 95% CI, 0.88-0.94; P = 2.5 × 10-8). A consistent association with AVC was also observed (OR, 0.91; 95% CI, 0.83-0.99; P = .03). A higher ratio of arachidonic acid to linoleic acid was associated with AVC (OR per SD of the natural logarithm, 1.19; 95% CI, 1.09-1.30; P = 6.6 × 10-5). In mendelian randomization, increased FADS1 liver expression and arachidonic acid were associated with AS (OR per unit of normalized expression, 1.31 [95% CI, 1.17-1.48; P = 7.4 × 10-6]; OR per 5-percentage point increase in arachidonic acid for AVC, 1.23 [95% CI, 1.01-1.49; P = .04]; OR per 5-percentage point increase in arachidonic acid for AS, 1.08 [95% CI, 1.04-1.13; P = 4.1 × 10-4]).

    Conclusions and Relevance: Variation at the FADS1/2 locus was associated with AS and AVC. Findings from biomarker measurements and mendelian randomization appear to link ω-6 fatty acid biosynthesis to AS, which may represent a therapeutic target.

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  • 24.
    Daelman, Bo
    et al.
    KU Leuven Department of Public Health and Primary Care, KU Leuven–University of Leuven, Leuven, Belgium.
    Van Bulck, Liesbet
    KU Leuven Department of Public Health and Primary Care, KU Leuven–University of Leuven, Leuven, Belgium; Research Foundation Flanders, Brussels, Belgium; University Hospitals Leuven, Leuven, Belgium.
    Luyckx, Koen
    School Psychology and Development in Context, KU Leuven–University of Leuven, Leuven, Belgium; Unit for Professional Training and Service in the Behavioural Sciences, University of the Free State, Bloemfontein, South Africa; University Hospitals Leuven, Leuven, Belgium.
    Kovacs, Adrienne H.
    Equilibria Psychological Health, ON, Toronto, Canada.
    Van De Bruaene, Alexander
    Division of Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium; University Hospitals Leuven, Leuven, Belgium.
    Ladouceur, Magalie
    Centre de recherche Cardiovasculaire de Paris, INSERM U970, Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France; Hôpital Européen Georges Pompidou, Paris, France.
    Yang, Hsiao-Ling
    School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan; National Taiwan University Hospital, Taipei City, Taiwan.
    Moon, Ju Ryoung
    Department of Nursing, Cardiac Center, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, South Korea; Samsung Medical Center, Heart Vascular Stroke Institute, Seoul, South Korea.
    Schmidt, André
    Adult Congenital Heart Disease Unit, Hospital das Clínicas, Facultdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil.
    Lykkeberg, Birgitte
    The Cardiology Clinic, the Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Copenhagen University Hospital, Copenhagen, Denmark.
    Callus, Edward
    Clinical Psychology Service, Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico San Donato, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy; Policlinico San Donato & University of Milan, Milan, Italy.
    de Hosson, Michèle
    Department of Adult Congenital Heart Disease Ghent, Ghent University Hospital, Ghent, Belgium; University Hospital Ghent, Ghent, Belgium.
    Sandberg, Camilla
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. Umeå University Hospital, Umeå, Sweden.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Umeå University Hospital, Umeå, Sweden.
    Hlebowicz, Joanna
    Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden; Skånes University Hospital, Lund, Sweden.
    Areias, Maria Emília
    UnIC@RISE, Faculty of Medicine, University of Porto, Porto, Portugal; CHUSJ; Faculty of Medicine, University of Porto; University Institute of Health Sciences, Gandra, Portugal, Porto, Portugal.
    Amedro, Pascal
    University of Bordeaux, Liryc Institute, Hôpital cardiologique Haut-Leveque, Bordeaux, France; Paediatric and Congenital Cardiology Department, M3C Regional Reference Centre, Montpellier University Hospital, Montpellier, France; Montpellier University Hospital, Montpellier, France.
    Coats, Louise
    Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom; Freeman Hospital, Newcastle upon Tyne, United Kingdom.
    Mandalenakis, Zacharias
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
    Kaneva, Anna
    Pediatric Cardiology Department, National Cardiology Hospital, Sofia, Bulgaria; National Heart Hospital, Sofia, Bulgaria.
    Moons, Philip
    KU Leuven Department of Public Health and Primary Care, KU Leuven–University of Leuven, Leuven, Belgium; Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa; University Hospitals Leuven, Leuven, Belgium.
    Goossens, Eva
    KU Leuven Department of Public Health and Primary Care, KU Leuven–University of Leuven, Leuven, Belgium; Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care, Division of Nursing and Midwifery, University of Antwerp, Antwerp, Belgium; University Hospitals Leuven, Leuven, Belgium.
    Sasikumar, Navaneetha
    Amrita Institute of Medical Sciences, Kerala, Kochi, India.
    Enomoto, Junko
    Chiba Cerebral and Cardiovascular Center, Chiba, Japan.
    Mizuno, Yoshiko
    Chiba Cerebral and Cardiovascular Center, Chiba, Japan.
    Leong, Ming Chern
    Paediatric & Congenital Heart Center, IJN, Kuala Lumpur, Malaysia.
    Binto Sabran, Izzatun Nafsi
    Paediatric & Congenital Heart Center, IJN, Kuala Lumpur, Malaysia.
    Ladak, Laila Akbar
    Aga Khan University, Karachi, Pakistan.
    Hasan, Babar
    Aga Khan University, Karachi, Pakistan.
    Siddiqui, Ayat
    Aga Khan University, Karachi, Pakistan.
    Huh, June
    Samsung Medical Center, Heart Vascular Stroke Institute, Seoul, South Korea.
    Wang, Jou-Kou
    National Taiwan University Hospital, Taipei City, Taiwan.
    Lu, Chun-Wei
    National Taiwan University Hospital, Taipei City, Taiwan.
    Demir, Fatma
    Ege University Health Application and Research Center, Bornova/İZMİR, Turkey.
    Öden, Tuğba
    Ege University Health Application and Research Center, Bornova/İZMİR, Turkey.
    Tefera, Endale
    Princess Marina Hospital, Gaborone, Botswana.
    Mwita, Julius
    Princess Marina Hospital, Gaborone, Botswana.
    Ambassa, Jean-Claude
    Clinique Medical Le Jourdain, Yaoundé, Cameroon.
    Mvondo, Charles
    Clinique Medical Le Jourdain, Yaoundé, Cameroon.
    Fanka, Marcel
    Clinique Medical Le Jourdain, Yaoundé, Cameroon.
    Yadeta, Dejuma
    Addis Ababa University Faculty of Medicine, Addis Ababa, Ethiopia.
    Alemayehu, Mulualem
    Addis Ababa University Faculty of Medicine, Addis Ababa, Ethiopia.
    Leye, Mohamed
    University of Thiés, UFR des sciences de la santé, Thiés, Senegal.
    Gueye, Khadija
    University of Thiés, UFR des sciences de la santé, Thiés, Senegal.
    Gabriel, Harald
    Medical University of Vienna, Vienna, Austria.
    Svhneider, Matthias
    Medical University of Vienna, Vienna, Austria.
    Seeliger, Selina
    Medical University of Vienna, Vienna, Austria.
    Budts, Werner
    University Hospitals Leuven, Leuven, Belgium.
    Rassart, Jessica
    University Hospitals Leuven, Leuven, Belgium.
    De Backer, Julie
    University Hospital Ghent, Ghent, Belgium.
    Markova, Mila
    National Heart Hospital, Sofia, Bulgaria.
    Biyai, Miriam
    Copenhagen University Hospital, Copenhagen, Denmark.
    Boubrit, Anissa
    Hôpital Européen Georges Pompidou, Paris, France.
    Thambo, Jean-Benoît
    Hôpital cardiologique Haut-Leveque, Bordeaux, France.
    Ruissel, Amandine
    Hôpital cardiologique Haut-Leveque, Bordeaux, France.
    Jore, Cecile
    Hôpital cardiologique Haut-Leveque, Bordeaux, France.
    Abassi, Hamouda
    Montpellier University Hospital, Montpellier, France.
    Soltani, Sonia
    Montpellier University Hospital, Montpellier, France.
    Bredy, Charlene
    Montpellier University Hospital, Montpellier, France.
    Giannakoulas, George
    Aristotle University of Thessaloniki, Medical School, Greece.
    Kosmidis, Diamantis
    Aristotle University of Thessaloniki, Medical School, Greece.
    Ntiloudi, Despina
    Aristotle University of Thessaloniki, Medical School, Greece.
    Pagliuca, Silvana
    Policlinico San Donato & University of Milan, Milan, Italy.
    Bertoldo, Enrico Giuseppe
    Policlinico San Donato & University of Milan, Milan, Italy.
    Fiolo, Valentina
    Policlinico San Donato & University of Milan, Milan, Italy.
    Caruana, Maryanne
    Mater Dei Hospital, L-Imsida, Malta.
    Swain, Justine
    Mater Dei Hospital, L-Imsida, Malta.
    Grech, Neil
    Mater Dei Hospital, L-Imsida, Malta.
    Xuereb, Rachel
    Mater Dei Hospital, L-Imsida, Malta.
    Craus, Sarah
    Mater Dei Hospital, L-Imsida, Malta.
    Bonello, Maria
    Mater Dei Hospital, L-Imsida, Malta.
    Borg, Darren
    Mater Dei Hospital, L-Imsida, Malta.
    Farrugia, Paul
    Mater Dei Hospital, L-Imsida, Malta.
    Cardona, Joanne
    Mater Dei Hospital, L-Imsida, Malta.
    Estensen, Mette-Elise
