liu.seSearch for publications in DiVA
Change search
Link to record
Permanent link

Direct link
BETA
Escobar Kvitting, John-Peder
Alternative names
Publications (10 of 50) Show all publications
Svensson, A. S., Escobar Kvitting, J.-P., Kovesdy, C. P., Cederholm, I. & Szabó, Z. (2016). Changes in serum cystatin C, creatinine, and C-reactive protein after cardiopulmonary bypass in patients with normal preoperative kidney function.. Nephrology (Carlton. Print), 21(6), 519-525
Open this publication in new window or tab >>Changes in serum cystatin C, creatinine, and C-reactive protein after cardiopulmonary bypass in patients with normal preoperative kidney function.
Show others...
2016 (English)In: Nephrology (Carlton. Print), ISSN 1320-5358, E-ISSN 1440-1797, Vol. 21, no 6, p. 519-525Article in journal (Refereed) Published
Abstract [en]

AIM: The use of cardiopulmonary bypass (CPB) can cause changes in serum creatinine and cystatin C independent of glomerular filtration rate. We aimed to quantify the temporal changes of these biomarkers and C-reactive protein (CRP) after CPB.

METHODS: This was a prospective study at an academic medical center between April and October 2013. We compared postoperative changes in serum creatinine and cystatin C in 38 patients with normal preoperative kidney function who underwent cardiac surgery using CPB and did not develop perioperative acute kidney injury (AKI). The effect of inflammation on intra-individual changes was examined in mixed effects regressions, using measurements of pre- and postoperative CRP.

RESULTS: Both serum creatinine (79.9 ± 22.7 vs. 92.6 ± 21.4 µmol/L, p = 0.001) and cystatin C (1.16 ± 0.39 vs. 1.33 ± 0.37 mg/L, p = 0.012) decreased significantly in the first 8 hours postoperatively compared to preoperatively, as a result of hemodilution. Thereafter serum creatinine returned to preoperative levels, whereas serum cystatin C continued to rise and was significantly elevated at 72 hours post-CPB compared to preoperative levels (1.53 ± 0.48 vs. 1.33 ± 0.37 mg/L, p = 0.003). CRP levels increased significantly post-CPB and were significantly associated with increases in both serum creatinine and cystatin C.

CONCLUSIONS: Serum creatinine and cystatin C appear not to be interchangeable biomarkers during and immediately after CPB. Processes unrelated to kidney function such as acute inflammation have a significant effect on post-CPB changes in these biomarkers, and may result in significant increases in serum cystatin C that could erroneously be interpreted as AKI. This article is protected by copyright. All rights reserved.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2016
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-122030 (URN)10.1111/nep.12630 (DOI)000379594600010 ()26396066 (PubMedID)
Note

Funding agencies: county council of Ostergotland [LIO-205491, LIO-277491]

Available from: 2015-10-16 Created: 2015-10-16 Last updated: 2017-12-01
Johansson, M., Escobar Kvitting, J.-P., Flatebø, T., Nicolaysen, A., Nicolaysen, G. & Walther, S. (2016). Inhibition of constitutive nitric oxide synthase does not influence ventilation: matching in normal prone adult sheep with mechanical ventilation. Anesthesia and Analgesia, 123(6), 1492-1499
Open this publication in new window or tab >>Inhibition of constitutive nitric oxide synthase does not influence ventilation: matching in normal prone adult sheep with mechanical ventilation
Show others...
2016 (English)In: Anesthesia and Analgesia, ISSN 0003-2999, E-ISSN 1526-7598, Vol. 123, no 6, p. 1492-1499Article in journal (Refereed) Published
Abstract [en]

Background

Local formation of nitric oxide (NO) in the lung in proportion to ventilation, leading to vasodilation, is a putative mechanism behind ventilation- perfusion matching. We examined the role of local constitutive NO formation on regional distributions of ventilation (V) and perfusion (Q) and ventilation-perfusion matching (V/Q) in mechanically ventilated adult sheep with normal gas exchange.

