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  • 1.
    Blomstrand, Peter
    et al.
    County Hospital Ryhov, Jököping, Sweden.
    Maret, Eva
    Linköpings universitet, Institutionen för medicin och hälsa, Klinisk fysiologi. Linköpings universitet, Hälsouniversitetet.
    Ohlsson, Jan
    County Hospital Ryhov, Jönköping, Sweden.
    Scheike, Morten
    Linköpings universitet, Institutionen för medicin och hälsa, Klinisk fysiologi. Linköpings universitet, Hälsouniversitetet.
    Karlsson, Jan-Erik
    County Hospital Ryhov, Jönköping, Sweden.
    Säfström, Kåge
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Swahn, Eva
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet.
    Engvall, Jan
    Linköpings universitet, Institutionen för medicin och hälsa, Klinisk fysiologi. Linköpings universitet, Hälsouniversitetet.
    Pulsed tissue Doppler imaging for the detection of myocardial ischaemia, a comparison with myocardial perfusion SPECT2004Ingår i: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 24, nr 5, s. 289-295Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In order to compare the diagnostic ability of pulsed tissue Doppler and myocardial perfusion Single Photon Emission Computed Tomography (SPECT) in patients with a history of unstable coronary artery disease, CAD, 26 patients, 22 men and four women, age 47-76 years, were investigated in a prospective study, 5-10 day after an episode of unstable angina. Tissue Doppler and two-dimensional echocardiography were performed during dobutamine stress testing and myocardial scintigraphy after bicycle exercise and at rest. Patients with a normal SPECT had higher peak systolic velocity during dobutamine infusion, 18.9 +/- 4.1 cm s(-1), than patients with ischaemia, 12.2 +/- 3.8 cm s(-1) (P<0.001) or scar, 8.8 +/- 3.0 cm s(-1) (P<0.01). In a territorial analysis the difference in peak systolic velocity between areas with a normal and abnormal SPECT was less apparent. Failure to achieve >/=13 cm s(-1) in mean-peak systolic velocity was the most accurate criterion for detection of significant CAD on SPECT. We conclude that pulsed tissue Doppler can be used for objective quantification of left ventricular wall motion during dobutamine stress testing and for identification of patients with CAD on SPECT but not for identification of regional ischaemia.

  • 2.
    Caceres, R.
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Neurologi. Linköpings universitet, Hälsouniversitetet.
    Richter, J.
    Östergötlands Läns Landsting, Rekonstruktionscentrum, Neurokirurgiska kliniken US.
    Säfström, Kåge
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Landtblom, Anne-Marie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Neurologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Neurologiska kliniken. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Medicinska specialistkliniken .
    Editorial: Application of a vagal nerve stimulator in an epilepsy patient with cardiac pacemaker after post-ictal cardiac arrest2009Ingår i: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 120, nr 2, s. 139-142Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    In this case report we present a patient with temporal lobe epilepsy (TLE) showing partial complex seizures and secondary generalization, and treated with several antiepileptic drugs. After two consecutive seizures she had an episode of cardiac arrest followed by AV-block III which led to the implantation of a cardiac pacemaker. She subsequently received a vagal nerve stimulator because of poor response to epilepsy treatment. Combined treatment with two different electromagnetic stimulators raises the question of safety during surgery which is discussed.

  • 3.
    Caceres, R
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Neurologi. Linköpings universitet, Hälsouniversitetet.
    Richter, J
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Neurologi. Linköpings universitet, Hälsouniversitetet.
    Säfström, Kåge
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Landtblom, Anne-Marie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Neurologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Medicinska specialistkliniken .
    Letter: Increased need for combinated nervus vagus-stimulators and electronic cardiac devices: aspects on methods and safety2010Ingår i: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 121, nr 4, s. 287-288Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    n/a