    Oslo University Hospital, Rikshospitalet, Oslo, Norway.
    Andresen, Brith
    Oslo University Hospital, Rikshospitalet, Oslo, Norway.
    Eriksen, Katrine
    Oslo University Hospital, Rikshospitalet, Oslo, Norway.
    Miranda, Joana
    CHUSJ; Faculty of Medicine, University of Porto; University Institute of Health Sciences, Gandra, Portugal, Porto, Portugal.
    Areias, José Carlos
    CHUSJ; Faculty of Medicine, University of Porto; University Institute of Health Sciences, Gandra, Portugal, Porto, Portugal.
    Cruz, Cristina
    CHUSJ; Faculty of Medicine, University of Porto; University Institute of Health Sciences, Gandra, Portugal, Porto, Portugal.
    Macedo, Filipe
    CHUSJ; Faculty of Medicine, University of Porto; University Institute of Health Sciences, Gandra, Portugal, Porto, Portugal.
    Ribeiro Nunes, Filipa Manuela
    CHUSJ; Faculty of Medicine, University of Porto; University Institute of Health Sciences, Gandra, Portugal, Porto, Portugal.
    Barbosa de Bessa, Ana Maria
    CHUSJ; Faculty of Medicine, University of Porto; University Institute of Health Sciences, Gandra, Portugal, Porto, Portugal.
    Espírito Santo, Sara Mafalda
    CHUSJ; Faculty of Medicine, University of Porto; University Institute of Health Sciences, Gandra, Portugal, Porto, Portugal.
    Brito, Paula
    CHUSJ; Faculty of Medicine, University of Porto; University Institute of Health Sciences, Gandra, Portugal, Porto, Portugal.
    Pereira, Marisa
    CHUSJ; Faculty of Medicine, University of Porto; University Institute of Health Sciences, Gandra, Portugal, Porto, Portugal.
    Teixeira, Sofia
    CHUSJ; Faculty of Medicine, University of Porto; University Institute of Health Sciences, Gandra, Portugal, Porto, Portugal.
    Marques, Brenda
    CHUSJ; Faculty of Medicine, University of Porto; University Institute of Health Sciences, Gandra, Portugal, Porto, Portugal.
    Marques, Ana Raquel
    CHUSJ; Faculty of Medicine, University of Porto; University Institute of Health Sciences, Gandra, Portugal, Porto, Portugal.
    Cronesten, Helena
    Umeå University Hospital, Umeå, Sweden.
    Dellborg, Mikael
    Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
    Mattson, Eva
    Karolinska University Hospital/Solna, Stockholm, Sweden.
    Christersson, Christina
    Uppsala University Hospital, Uppsala, Sweden.
    Robertsson, Louise
    Uppsala University Hospital, Uppsala, Sweden.
    Ternrud, Linda
    Skånes University Hospital, Lund, Sweden.
    Thomet, Corina
    University Hospital Bern, Bern, Switzerland.
    Ruperti, Javier
    University Hospital Bern, Bern, Switzerland.
    Bouchardy, Judith
    Centre Hospitalier Universitaire Vaudois & Genève, Switzerland, Hôpitaux Universitaires de Genève, Lausanne, Switzerland.
    Brand, Fanny
    Centre Hospitalier Universitaire Vaudois & Genève, Switzerland, Hôpitaux Universitaires de Genève, Lausanne, Switzerland.
    Rutz, Tobias
    Centre Hospitalier Universitaire Vaudois & Genève, Switzerland, Hôpitaux Universitaires de Genève, Lausanne, Switzerland.
    Blanche, Coralie
    Centre Hospitalier Universitaire Vaudois & Genève, Switzerland, Hôpitaux Universitaires de Genève, Lausanne, Switzerland.
    van Melle, Joost P.
    UMCG, Groningen, Netherlands.
    Boer, Anna
    UMCG, Groningen, Netherlands.
    Constantine, Andrew
    Royal Brompton Hospital, Royal Brompton & Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
    Gatzoulis, Michael A.
    Royal Brompton Hospital, Royal Brompton & Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
    Dimopoulos, Konstantinos
    Royal Brompton Hospital, Royal Brompton & Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
    McParlin, Debbie
    Freeman Hospital, Newcastle upon Tyne, United Kingdom.
    Khairy, Paul
    Montreal Heart Institute, Université de Montréal, Montreal, Canada.
    Proietti, Anna
    Montreal Heart Institute, Université de Montréal, Montreal, Canada.
    Roy, Veronique
    Montreal Heart Institute, Université de Montréal, Montreal, Canada.
    Windram, Jonathan
    Mazankowski Alberta Heart Institute, Edmonton, Canada.
    Jandura, Deborah
    Mazankowski Alberta Heart Institute, Edmonton, Canada.
    Jameson, Susan
    Lucile Packard Children's Hospital and Stanford Health Care, CA, Stanford, United States.
    Major, Melissa
    Lucile Packard Children's Hospital and Stanford Health Care, CA, Stanford, United States.
    Mahadevan, Vaikom Subremanian
    University of California San Francisco (UCSF), CA, San Francisco, United States.
    Nguyen, Thomas
    University of California San Francisco (UCSF), CA, San Francisco, United States.
    Sarwary, Shabir
    University of California San Francisco (UCSF), CA, San Francisco, United States.
    Saidi, Arwa
    University of Florida Health, FL, Gainesville, United States.
    Breault, Leah
    University of Florida Health, FL, Gainesville, United States.
    Colon, Dalia Lopez
    University of Florida Health, FL, Gainesville, United States.
    Cedars, Ari
    Taussig Heart Center of John Hopkins Hospital & Dallas, Texas, United States, University of Southwestern Medical Center, MD, Baltimore, United States.
    Kutty, Shelby
    Taussig Heart Center of John Hopkins Hospital & Dallas, Texas, United States, University of Southwestern Medical Center, MD, Baltimore, United States.
    Ko, Jong
    Taussig Heart Center of John Hopkins Hospital & Dallas, Texas, United States, University of Southwestern Medical Center, MD, Baltimore, United States.
    Valente, Anne Marie
    Boston Children's Hospital / Brigham and Women's / Harvard Medical School, MA, Boston, United States.
    Brainard, Sarah
    Boston Children's Hospital / Brigham and Women's / Harvard Medical School, MA, Boston, United States.
    Reichman, Jeffrey
    Boston Children's Hospital / Brigham and Women's / Harvard Medical School, MA, Boston, United States.
    Zaidi, Ali
    Mount Sinai Heart, NY, New York, United States.
    Amlani, Amrin
    Mount Sinai Heart, NY, New York, United States.
    Jackson, Jamie
    Nationwide Children's Hospital, OH, Columbus, United States.
    Swenski, Taylor
    Nationwide Children's Hospital, OH, Columbus, United States.
    Neville, Steven
    Nationwide Children's Hospital, OH, Columbus, United States.
    Kovacs, Adrienne
    Oregon Health and Science University, OR, Portland, United States.
    McGrath, Lidija
    Oregon Health and Science University, OR, Portland, United States.
    Taunton, Marshall
    Oregon Health and Science University, OR, Portland, United States.
    Kim, Yuli
    Philadelphia Penn Medicine and Children's Hospital of Philadelphia, PA, Philadelphia, United States.
    Carducci, Jessica
    Philadelphia Penn Medicine and Children's Hospital of Philadelphia, PA, Philadelphia, United States.
    Bashey, Saffy
    Philadelphia Penn Medicine and Children's Hospital of Philadelphia, PA, Philadelphia, United States.
    Alday, Luis
    Hospital de Niños, Cordoba, Argentina.
    Lousararian, Marina
    Hospital de Niños, Cordoba, Argentina.
    Maisuls, Héctor
    Hospital de Niños, Cordoba, Argentina.
    Quinteros, Marisa
    Hospital de Niños, Cordoba, Argentina.
    Lucero, Mónica
    Hospital de Niños, Cordoba, Argentina.
    Ortiz, Lucia
    Hospital San Juan De Dios De La Plata, Buenos Aires, Argentina.
    Amaral, Fernando
    Hospital das Clinicas da Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, Brazil.
    Schmidt, Andre
    Hospital das Clinicas da Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, Brazil.
    Manso, Paulo Henrique
    Hospital das Clinicas da Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, Brazil.
    Pavão, Rafael Brolio
    Hospital das Clinicas da Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, Brazil.
    Reyes, Fernando Baraona
    Intituto Nacional Del Torax, Santiago, Chile.
    Arancibia, M. Francisca
    Intituto Nacional Del Torax, Santiago, Chile.
    Araujo, John Jairo
    Meintegral-Clinic, Manizales, Colombia.
    Súarez, Alberto Hernadez
    Meintegral-Clinic, Manizales, Colombia.
    Menahem, Samuel
    Melbourne Children's Cardiology/Adult Congenital Heart, Monash University.
    Wijayarathne, Pasangi Madhuka
    Melbourne Children's Cardiology/Adult Congenital Heart, Monash University.
    Frailty and cognitive function in middle-aged and older adults with congenital heart disease2024Ingår i: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 83, nr 12, s. 1149-1159Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Life expectancy of patients with congenital heart disease (CHD) has increased rapidly, resulting in a growing and aging population. Recent studies have shown that older people with CHD have higher morbidity, health care use, and mortality. To maintain longevity and quality of life, understanding their evolving medical and psychosocial challenges is essential.