Methods

V and Q were analyzed in lung regions (≈1.5 cm3) before and after inhibition of constitutive nitric oxide synthase (cNOS) with Nω-nitro-L-arginine methyl ester (L-NAME) (25 mg/kg) in seven prone sheep ventilated with PEEP. V and Q were measured using aerosolized fluorescent and infused radiolabeled microspheres, respectively. The animals were exsanguinated while deeply anaesthetized; lungs were excised, dried at total lung capacity and divided into cube units. The spatial location for each cube was tracked and fluorescence and radioactivity per unit weight determined.

Results

Pulmonary artery pressure increased significantly after L-NAME (from mean 16.6 to 23.6 mmHg, P<0.01) while there were no significant changes in PaO2, PaCO2 or SD log(V/Q). Distribution of V was not influenced by L-NAME but a small redistribution of Q from ventral to dorsal lung regions resulting in less heterogeneity in Q along the gravitational axis was seen (p<0.01). Perfusion to regions with the highest ventilation (5th quintile of the V distribution) remained unchanged with L-NAME.

Conclusions

There was minimal or no influence of cNOS inhibition by L-NAME on the distributions of V and Q, and V/Q in prone anesthetized and ventilated adult sheep with normal gas exchange.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2016
National Category
Surgery Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-112361 (URN)10.1213/ANE.0000000000001556 (DOI)000388144000020 ()
Note

Funding agencies: Faculty of Medicine and Health Sciences, Linkoping University, Sweden; Faculty of Medicine, University of Oslo, Norway; Anders Jahres Foundation for Promotion of Sciences, Norway; AGA Gas AB, Lidingo, Sweden

Vid tiden för disputationen förelåg publikationen som manuskript

Available from: 2014-11-24 Created: 2014-11-24 Last updated: 2017-12-05Bibliographically approved
Stephens, E. H., Hope, T. A., Kari, F. A., Escobar Kvitting, J.-P., Liang, D. H., Herfkens, R. J. & Craig Miller, D. (2015). Greater asymmetric wall shear stress in Sievers type 1/LR compared with 0/LAT bicuspid aortic valves after valve-sparing aortic root replacement. Journal of Thoracic and Cardiovascular Surgery, 150(1), 59-68
Open this publication in new window or tab >>Greater asymmetric wall shear stress in Sievers type 1/LR compared with 0/LAT bicuspid aortic valves after valve-sparing aortic root replacement
Show others...
2015 (English)In: Journal of Thoracic and Cardiovascular Surgery, ISSN 0022-5223, E-ISSN 1097-685X, Vol. 150, no 1, p. 59-68Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate the role of commissure orientation on downstream blood flow patterns and ascending aortic wall shear stress (WSS) in patients with bicuspid aortic valves (BAV) after valve-sparing aortic root replacement (V-SARR). Methods: Nineteen BAV patients after V-SARR (9 Sievers type 1/LR [type 1 valve with fusion of the left and right cusps] and 10 Sievers type 0/LAT ["naturally perfect; type 0 valve without the presence of a raphe, and with the 2 commissures oriented right-anterior-to-left-posterior]) were imaged using time-resolved 3-D phase contrast magnetic resonance imaging. A control group of 5 unoperated tricuspid aortic valve patients were used for comparison purposes. Wall shear stress and eccentricity of flow normalized to aortic diameter were measured in planes placed perpendicular to the axis of the ascending aorta at the level of the sinotubular junction (proximal ascending), main pulmonary artery (mid-ascending), and origin of the brachiocephalic (distal ascending). Results: The ratio of WSS along the outer curvature to that along the inner curvature was greater in Sievers type 1/LR patients compared with Sievers type 0/LAT patients in the proximal (3.8 +/- 1.6 vs 2.1 +/- 0.9, P = .009) and mid-ascending aorta (4.5 +/- 2.4 vs 2.4 +/- 1.3, P = .027). Relative to control normal tricuspid patients, Sievers type 1/LR BAV patients had a higher WSS ratio in the mid-ascending aorta (4.5 +/- 2.4 vs 1.2 +/- 1.2, P = .007). Conversely, WSS in Sievers type 0/LAT patients was not different than in normal tricuspid patients. Conclusions: After V-SARR, BAV cusp morphology has a major impact on the pattern of blood flow and WSS in the ascending aorta.