  • 4.
    Jonsson, Anders
    et al.
    Östergötlands Läns Landsting.
    Liuba, Ioan
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Säfström, Kåge
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Walfridsson, Håkan
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Arrhythmia symptoms with and without arrhythmias in patients monitored with transtelephonic ECG after AF-ablation in CIRCULATION, vol 125, issue 19, pp E687-E6872012Ingår i: CIRCULATION, American Heart Association , 2012, Vol. 125, nr 19, s. E687-E687Konferensbidrag (Refereegranskat)
    Abstract [en]

    n/a

  • 5.
    Kühme, Tobias
    et al.
    Linköpings universitet, Institutionen för medicin och vård. Linköpings universitet, Hälsouniversitetet.
    Säfström, Kåge
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Kardiologi. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Nielsen, Niels Erik
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Kardiologi. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Nylander, Eva
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Klinisk fysiologi. Östergötlands Läns Landsting, Hjärtcentrum, Fysiologiska kliniken.
    Olin, Christian
    Rupture of a synthetic VSD patch 28 years after total correction of Fallot's anomaly2006Ingår i: Annals of Thoracic Surgery, ISSN 0003-4975, E-ISSN 1552-6259, Vol. 81, nr 4, s. 1510-1512Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Patients operated on for complex congenital heart malformations need continuous follow-up. We present a male patient born in 1948 with Fallot's anomaly. A total correction was performed when he was 21 years old. Twenty-eight years after the operation, at routine follow-up, he presented with a significant left-to-right shunt because of a new ventricular septal defect. During the operation we found the original patch to be fractured with a central perforation. The patient received a new patch and has been without any clinical symptoms since. © 2006 by The Society of Thoracic Surgeons.

  • 6.
    Lagerqvist, B
    et al.
    Univ Uppsala Hosp, Dept Cardiol, Uppsala, Sweden Linkoping Univ Hosp, Dept Cardiol, S-58185 Linkoping, Sweden Univ Uppsala Hosp, Dept Thorac & Cardiovasc Surg, S-75185 Uppsala, Sweden Inst Med & Care, Linkoping, Sweden.
    Säfström, Kåge
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Stahle, E
    Univ Uppsala Hosp, Dept Cardiol, Uppsala, Sweden Linkoping Univ Hosp, Dept Cardiol, S-58185 Linkoping, Sweden Univ Uppsala Hosp, Dept Thorac & Cardiovasc Surg, S-75185 Uppsala, Sweden Inst Med & Care, Linkoping, Sweden.
    Wallentin, L
    Univ Uppsala Hosp, Dept Cardiol, Uppsala, Sweden Linkoping Univ Hosp, Dept Cardiol, S-58185 Linkoping, Sweden Univ Uppsala Hosp, Dept Thorac & Cardiovasc Surg, S-75185 Uppsala, Sweden Inst Med & Care, Linkoping, Sweden.
    Swahn, Eva
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Invasive treatment in women in the acute stage of unstable coronary artery disease (FRISCII)2000Ingår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 21, s. 1918-Konferensbidrag (Övrigt vetenskapligt)
  • 7. Lagerqvist, B
    et al.
    Säfström, Kåge
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Kardiologi. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Ståhle, E
    Wallentin, L
    Swahn, Eva
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Kardiologi. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Is early invasive treatment of unstable coronary artery disease equally effective for both women and men?2001Ingår i: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 38, nr 1, s. 41-48Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The Fragmin and fast Revascularization during InStability in Coronary artery disease (FRISC II) trial compared the effectiveness of an early invasive versus a noninvasive strategy in terms of the incidence of death and myocardial infarction (MI) in patients with unstable coronary artery disease (CAD). OBJECTIVES: In this subanalysis, we sought to evaluate gender differences in the effect of these different strategies. METHODS: The patients (749 women and 1,708 men) were randomized to early invasive or noninvasive strategies. Coronary angiography was performed within the first 7 days in 96% and 10% of the invasive and noninvasive groups, respectively, and revascularization was performed within the first 10 days in 71% and 9% of the invasive and noninvasive groups, respectively. RESULTS: Women presenting with unstable CAD were older, but fewer had previous infarctions, left ventricular dysfunction and elevated troponin T levels. Women had fewer angiographic changes. There was no difference in MI or death at 12 months among women in the invasive and noninvasive groups (12.4% vs. 10.5%, respectively), in contrast to the favorable effect in the invasively treated group of men (9.6% vs. 15.8%, p < 0.001). In an interaction analysis, there was a different effect of the early invasive strategy for the two genders (p = 0.008). CONCLUSIONS: Women with symptoms and/or signs of unstable CAD are older, but still have less severe CAD and a better prognosis compared with men. In contrast to its beneficial effect in men, an early invasive strategy did not reduce the risk of future events among women. Further research is warranted to identify the most appropriate treatment strategy in women with unstable CAD. ⌐ 2001 American College of Cardiology.