    Objectives: The authors describe the frailty and cognitive profile of middle-aged and older adults with CHD to identify predictor variables and to explore the relationship with hospital admissions and outpatient visits.

    Methods: Using a cross-sectional, multicentric design, we included 814 patients aged ≥40 years from 11 countries. Frailty phenotype was determined using the Fried method. Cognitive function was assessed by the Montreal Cognitive Assessment.

    Results: In this sample, 52.3% of patients were assessed as robust, 41.9% as prefrail, and 5.8% as frail; 38.8% had cognitive dysfunction. Multinomial regression showed that frailty was associated with older age, female sex, higher physiologic class, and comorbidities. Counterintuitively, patients with mild heart defects were more likely than those with complex lesions to be prefrail. Patients from middle-income countries displayed more prefrailty than those from higher-income countries. Logistic regression demonstrated that cognitive dysfunction was related to older age, comorbidities, and lower country-level income.

    Conclusions: Approximately one-half of included patients were (pre-)frail, and more than one-third experienced cognitive impairment. Frailty and cognitive dysfunction were identified in patients with mild CHD, indicating that these concerns extend beyond severe CHD. Assessing frailty and cognition routinely could offer valuable insights into this aging population.

  • 25. Diller, Gerhard-Paul
    et al.
    Dimopoulos, Konstantinos
    Okonko, Darlington
    Li, Wei
    Babu-Narayan, Sonya V
    Broberg, Craig S
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Bouzas, Beatriz
    Mullen, Michael J
    Poole-Wilson, Philip A
    Francis, Darrel P
    Gatzoulis, Michael A
    Exercise intolerance in adult congenital heart disease: comparative severity, correlates, and prognostic implication.2005Ingår i: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 112, nr 6, s. 828-35Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Although some patients with adult congenital heart disease (ACHD) report limitations in exercise capacity, we hypothesized that depressed exercise capacity may be more widespread than superficially evident during clinical consultation and could be a means of assessing risk.

    METHODS AND RESULTS: Cardiopulmonary exercise testing was performed in 335 consecutive ACHD patients (age, 33+/-13 years), 40 non-congenital heart failure patients (age, 58+/-15 years), and 11 young (age, 29+/-5 years) and 12 older (age, 59+/-9 years) healthy subjects. Peak oxygen consumption (peak VO2) was reduced in ACHD patients compared with healthy subjects of similar age (21.7+/-8.5 versus 45.1+/-8.6; P<0.001). No significant difference in peak VO2 was found between ACHD and heart failure patients of corresponding NYHA class (P=NS for each NYHA class). Within ACHD subgroups, peak VO2 gradually declined from aortic coarctation (28.7+/-10.4) to Eisenmenger (11.5+/-3.6) patients (P<0.001). Multivariable correlates of peak VO2 were peak heart rate (r=0.33), forced expiratory volume (r=0.33), pulmonary hypertension (r=-0.26), gender (r=-0.23), and body mass index (r=-0.19). After a median follow-up of 10 months, 62 patients (18.5%) were hospitalized or had died. On multivariable Cox analysis, peak VO2 predicted hospitalization or death (hazard ratio, 0.937; P=0.01) and was related to the frequency and duration of hospitalization (P=0.01 for each).

    CONCLUSIONS: Exercise capacity is depressed in ACHD patients (even in allegedly asymptomatic patients) on a par with chronic heart failure subjects. Lack of heart rate response to exercise, pulmonary arterial hypertension, and impaired pulmonary function are important correlates of exercise capacity, as is underlying cardiac anatomy. Poor exercise capacity identifies ACHD patients at risk for hospitalization or death.

  • 26.
    Erelund, Sofia
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Klinisk fysiologi.
    Karp, Kjell
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Klinisk fysiologi.
    Arvidsson, Sandra
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Klinisk fysiologi.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Klinisk fysiologi.
    Sundström, Nina
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.
    Wiklund, Urban
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Pulmonary function in a cohort of heart-healthy individuals from Northern Sweden: a comparison with discordant reference values2023Ingår i: BMC Pulmonary Medicine, E-ISSN 1471-2466, Vol. 23, nr 1, artikel-id 110Artikel i tidskrift (Refereegranskat)
    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.

