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  • 1.
    Ahlsson, Anders
    et al.
    Örebro University Hospital.
    Jideus, Lena
    Uppsala University Hospital .
    Albåge, Anders
    Karolinska University Hospital, Stockholm.
    Källner, Göran
    Karolinska University Hospital, Stockholm.
    Holmgren, Anders
    Umeå University Hospital .
    Boano, Gabriella
    Östergötlands Läns Landsting.
    Hermansson, Ulf
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Thoracic and Vascular Surgery in Östergötland.
    Kimblad, Per-Ola
    Lund University Hospital.
    Schersten, Henrik
    Sahlgrenska University Hospital, Gothenburg.
    Sjögren, Johan
    Lund University Hospital .
    Ståhle, Elisabeth
    Uppsala University Hospital.
    Åberg, Bengt
    Blekinge Hospital, Karskrona, Sahlgrenska University Hospital, Gothenburg.
    Berglin, Eva
    Sahlgrenska University Hospital, Gothenburg.
    A Swedish consensus on the surgical treatment of concomitant atrial fibrillation2012In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 46, no 4, p. 212-218Article, review/survey (Refereed)
    Abstract [en]

    Atrial fibrillation (AF) is a common arrhythmia among patients scheduled for open heart surgery and is associated with increased morbidity and mortality. According to international guidelines, symptomatic and selected asymptomatic patients should be offered concomitant surgical AF ablation in conjunction with valvular or coronary surgery. The gold standard in AF surgery is the Cox Maze III ("cut-and-sew") procedure, with surgical incisions in both atria according to a specified pattern, in order to prevent AF reentry circuits from developing. Over 90% of patients treated with the Cox Maze III procedure are free of AF after 1 year. Recent developments in ablation technology have introduced several energy sources capable of creating nonconducting atrial wall lesions. In addition, simplified lesion patterns have been suggested, but results with these techniques have been unsatisfactory. There is a clear need for standardization in AF surgery. The Swedish Arrhythmia Surgery Group, represented by surgeons from all Swedish units for cardiothoracic surgery, has therefore reached a consensus on surgical treatment of concomitant AF. This consensus emphasizes adherence to the lesion pattern in the Cox Maze III procedure and the use of biatrial lesions in nonparoxysmal AF.

  • 2.
    Aneq Åström, Meriam
    et al.
    Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Clinical Physiology UHL.
    Fluur, Christina
    Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Rehnberg, Malin
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Söderkvist, Peter
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Engvall, Jan
    Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Clinical Physiology UHL.
    Nylander, Eva
    Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Clinical Physiology UHL.
    Gunnarsson, Cecilia
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Diagnostics, Department of Clinical Pathology and Clinical Genetics.
    Novel plakophilin2 mutation. Three generation family with arrhythmogenic right ventricular cardiomyopathy2012In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 46, no 2, p. 72-75Article in journal (Refereed)
    Abstract [en]

    Objectives: The autosomal dominant form of arrhythmogenic right ventricular cardiomyopathy (ARVC)has been linked to mutations in desmosomal proteins. Different studies have shown that amutation in plakophilin-2 (PKP 2) is a frequent genetic cause for ARVC. We describe a newmutation in the PKP2 gene, the genotype-phenotype variation in this mutation and its clinicalconsequences.

    Design: Individuals in a three generation family were investigated after the sudden cardiac death of a young male. Clinical evaluation, electrocardiography, echocardiography, magnetic resonance imaging, endomyocardial biopsy and genetic testing were performed.

    Results: A novel heterozygote mutation, a c.368G>A transition, located in exon 3 of the PKP2 gene was found (p.Trp123X). The phenotype was characterized by arrhythmia at an early age in some individuals, with mild abnormalities on imaging. However a relative carrying this mutation, with positive findings on endomyocardial biopsy had an otherwise normal phenotype, for 16 years, whereas a relative fulfilling the modified Task Force Criteria for ARVC turned out to be a non-carrier.

    Conclusions: This shows the variable penetrance and phenotypic expression in ARVC and highlights the need of genetic testing as well as a thorough phenotype examination as a part of the investigations in ARVC pedigrees.

  • 3.
    Appel, Carl-Fredrik
    et al.
    Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Thoracic and Vascular Surgery in Östergötland. Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences.
    Hultkvist, Henrik
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Thoracic and Vascular Surgery in Östergötland.
    Nylander, Eva
    Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Clinical Physiology UHL.
    Ahn, Henrik Casimir
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Thoracic and Vascular Surgery in Östergötland.
    Nielsen, Niels Erik
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Freter, Wolfgang
    Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Thoracic and Vascular Surgery in Östergötland. Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences.
    Vánky, Farkas
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Thoracic and Vascular Surgery in Östergötland.
    Transcatheter versus surgical treatment for aortic stenosis: Patient selection and early outcome2012In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 46, no 5, p. 301-307Article in journal (Refereed)
    Abstract [en]

    Objectives. To describe short-term clinical and echocardiography outcomes in patients undergoing transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR). To explore patient selection criteria for treatment with TAVI. Design. TAVI patients (n = 45) were matched to SAVR patients (n = 45) with respect to age within +/- 10 years, sex and systolic left ventricular function. Results. TAVI patients were older, 82 +/- 8 versus 78 +/- 5 years (p = 0.005) and they had higher logEuroSCORE, 16 +/- 11% versus 8 +/- 4% (p andlt; 0.001). There were no significant differences in 30 days mortality, stroke and myocardial infarction. TAVI patients received less erythrocyte (53% vs. 78%, p = 0.03) and thrombocyte (7% vs. 27%, p = 0.02) transfusions. Postoperative atrial fibrillation was less common (18% vs. 60%, p andlt; 0.001) in the TAVI group. Paravalvular regurgitation was more common in TAVI patients (87% vs. 0%, p andlt; 0.001) and 27% had access site complications. Aortic transvalvular velocity was 2.3 +/- 0.4 m/s versus 2.6 +/- 0.5 m/s (p = 0.002) and mean valve pressure gradient was 12 +/- 4 mmHg versus 15 +/- 5 mmHg (p = 0.01) in the TAVI and SAVR groups, respectively. Twenty-nine (64%) of the TAVI patients had logEuroSCORE andlt; 15%. Conclusions. Both TAVI and SAVR have good short term clinical outcome with excellent hemodynamic result. In clinical practice, factors other than high logEuroSCORE play an important role in patient selection for TAVI.

  • 4.
    Berglund, Ulf
    et al.
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Nilsson, Lennart
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Abciximab bolus with optional infusion in intervention for ST-elevation myocardial infarction2013In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 47, no 4, p. 230-235Article in journal (Refereed)
    Abstract [en]

    Objectives. The standard abciximab regimen is a bolus dose followed by a 12-h infusion. Whether the bolus dose alone is sufficient for ST-elevation myocardial infarction patients receiving a high loading dose of clopidogrel is unknown. Design. In an observational study, 693 consecutive patients were treated with abciximab during percutaneous coronary intervention for ST-elevation myocardial infarction. Totally 354 patients received standard strategy of abciximab bolus and infusion followed by 339 patients that recieved abciximab bolus only (271 patients) or bolus and infusion if suboptimal result (68 patients) in combination with a higher loading dose of clopidogrel (600 mg) the modified strategy. Results. The two groups were similar regarding baseline characteristics and in hospital bleeding events. At 30 days, the composite of death, re-infarction or target vessel revascularization was 9.1% in the standard and 7.5% in the modified strategy (p = 0.45). The rate of stent thrombosis was lower in the modified strategy group with 0% and 2.3% in the standard group (pandlt;0.001) and the mean total medical cost was lower in the modified strategy group with 8032 and 8665 in the standard group (pandlt;0.001). Conclusions. In primary percutaneous coronary intervention with a loading dose of 600 mg clopidogrel, it seems safe and cost-saving to give abciximab bolus with optional infusion.

  • 5.
    Boano, Gabriella
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery. Linköping University, Faculty of Medicine and Health Sciences.
    Åström Aneq, Meriam
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping. Linköping University, Faculty of Medicine and Health Sciences.
    Kemppi, Jennie
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping. Linköping University, Faculty of Medicine and Health Sciences.
    Vánky, Farkas
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery. Linköping University, Faculty of Medicine and Health Sciences.
    Cox-maze IV cryoablation and postoperative heart failure in mitral valve surgery patients2017In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 51, no 1, p. 15-20Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The indications for and the risk and benefit of concomitant surgical ablation for atrial fibrillation (AF) have not been fully delineated. Our aim was to survey whether the Cox-maze IV procedure is associated with postoperative heart failure (PHF) or other adverse short-term outcomes after mitral valve surgery (MVS).

    DESIGN: Consecutive patients with AF undergoing MVS with (n = 50) or without (n = 66) concomitant Cox-maze IV cryoablation were analysed regarding perioperative data and one-year mortality.

    RESULTS: The patients in the Maze group were younger, were in lower NYHA classes, had better right ventricular function and had lower pulmonary artery pressure. The Maze group had 30 min longer median cross-clamp time (CCT) and 50% had PHF compared with 33% in the No-maze group, p = 0.09. Two patients in the No-maze group died within one year of surgery. Congestive heart failure (OR 4.3 [CI 95%: 1.8-10], p < 0.0001) and CCT (OR 1.03 [CI 95%: 1.01-1.04], p = 0.001) were associated with PHF.

    CONCLUSION: The current data cannot exclude that concomitant cryoablation increases the risk for PHF, possibly by increasing the cross clamp time.