  • 8.
    Lagerqvist, Bo
    et al.
    Departments of Cardiology, University Hospital, Uppsala.
    Säfström, Kåge
    Linköpings universitet, Institutionen för medicin och vård, Kardiologi. Linköpings universitet, Hälsouniversitetet.
    Ståhle, Elisabeth
    Thoracic Surgery, University Hospital, Uppsala.
    Wallentin, Lars
    Departments of Cardiology, University Hospital, Uppsala.
    Swahn, Eva
    Linköpings universitet, Institutionen för medicin och vård, Kardiologi. Linköpings universitet, Hälsouniversitetet.
    Are There Different Effects of Invasive Treatment Between Women and Men During the Acute Stage of Unstable Coronary Artery Disease?Manuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    OBJECTIVES The FRISC II invasive trial compared an early invasive versus a noninvasive strategy concerning death and MI in CAD. This paper deals with the gender perspective in the same study.

    METHODS There were 749 women and 1708 men included in the study with a mean age of 66 and 64 years in women and men respectively. The patients were randomized to early invasive or noninvasive strategy and to placebo controlled long-term low molecular mass (1mm) heparin ( dalteparin) treatment for 3 months. Coronary angiographies were performed within the first seven days in 96 % and 10 % and revascularisation was performed within the first 10 days in 71 % and 9 % in the invasive and noninvasive groups, respectively.

    RESULTS Women were older but had less previous infarctions, better left ventricular function and less frequently had elevated troponin-levels. There were more patients with normal coronary arteries and less severe coronary artery lesions amongst the women. Accordingly, less interventions were performed in the female group although, among those who were revascularized, there was. no significant difference in the choice of procedure compared to men. There was no difference in the composite endpoint of MI and death at 12 months amongst women (12.4 vs. 10.5% in the invasive and non-invasive groups respectively) in contrast to the very favorable effect of the invasively treated group amongst the men (9.6 vs. 15.8%, p<0.001). In a multivariate interaction analysis there was different effect of early invasive strategy in the two genders (p=0.008)

    CONCLUSIONS Women with symptoms and/or signs of unstable coronary artery disease are older but still have less severe CAD and a better prognosis than men. In contrast to men, an early invasive strategy did not reduce the risk for future events amongst women. Further research is warranted to identify the most appropriate treatment strategy in women with unstable CAD.

  • 9.
    Landtblom, Anne-Marie
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för nervsystem och rörelseorgan. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Neurologiska kliniken.
    Dige, N
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för nervsystem och rörelseorgan. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Neurologiska kliniken.
    Schwerdt, K
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för nervsystem och rörelseorgan. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Neurologiska kliniken.
    Säfström, Kåge
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Radiologi. Östergötlands Läns Landsting, Bildmedicinskt centrum, Avdelningen för radiologi US.
    Granerus, Göran
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Klinisk fysiologi. Östergötlands Läns Landsting, Hjärtcentrum, Fysiologiska kliniken.
    A case of Kleine-Levin syndrome examined with SPECT and neuropsychological testing2002Ingår i: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 105, nr 4, s. 318-321Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    A case of Kleine-Levin syndrome with typical periodic hypersomnia and bulemia was diagnosed. On examination with single photo emission tomography (SPECT) (CERETEC«) during a relapse period and 2 weeks later there was marked cortical hypoperfusion of the frontal and temporal lobes, especially on the left side as well as in the right parietal lobe. Neuropsychological testing performed 1 week after a relapse showed a reduction in encoding to memory function of verbal learning indicating neocortical damage of the left fronto-temporal region. A follow-up 2 months later after the patient had spontaneously recovered showed only a slight left fronto-temporal disturbance. CT and MRI of the brain were normal although the MRI showed a large and asymmetric mamillary body. Neuropsychological testing 6 years after recovery showed pronounced reduction in short-time verbal and visual memory. Seven years after recovery SPECT demonstrated a normalized frontal perfusion but still a slight hypoperfusion in the left temporal lobe. Our results correlate to autopsy findings in two cases described previously.