    Ladda ner fulltext (pdf)
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  • 27.
    Erelund, Sofia
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Klinisk fysiologi.
    Slunga-Järvholm, Lisbeth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Nordendahl, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Wiklund, Urban
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Sundström, Nina
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Heart rate variability and long-term survival in females with ischemic heart diseaseManuskript (preprint) (Övrigt vetenskapligt)
  • 28.
    Hannuksela, Matias
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Carlberg, Bo
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Aortic stiffness in families with inherited non-syndromic thoracic aortic disease2018Ingår i: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 52, nr 6, s. 301-307Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

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  • 29.
    Hannuksela, Matias
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Stattin, Eva-Lena
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Medicinsk och klinisk genetik.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Carlberg, Bo
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Screening for familial thoracic aortic aneurysms with aortic imaging does not detect all potential aarriers of the disease2015Ingår i: Aorta, ISSN 2325-4637, Vol. 3, nr 1, s. 1-8Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: About 20% of patients with thoracic aortic aneurysm or dissection (TAAD) have a first-degree relative with a similar disease. The familial form (FTAAD) of the disease is inherited in an autosomal-dominant pattern. Current guidelines for thoracic aortic disease recommend screening of first-degree relatives of TAAD patients. In known familial disease, screening of both first- and second-degree relatives is recommended. However, the outcomes of such a screening program are unknown.

    Methods: We screened all first- and second-degree relatives in seven families with known FTAAD with echo- cardiography. No underlying gene defect had been detected in these families.

    Results: Of 119 persons investigated, 13 had known thoracic aortic disease. In the remaining 106 cases, we diagnosed 19 additional individuals with a dilated ascending thoracic aorta; for an autosomal-dominant disease, the expected number of individuals in this group would have been 40 (p<0.0001). Further, only one of the 20 first-degree relatives younger than 40 years had a dilated aorta, although the expected number of individuals with a disease-causing mutation would have been 10.

    Conclusions: In most families with TAAD, a diagnosis still relies on measuring the diameter of the thoracic aorta. We show that a substantial number of previously unknown cases of aortic dilatation can be identified by screening family members. It is, however, not possible to consider anyone free of the condition, even if the aortic diameter is normal, especially at a younger age.

  • 30.
    Hannuksela, Matias
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Stattin, Eva-Lena
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Medicinsk och klinisk genetik. Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
    Klar, Joakim
    Ameur, Adam
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Sorensen, Karen
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Diagnostisk radiologi.
    Carlberg, Bo
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    A novel variant in MYLK causes thoracic aortic dissections: genotypic and phenotypic description2016Ingår i: BMC Medical Genetics, E-ISSN 1471-2350, Vol. 17, artikel-id 61Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Mutations in MYLK cause non- syndromic familial thoracic aortic aneurysms and dissections (FTAAD). Very little is known about the phenotype of affected families. We sought to characterize the aortic disease and the presence of other vascular abnormalities in FTAAD caused by a deletion in MYLK and to compare thoracic aortic diameter and stiffness in mutation carriers and non-carriers.

    Methods: We studied FTAAD in a 5-generation family that included 19 living members. Exome sequencing was performed to identify the underlying gene defect. Aortic elastic properties measured by TTE, MRI and pulse wave velocity were then compared between mutation carriers and non-carriers.

    Results: Exome sequencing led to the identification of a 2-bp deletion in MYLK (c3272_ 3273del, p. Ser1091*) that led to a premature stop codon and nonsense-mediated decay. Eleven people were mutation carriers and eight people were non-carriers. Five aortic ruptures or dissections occurred in this family, with two survivors. There were no differences in aortic diameter or stiffness between carriers and non-carriers of the mutation.

    Conclusions: Individuals carrying this deletion in MYLK have a high risk of presenting with an acute aortic dissection or rupture. Aortic events occur over a wide range of ages and are not always preceded by obvious aortic dilatation. Aortic elastic properties do not differ between carriers and non-carriers of this mutation, rendering it uncertain whether and when carriers should undergo elective prophylactic surgery.

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  • 31.
    Hansén, Nike
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Ljungberg, Johan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Bergdahl, Ingvar
    Umeå universitet, Medicinska fakulteten, Enheten för biobanksforskning.
    Hultdin, Johan
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Klinisk kemi.
    Näslund, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Adipokines are possible risk markers for aortic stenosis requiring surgery2023Ingår i: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 57, nr 1, artikel-id 2247193Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: Aortic stenosis (AS) is the most prevalent valvular heart disease among adults. The adipocyte-derived hormones, leptin and adiponectin, have profound metabolic actions. We examined whether these adipokines are independently associated with future aortic valve replacement (AVR).

    Design: In this longitudinal case-control study, we identified 336 cases who had undergone AVR due to AS, and who had previously participated in population-based health surveys. Two referents were matched to each case and leptin and adiponectin concentrations were analysed from stored baseline survey samples. Uni- and multivariable logistic regression analyses were used to estimate the risk of future AVR. An additional cohort was identified for validation including 106 cases with AVR and 212 matched referents.

    Results: Median age (interquartile range (IQR)) in years at survey was 59.9 (10.4) and at surgery 68.3 (12.7), and 48% were women. An elevated concentration of leptin was not associated with future AVR (odds ratio [95% confidence interval]) (1.10 [0.92–1.32]), although leptin was associated with a higher risk in patients with coronary artery disease (CAD) having more than 5 years between survey and AVR (1.41 [1.08–1.84]). Adiponectin was not associated with higher risk for future AVR (0.95 [0.82–1.11]), although after stratification for age, higher levels were associated with reduced risk for AVR in persons aged ≥60 years at surgery (0.79 [0.64–0.98]). In the validation study, leptin was associated with future AVR whereas adiponectin was not. None of the associations remained significant after adjustment for body mass index (BMI).

    Conclusions: The adipokine leptin may promote the development of AS.

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  • 32.
    Hedlund, Mattias
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Lindelöf, Nina
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Boraxbekk, Carl-Johan
    Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR). Danish Research Center for Magnetic Resonance, Center for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital, Hvidovre, Denmark.
    Rosendahl, Erik
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Development and Feasibility of a Regulated, Supramaximal High-Intensity Training Program Adapted for Older Individuals2019Ingår i: Frontiers in Physiology, E-ISSN 1664-042X, Vol. 10, artikel-id 590Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: High-intensity training (HIT) with extremely short intervals (designated here as supramaximal HIT) is a time-efficient training method for health and performance. However, a protocol for regulation and control of intensity is missing, impeding implementation in various groups, such as older individuals.

    Methods: This study presents the development and characteristics of a novel training protocol with regulated and controlled supramaximal intervals adapted for older people. Using both quantitative and qualitative analyses, we explored the feasibility of the program, performed in a group training setting, with physically active older individuals (aged 65–75, n = 7; five women). The developed supramaximal HIT program consisted of 10 × 6 s cycle sprint intervals with ∼1 min of active recovery with the following key characteristics: (1) an individual target power output was reached and maintained during all intervals and regulated and expressed as the percentage of the estimated maximum mean power output for the duration of the interval (i.e., 6 s); (2) pedaling cadence was standardized for all participants, while resistance was individualized; and (3) the protocol enabled controlled and systematic adjustments of training intensity following standardized escalation criteria.