  • 6.
    Casimir Ahn, Henrik
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Granfeldt, Hans
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Hübbert, Laila
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Peterzén, Bengt
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Long-term left ventricular support in patients with a mechanical aortic valve2013In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 47, no 4, p. 236-239Article in journal (Refereed)
    Abstract [en]

    Objectives. The presence of a mechanical prosthesis has been regarded as an increased risk of thromboembolic complications and as a relative contraindication for a left ventricular assist device (LVAD). Five patients in our center had a mechanical aortic valve at the time of device implantation and were studied regarding thromboembolic complications. Design. Five patients operated upon with an LVAD (1 HeartMate I (TM), 4 HeartMate II (TM)) between 2002 and 2011 had a mechanical aortic valve at the time of implantation. The first patient had a patch closure of the aortic valve. In four patients, the prosthesis was left in place. Anticoagulants included aspirin, warfarin, and clopidogrel. Results. The average and accumulated treatment times were 150 and 752 days, respectively. Three of the five patients showed early signs of valve thrombosis on echo with concomitant valve dysfunction. Four patients were transplanted without thromboembolic events during pump treatment. One patient died from a hemorrhagic stroke after 90 days on the LVAD. Conclusions. The strategy of leaving a mechanical heart valve in place at the time of LVAD implantation in five patients led to valvular thrombosis in three but did not provoke embolic events. It increased the complexity of postoperative anticoagulation.

  • 7.
    Dahlin, Lars-Göran
    et al.
    Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Eveling-Barbier, C.
    Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Nylander, Eva
    Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Rutberg, Hans
    Östergötlands Läns Landsting, Heart Centre.
    Svedjeholm, Rolf
    Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Vectorcardiography is Superior to Conventional ECG for Detection of Myocardial Injury after Coronary Surgery2001In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 35, no 2, p. 125-128Article in journal (Refereed)
    Abstract [en]

    Objective - The reliability of conventional scalar ECG for diagnosis of perioperative myocardial infarction (PMI) in cardiac surgery has been questioned. For the diagnosis of myocardial infarction in general vectorcardiography (VCG) is superior to ECG. Therefore, the usefulness of conventional VCG and computerized analysis of spatial VCG changes for diagnosis of PMI were studied.

    Design - VCG registrations were obtained from 218 patients undergoing coronary surgery. The spatial QRS vector loop area of each VCG registration was calculated and the loop area before surgery compared with the loop area after surgery. Conventional VCG criteria for myocardial infarction and set values for loop area reduction were related to sustained elevation of plasma troponin-T and clinical course.

    Results - Both conventional VCG criteria and spatial changes translated better than Q-waves on scalar ECG into elevation of biochemical markers of myocardial injury and impaired clinical course.

    Conclusion - VCG appears superior to conventional ECG as regards detection of myocardial injury in coronary surgery. Computerized programs have facilitated the registration and the interpretation of VCG and this methodology deserves further evaluation in cardiac surgery.

  • 8.
    Dahlin, Lars-Göran
    et al.
    Linköping University, Department of Medicine and Care, Thoracic Surgery. Linköping University, Faculty of Health Sciences.
    Kågedal, Bertil
    Linköping University, Department of Biomedicine and Surgery, Clinical Chemistry. Linköping University, Faculty of Health Sciences.
    Nylander, Eva
    Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Olin, Christian
    Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Rutberg, Hans
    Linköping University, Department of Medicine and Care, Anaesthesiology. Linköping University, Faculty of Health Sciences.
    Svedjeholm, Rolf
    Linköping University, Department of Medicine and Care, Thoracic Surgery. Linköping University, Faculty of Health Sciences.
    Early Identification of Permanent Myocardial Damage after Coronary Surgery is Aided by Repeated Measurements of CK-MB2002In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 36, no 1, p. 35-40Article in journal (Refereed)
    Abstract [en]

    Objective - ECG diagnosis of myocardial infarction after cardiac surgery is associated with major pitfalls and enzyme diagnosis is interfered by unspecific elevation unrelated to permanent myocardial injury. Sustained release of troponin-T is a marker of permanent myocardial injury if renal function is maintained. However, early identification of perioperative myocardial infarction is desirable and therefore the usefulness of creatine kinase monobasic (CK-MB) kinetics to detect myocardial injury early after coronary surgery was investigated.

    Design - Two hundred and eighty-six patients undergoing coronary surgery were studied with respect to release of enzymes and troponin-T preoperatively and postoperatively 3 and 8 h after unclamping the aorta, and every morning postoperative days 1-4.

    Results - CK-MB peak was found at 3 h ( n = 145), 8 h ( n = 103) and 16-20 h after unclamping ( n = 38). Depending on when the CK-MB peak was recorded different demographic and perioperative characteristics were found. A sustained release of troponin-T was characteristic for the group with the CK-MB peak at 16-20 h after unclamping.

    Conclusion - If CK-MB is measured only once it may be advisable to do it on the first postoperative morning as these measurements provided the best discrimination between patients with and without sustained elevation of troponin-T. However, repeated sampling provides additional information that aids in the early identification of permanent myocardial injury particularly in patients with borderline elevations of CK-MB.

  • 9.
    Dahlin, Lars-Göran
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Kågedal, Bertil
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Clinical Chemistry. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Chemistry.
    Nylander, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Physiology. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Olin, Christian
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery.
    Rutberg, Hans
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Svedjeholm, Rolf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Unspecific elevation of plasma troponin-T and CK-MB after coronary surgery2003In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 37, no 5, p. 283-287Article in journal (Refereed)
    Abstract [en]

    Objective - Biochemical markers of myocardial injury are frequently elevated after cardiac surgery. It is generally accepted that release unrelated to permanent myocardial damage explains a proportion of these elevations. However, little is known about the magnitude and temporal characteristics of this diagnostic noise. One way to address this issue would be to study a group without permanent myocardial injury. Design - The unique release kinetics of troponin-T (permanent myocardial injury causes a sustained release of structurally bound troponin) were used to identify patients with no or minimal permanent myocardial injury. Blood was sampled from patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) before surgery, 3 and 8 h after unclamping the aorta, and each morning until postoperative day 4, for analysis of enzymes and troponin-T. From 302 consecutive patients a subgroup was identified that fulfilled the following criteria: (a) normalized troponin-T levels =postoperative day 4, (b) no ECG changes indicating myocardial injury. Results - Seventy-seven patients fulfilled the criteria above and in this subgroup troponin-T (2.08 ▒ 1.42 ╡g/ 1, range 0.35-8.99 ╡g/l) peaked at the 3 h recording and creatine kinase monobasic (CK-MB) (28.6 ▒ 11.3 ╡g/l, range 11.9-86.0 ╡g/l) peaked at the 8 h recording after unclamping the aorta. Conclusion - Substantial early elevations of plasma CK-MB and troponin-T occurred in patients with no or minimal permanent myocardial injury after CABG. Unspecific release was most pronounced during the timeframe that is usually studied to evaluate myocardial protective strategies or to compare revascularization procedures.

  • 10.
    Dahlin, Lars-Göran
    et al.
    Linköping University, Department of Medicine and Care, Thoracic Surgery. Linköping University, Faculty of Health Sciences.
    Olin, Christian
    Linköping University, Department of Medicine and Care, Thoracic Surgery. Linköping University, Faculty of Health Sciences.
    Svedjeholm, Rolf
    Linköping University, Department of Medicine and Care, Thoracic Surgery. Linköping University, Faculty of Health Sciences.
    Perioperative myocardial infarction in cardiac surgery - risk factors and consequences: a case control study2000In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 34, no 5, p. 522-527Article in journal (Refereed)
    Abstract [en]

    Objective. The aim of the study was to analyze risk factors and clinical outcome in patients sustaining perioperative myocardial infarction (PMI) after cardiac surgery.

    Design. A retrospective, case control study was conducted, in which 42 patients fulfilling both Q-wave criteria and enzyme criteria for PMI, or autopsy diagnosis, from a cohort of 1147 operated on during the same time period were compared with matched controls. A follow-up by telephone interview was conducted, on average 24 months after the operation.

    Results. Unstable angina, peripheral vascular disease, short stature and low body weight were more prevalent in the PMI group. Intraoperative remarks of poor quality coronary vessels and incomplete revascularization were more frequent in the PMI group, 30-day mortality was 24% in the PMI group vs 0% in the control group (p < 0.01). The postoperative course was more complicated and protracted in the PMI group. At follow-up, the control group managed significantly better with regard to freedom from angina and the need for nitroglycerine. However, 24 of the 30 survivors in the PMI group reported an improved quality of life after surgery.

    Conclusions. We found that PMI was mainly associated with coronary surgery and that unstable angina was the most important preoperative risk factor for PMI. Poorer conditions for revascularization may explain some of the infarcts and could also contribute to the impaired long-term outcome in the PMI group.

  • 11.
    Eckard, Nathalie
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Compilation of cost-effectiveness evidence for different heart conditions and treatment strategies2011In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 45, no 2, p. 72-76Article, review/survey (Refereed)
    Abstract [en]

    Objectives. Despite the continuing interest in health economic research, we could find no accessible data set on cost-effectiveness, useful as practical information to decision makers who must allocate scarce resources within the cardiovascular field. The aim of this paper was to present cost-effectiveness ratios, based on a systematic literature search for the treatment of heart diseases. Design. A comprehensive literature search on cost-effectiveness analyses of intervention strategies for the treatment of heart diseases was conducted. We compiled available cost-effectiveness ratios for different heart conditions and treatment strategies, in a cost-effectiveness ranking table. The cost-effectiveness ratios were expressed as a cost per quality adjusted life year (QALY) or life year gained. Results. Cost-effectiveness ratios, ranging from dominant to those costing more than 1,000,000 Euros per QALY gained, and bibliographic references are provided for. The table was categorized according to disease group, making the ranking table readily available. Conclusions. Cost-effectiveness ranking tables provide a means of presenting cost-effectiveness evidence. They provide valid information within a limited space aiding decision makers on the allocation of health care resources. This paper represents an extensive compilation of health economic evidence for the treatment of heart diseases.