Place, publisher, year, edition, pages
Elsevier, 2015
Keywords
Bicuspid aortic valve; valve-sparing aortic root replacement; 4D flow MRI; thoracic aorta
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-120351 (URN)10.1016/j.jtcvs.2015.04.020 (DOI)000357129900023 ()25956338 (PubMedID)
Note

Funding Agencies|Carl and Leah McConnell Cardiovascular Surgical Research Fellowship

Available from: 2015-07-31 Created: 2015-07-31 Last updated: 2017-12-04
Svensson, A., Kovesdy, C. P., Escobar Kvitting, J.-P., Cederholm, I. & Szabó, Z. (2014). Serum cystatin C as disgnostic marker of acute kidney injury after cardiopulmonary bypass: a word of caution. In: : . Paper presented at Journal of the American Society of Nephrology 2014.
Open this publication in new window or tab >>Serum cystatin C as disgnostic marker of acute kidney injury after cardiopulmonary bypass: a word of caution
Show others...
2014 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-114950 (URN)
Conference
Journal of the American Society of Nephrology 2014
Available from: 2015-03-06 Created: 2015-03-06 Last updated: 2015-06-11
Svensson, A. S., Kovesdy, C. P., Escobar Kvitting, J.-P., Rosén, M., Cederholm, I. & Szabó, Z. (2013). Comparison of serum cystatin C and creatinine changes after cardiopulmonary bypass in patients with normal preoperative kidney function. International Urology and Nephrology, 45(6), 1597-1603
Open this publication in new window or tab >>Comparison of serum cystatin C and creatinine changes after cardiopulmonary bypass in patients with normal preoperative kidney function
Show others...
2013 (English)In: International Urology and Nephrology, ISSN 0301-1623, E-ISSN 1573-2584, Vol. 45, no 6, p. 1597-1603Article in journal (Refereed) Published
Abstract [en]

Purpose

Serum creatinine is used ubiquitously to estimate glomerular filtration rate and to diagnose acute kidney injury after cardiac surgery. Serum cystatin C is a novel biomarker that has emerged as a possible diagnostic alternative to serum creatinine. It is unclear if the dynamic changes in serum cystatin C immediately following cardiopulmonary bypass (CPB) differ from those of serum creatinine in patients with normal preoperative kidney function.

Methods

We compared changes in serum levels of creatinine and cystatin C by measuring them serially in 19 patients undergoing CPB. Within-patient differences for serum creatinine and serum cystatin C were compared by repeated measures ANOVA.

Results

Serum creatinine and cystatin C levels showed significant correlation with each other. Both biomarkers showed a significant decrease after CPB, but their serum concentrations reverted to pre-CPB levels within 12 h. Serum levels of serum creatinine remained unchanged from baseline levels throughout 72-h post-CPB. In contrast, serum cystatin C levels rose further and became significantly higher compared to baseline within 48 h. Serum cystatin C remained significantly elevated at 48- and 72-h post-CPB.

Conclusions

Processes that determine the serum concentrations of serum creatinine and cystatin C in the post-CPB period affect the two biomarkers differently, suggesting that the two are not interchangeable as diagnostic markers of glomerular filtration rate. Future studies are needed to examine if these discrepancies are related to differences in their production rates, in their ability to detect small changes in glomerular filtration rate, or to a combination of these, and to determine the effect of such differences on the diagnostic and prognostic accuracy of the two biomarkers.