    Aim: Our aim was to test the feasibility of a novel training regimen with regulated and controlled supramaximal HIT, adapted for older people. The feasibility criteria for the program were to support participants in reaching a supramaximal intensity (i.e., power output > 100% of estimated VO2 max), avoid inducing a negative affective response, and have participants perceive it as feasible and acceptable.

    Results: All feasibility criteria were met. The standardized escalation procedure provided safe escalation of training load up to a supramaximal intensity (around three times the power output at estimated VO2 max). The participants never reported negative affective responses, and they perceived the program as fun and feasible.

    Conclusion: This novel program offers a usable methodology for further studies on supramaximal HIT among older individuals with different levels of physical capacity. Future research should explore the effects of the program in various populations of older people and their experiences and long-term adherence compared with other forms of training.

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  • 33.
    Hellström, Martin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin. Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Engström-Laurent, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Mörner, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Hyaluronan and collagen in human hypertrophic cardiomyopathy: a morphological analysis2012Ingår i: Cardiology Research and Practice, ISSN 2090-8016, E-ISSN 2090-0597, Vol. 2012, s. 545219-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The hypertrophic cardiomyopathy (HCM) disease process is not only limited to cardiomyocyte abnormalities but also engages the extracellular matrix. Hyaluronan (HA) and its receptor CD44 are involved in cellular growth and tissue proliferation but have so far been less studied in myocardial hypertrophy. In HCM, collagens are abundant but their histological distribution and relation to hyaluronan have not been described. Material and Methods. Myocardial specimens from 5 patients with symptomatic left ventricular tract obstruction undergoing myectomy due to HCM were processed for histochemistry and immunohistochemistry. Results. HA staining was more intense in HCM patients. The histological distribution of HA was the same in patients and controls, that is, interstitial staining including the space between cardiomyocytes, in fibrous septa, and in the adventitia of intramyocardial blood vessels. CD44 was not detected in the myocardium of patients or controls. Collagen I showed the same general localisation as HA but detailed distribution differed. Conclusions. This is the first study that describes the distribution of hyaluronan in human HCM. HA staining is more intense in HCM patients but without coexpression of its receptor CD44, at least not in the chronic phase of HCM. HA and collagen I have the same localisation.

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  • 34.
    Hellström, Martin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Ericsson, Madelene
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Fysiologisk kemi.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Faraz, Mahmood
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Anderson, Fredrick
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Fysiologisk kemi.
    Henriksson, Roger
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi. Regional Cancer Center Stockholm/Gotland, Stockholm, Sweden.
    Nilsson, Stefan K.
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Fysiologisk kemi.
    Hedman, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Cardiac hypertrophy and decreased high-density lipoprotein cholesterol in Lrig3-deficient mice2016Ingår i: American Journal of Physiology. Regulatory Integrative and Comparative Physiology, ISSN 0363-6119, E-ISSN 1522-1490, Vol. 310, nr 11, s. R1045-R1052Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Genetic factors confer risk for cardiovascular disease. Recently, large genome-wide population studies have shown associations between genomic loci close to LRIG3 and heart failure and plasma high-density lipoprotein (HDL) cholesterol level. Here, we ablated Lrig3 in mice and investigated the importance of Lrig3 for heart function and plasma lipid levels. Quantitative reverse transcription-polymerase chain reaction (RT-PCR) was used to analyze Lrig3 expression in the hearts of wild-type and Lrig3-deficient mice. In addition, molecular, physiological, and functional parameters such as organ weights, heart rate, blood pressure, heart structure and function, gene expression in the heart, and plasma insulin, glucose, and lipid levels were evaluated. The Lrig3-deficient mice were smaller than the wild-type mice but otherwise appeared grossly normal. Lrig3 was expressed at detectable but relatively low levels in adult mouse hearts. At 9 mo of age, ad libitum-fed Lrig3-deficient mice had lower insulin levels than wildtype mice. At 12 mo of age, Lrig3-deficient mice exhibited increased blood pressure, and the Lrig3-deficient female mice displayed signs of cardiac hypertrophy as assessed by echocardiography, heart-to-body weight ratio, and expression of the cardiac hypertrophy marker gene Nppa. Additionally, Lrig3-deficient mice had reduced plasma HDL cholesterol and free glycerol. These findings in mice complement the human epidemiological results and suggest that Lrig3 may influence heart function and plasma lipid levels in mice and humans.

  • 35.
    Hellström, Martin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Engström Laurent, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Hyaluronan and its receptor CD44 in the heart of newborn and adult rats.2006Ingår i: Anatomical record part A: discoveries in molecular, cellular, and evolutionary biology, ISSN 1552-4884, Vol. 288, nr 6, s. 587-592Artikel i tidskrift (Refereegranskat)
  • 36.
    Henein, Michael
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Bengrid, Tarek
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Nicoll, Rachel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Zhao, Y.
    Ultrasound Department, Capital Medical University, Beijing, China.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Schmermund, A.
    Medicine, Bethanien Hospital, Frankfurt, Germany.
    Extensive coronary calcification compromises myocardial perfusion in the absence of high grade stenosis2014Ingår i: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 235, nr 2, s. E68-E68Artikel i tidskrift (Övrigt vetenskapligt)
  • 37.
    Henein, Michael Y.
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Bengrid, Tarek
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Nicoll, Rachel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Zhao, Ying
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Schmermund, Axel
    Coronary calcification compromises myocardial perfusion irrespective of luminal stenosis2017Ingår i: IJC Heart & Vasculature, E-ISSN 2352-9067, Vol. 14, s. 41-45Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: The aim of this study was to evaluate the relationship between coronary artery calcification (CAC) assessed by multi-detector computed tomography (MDCT) and myocardial perfusion assessed by cardiac magnetic resonance imaging (CMR) in a group of symptomatic patients. Method: Retrospective analysis of 120 patients (age 65.1 +/- 8.9 years, 88 males) who presented with atypical chest pain to Bethanien Hospital, Frankfurt, Germany, between 2007 and 2010 and who underwent CAC scoring using MDCT, CMR, and conventional coronary angiography. Patients were divided into those with high-grade (HG) stenosis (n = 67, age 65.1 +/- 9.4 years) and those with no-HG stenosis (n = 53, age 65.1 +/- 8.6 years). Results: There were more males with HG stenosis (82.1% vs. 62.3%, p = 0.015), in whom the percentage and number of abnormal perfusion segments were higher at rest (37.3% vs. 17%, p = 0.014) but not different with stress (p = 0.83) from those with no-HG stenosis. Thirty-four patients had myocardial perfusion abnormalities at rest and 26 patients developed perfusion defects with stress. Stress-induced myocardial perfusion defects were 22.4% sensitive and 79.2% specific for detecting HG stenosis. The CAC score was lower in patients with no-HG stenosis compared to those with HG stenosis (p < 0.0001). On the ROC curve, a CAC score of 293 had a sensitivity of 71.6% and specificity of 83% in predicting HG stenosis [(AUC 0.80 (p < 0.0001)]. A CAC score of 293 or the presence of at least 1 segment myocardial perfusion abnormality was 74.6% sensitive and 71.7% specific in detecting HG stenosis, the respective values for the 2 abnormalities combined being 19.4% and 90.6%. The severity of CAC correlated with the extent of myocardial perfusion in the patient group as a whole with stress (r = 0.22, p = 0.015), particularly in those with no-HG stenosis (r = 0.31, p = 0.022). A CAC score of 293 was 31.6% sensitive and 87.3% specific in detecting myocardial perfusion abnormalities. Conclusion: In a group of patients with exertional angina, coronary calcification is more accurate in detecting high-grade luminal stenosis than myocardial perfusion defects. In addition, in patients with no stenosis, the incremental relationship between coronary calcium score and the extent of myocardial perfusion suggests coronary wall hardening as an additional mechanism for stress-induced angina other than luminal narrowing. These preliminary findings might have a clinical impact on management strategies of these patients other than conventional therapy.