  • 12.
    Emilsson, Kent
    et al.
    Department of Clinical Physiology, Örebro Medical Centre Hospital, Örebro, Sweden.
    Kähäri, Anders
    Department of Radiology, Örebro Medical Centre Hospital, Örebro, Sweden.
    Wandt, Birger
    Department of Clinical Physiology, Örebro Medical Centre Hospital, Örebro, Sweden.
    Comparison between circumflex artery motion and mitral annulus motion2001In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 35, no 5, p. 318-325Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    To compare mitral annulus motion (MAM) with circumflex artery motion (CXM) and the motion amplitude at an endocardial site (representing MAM) with an epicardial site (representing CXM) at the most basal lateral part of the atrioventricular plane (AVP).

    DESIGN:

    MAM and CXM were obtained in 28 patients examined by echocardiography and coronary angiography. The motion amplitude epicardially and endocardially was recorded by echocardiography in 13 patients with normal ejection fraction (EF) (> or = 0.50) and in 13 patients with decreased EF (<0.50).

    RESULTS:

    CXM was higher than MAM in most patients with normal EF but lower than MAM in most patients with decreased EF. The motion amplitude epicardially was significantly higher (p < 0.001) than endocardially in patients with normal EF. while there was no significant difference in patients with decreased EF.

    CONCLUSION:

    CXM represents the motion of the epicardial part of the AVP and differs from MAM, which represents the endocardial part of the wall. This must be considered when CXM is used for assessment of left ventricular systolic function.

  • 13.
    Engvall, Jan
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Physiology. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Nyström, Fredrik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: endomed.
    Daytime ambulatory blood pressure correlates strongly with the echocardiographic diameter of aortic coarctation2001In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 35, no 5, p. 335-339Article in journal (Refereed)
    Abstract [en]

    Objective.-To relate the echocardiographic aortic arch-diameter to ambulatory and clinic blood pressure (BP) in patients with aortic coarctation. Design.-Eighteen adult patients (50% men) were recruited from the coarctation registry of the Linkoping Heart Centre. Biplane-trans-oesophageal echocardiography (TEE) was performed with Acuson XP 128/10, ambulatory BP was recorded with Spacelab models 90202/90205. Results.-Systolic clinic and ambulatory BP levels were higher in patients than in the 36 controls (clinic BP: 146 ▒ 25 mmHg vs 119 ▒ 10 mmHg, p = 0.0009, ambulatory BP: 140 ▒ 18 mmHg vs 124 ▒ 11 mmHg, p = 0.009). The differences in diastolic BP levels were less obvious (clinic BP: 87 ▒ 16 mmHg vs 76 ▒ 8 mmHg, p = 0.02, ambulatory BP: 84 ▒ 13 mmHg vs 77 ▒ 9 mmHg, p = 0.052). Daytime ambulatory BP was more strongly related than clinic BP to the coarctation diameter (AD) (systolic BP r = -0.73, p = 0.0006 and r = -0.61, p = 0.007, respectively). In surgically corrected patients (n = 14) only the correlations between ambulatory systolic daytime (r = -0.61, p = 0.02) and night-time (r = -0.58, p = 0.03) BP to AD was statistically significant. Conclusion.-Ambulatory BP correlates strongly with aortic coarctation measured by TEE and would thus be the preferred technique for evaluating BP in this patient category.

  • 14.
    Eriksson, Jenny
    et al.
    Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting.
    Huljebrant, Inger
    Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Thoracic and Vascular Surgery in Östergötland.
    Nettelblad, Hans
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Plastic Surgery, Hand surgery UHL.
    Svedjeholm, Rolf
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Thoracic and Vascular Surgery in Östergötland.
    Functional impairment after treatment with pectoral muscle flaps because of deep sternal wound infection2011In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 45, no 3, p. 174-180Article in journal (Refereed)
    Abstract [en]

    Objective. Pectoral muscle flaps (PMF) are effective in terminating protracted sternal wound infections (SWI) but long-term outcome remains uncertain. Therefore, the aim of this study was to evaluate long-term outcome in patients treated with PMF. Design. Thirty-four of 263 patients revised because of deep SWI from 1991-2005 were treated with PMF. Of the 21 patients alive, 11 had left-sided, two right-sided and eight bilateral procedures. Sternal debridement without closure of the sternum was done in 17 patients. Nineteen of 21 patients responded to a questionnaire. Results. At follow-up on average 5.9 years (range 1.9-14.8 years) after surgery 63% (12/19) experienced unstable chest. Two thirds (12/18) reported problems carrying a grocery bag and 37% (7/19) had problems putting on a coat. Reduction of power and mobility was more common in the right arm and shoulder even in patients with left-sided PMF. Thirty-two percent (6/19) would have preferred alternative treatment if possible to avoid sternal instability even if healing had been substantially delayed. Conclusions. Surgery with PMF and sternal debridement was associated with long-term disability, which appeared to be significant in one third of the patients. The function of the right arm and shoulder was affected more often despite the majority of procedures being left-sided suggesting that loss of skeletal continuity of the chest wall is more disabling than loss of pectoral muscle function.

  • 15.
    Franzén, Stefan
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Nylander, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Physiology. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Olin, Christian
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Aortic valve replacement with pericardial valves in patients with small aortic roots. Clinical results in a consecutive series of patients receiving 19 and 21 mm prostheses2001In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 35, no 2, p. 114-118Article in journal (Refereed)
    Abstract [en]

    Objective - To determine how second generation pericardial valves perform in patients with small aortic roots. Design - Ninety patients who underwent isolated aortic valve replacement (AVR) with 19 or 21 mm Mitroflow« or Carpentier-Edwards (Perimount«) valves between 1989 and 1996 were studied. Mean age was 78 years. Concomitant coronary bypass surgery was performed in 41%. Results - Thirty-day mortality was 5.6%. Ninety-seven percent had acceptable transprosthetic mean pressure gradients (25 mmHg or less) 1 week after surgery. Follow-up was 100% complete and 76% of the patients were alive after a mean of 5 years. There was no structural valve failure or valve thrombosis. One patient required reoperation for perivalvular leak. Four patients had transient ischemic attacks and seven had strokes. These figures are, however, within the expected range for the age. Conclusion - Second generation pericardial valves perform well in elderly patients with small aortic roots. Postoperative hemodynamics are acceptable, valve durability of up to 8 years adequate, and the clinical results good, considering the age of the patients.

  • 16.
    Granfeldt, Hans
    et al.
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Hellgren, Laila
    Uppsala University Hospital, Uppsala, Sweden.
    Dellgren, Goran
    Karolinska University Hospital, Stockholm, Sweden.
    Myrdal, Gunnar
    Uppsala University Hospital, Uppsala, Sweden.
    Wassberg, Erik
    Uppsala University Hospital, Uppsala, Sweden.
    Kjellman, Ulf
    Karolinska University Hospital, Stockholm, Sweden.
    Ahn, Henrik
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Experience with the Impella® recovery axial-flow system for acute heart failure at three cardiothoracic centers in Sweden2009In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 43, no 4, p. 233-239Article in journal (Refereed)
    Abstract [en]

    Objectives. The Impella (R) recovery axial-flow system is a mechanical assist system for use in acute heart failure. This retrospective study reports the use of the device at three cardiothoracic units in Sweden. Design. Fifty patients (35 men, mean age 55.8 years, range 26 to 84 years) underwent implantation of 26 Impella (R) LP 2.5/5.0 (support-time 0.1 to 14 days), 16 Impella (R) LD (support-time 1 to 7 days) and 8 Impella (R) RD (support-time 0.1 to 8 days) between 2003 and 2007. Implantation was performed because of postcardiotomy heart failure (surgical group, n=33) or for various states of heart failure in cardiological patients (non-surgical group, n=17). The intention for the treatments was mainly to use the pump as a obridge-to-recoveryo. Results. Early mortality in the surgical and non-surgical groups was 45% and 23%, respectively. Complications included infection, 36% and right ventricular failure, 28%. Cardiac output and cardiac power output postoperatively were significantly higher among survivors than non-survivors. Conclusions. The Impella (R) recovery axial-flow system facilitates treatment in acute heart failure. Early intervention in patients with acute heart failure and optimized hemodynamics in the post-implantation period seem to be of importance for long-term survival. Insufficient early response to therapy should urge to consider further treatment options.