Place, publisher, year, edition, pages
Springer Netherlands, 2013
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-90057 (URN)10.1007/s11255-013-0403-5 (DOI)000327950000009 ()
Available from: 2013-03-19 Created: 2013-03-19 Last updated: 2017-12-06
Tsamis, A., Bothe, W., Kvitting, J.-P. E., Swanson, J. J., Miller, D. C. & Kuhl, E. (2011). Active contraction of cardiac muscle: In vivo characterization of mechanical activation sequences in the beating heart. Journal of The Mechanical Behavior of Biomedical Materials, 4(7), 1167-1176
Open this publication in new window or tab >>Active contraction of cardiac muscle: In vivo characterization of mechanical activation sequences in the beating heart
Show others...
2011 (English)In: Journal of The Mechanical Behavior of Biomedical Materials, ISSN 1751-6161, E-ISSN 1878-0180, Vol. 4, no 7, p. 1167-1176Article in journal (Refereed) Published
Abstract [en]

Progressive alterations in cardiac wall strains are a classic hallmark of chronic heart failure. Accordingly, the objectives of this study are to establish a baseline characterization of cardiac strains throughout the cardiac cycle, to quantify temporal, regional, and transmural variations of active fiber contraction, and to identify pathways of mechanical activation in the healthy beating heart. To this end, we insert two sets of twelve radiopaque beads into the heart muscle of nine sheep; one in the anterior-basal and one in the lateral-equatorial left ventricular wall. During three consecutive heartbeats, we record the bead coordinates via biplane videofluoroscopy. From the resulting four-dimensional data sets, we calculate the temporally and transmurally varying Green-Lagrange strains in the anterior and lateral wall. To quantify active contraction, we project the strains onto the local muscle fiber directions. We observe that mechanical activation is initiated at the endocardium slightly after end diastole and progresses transmurally outward, reaching the epicardium slightly before end systole. Accordingly, fibers near the outer wall are in contraction for approximately half of the cardiac cycle while fibers near the inner wall are in contraction almost throughout the entire cardiac cycle. In summary, cardiac wall strains display significant temporal, regional, and transmural variations. Quantifying wall strain profiles might be of particular clinical significance when characterizing stages of left ventricular remodeling, but also of engineering relevance when designing new biomaterials of similar structure and function.

Place, publisher, year, edition, pages
Elsevier, 2011
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-76229 (URN)10.1016/j.jmbbm.2011.03.027 (DOI)21783125 (PubMedID)
Available from: 2012-03-30 Created: 2012-03-30 Last updated: 2017-12-07
Rausch, M. K., Bothe, W., Kvitting, J.-P. E., Swanson, J. C., Ingels, N. B., Miller, D. C. & Kuhl, E. (2011). Characterization of mitral valve annular dynamics in the beating heart. Annals of Biomedical Engineering, 39(6), 1690-1702
Open this publication in new window or tab >>Characterization of mitral valve annular dynamics in the beating heart
Show others...
2011 (English)In: Annals of Biomedical Engineering, ISSN 0090-6964, E-ISSN 1573-9686, Vol. 39, no 6, p. 1690-1702Article in journal (Refereed) Published
Abstract [en]

The objective of this study is to establish a mathematical characterization of the mitral valve annulus that allows a precise qualitative and quantitative assessment of annular dynamics in the beating heart. We define annular geometry through 16 miniature markers sewn onto the annuli of 55 sheep. Using biplane videofluoroscopy, we record marker coordinates in vivo. By approximating these 16 marker coordinates through piecewise cubic splines, we generate a smooth mathematical representation of the 55 mitral annuli. We time-align these 55 annulus representations with respect to characteristic hemodynamic time points to generate an averaged baseline annulus representation. To characterize annular physiology, we extract classical clinical metrics of annular form and function throughout the cardiac cycle. To characterize annular dynamics, we calculate displacements, strains, and curvature from the discrete mathematical representations. To illustrate potential future applications of this approach, we create rapid prototypes of the averaged mitral annulus at characteristic hemodynamic time points. In summary, this study introduces a novel mathematical model that allows us to identify temporal, regional, and inter-subject variations of clinical and mechanical metrics that characterize mitral annular form and function. Ultimately, this model can serve as a valuable tool to optimize both surgical and interventional approaches that aim at restoring mitral valve competence.