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  • 38. Hjortshoj, Cristel Sorensen
    et al.
    Jensen, Annette Schophuus
    Sorensen, Keld
    Nagy, Edit
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Kronvall, Thomas
    Dellborg, Mikael
    Estensen, Mette-Elise
    Holmstrom, Henrik
    Turanlahti, Maila
    Thilen, Ulf
    Sondergaard, Lars
    Epidemiological changes in Eisenmenger syndrome in the Nordic region in 1977-20122017Ingår i: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 103, nr 17, s. 1353-1358Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Improved diagnostic tools, timely closure of the shunt and a better understanding of the complexity of Eisenmenger syndrome (ES) have led to improved care and treatment in tertiary centres. These may have decreased the incidence of ES and improved survival of patients with ES, although evidence is still lacking. The aim of this study was to investigate temporal changes in incidence, prevalence and mortality in patients with ES for 35 years in the Nordic region.

    Methods: This was a retrospective population-based study including 714 patients with ES. Survival analysis was performed based on all-cause mortality and accounting for immortal time bias.

    Results: The incidence of ES decreased from 2.5/million inhabitants/year in 1977 to 0.2/million inhabitants/year in 2012. Correspondingly, prevalence decreased from 24.6 to 11.9/million inhabitants. The median survival was 38.4 years, with 20-year, 40-year and 60-year survival of 72.5%, 48.4%, and 21.3%, respectively. Complex lesions and Down syndrome were independently associated with worse survival (HR 2.2, p<0.001 and HR 1.8, p<0.001, respectively). Age at death increased from 27.7 years in the period from 1977 to 1992, to 46.3 years from July 2006 to 2012 (p<0.001).

    Conclusions: The incidence and prevalence of ES in the Nordic region have decreased markedly during the last decades. Furthermore, the median age at death increased throughout the study period, indicating prolonged life expectancy in the ES population. However, increasing age represents decreased incidence, rather than improved survival. Nonetheless, longevity with ES is still shorter than in the background population.

  • 39. Holbein, Christina E.
    et al.
    Fogleman, Nicholas D.
    Hommel, Kevin
    Apers, Silke
    Rassart, Jessica
    Moons, Philip
    Luyckx, Koen
    Sluman, Maayke A.
    Enomoto, Junko
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Yang, Hsiao-Ling
    Dellborg, Mikael
    Subramanyan, Raghavan
    Jackson, Jamie L.
    Budts, Werner
    Kovacs, Adrienne H.
    Morrison, Stacey
    Tomlin, Martha
    Gosney, Kathy
    Soufi, Alexandra
    Eriksen, Katrine
    Thomet, Corina
    Berghammer, Malin
    Alday, Luis
    Callus, Edward
    Fernandes, Susan M.
    Caruana, Maryanne
    Menahem, Samuel
    Cook, Stephen C.
    Rempel, Gwen R.
    White, Kamila
    Khairy, Paul
    Kutty, Shelby
    Veldtman, Gruschen
    A multinational observational investigation of illness perceptions and quality of life among patients with a Fontan circulation2018Ingår i: Congenital Heart Disease, ISSN 1747-079X, E-ISSN 1747-0803, Vol. 13, nr 3, s. 392-400Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: First, to compare QOL and illness perceptions between patients with a Fontan circulation and patients with anatomically simple defects (ie, atrial septal defects [ASD] or ventricular septal defects [VSD]). Second, to explore illness perceptions as a mediator of the association between congenital heart disease (CHD) diagnosis and QOL.

    DESIGN: Cross-sectional observational study.

    SETTING: Twenty-four cardiology centers from 15 countries across five continents.

    PATIENTS: Four hundred thirty-five adult patients with congenital heart disease (177 Fontan and 258 ASD/VSD) ages 18-83 years.

    OUTCOME MEASURES: QOL and illness perceptions were assessed by the Satisfaction With Life Scale and the Brief Illness Perceptions Questionnaire, respectively.

    RESULTS: Patients with a Fontan circulation reported lower QOL (Wald Z = -3.59, p = <.001) and more negative perceptions of their CHD (Wald Z = -7.66, p < .001) compared with patients with ASD/VSD. After controlling for demographics, anxiety, depressive symptoms, and New York Heart Association functional class, path analyses revealed a significant mediation model, αβ = 0.15, p = .002, 95% CI = 0.06-0.25, such that CHD diagnosis was indirectly related to QOL through illness perceptions.

    CONCLUSIONS: The Fontan sample's more negative perceptions of CHD were likely a reflection of life with a more complex defect. Illness perceptions appear to account for unique differences in QOL between groups of varying CHD complexity. Psychosocial screening and interventions may be important treatment components for patients with CHD, particularly those with Fontan circulations.

  • 40. Holbein, Christina E.
    et al.
    Peugh, James
    Veldtman, Gruschen R.
    Apers, Silke
    Luyckx, Koen
    Kovacs, Adrienne H.
    Thomet, Corina
    Budts, Werner
    Enomoto, Junko
    Sluman, Maayke A.
    Lu, Chun-Wei
    Jackson, Jamie L.
    Khairy, Paul
    Cook, Stephen C.
    Chidambarathanu, Shanthi
    Alday, Luis
    Eriksen, Katrine
    Dellborg, Mikael
    Berghammer, Malin
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Mackie, Andrew S.
    Menahem, Samuel
    Caruana, Maryanne
    Soufi, Alexandra
    Fernandes, Susan M.
    White, Kamila
    Callus, Edward
    Kutty, Shelby
    Moons, Philip
    Health behaviours reported by adults with congenital heart disease across 15 countries2020Ingår i: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 27, nr 10, s. 1077-1087Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Health behaviours are essential to maintain optimal health and reduce the risk of cardiovascular complications in adults with congenital heart disease. This study aimed to describe health behaviours in adults with congenital heart disease in 15 countries and to identify patient characteristics associated with optimal health behaviours in the international sample.

    Design This was a cross-sectional observational study.

    Methods Adults with congenital heart disease (n = 4028, median age = 32 years, interquartile range 25-42 years) completed self-report measures as part of the Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease - International Study (APPROACH-IS). Participants reported on seven health behaviours using the Health Behaviors Scale-Congenital Heart Disease. Demographic and medical characteristics were assessed via medical chart review and self-report. Multivariate path analyses with inverse sampling weights were used to investigate study aims.

    Results Health behaviour rates for the full sample were 10% binge drinking, 12% cigarette smoking, 6% recreational drug use, 72% annual dental visit, 69% twice daily tooth brushing, 27% daily dental flossing and 43% sport participation. Pairwise comparisons indicated that rates differed between countries. Rates of substance use behaviours were higher in younger, male participants. Optimal dental health behaviours were more common among older, female participants with higher educational attainment while sports participation was more frequent among participants who were younger, male, married, employed/students, with higher educational attainment, less complex anatomical defects and better functional status.

    Conclusions Health behaviour rates vary by country. Predictors of health behaviours may reflect larger geographic trends. Our findings have implications for the development and implementation of programmes for the assessment and promotion of optimal health behaviours in adults with congenital heart disease.