  • 17.
    Granfeldt, Hans
    et al.
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Peterzén, Bengt
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Hubbert, Laila
    Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Jansson, Kjell
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Casimir Ahn, Henrik
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    A single center experience with the HeartMate II (TM) Left Ventricular Assist Device (LVAD)2009In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 43, no 6, p. 360-365Article in journal (Refereed)
    Abstract [en]

    Objectives. Left ventricular assist devices (LVAD), used in the setting bridge-to-transplantation and destination therapy, for patients with deteriorating severe heart failure are continuously developing. The second generation, the axial flow pumps, have been introduced since some years. Design. Eleven consecutive patients, seven male, with severe heart failure due to ischemic cardiomyopathy (n = 5), dilated cardiomyopathy (n = 5) and cytotoxic ethiology (n = 1) were implanted with the HeartMate-II (TM). They were preoperatively treated with inotropic support (n = 9), ventricular assist device (n = 2) and mechanical ventilation (n = 4). Results. Eight patients were bridged to transplant after median 155 days (range, 65 to 316 days). One patient is ongoing for 748 days, intended for destination therapy. Ten of eleven patients were discharged after median 64 days (range, 40 to 105 days). Four patients were reoperated due to bleeding. Two embolic events were recorded. One perioperative death. Conclusion. Eleven HM-II (TM) LVADs have been implanted in our institution with good early results. Eight patients were successfully bridged to heart transplantation. One patient is intended for destination therapy and is ongoing since November 2006. In these severely ill patients, this technique offers a good chance surviving until heart transplantation. In selected cases the technique also offers the possibility of a permanent support and longevity.

  • 18.
    Gredmark, Sara
    et al.
    Karolinska Institutet.
    Jonasson, Lena
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Van Gosliga, Djoke
    Karilinska Institutet.
    Ernerudh, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Clinical Immunology. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Söderberg-Nauclér, Cecilia
    Karolinska Institutet.
    Active cytomegalovirus replication in patients with coronary disease2007In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 41, no 4, p. 230-234Article in journal (Refereed)
    Abstract [en]

    Objectives. To study the prevalence of active cytomegalovirus (CMV) infection in patients with stable and unstable conditions of coronary artery disease (CAD). Design. Forty patients with acute coronary syndrome (ACS), 50 patients with stable angina and angiographically verified CAD (SA) and 50 clinically healthy controls were included. Monocytes were isolated from peripheral blood and CMV-RNA expression was determined by a nested RT-PCR assay. CMV IgM and IgG antibodies, interleukin-(IL)-6, IL-10 and CRP were measured in serum. Results. The prevalence of active CMV infection was significantly higher in patients with ACS (15%) and in patients with SA (10%) compared with controls (2%) (p < 0.001). The presence of an active CMV infection was associated with increased serum concentrations of IL-6. Conclusions. Active CMV infection was found to a larger extent in CAD patients than in healthy controls. The data indicate that CAD patients are more susceptible to reactivation of CMV and put new focus on the role of CMV in atherosclerosis.

  • 19.
    Haugaa, Kristina H
    et al.
    Oslo University Hospital, Norway.
    Bundgaard, Henning
    National University Rigshospitalet, Copenhagen, Denmark.
    Edvardsen, Thor
    Oslo University Hospital, Norway.
    Eschen, Ole
    Aalborg University Hospital, Denmark.
    Gilljam, Thomas
    Sahlgrenska Academy, University of Gothenburg, Sweden.
    Hansen, Jim
    University of Copenhagen, Denmark.
    Jensen, Henrik Kjærulf
    Aarhus University Hospital, Denmark.
    Platonov, Pyotr G
    Skåne University Hospital, Sweden.
    Svensson, Anneli
    Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Svendsen, Jesper H
    Univesity of Copenhagen, Denmark.
    Management of patients with Arrhythmogenic Right Ventricular Cardiomyopathy in the Nordic countries.2015In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 49, no 6, p. 299-307Article, review/survey (Refereed)
    Abstract [en]

    OBJECTIVES: Diagnostics of patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) are complex, and based on the 2010 Task Force document including different diagnostic modalities. However, recommendations for clinical management and follow-up of patients with ARVC and their relatives are sparse. This paper aims to give a practical overview of management strategies, risk stratification, and selection of appropriate therapies for patients with ARVC and their family members.

    DESIGN: This paper summarizes follow-up and treatment strategies in ARVC patients in the Nordic countries. The author group represents cardiologists who are actively involved in the Nordic ARVC Registry which was established in 2009, and contains prospectively collected clinical data from more than 590 ARVC patients from Denmark, Norway, Sweden, and Finland.

    RESULTS: Different approaches of management and follow-up are required in patients with definite ARVC and in genetic-mutation-positive family members. Furthermore, ARVC patients with and without implantable cardioverter defibrillators (ICDs) require different follow-up strategies.

    CONCLUSION: Careful follow-up is required in patients with ARVC diagnosis to evaluate the need of anti-arrhythmic therapy and ICD implantation. Mutation-positive family members should be followed regularly for detection of early disease and risk stratification of ventricular arrhythmias.

  • 20.
    Heiberg, Einar
    et al.
    Lund.
    Engblom, Henrik
    Lund.
    Engvall, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Physiology. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Hedström, Erik
    Lund.
    Ugander, Martin
    Lund.
    Arheden, Håkan
    Lund.
    Semi-automatic quantification of myocardial infarction from delayed contrast enhanced magnetic resonance imaging2005In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 39, no 5, p. 267-275Article in journal (Refereed)
    Abstract [en]

    Objective. Accurate and reproducible assessment of myocardial infarction is important for treatment planning in patients with ischemic heart disease. This study describes a novel method to quantify myocardial infarction by semi-automatic delineation of hyperenhanced myocardium in delayed contrast enhanced (DE) magnetic resonance (MR) images. Design. The proposed method automatically detects the hyperenhanced tissue by first determining the signal intensity of non-enhanced myocardium. A fast level set algorithm was used to limit the heterogeneity of the hyperenhanced regions, and to exclude small regions that constitute noise rather than infarction. The method was evaluated in 40 patients, 20 with acute infarction and 20 with chronic healed infarction using scanners from two different manufacturers. Infarct size measured by the proposed semi-automatic method was compared with manual measurements from three experienced observers. The software used is freely available for research purposes at http://segment.heiberg.se. Results. The difference in infarct size between semi-automatic quantification and the mean of the three observers was 6.1 ± 6.6 ml (mean ± SD), and the interobserver variability (SD) was 4.2 ml. Conclusions. The method presented is a highly automated method for analyzing myocardial viability from DE-MR images. The bias of the method is acceptable and the variability is in the same order of magnitude as the interobserver variability for manual delineations. © 2005 Taylor & Francis.

  • 21.
    Henriksson, Martin
    et al.
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences. Astra Zeneca Nordic-Baltic, Södertälje, Sweden.
    Nikolic, Elisabet
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Ohna, Audun
    Astra Zeneca Nordic-Baltic, Södertälje, Sweden.
    Wallentin, Lars
    Uppsala University, Sweden.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Ticagrelor treatment in patients with acute coronary syndrome is cost-effective in Sweden and Denmark2014In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 48, no 3, p. 138-147Article in journal (Refereed)
    Abstract [en]

    Objectives. To evaluate the cost-effectiveness of treating patients with acute coronary syndromes (ACS) for 12 months with ticagrelor compared with generic clopidogrel in Sweden and Denmark. Design. Decision-analytic model to estimate lifetime costs, life-expectancy, and quality-adjusted life years (QALYs) with ticagrelor and clopidogrel. Event rates, healthcare resource use, and health-related quality of life during 12 months of therapy were estimated from the PLATelet inhibition and patient Outcomes (PLATO) trial. Beyond 12 months, quality-adjusted survival and costs were estimated conditional on events occurring during the 12 months of therapy. When available, country-specific data were employed in the analysis. Incremental cost-effectiveness ratios are presented from a healthcare perspective and a broader societal perspective including costs falling outside the healthcare sector in 2010 local currency. Results. The cost per QALY with ticagrelor compared with generic clopidogrel was SEK 25 022 and DKK 26 892 for Sweden and Denmark, respectively, from a healthcare perspective. The cost per QALY from a broader societal perspective was SEK 24 290 and DKK 25 051 for Sweden and Denmark, respectively. Conclusion. The cost per QALY of treating ACS-patients with ticagrelor compared with generic clopidogrel is below the conventional thresholds of cost-effectiveness in Sweden and Denmark.

  • 22.
    Holm, Jonas
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Vidlund, Marten
    University of Örebro, Sweden .
    Vánky, Farkas
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Friberg, Orjan
    University of Örebro, Sweden .
    Hakanson, Erik
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Svedjeholm, Rolf
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Preoperative NT-proBNP independently predicts outcome in patients with acute coronary syndrome undergoing CABG2013In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 47, no 1, p. 28-35Article in journal (Refereed)
    Abstract [en]

    Objectives. The predictive value of preoperative N-terminal pro-B-type natriuretic peptide (NT-proBNP) was evaluated in patients with acute coronary syndrome undergoing coronary artery bypass grafting (CABG). Design. As a substudy to a clinical trial 383 patients with acute coronary syndrome undergoing CABG were studied. 17 patients had a concomitant procedure. NT-proBNP was measured immediately preoperatively and evaluated with regard to in-hospital mortality, and severe circulatory failure postoperatively according to prespecified criteria. Follow-up was 3.2 +/- 0.9 years. Results. In patients with isolated CABG, receiver operating characteristics (ROC) analysis showed an area under the curve (AUC) of 0.82 for in-hospital mortality and 0.87 for severe circulatory failure respectively with a best cut-off for preoperative NT-proBNP of 1028 ng/L. This cut-off level independently predicted severe circulatory failure. Patients with NT-proBNP andlt; 1028 ng/L had significantly better long-term survival (p = 0.004). Preoperative NT-proBNP was higher in patients with concomitant procedure than isolated CABG (2146 +/- 1858 v 887 +/- 1635 ng/L; p = 0.0005). In patients with concomitant procedure ROC analysis showed an AUC of 0.93 for severe circulatory failure with a best cut-off for preoperative NT-proBNP of 3145 ng/L. Conclusions. Preoperative NT-proBNP predicted in-hospital mortality, severe circulatory failure postoperatively and long-term survival in patients undergoing surgery for acute coronary syndrome but a higher threshold was found in patients having concomitant procedures.