Place, publisher, year, edition, pages
New York: Springer-Verlag New York, 2011
Keywords
Mitral regurgitation – Mitral valve – Annulus – Dynamics – Strain – Curvature – Splines
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-76228 (URN)10.1007/s10439-011-0272-y (DOI)21336803 (PubMedID)
Available from: 2012-03-30 Created: 2012-03-30 Last updated: 2017-12-07Bibliographically approved
Bothe, W., Kvitting, J.-P. E., Stephens, E. H., Swanson, J. C., Liang, D. H., Ingels, N. B. & Miller, D. C. (2011). Effects of different annuloplasty ring types on mitral leaflet tenting area during acute myocardial ischemia. Journal of Thoracic and Cardiovascular Surgery, 141(2), 345-353
Open this publication in new window or tab >>Effects of different annuloplasty ring types on mitral leaflet tenting area during acute myocardial ischemia
Show others...
2011 (English)In: Journal of Thoracic and Cardiovascular Surgery, ISSN 0022-5223, E-ISSN 1097-685X, Vol. 141, no 2, p. 345-353Article in journal (Refereed) Published
Abstract [en]

Objective

The study objective was to quantify the effects of different annuloplasty rings on mitral leaflet septal-lateral tenting areas during acute myocardial ischemia.

Methods

Radiopaque markers were implanted along the central septal-lateral meridian of the mitral valve in 30 sheep: 1 each to the septal and lateral aspects of the mitral annulus and 4 and 2 along the anterior and posterior mitral leaflets, respectively. Ten true-sized Carpentier-Edwards Physio, Edwards IMR ETLogix, and GeoForm annuloplasty rings (Edwards Lifesciences, Irvine, Calif) were inserted in a releasable fashion. Marker coordinates were obtained using biplane videofluoroscopy with ring inserted at baseline (RING_BL) and after 90 seconds of left circumflex artery occlusion (RING_ISCH). After ring release, another dataset was acquired before (No_Ring_BL) and after left circumflex artery occlusion (No_Ring_ISCH). Anterior and posterior mitral leaflet tenting areas were computed at mid-systole from sums of marker triangles with the midpoint between the annular markers being the vertex for all triangles.

Results

Compared with No_Ring_BL, mitral regurgitation grades and all tenting areas significantly increased with No_Ring_ISCH. Compared with No_Ring_ISCH, (1) all rings significantly prevented mitral regurgitation and reduced all tenting areas; (2) Edwards IMR ETLogix and GeoForm rings reduced posterior mitral leaflet area, but not anterior mitral leaflet tenting area, to a significantly greater extent than the Carpentier-Edwards Physio ring; and (3) Edwards IMR ETLogix and GeoForm rings affected tenting areas similarly.

Conclusions

In response to acute left ventricular ischemia, disease-specific functional/ischemic mitral regurgitation rings (Edwards IMR ETLogix, GeoForm) more effectively reduced posterior mitral leaflet area, but not anterior mitral leaflet tenting area, compared with true-sized physiologic rings (Carpentier-Edwards Physio). Despite its radical 3-dimensional shape and greater amount of mitral annular septal-lateral downsizing, the GeoForm ring did not reduce tenting areas more than the Edwards IMR ETLogix ring, suggesting that further reduction in tenting areas in patients with FMR/IMR may not be effectively achieved on an annular level.

Place, publisher, year, edition, pages
Elsevier, 2011
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-76223 (URN)10.1016/j.jtcvs.2010.10.015 (DOI)21241857 (PubMedID)
Available from: 2012-03-30 Created: 2012-03-30 Last updated: 2017-12-07
Swanson, J. C., Krishnamurthy, G., Kvitting, J.-P. E., Miller, D. C. & Ingels Jr, N. B. (2011). Electro-Mechanical coupling between the atria and the mitral valve. American Journal of Physiology, 300(4), H1267-H1273
Open this publication in new window or tab >>Electro-Mechanical coupling between the atria and the mitral valve
Show others...
2011 (English)In: American Journal of Physiology, ISSN 0002-9513, E-ISSN 2163-5773, Vol. 300, no 4, p. H1267-H1273Article in journal (Refereed) Published
Abstract [en]