  • 41. Holbein, Christina E.
    et al.
    Veldtman, Gruschen R.
    Moons, Philip
    Kovacs, Adrienne H.
    Luyckx, Koen
    Apers, Silke
    Chidambarathanu, Shanti
    Soufi, Alexandra
    Eriksen, Katrine
    Jackson, Jamie L.
    Enomoto, Junko
    Fernandes, Susan M.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Alday, Luis
    Dellborg, Mikael
    Berghammer, Malin
    Menahem, Samuel
    Caruana, Maryanne
    Kutty, Shelby
    Mackie, Andrew S.
    Thomet, Corina
    Budts, Werner
    White, Kamila
    Sluman, Maayke A.
    Callus, Edward
    Cook, Stephen C.
    Khairy, Paul
    Cedars, Ari
    Perceived Health Mediates Effects of Physical Activity on Quality of Life in Patients With a Fontan Circulation2019Ingår i: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 124, nr 1, s. 144-150Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Patients with a Fontan circulation are at risk of a sedentary lifestyle. Given the direct relationship between physical activity and health, promotion of physical activity has the potential to improve outcomes, including quality of life (QOL). This study aimed to describe self-reported physical activity levels in adult Fontan patients and examine associations between physical activity, perceived health status and QOL. The sample consisted of 177 Fontan patients (M-age = 27.5 +/- 7.6 years, 52% male) who reported their physical activity, perceived health status, and QOL as part of the cross-sectional Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease - International Study. Descriptive statistics and univariate analyses of variance with planned contrasts were computed to describe physical activity characteristics. Mediation analyses tested whether perceived health status variables mediated the association between physical activity and QOL. Forty-six percent of patients were sedentary while only 40% met international physical activity guidelines. Higher physical activity was associated with younger age, lower NYHA class, higher perceived general health, and greater QOL. Patients who commuted by walking and engaged in sports reported better perceived health and QOL. Mediation analyses revealed that perceived general health but not NYHA functional class mediated the association between physical activity and QOL (alpha beta = 0.22, 95% confidence interval = 0.04 to 0.49). In conclusion, Fontan patients likely benefit from regular physical activity, having both higher perceived general health and functional capacity; greater perceived health status may contribute to enhanced QOL. In conclusion, these data support the pivotal role of regular physical activity for Fontan patients.

  • 42.
    Holmgren, Anders
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Ljungberg, Johan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Hultdin, Johan
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Klinisk kemi.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Bergdahl, Ingvar
    Umeå universitet, Medicinska fakulteten, Enheten för biobanksforskning.
    Näslund, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Troponin T but not C-reactive protein is associated with future surgery for aortic stenosis: a population based nested case-referent study2020Ingår i: Open heart, E-ISSN 2053-3624, Vol. 7, nr 2, artikel-id e001325Artikel i tidskrift (Refereegranskat)
    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.

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  • 43.
    Holstad, Ylva
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Lindqvist, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi. Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Westergren, Agneta
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Sundström Poromaa, Inger
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Christersson, Christina
    Department of Medical Science, Cardiology, Uppsala University, Uppsala, Sweden.
    Dellborg, Mikael
    Department of Clinical and Molecular Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Trzebiatowska-Krzynska, Aleksandra
    Department of Cardiology, Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
    Sörensson, Peder
    Department of Medicine, Solna, Department of Cardiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Thilén, Ulf
    Department of Clinical Sciences, Cardiology, Lund University, Lund, Sweden.
    Wikström, Anna-Karin
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Bay, Annika
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Breastfeeding in primiparous women with congenital heart disease: a register study2024Ingår i: International Breastfeeding Journal, E-ISSN 1746-4358, Vol. 19, nr 1, artikel-id 19Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The number of pregnant women with congenital heart disease (CHD) is rising, and the disease poses increased risks of cardiovascular and obstetric complications during pregnancy, potentially impacting breastfeeding success. This study aimed to investigate breastfeeding in primiparous women with CHD compared to primiparous women without CHD, and to examine potential hindering factors for breastfeeding in women with CHD.

    Methods: The data were gathered between 2014 and 2019 and obtained by merging the Swedish Congenital Heart Disease Register (SWEDCON) with the Swedish Pregnancy Register. Primiparous women ≥ 18 years of age with CHD (n = 578) were matched by age and municipality to 3049 women without CHD, giving birth after 22 gestational weeks. Multivariable logistic regression analysis was used to identify factors associated with non-breastfeeding in women with CHD.

    Results: Fewer women with CHD breastfed than women without CHD two days (94% vs. 97%, p = 0.001) and four weeks after birth (84% vs. 89%, p = 0.006). When all women were analysed, having CHD was associated with non-breastfeeding at both two days and four weeks after birth. For women with CHD, body mass index (BMI) ≥ 30 (OR 3.1; 95% CI 1.4, 7.3), preterm birth (OR 6.4; 95% CI 2.1, 19.0), self-reported history of psychiatric illness (OR 2.4; 95% CI 1.2, 5.1), small for gestational age (OR 4.2; 95% CI 1.4, 12.2), and New York Heart Association Stages of Heart Failure class II − III (OR 6.0; 95% CI 1.4, 26.7) were associated with non-breastfeeding two days after birth. Four weeks after birth, factors associated with non-breastfeeding were BMI ≥ 30 (OR 4.3; 95% CI 2.1, 9.0), self-reported history of psychiatric illness (OR 2.2; 95% CI 1.2, 4.2), and preterm birth (OR 8.9; 95% CI 2.8, 27.9).

    Conclusions: The study shows that most women with CHD breastfeed, however, at a slightly lower proportion compared to women without CHD. In addition, factors related to the heart disease were not associated with non-breastfeeding four weeks after birth. Since preterm birth, BMI ≥ 30, and psychiatric illness are associated with non-breastfeeding, healthcare professionals should provide greater support to women with CHD having these conditions.

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  • 44.
    Holstad, Ylva
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Lindqvist, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi. Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Westergren, Agneta
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Sundström Poromaa, Inger
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Christersson, Christina
    Department of Medical Science, Cardiology, Uppsala University, Uppsala, Sweden.
    Dellborg, Mikael
    Department of Clinical and Molecular Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Trzebiatowska-Krzynska, Aleksandra
    Department of Cardiology and Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
    Sörensson, Peder
    Department of Medicine, Solna, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
    Thilén, Ulf
    Department of Clinical Sciences, Cardiology, Lund University, Lund, Sweden.
    Wikström, Anna-Karin
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Bay, Annika
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Self-rated health in primiparous women with congenital heart disease before, during and after pregnancy: a register study2023Ingår i: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 58, nr 1, artikel-id 2295782Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Poor maternal self-rated health in healthy women is associated with adverse neonatal outcomes, but knowledge about self-rated health in pregnant women with congenital heart disease (CHD) is sparse. This study, therefore, investigated self-rated health before, during, and after pregnancy in women with CHD and factors associated with poor self-rated health.

    Methods: The Swedish national registers for CHD and pregnancy were merged and searched for primiparous women with data on self-rated health; 600 primiparous women with CHD and 3062 women in matched controls. Analysis was performed using descriptive statistics, chi-square test and logistic regression.

    Results: Women with CHD equally often rated their health as poor as the controls before (15.5% vs. 15.8%, p = .88), during (29.8% vs. 26.8% p = .13), and after pregnancy (18.8% vs. 17.6% p = .46). None of the factors related to heart disease were associated with poor self-rated health. Instead, factors associated with poor self-rated health during pregnancy in women with CHD were ≤12 years of education (OR 1.7, 95%CI 1.2–2.4) and self-reported history of psychiatric illness (OR 12.6, 95%CI 1.4–3.4). After pregnancy, solely self-reported history of psychiatric illness (OR 5.2, 95%CI 1.1–3.0) was associated with poor self-rated health.

    Conclusion: Women with CHD reported poor self-rated health comparable to controls before, during, and after pregnancy, and factors related to heart disease were not associated with poor self-rated health. Knowledge about self-rated health may guide professionals in reproductive counselling for women with CHD. Further research is required on how pregnancy affects self-rated health for the group in a long-term perspective.