  • 23.
    Holmberg, Erica
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Ahn, Henrik
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Peterzén, Bengt
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    More than 20 years' experience of left ventricular assist device implantation at a non-transplant Centre2017In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 51, no 6, p. 293-298Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Over recent decades implantable left ventricular assist devices (LVAD) have increased the possibility of improved survival in patients with advanced heart failure who also benefit from a better quality of life. The aim of this retrospective survey was to review the clinical results of LVAD implantation at a low-volume non-transplant centre (Linköping, Sweden) between 1993 and 2016. Our aim was also to assess the mortality and morbidity rates associated with implantation of three LVAD versions at our centre, and to compare our results with those from transplant centres.

    DESIGN: A retrospective cohort study was performed examining the medical records of patients who had a HeartMate(®) (HMI, HMII, HMIII) LVAD implanted as a bridge to heart transplantation (BTT) or as destination therapy (DT) at the University Hospital, Linköping.

    RESULTS: Our main finding was a survival to heart transplantation rate of 82% among our BTT LVAD patients. The most common adverse event among our patients was infection. A higher frequency of temporary dialysis was seen in the HMII group compared to the HMI group, and the frequency of right ventricular failure was higher in our HMII material.

    CONCLUSIONS: Our data suggests that patients requiring long-term LVAD support can safely have their device implanted and cared for at a non-transplant centre.

  • 24.
    Holst, Marie
    et al.
    Malmö universitet.
    Strömberg, Anna
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Nursing Science. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Lindholm, Maud
    Malmö Universitet.
    Willenheimer, Ronnie
    Lunds universitet.
    Liberal versus restricted fluid prescription in stabilised patients with chronic heart failure: Result of a randomised cross-over study of the effects on health-related quality of life, physical capacity, thirst and morbidity2008In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 42, no 5, p. 316-322Article in journal (Refereed)
    Abstract [en]

    Objective. To compare the effects of a restrictive versus a liberal fluid prescription, on quality of life, physical capacity, thirst and hospital admissions, in patients who had improved from NYHA class (III-)IV CHF to a stable condition without clinical signs of significant fluid overload. Design. The present study is a randomised cross-over study. Seventy-four patients (mean age 70±10 years, 16% women) - with mild-moderate CHF - were randomised 1:1 to either of two 16-week interventions. Intervention 1 prescribed a maximum fluid intake of 1.5 L/day. Intervention 2 prescribed a maximum fluid intake of 30-35 ml/kg body weight/day. Sixty-five patients completed the study. Results. There were no significant between-intervention differences in end-of-intervention quality of life, physical capacity or hospitalisation. However, there was a significant favourable effect on thirst and less difficulties to adhere to the fluid prescription during the liberal fluid prescription intervention. Conclusion. The results from this study indicate that it may be beneficial and safe to recommend a liberal fluid prescription, based on body weight, in stabilised CHF patients. These results warrant further investigation of the effects of fluid advice in CHF. © 2008 Informa UK Ltd.

  • 25.
    Janerot-Sjöberg, Birgitta
    et al.
    Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology. Clinical Physiology, University Hospital, Linköping .
    Broqvist, Mats
    Östergötlands Läns Landsting, Heart Centre, Department of Cardiology. Cardiology, University Hospital, Linköping.
    Fransson, Sven-Göran
    Östergötlands Läns Landsting, Heart Centre, Department of Cardiology Thoracic Radiology.
    Femoral artery haemostasis with a pneumatic compression device versus a clamp after coronary angiography1998In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 32, no 5, p. 281-284Article in journal (Refereed)
    Abstract [en]

    To evaluate the safety and efficacy of a new pneumatic compression device for achieving haemostasis after femoral artery catheterization, 1,017 patients undergoing selective coronary angiography by a SF unilateral femoral route were prospectively randomised to pneumatic or the routinely used clamp compression technique. All initial bleedings could be controlled in the pneumatic group, whereas in 38 patients (8%) of the clamp group the initial positioning of the clamp was unsuccessful or was not tolerated by the patient (p less than 0.05). Ultrasound Doppler study of the puncture site because of suspected postcatheterization vascular complication revealed two haematomas which needed no further measure and two pseudoaneurysms which were successfully treated with ultrasound-guided compression or surgical repair. The rate of complications requiring treatment (pseudoaneurysms) was 0.2% overall, 0.5% in the clamp group and nil in the pneumatic compression group (NS). We conclude that the pneumatic compression device is effective, convenient and at least as safe as the clamp and, by shortening the time in the catheterization laboratory, offers time for further angiograms.

  • 26.
    Jansson, Kjell
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Dahlström, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Karlberg, Karl-Erik
    Karlsson, Erling
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Nyquist, Olof
    Nylander, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Physiology. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    The value of repeated echocardiographic evaluation in patients with idiopathic dilated cardiomyopathy during treatment with metoprolol or captopril2000In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 34, no 3, p. 293-300Article in journal (Refereed)
    Abstract [en]

    Serial echocardiographic investigations were carried out on patients with idiopathic dilated cardiomyopathy, to evaluate treatment effects on left ventricular (LV) performance during therapy with either metoprolol or captopril. Thirty-two patients (23 males and 9 females) with mild to moderate symptoms of heart failure (NYHA II-III) and a mean age of 49 years were included in the investigation. The patients were investigated with Doppler echocardiography before treatment, after 3 and 6 months of treatment (either metoprolol or captopril) and 1 month after withdrawal of treatment. Intra- and inter-investigator reproducibility was acceptable, with a coefficient of variation of less than 5% for LV dimensions. A reduction in LV dimensions was seen in both treatment groups. In the metoprolol group there was also an increase in LV stroke volume and fractional shortening. The non-invasive data were in accordance with invasive measurements of stroke volume and LV filling pressure. In patients with idiopathic dilated cardiomyopathy and mild to moderate symptoms of heart failure, echocardiography seemed to be sufficiently reproducible to be used for determination of treatment effects in a longitudinal heart failure study. Both metoprolol and captopril were well tolerated and had favourable effects on LV performance.

  • 27.
    Johansson, Peter
    et al.
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Dahlström, Ulf
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Alehagen, Urban
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Depressive symptoms and six-year cardiovascular mortality in elderly patients with and without heart failure2007In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 41, no 5, p. 299-307Article in journal (Refereed)
    Abstract [en]

    Objectives: To evaluate whether depressive symptoms (DS) in elderly patients with heart failure (HF) in the community is associated with increased mortality.

    Design: A cohort of 510 elderly patients (65-82 years) in a primary healthcare setting with symptoms associated with HF underwent a clinical and echocardiographic examination. A left ventricular ejection fraction (LVEF) <40% indicated HF. The mental health index scale was used to screen for DS. Cardiovascular and all-cause mortality was registered over 6 years.

    Results: After adjustments those with DS had an increased risk (HR) of 3.0 (CI 95% 1.6-5.5, p=0.0001) and 2.2 (CI 95% 1.3-3.7, p=0.0004) of cardiovascular and all-cause mortality, respectively. Patients with HF and DS had the highest risk of cardiovascular mortality, HR 15.7 (CI 95% 4.8-52.2) compared to patients with HF without DS and those with LVEF ≥50% and normal left ventricular diastolic function with and without DS.

    Conclusion: DS in elderly patients with HF is independently associated with increased mortality. Screening for DS is recommended as part of the clinical routine in managing patients with HF.

  • 28.
    Johansson, Peter
    et al.
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Dahlström, Örjan
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Dahlström, Ulf
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Alehagen, Urban
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Effect of selenium and Q10 on the cardiac biomarker NT-proBNP2013In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 47, no 5, p. 281-288Article in journal (Refereed)
    Abstract [en]

    Objective. To investigate whether the effect of 48-month usage of coenzyme Q10 and selenium on cardiac function was different for participants with different levels of cardiac wall tension as measured by plasma levels of N-terminal natriuretic peptide (NT-proBNP) at baseline. Methods. A 48-month randomized double-blind controlled trial in a cohort of community-dwelling elderly (mean age 78 years) was carried out. A total of 443 participants were given coenzyme Q10 combined with selenium, or a placebo. NT-proBNP measured at baseline and 48 months was used to evaluate the cardiac wall tension. Results. After 48 months, supplementation of coenzyme Q10 and selenium had varying impacts depending on the severity of impairment of cardiac function. Analyses of the responses in the different quintiles of baseline NT-proBNP showed that those with active supplementation, and a plasma level of NT-proBNP in the second to fourth quintiles demonstrated significantly reduced NT-proBNP levels (p = 0.022) as well as cardiovascular mortality after 48 months (p = 0.006). Conclusion. Long-term supplementation of coenzyme Q10/selenium reduces NT-proBNP levels and cardiovascular mortality in those with baseline NT-proBNP in the second to fourth quintiles indicating those who gain from supplementation are patients with mild to moderate impaired cardiac function.