Anterior leaflet (AL) stiffening during isovolumic contraction (IVC) may aid mitral valve closure. We tested the hypothesis that AL stiffening requires atrial depolarization. Ten sheep had radioopaque-marker arrays implanted in the left ventricle, mitral annulus, AL, and papillary muscle tips. Four-dimensional marker coordinates (x, y, z, and t) were obtained from biplane videofluoroscopy at baseline (control, CTRL) and during basal interventricular-septal pacing (no atrial contraction, NAC; 110-117 beats/min) to generate ventricular depolarization not preceded by atrial depolarization. Circumferential and radial stiffness values, reflecting force generation in three leaflet regions (annular, belly, and free-edge), were obtained from finite-element analysis of AL displacements in response to transleaflet pressure changes during both IVC and isovolumic relaxation (IVR). In CTRL, IVC circumferential and radial stiffness was 46 ± 6% greater than IVR stiffness in all regions (P < 0.001). In NAC, AL annular IVC stiffness decreased by 25% (P = 0.004) in the circumferential and 31% (P = 0.005) in the radial directions relative to CTRL, without affecting edge stiffness. Thus AL annular stiffening during IVC was abolished when atrial depolarization did not precede ventricular systole, in support of the hypothesis. The likely mechanism underlying AL annular stiffening during IVC is contraction of cardiac muscle that extends into the leaflet and requires atrial excitation. The AL edge has no cardiac muscle, and thus IVC AL edge stiffness was not affected by loss of atrial depolarization. These findings suggest one reason why heart block, atrial dysrhythmias, or ventricular pacing may be accompanied by mitral regurgitation or may worsen regurgitation when already present.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-76224 (URN)10.1152/ajpheart.00971.2010 (DOI)21278134 (PubMedID)
Available from: 2012-03-30 Created: 2012-03-30 Last updated: 2017-12-07
Dyverfeldt, P., Escobar Kvitting, J.-P., Carlhäll, C. J., Boano, G., Sigfridsson, A., Hermansson, U., . . . Ebbers, T. (2011). Hemodynamic aspects of mitral regurgitation assessed by generalized phase-contrast MRI. Journal of Magnetic Resonance Imaging, 33(3), 582-588
Open this publication in new window or tab >>Hemodynamic aspects of mitral regurgitation assessed by generalized phase-contrast MRI
Show others...
2011 (English)In: Journal of Magnetic Resonance Imaging, ISSN 1053-1807, E-ISSN 1522-2586, Vol. 33, no 3, p. 582-588Article in journal (Refereed) Published
Abstract [en]

Purpose: Mitral regurgitation creates a high velocity jet into the left atrium (LA), contributing both volume andpressure; we hypothesized that the severity of regurgitation would be reflected in the degree of LA flowdistortion.

Material and Methods: Three-dimensional cine PC-MRI was applied to determine LA flow patterns andturbulent kinetic energy (TKE) in seven subjects (five patients with posterior mitral leaflet prolapse, two normalsubjects). In addition, the regurgitant volume and the time-velocity profiles in the pulmonary veins weremeasured.

Results: The LA flow in the mitral regurgitation patients was highly disturbed with elevated values of TKE.Peak TKE occurred consistently at late systole. The total LA TKE was closely related to the regurgitant volume.LA flow patterns were characterized by a pronounced vortex in proximity to the regurgitant jet. In some patients,pronounced discordances were observed between individual pulmonary venous inflows, but these could not berelated to the direction of the flow jet or parameters describing global LA hemodynamics.

Conclusion: PC-MRI permits investigations of atrial and pulmonary vein flow patterns and TKE in significantmitral regurgitation, reflecting the impact of the highly disturbed blood flow that accompanies this importantvalve disease.

Place, publisher, year, edition, pages
John Wiley and Sons, 2011
Keywords
Hemodynamics, mitral valve insufficiency, turbulent flow, phase-contrast magnetic resonance imaging, pulmonary veins, blood flow velocity
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-53190 (URN)10.1002/jmri.22407 (DOI)000287951100009 ()
Available from: 2010-01-19 Created: 2010-01-19 Last updated: 2017-12-12
Organisations

Search in DiVA

Show all publications