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  • 45.
    Johansson, B
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB).
    Eriksson, A
    Ramaekers, F
    Thornell, L
    Smoothelin in adult and developing human arteries and myocardium.1999Ingår i: Histochemistry and Cell Biology, ISSN 0948-6143, E-ISSN 1432-119X, Vol. 112, nr 4, s. 291-9Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this investigation was to study, with immunohistochemical methods, the distribution of the novel cytoskeletal protein smoothelin in human cardiovascular tissues, the possible changes during the development of the cardiovascular system and its correlation to the intermediate filament proteins desmin and vimentin. Smoothelin was detected in smooth muscle cells of the fetal coronary arteries. In very young subjects (up to 3 months of age), only a few cells in the media of the elastic arteries contained smoothelin, whereas it was present in most smooth muscle cells in the muscular arteries. In individuals older than 1 year, most smooth muscle cells in the media of all blood vessels contained smoothelin. In vessels with a developed intima, smoothelin was present in a variable proportion of the smooth muscle cells. With few exceptions, smoothelin was more frequently detected than desmin in medial smooth muscle cells. Smoothelin and vimentin were codistributed in the smooth muscle cells of the media in most vessels. In the cardiomyocytes (fetal to adult age), the smoothelin antibody detected epitopes located at the Z-disc level but not in the intercalated discs. In conclusion, smoothelin is more widely distributed in the muscular arteries than in the elastic arteries early in life, and thus exhibits a variable distribution during postnatal development of vascular tissues. In the adult, smoothelin is detected in the media of most vascular smooth muscle cells, both in muscular and elastic arteries, and is not necessarily codistributed with either desmin or vimentin. Evidence that smoothelin is present in human striated cardiomyocytes is also presented.

  • 46. Johansson, B
    et al.
    Eriksson, A
    Ramaekers, F
    Thornell, L E
    Smoothelin and intermediate filament proteins in human aortocoronary saphenous vein by-pass grafts.1999Ingår i: The Histochemical Journal, ISSN 0018-2214, E-ISSN 1573-6865, Vol. 31, nr 11, s. 723-7Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this immunohistochemical investigation was to study the distribution of the novel cytoskeletal protein smoothelin and the intermediate filament proteins vimentin and desmin in normal human great saphenous vein and in human aortocoronary by-pass vein grafts. Smoothelin was present in most smooth muscle cells in the media of the native vein. In the neointima of the vein grafts that had been in situ for three months or more, smoothelin was, in general, present only in few smooth muscle cells. Desmin was distributed in the same pattern as smoothelin in the native great saphenous vein. When desmin and smoothelin were present in the neointima, smoothelin was detected in more cells than desmin. Vimentin was present in most cells in all wall layers of both the native saphenous vein and the vein grafts. Vascular smooth muscle cells containing vimentin but not desmin or smoothelin are the principal cells in the neointima of human aortocoronary vein grafts. In some grafts, however, all three cytoskeletal proteins were detected in the neointima. The distribution of smoothelin and desmin in aortocoronary vein grafts support the postulate that these proteins are expressed mainly in the contractile smooth muscle cell phenotype.

  • 47. Johansson, B
    et al.
    Eriksson, A
    Thornell, L E
    Intermediate filament proteins in developing human arteries.1999Ingår i: Anatomy and Embryology, ISSN 0340-2061, E-ISSN 1432-0568, Vol. 199, nr 3, s. 225-31Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The distribution of intermediate filament proteins in adult human blood vessels and in human fetal elastic arteries is relatively well-known. However, the distribution of these proteins in the course from neonate to adult has not been established. In this investigation, human postnatal arteries were studied with immunohistochemistry, using antibodies targeted on the intermediate filament proteins desmin, vimentin and cytokeratins 8, 18 and 19. Vimentin was present in most smooth muscle cells in all vessels and at all ages. The proportions of desmin-expressing cells increased in the elastic arteries during the first year of life and was higher in the pulmonary trunk than in the aorta. In the muscular arteries, the proportion of desmin-labelled cells increased in the coronary and the deep femoral arteries, but remained constant in the renal and the cerebral arteries. Cytokeratins were detected in the pulmonary trunk earlier than in the aorta. Cytokeratins were present throughout the wall of the ductus arteriosus, but desmin was present only in some cells. Thus, there are postnatal changes in the distribution of intermediate filament proteins in the elastic arteries and in some muscular arteries, whereas the intermediate filament pattern remains unchanged in other muscular arteries.

  • 48.
    Johansson, B
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB).
    Eriksson, A
    Virtanen, I
    Thornell, L E
    Intermediate filament proteins in adult human arteries.1997Ingår i: Anatomical Record, ISSN 0003-276X, E-ISSN 1097-0185, Vol. 247, nr 4, s. 439-48Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The cytoskeleton of cells in blood vessel walls contains desmin, vimentin, and cytokeratins. The distribution of these proteins in human vessels is not fully known. We have mapped the distribution of intermediate filament proteins in human arterial walls.

    METHODS: Monoclonal antibodies targeted at the intermediate filament proteins desmin, vimentin, and cytokeratins were used, and the distribution of these proteins was studied by immunohistochemistry.

    RESULTS: In the muscular arteries, most smooth muscle cells in the media expressed both desmin and vimentin; in the elastic arteries, the proportion of desmin-labelled cells was lower and preferentially located to the periphery of the media. In general, the desmin immunoreactivity within the intima was weak, but some smooth muscle cells and smooth muscle cells in the musculoelastic layer showed strong immunoreactivity. The vasa vasorum exhibited a heterogeneous desmin-labelling pattern. The vimentin antibodies labelled the endothelium and showed a heterogeneous staining pattern in the other layers of the arterial wall. Cytokeratin was detected in occasional cells in the media of muscular arteries, in many adluminal cells and cell clusters in the coronary intima, and in smooth muscle cells in the media of the elastic arteries.

    CONCLUSIONS: Vimentin is widely distributed in vascular smooth muscle cells, whereas the distribution of desmin and cytokeratin varies. Each artery studied had an intermediate filament pattern typical for the anatomical location. There were no interindividual variations in the distribution of intermediate filament proteins.

  • 49.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Cardiovascular Magnetic Resonance in Heart Failure2010Ingår i: Heart Failure in Clinical Practice / [ed] Michael Y. Henein, Springer London, 2010, s. 241-253Kapitel i bok, del av antologi (Refereegranskat)
    Abstract [en]

    Cardiovascular magnetic resonance (CMR) is an increasingly used imaging tool in cardiology. Initially, technical resources and access to trained staff were limited to a few centers. As scanners become more available and thanks to widespread training of cardiologists and technicians, CMR can now be performed in most cardiology centers. Without exposing the patient to ionizing radiation, a comprehensive cardiac study can be performed in 30–45 min, depending on clinical problem and scanner capabilities. A typical cardiac exam consists of anatomical images for gross anatomy and cine images for the evaluation of ventricular function. Depending on the clinical problem, a number of additional techniques can be added. Using chelated gadolinium contrast agents, first pass myocardial perfusion can be analyzed during pharmacological stress for the diagnosis of coronary artery disease. After injection of contrast in a peripheral vein, high resolution angiography can be performed. Phase contrast velocity maps (which despite the terminology it does not include contrast agents) can also be used to analyze intrathoracic vascular blood flow and flow velocity.

  • 50.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Introduction The 99th Berzelius symposium: the Cardiac Patient from Birth to Adulthood2020Ingår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 288, nr 4, s. 381-382Artikel i tidskrift (Övrigt vetenskapligt)
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