  • 29.
    Johansson, Torsten
    et al.
    Department of Cardiothoracic Surgery, University Hospital, Linköping, Sweden.
    Arén, Claes
    Department of Cardiothoracic Surgery, University Hospital, Linköping, Sweden.
    Fransson, Sven-Göran
    Department of Thoracic Radiology, University Hospital, Linköping, Sweden.
    Uhre, Poul
    Department of Radiology, University Hospital, Linköping, Sweden.
    Intra- and Postoperative Cerebral Complications of Open-Heart Surgery1995In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 29, no 1, p. 17-22Article in journal (Refereed)
    Abstract [en]

    A consecutive series of 1400 patients who had undergone open-heart surgery was retrospectively reviewed concerning postoperative cerebral dysfunction. The 30-day mortality was 1.6%. Forty-one patients (2.9%) showed signs of cerebral dysfunction, which proved fatal in seven cases. Neurologic symptoms were observed immediately after surgery in 14 patients, suggesting intraoperative damage. In 20 others there was an interval between surgery and the onset of cerebral symptoms, which in 12 cases were preceded by supraventricular tachycardia. Computed tomographic scans were performed on 27 patients and showed recent brain infarction in 22. No bleeding was found. At followup 34 of the 41 patients were alive, 21 of them with neurologic sequelae and 13 reporting complete recovery. Nineteen of the 34 survivors experienced no diminution of quality of life. Since half of the cerebral complications occurred postoperatively, more aggressive prevention and management of supraventricular tachyarrhythmia and anticoagulation therapy should be considered.

  • 30.
    Karlström, Patric
    et al.
    Department of Medicine , Division of Cardiology, County Hospital Ryhov , Jönköping , Sweden.
    Dahlström, Ulf
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Boman, Kurt
    Research unit Skellefteå Department of Medicine , Institution of Public Health and Clinical Medicine, Umeå University Sweden.
    Alehagen, Urban
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Responder to BNP-guided treatment in heart failure. The process of defining a responder.2015In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 49, no 6, p. 316-324Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: B-type natriuretic peptide (BNP) levels predict prognosis and outcome in heart failure (HF) patients. To evaluate the optimal cut-off level of BNP to predict death, need for hospitalization, and worsening HF, and also to determine the optimal time to apply the chosen cut-off value.

    DESIGN: In a sub-study from the Use of PeptideS in Tailoring hEart failure Project or UPSTEP study where tailoring treatment of HF by BNP level was evaluated, we assessed the change in percentage between levels of BNP at study start versus a specific week (2, 6, 10, 16, 24, 36, or 48) during the follow-up period.

    RESULTS: The optimum cut-off percentage levels were obtained using a Cox proportional regression analysis of death, hospitalization, and worsening HF. A decrease in BNP by less than 40% in week 16 compared with study start and/or a BNP > 300 ng/L presented the highest hazard ratio (HR) for a non-responder to reach a combined endpoint (HR: 2.43; 95% confidence interval or CI: 1.61-3.65; p < 0.00003). This definition gave a 78% risk reduction of cardiovascular (CV) mortality (p > 0.0005) and an 89% risk reduction of HF mortality (p > 0.004), and reduced risk of CV and HF hospitalization for the responders.

    CONCLUSIONS: Patients with a decrease in BNP of more than 40% compared with that at study start and/or a BNP level below 300 ng/L at week 16 had a significantly reduced risk of CV and HF mortality and hospitalization.

  • 31.
    Kähäri, Anders
    et al.
    Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Emilsson, Kent
    Department of Clinical Physiology, Örebro University Hospital, Örebro, Sweden.
    Danielewicz, Mikael
    Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
    Andersson, Torbjörn
    Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Wandt, Birger
    Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Circumflex artery motion: a new angiographic method for assessment of left ventricular function2003In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 37, no 2, p. 80-86Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate the usefulness of circumflex artery motion (CAM) for assessment of left ventricular (LV) function.

    DESIGN: Seventy-three consecutive patients referred for coronary angiography and LV angiography were included. Ejection fraction (EF) was calculated from LV angiography and CAM was measured from coronary angiography.

    RESULTS: The ratio between CAM and the end-diastolic length of the ventricle, which can be denominated long-axis fractional shortening (FS(L)), was found to be a better index of LV function than CAM per se. There was a significant linear correlation between EF and FS(L) (r = 0.81, SEE = 8.2, p < 0.001). When values of FS(L) > or =10% were selected to define a normal EF (> or =50%) there was a sensitivity of 95% and a specificity of 93%. Visual estimation of EF from CAM was not as good as the use of calculated FS(L) but may me useful as a fast screening method.

    CONCLUSION: LV systolic function can be assessed by studying CAM recorded by coronary angiography.

  • 32.
    Kähäri, Anders
    et al.
    Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Thunberg, Per
    Department of Biomedical Engineering, Örebro University Hospital, Örebro, Sweden.
    Emilsson, Kent
    Department of Clinical Physiology, Karlskoga Hospital, Karlskoga, Sweden.
    Geijer, Håkan
    Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Andersson, Torbjörn
    Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Wandt, Birger
    Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Assessment of left ventricular function from M‐mode measurement of circumflex artery motion recorded by coronary angiography2003In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 37, no 5, p. 259-265Article in journal (Refereed)
    Abstract [en]

    Objective—To evaluate the usefulness of M‐mode measurement of circumflex artery motion (CAM) for assessment of left ventricular (LV) function.

    Design—Seventy‐two patients referred for coronary angiography and LV angiography were included. Ejection fraction (EF) was calculated from LV angiography and systolic and diastolic parameters of CAM were measured by M‐mode from coronary angiography. Twenty‐three patients, examined by echocardiography of mitral annulus motion (MAM) within 24 h before the angiographic examination, formed a subgroup for comparison between angiographic M‐mode of CAM and echocardiographic M‐mode of MAM.

    Results—In addition to previous reported CAM amplitude and longitudinal fractional shortening (FS L ) the maximal systolic velocity of CAM can be reliably recorded by M‐mode. The diastolic indices, atrial contribution to the total amplitude and maximal early and late diastolic velocities, are also well monitored by M‐mode of CAM in comparison with echocardiographic MAM.

    Conclusion—LV systolic and diastolic function can be assessed by M‐mode of CAM.

  • 33.
    Lindström, Lena
    et al.
    Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Wigström, Lars
    Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Dahlin, Lars-Göran
    Linköping University, Department of Medicine and Care, Thoracic Surgery. Linköping University, Faculty of Health Sciences.
    Aren, Claes
    Linköping University, Department of Medicine and Care, Thoracic Surgery. Linköping University, Faculty of Health Sciences.
    Wranne, Bengt
    Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Lack of effect of synthetic pericardial substitute on right ventricular function after coronary artery bypass surgery: An echocardiographic and magnetic resonance imaging study2000In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 34, no 3, p. 331-338Article in journal (Refereed)
    Abstract [en]

    Abnormal right heart function after cardiac surgery is a well-known finding. Inadequate preservation during the operation and restricted cardiac motion due to pericardial adhesions have been proposed as underlying mechanisms. This study focuses on the impact of a pericardial substitute implantation on right ventricular function, using echocardiography and magnetic resonance imaging. A test group of six patients (mean age 54 years) was examined before surgery, and 4-15 days and 5-9 months after coronary artery bypass surgery, where the pericardium was closed with a biodegradable pericardial patch. A group of 11 patients (mean age 63 years) in whom the pericardium was left open served as controls. Tricuspid annulus motion was markedly decreased, abnormal septal motion was present and decreased systolic to diastolic ratio in the vena cava superior flow was present in all patients in both groups one week after surgery. At the late follow-up, all patients still had decreased tricuspid annulus motion, while 17% of the patients in the test group and 22% of the patients in the control group (ns) demonstrated normal septal motion. We conclude that closing the pericardium with a biodegradable patch does not affect the postoperative changes in right heart function normally seen after open-heart surgery.

  • 34.
    Maret, Eva
    et al.
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Ryhov University Hospital, Sweden; Karolinska University Hospital, Sweden.
    Liehl, Monika
    Ryhov University Hospital, Sweden.
    Brudin, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Kalmar University Hospital, Kalmar, Sweden.
    Tödt, Tim
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Edvardsen, Thor
    Oslo University Hospital, Norway.
    Engvall, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Phase analysis detects heterogeneity of myocardial deformation on cine MRI2015In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 49, no 3, p. 149-158Article in journal (Refereed)
    Abstract [en]

    Abstract Objectives. Myocardial scar will lead to heterogeneous left ventricular deformation. We hypothesized that a myocardial scar will display an elevated standard deviation of phase and that this effect could be compared with mechanical dispersion. Design. Thirty patients (3 women and 27 men) were investigated 4-8 weeks after ST-elevation myocardial infarction treated with percutaneous coronary intervention. Seventeen had a scar area >75% in at least one antero- or inferoseptal segment (scar) and 13 had scar <1% (non-scar). The phase delays of velocity, displacement and strain were measured in the longitudinal direction, tangential to the endocardial outline, and in the radial direction, perpendicular to the tangent. Results. The standard deviation of phase in radial measurements differentiated scar patients from those without scar (p<0.01), while longitudinal measurements did so only for longitudinal strain. Likewise, the standard deviation for radial measurements of time to peak for segmental velocity, displacement and strain performed better than longitudinal measurements and equal to the results of phase. Conclusion. Phase dispersion in deformation imaging may be used for detecting heterogeneous left ventricular contraction.

  • 35.
    Olsson, Anki
    et al.
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping. Blekinge Institute Technology, Sweden.
    Alfredsson, Joakim
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Håkansson, Erik
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Svedjeholm, Rolf
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Berglund, Johan
    Blekinge Institute Technology, Sweden.
    Berg, Sören
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Protamine reduces whole blood platelet aggregation after cardiopulmonary bypass2016In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 50, no 1, p. 58-63Article in journal (Refereed)
    Abstract [en]

    Platelet dysfunction is an important cause of postoperative bleeding after cardiac surgery. Protamine is routinely used for reversal of heparin after cardiopulmonary bypass (CBP), but may affect platelet aggregation. We assessed changes in platelet function in relation to protamine administration. Design: Platelet aggregation was analyzed by impedance aggregometry before and after protamine administration in 25 adult cardiac surgery patients. Aggregation was also studied after in vitro addition of heparin and protamine. The activators adenosine diphosphate (ADP), thrombin receptor activating peptide-6 (TRAP), arachidonic acid (AA) and collagen (COL) were used.Results: Platelet aggregation was reduced by approximately 50% after in vivo protamine administration; ADP 640 +/- 230 (AU*min, mean +/- SD) to 250 +/- 160, TRAP 939 +/- 293 to 472 +/- 260, AA 307 +/- 238 to 159 +/- 143 and COL 1022 +/- 350 to 506 +/- 238 (all p&lt;0.001). Aggregation was also reduced after in vitro addition of protamine alone with activators ADP from 518 +/- 173 to 384 +/- 157 AU*min p&lt;0.001, and AA 449 +/- 311 to 340 +/- 285 (p&lt;0.01) and protamine combined with heparin (1:1 ratio) with activators ADP to 349 +/- 160 and AA to 308 +/- 260 (both p&lt;0.001); and COL from 586 +/- 180 to 455 +/- 172 (p&lt;0.05). Conclusions: Protamine given after CPB markedly reduces platelet aggregation. Protamine added in vitro also reduces platelet aggregation, by itself or in combination with heparin.

  • 36.
    Rademakers, Frank
    et al.
    University Hospital Leuven, Belgium .
    Engvall, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Edvardsen, Thor
    Oslo University Hospital, Norway .
    Monaghan, Mark
    Kings College Hospital London, England .
    Sicari, Rosa
    CNR, Italy .
    Nagel, Eike
    St Thomas Hospital, England .
    Zamorano, Jose
    Hospital University of Ramon and Cajal, Spain .
    Ukkonen, Heikki
    Turku University Hospital, Finland .
    Ebbers, Tino
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Di Bello, Vitantonio
    University of Pisa, Italy .
    Voigt, Jens-Uwe
    University Hospital Leuven, Belgium .
    Herbots, Lieven
    Katholieke University of Leuven, Belgium .
    Claus, Piet
    University Hospital Leuven, Belgium .
    DHooge, Jan
    Katholieke University of Leuven, Belgium .
    Determining optimal noninvasive parameters for the prediction of left ventricular remodeling in chronic ischemic patients2013In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 47, no 6, p. 329-334Article in journal (Refereed)
    Abstract [en]

    Objectives. DOPPLER-CIP aims to determine the optimal noninvasive parameters (myocardial function, perfusion, ventricular blood flow, cell integrity) and methodology (ergometry, echocardiography, scintigraphy, MRI) in a given ischemic substrate that best predicts the impact of an intervention (or the lack thereof) on adverse morphological ventricular remodeling and functional recovery. Moreover, the relative predictive value of each of these parameters, in respect to the cost of extracting this information in order to enable optimization of cost-effectiveness for improved health care, will be determined by this project. Design. DOPPLER-CIP is a multi-center registry study. All patients with ischemic heart disease included in this study undergo at least two noninvasive stress imaging examinations at baseline. The presence/or absence of left ventricular (LV) remodeling will be assessed after a follow-up of 2 years, during which all cardiac events will be registered. Results. 676 patients were included. Currently, baseline data analysis is almost finished and the follow-up is ongoing. Conclusions. After completion, DOPPLER-CIP will provide evidence-based guidelines toward the most effective use of cardiac imaging in the chronically ischemic heart disease patient. The study will generate information, knowledge, and insight into the new imaging methodologies and into the pathophysiology of chronic ischemic heart disease.

  • 37.
    Rådegran, Göran
    et al.
    Department of Clinical Sciences Lund, Cardiology, Lund University, Lund, Sweden; Haemodynamic Laboratory, the Section for Heart Failure and Valvular Disease, VO Heart and Lung Medicine, Skåne University Hospital, Lund, Sweden.
    Kjellström, Barbro
    Cardiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden.
    Ekmehag, Björn
    Department of Public Health and Caring Science, Uppsala University and Uppsala University Hospital, Uppsala, Sweden.
    Larsen, Flemming
    Department of Molecular Medicine and Surgery, Section of Clinical Physiology, Karolinska Institute, Stockholm, Sweden; Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden.
    Rundqvist, Bengt
    Department of Cardiology , Sahlgrenska University Hospital, the Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Berg Blomquist, Sofia
    Department of Medical Sciences Cardiology, Uppsala University, Uppsala, Sweden.
    Gustafsson, Carola
    Department of Cardiology, Sahlgrenska University Hospital, the Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Hesselstrand, Roger
    Department of Clinical Sciences Lund, Rheumatology, Lund University, and the Rheumatology Clinic, Skåne University Hospital, Lund, Sweden.
    Karlsson, Monica
    Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping. Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Kornhall, Björn
    Department of Clinical Sciences Lund, Cardiology, Lund University, Lund, Sweden; Haemodynamic Laboratory, the Section for Heart Failure and Valvular Disease, VO Heart and Lung Medicine, Skåne University Hospital, Lund, Sweden.
    Nisell, Magnus
    Department of Medicine, Karolinska Institute, Stockholm, Sweden; Clinic for Pulmonary Medicine, Karolinska University Hospital, Stockholm, Sweden.
    Persson, Liselotte
    Department of Clinical Sciences Lund, Cardiology, Lund University, Lund, Sweden; Haemodynamic Laboratory, the Section for Heart Failure and Valvular Disease, VO Heart and Lung Medicine, Skåne University Hospital, Lund, Sweden.
    Ryftenius, Henrik
    Department of Medicine, Karolinska Institute, Stockholm, Sweden; Clinic for Pulmonary Medicine, Karolinska University Hospital, Stockholm, Sweden .
    Selin, Maria
    Department of Public Health and Clinical Medicine, Cardiology and the Heart Centre, Umeå University, Umeå, Sweden.
    Ullman, Bengt
    Department of Cardiology, Karolinska Institute, Stockholm, Sweden; Department of Cardiology, Södersjukhuset, Sweden, Stockholm.
    Wall, Kent
    Department of Clinical Physiology, Örebro University, and Örebro University Hospital, Örebro, Sweden.
    Wikström, Gerhard
    Department of Medical Sciences Cardiology, Uppsala University, Uppsala, Sweden.
    Willehadson, Maria
    Department of Medical Sciences Cardiology, Uppsala University, Uppsala, Sweden.
    Jansson, Kjell
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Söderberg, Stefan
    Department of Medicine, Karolinska Institute, Stockholm, Sweden; Clinic for Pulmonary Medicine, Karolinska University Hospital, Stockholm, Sweden.
    Characteristics and survival of adult Swedish PAH and CTEPH patients 2000-20142016In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 50, no 4, p. 243-250Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The Swedish Pulmonary Arterial Hypertension Register (SPAHR) is an open continuous register, including pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) patients from 2000 and onwards. We hereby launch the first data from SPAHR, defining baseline characteristics and survival of Swedish PAH and CTEPH patients.

    DESIGN: Incident PAH and CTEPH patients 2008-2014 from all seven Swedish PAH-centres were specifically reviewed.

    RESULTS: There were 457 PAH (median age: 67 years, 64% female) and 183 CTEPH (median age: 70 years, 50% female) patients, whereof 77 and 81%, respectively, were in functional class III-IV at diagnosis. Systemic hypertension, diabetes, ischaemic heart disease and atrial fibrillation were common comorbidities, particularly in those >65 years. One-, 3- and 5-year survival was 85%, 71% and 59% for PAH patients. Corresponding numbers for CTEPH patients with versus without pulmonary endarterectomy were 96%, 89% and 86% versus 91%, 75% and 69%, respectively. In 2014, the incidence of IPAH/HPAH, associated PAH and CTEPH was 5, 3 and 2 per million inhabitants and year, and the prevalence was 25, 24 and 19 per million inhabitants.

    CONCLUSION: The majority of the PAH and CTEPH patients were diagnosed at age >65 years, in functional class III-IV, and exhibiting several comorbidities. PAH survival in SPAHR was similar to other registers.

  • 38.
    Svedjeholm, Rolf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Myocardial ischaemia and neuroendocrine stress: Metabolic consequences and possibilities2000In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 34, no 5, p. 461-463Article, review/survey (Refereed)
    Abstract [en]

    [No abstract available]

  • 39.
    Svedjeholm, Rolf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Myocardial ischemia and neuroendocrine stress: metabolic consequences and possibilities.2000In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 34, p. 461-463Article in journal (Refereed)
  • 40.
    Svedjeholm, Rolf
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Håkansson, Erik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Predictors of atrial fibrillation in patients undergoing surgery for ischemic heart disease2000In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 34, no 5, p. 516-521Article in journal (Refereed)
    Abstract [en]

    Objectives. Atrial fibrillation (AF) remains a common problem after cardiac surgery. AF increases the risk for stroke and is associated with increased length of hospitalization. The aim of this study was to analyze risk factors for postoperative AF in a uniformly managed cohort of patients. Design. The records of 775 consecutive patients undergoing coronary artery bypass grafting (CABG) or CABG + valve procedures were examined. Forward stepwise multiple logistic regression analysis was used for statistical evaluation. Results. Mean age was 64.6+/- 8.7 years. The incidence of AF was 29.1% in patients undergoing isolated CABG and 48.6% after CABG + valve procedures. Multivariate analysis identified advanced age (p = 0.000003), low postoperative mixed venous oxygen saturation (p = 0.0018), hypertension (p = 0.0059), preoperative history of AF (p = 0.023) and the need for mechanical circulatory support (p = 0.030) as predictors for postoperative of AF. Conclusions. In agreement with previous studies, advanced age was the most important predictor of AF. Hypertension, history of AF and signs of circulatory failure were also predictive of AF. Preventive measures against AF should preferably be tested in high-risk populations, such as elderly patients.

  • 41. Svenmarker, S.
    et al.
    Sandström, E.
    Karlsson, Thomas
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Behavioural Sciences, Cognition, Development and Disability.
    Åberg, T.
    Is there an association between release of protein S100B during cardiopulmonary bypass and memory disturbances?2002In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 36, no 2, p. 117-122Article in journal (Refereed)
    Abstract [en]

    Objective-The use of protein S100B as a marker of brain cell injury in conjunction with cardiopulmonary bypass (CPB) has recently been questioned. The present study investigates functional brain injury based on the relation between S100B and memory disturbances. Methods-Four hundred and fifteen low-risk coronary artery bypass patients exposed to CPB were examined. The protein S100B was sampled during and after surgery. Explicit and implicit memory function was assessed preoperatively and at discharge from hospital. Possible associations between the release of the protein S100B and memory function were studied. Results-Serum concentration of S100B peaked at termination of CPB (0.895 ▒ 0.84 ╡g/l) and decreased gradually, 7 h post CPB (0.436 ▒ 0.59 ╡g/l), day 1 (0.149 ▒ 0.27 ╡g/l) and day 2 (0.043 ▒ 0.15 ╡g/l). High levels of S100B (> 1.5 ╡g/l) 7 h post CPB were associated with a significant (-1 SD) decline of explicit memory function (p = 0.006), this was not seen at termination of CPB (p = 0.834). Predictors of memory decline were S100B 7 h post CPB, length of stay in hospital and concomitant neurological disorders. Postoperative S100B concentration was higher among patients with atrial fibrillation (p = 0.022). Conclusion-Only high levels of protein S100B found 7 h post CPB were associated with decline of explicit memory function, not the release seen during CPB. Thus, when using protein S100B, only values several hours remote from surgery should be used as a brain cell injury marker.

  • 42.
    Tegnell, Anders
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences.
    Ahrén, Claes
    Linköping University, Department of Medicine and Care, Thoracic Surgery. Linköping University, Faculty of Health Sciences.
    Öhman, Lena
    Linköping University, Department of Molecular and Clinical Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences.
    Wound infections after cardiac surgery: a Wound Scoring System may Improve Early Detection2002In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 36, no 1, p. 60-64Article in journal (Refereed)
    Abstract [en]

    Objective - This study was aimed at describing the early development of wound infections after cardiac surgery to identify markers for upcoming infections.

    Design - We followed a cohort of 200 patients for 3 months after cardiac surgery to establish the incidence of all types of postoperative infections. Wound healing and C-reactive protein (CRP) were followed for the first 2 weeks.

    Results - A total of 175 patients out of 200 could be followed up. Using a broad definition of wound infection a total of 30% of the patients had some kind of wound infection. The diagnosis of most infections occurred after the patients had left the cardiac surgery unit (median 12 d after surgery). Our wound scoring method shows significant differences at an early stage between infected and non-infected wounds. At the time of diagnoses CRP was elevated in patients with deep sternal infection.

    Conclusion - A long follow-up period is needed to establish the true incidence of infection. Wound scoring can give an early indication of wound infections and CRP can help in the diagnoses of deep infections.

  • 43.
    Vanhanen, Ingemar
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Håkansson, Erik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Jorfeldt, Lennart
    Stockholm.
    Svedjeholm, Rolf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Myocardial uptake and release of substrates in patients operated for unstable angina: Impact of glutamate infusion2003In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 37, no 2, p. 113-120Article in journal (Refereed)
    Abstract [en]

    Objective - To study cardiac uptake and release of substrates and the influence of intravenous glutamate in patients operated for unstable angina requiring intravenous nitrates. Design - Nineteen patients were randomized to blinded infusion of glutamate or saline. Arterial-coronary sinus differences of substrates were measured before cardiopulmonary bypass (CPB) and during early reperfusion. Results - Before CPB the only major substrates that were extracted by the heart in the saline group were free fatty acids (FFAs). During reperfusion uptake of glucose and glutamate was found but FFAs remained the major substrate extracted by the heart. Initially transient low oxygen extraction and lactate release were found. Conversion to lactate uptake was not observed. Glutamate infusion was associated with an uptake of glutamate and in contrast to the control group there was also uptake of lactate before CPB and at the end of the study period. Conclusion - The metabolic situation before CPB with a reliance on myocardial FFA uptake is less than ideal with regard to ischemia. Early reperfusion was characterized by dynamic changes and a shift towards myocardial glucose uptake but FFAs remained the major substrate extracted. The qualitative findings associated with glutamate infusion agree with previous animal and human studies but have to be interpreted cautiously due to lack of flow measurements.

  • 44.
    Vanhanen, Ingemar
    et al.
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Svedjeholm, Rolf
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Håkansson, Erik
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Joachimsson, P.O.
    Department of Anesthesiology, Akademiska Hospital, Uppsala.
    Jorfeldt, Lennart
    Department of Thoracic Physiology, Karolinska Hospital, Stockholm, Sweden.
    Vánky, Farkas
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences.
    Assessment of myocardial glutamate requirements early after coronary artery bypass surgery1998In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 32, no 3, p. 145-152Article in journal (Refereed)
    Abstract [en]

    Glutamate is an important substrate for the intermediary metabolism of the heart, particularly in association with ischemia. Early after coronary artery bypass surgery (CABG) myocardial uptake of glutamate seems to be limited by substrate availability (arterial levels). However, glutamate is not an innocuous substrate. As arterial levels of glutamate are important both for myocardial uptake and adverse effects, an attempt was made to determine a minimum dose of glutamate sufficient to supply the needs of the heart after CABG. Ten patients received and infusion of 220-240 ml of 0.1 M L-glutamic acid solution at varying rates during two 30-min periods, starting 2 h after uncomplicated elective CABG. Intravenous glutamate infusion caused a dose-dependent linear increase in arterial glutamate and an increased myocardial uptake of glutamate. However, myocardial uptake of glutamate correlated with arterial levels only at lower infusion rates. Although maximal peak uptake in individual patients (6.6 ± 1.1 μmol/min) occurred at an average increase of arterial whole blood glutamate of 172 ± 34 μmol/L, the greatest impact on myocardial glutamate uptake was achieved by increasing arterial whole blood glutamate by less than 100 μmol/L. This implies that an infusion rate of 30-40 mg glutamate/kg BW/h could suffice to achieve a maximal or near maximal myocardial glutamate uptake in most patients after CABG. The adequacy of this dosage remains to be confirmed in high-risk patients.

  • 45.
    Zachrisson, Helene
    et al.
    Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Jatuzis, D
    Blomstrand, C
    Holm, J
    Volkmann, R
    Middle cerebral artery circulation during carotid surgery. A transcranial Doppler study.2000In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 34, no 6, p. 597-602Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Perioperative carotid cross-clamping might induce low stump pressures as well as hypoperfusion of the middle cerebral artery. In this study blood flow velocities in the middle cerebral artery were compared with intraoperative measurements of the poststenotic carotid blood pressure.

    DESIGN: Forty-one patients with internal carotid artery stenosis were operated on without shunting, under general anesthesia. Poststenotic carotid pressures and middle cerebral artery flow velocities were measured before and during cross-clamping. The hemodynamic responses to preoperative carotid compressions and intraoperative cross-clamping were evaluated.

    RESULTS: In seven patients the poststenotic carotid blood pressure decreased on clamping despite unchanged or even increased middle cerebral artery blood flow velocities. In all other patients, pressure changes were significantly correlated to the decrease in middle cerebral artery blood flow velocities. Autoregulatory blood flow velocity responses after preoperative common carotid artery compression were not reproducible by cross-clamping.

    CONCLUSIONS: Stump blood pressure measurements may not reflect middle cerebral artery perfusion in about 20% of thrombendarterectomies performed under general anesthesia. A possible explanation might be dimished cerebral autoregulation and changes in collateral flow distributions.

  • 46.
    Åström Aneq, Meriam
    et al.
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Lindström, Lena
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences.
    Nylander, Eva
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Long-term follow-up in arrhythmogenic right ventricular cardiomyopathy using Tissue Doppler Imaging2008In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 42, no 6, p. 368-374Article in journal (Refereed)
    Abstract [en]

    Aim: To study patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) and describe different echocardiographic parameters and their change over time during almost 10 years follow-up period.

    Methods: Fifteen patients (9 male, 6 female), aged 22-58 years (mean 40) with a diagnosis of ARVC, were followed up for a period of 6-10 years (mean 8.7). Twelve-lead and a signal- averaged ECG was recorded. Tricuspid and mitral annular motion and tissue Doppler imaging were registered by echocardiography. Wall motion score index (WMSI) was calculated for the left and right ventricles.

    Results: We registered significant reduction in systolic tissue velocity on right ventricle free wall between the first and last investigations: 7-17cm/s (mean 11.8) to 4-15 (mean 9.1), p=0.005. WMSI increased by at least 0.2 in 10/14 patients for the right and in 8/15 patients for the left ventricle. A decrease in velocity time integral for the left ventricular outflow was observed (16-30 to 13-21, p=0.009).

    Conclusion: ARVC is a progressive disease with individual variation. Left ventricular involvement may occur early in the disease. Tissue Doppler imaging is a useful tool to follow-up right ventricular abnormalities.

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