  • 10.
    Landtblom, Anne-Marie
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för nervsystem och rörelseorgan. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Neurologiska kliniken.
    Dige, N
    Schwerdt, K
    Säfström, Kåge
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Radiologi. Östergötlands Läns Landsting, Bildmedicinskt centrum, Avdelningen för radiologi US.
    Granerus, Göran
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Klinisk fysiologi. Östergötlands Läns Landsting, Hjärtcentrum, Fysiologiska kliniken.
    Short-term memory dysfunction in Kleine-Levin syndrome2003Ingår i: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 108, nr 5, s. 363-367Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background - A previous investigation at our department of a young man with typical Kleine-Levin syndrome revealed short-term memory dysfunction as well as hypoperfusion of the temporal lobes on single photon emission tomography (SPECT) (CERETECR) examination, 6 and 7 years after recovery, suggesting long lasting or even permanent cerebral dysfunction. Patients and methods - We investigated four cases with classical adolescent Kleine-Levin syndrome characterized by hypersomnia and typical associated symptoms. We used neuropsychological testing and SPECT (CERETECR) of the brain. The results from the previous report related to above is included. Results - Examination with SPECT (CERETECR) during remission revealed hypoperfusion of the temporal lobes and fronto-temporal region in two of four cases. There were normal findings in two. Neuropsychological testing performed during remission showed reduction in the short-term memory capacity in all four cases. Conclusion - It is striking that all the cases investigated showed short-term memory dysfunction. One patient who had recovered from paroxysmal symptoms (hypersomnia attacks and bulimia) 6 years earlier showed progress in the short-term memory dysfunction. A pathologic condition in the temporal lobes may be suspected in Kleine-Levin syndrome.

  • 11.
    Liuba, Ioan
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Ahlmroth, Henrik
    Department of Cardiology, University Hospital Örebro, Örebro, Sweden.
    Jonasson, Lena
    Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken. Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet.
    Englund, Anders
    Department of Cardiology, University Hospital Örebro, Örebro, Sweden.
    Jönsson, Anders
    Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Säfström, Kåge
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Walfridsson, Håkan
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Source of inflammatory markers in patients with atrial fibrillation2008Ingår i: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, ISSN 1532-2092, Vol. 10, nr 7, s. 848-853Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS: Elevated levels of C-reactive protein and other inflammatory markers have been reported in some patients with atrial fibrillation (AF). Whether this finding is related to AF per se or to other conditions remains unclear. In addition, the source of inflammatory markers is unknown. Therefore, in the present study, we sought to assess the extent and the source of inflammation in patients with AF and no other concomitant heart or inflammatory conditions.

    METHODS AND RESULTS: The study group consisted of 29 patients referred for radiofrequency catheter ablation: 10 patients with paroxysmal AF, 8 patients with permanent AF, and 10 control patients with Wolf-Parkinson-White (WPW) syndrome and no evidence of AF (mean age 54 +/- 11 vs. 57 +/- 13 vs. 43 +/- 16). No patient had structural heart diseases or inflammatory conditions. High-sensitive C-reactive protein, interleukin-6 (IL-6), and interleukin-8 (IL-8) were assessed in blood samples from the femoral vein, right atrium, coronary sinus, and the left and right upper pulmonary veins. All samples were collected before ablation. Compared with controls and patients with paroxysmal AF, patients with permanent AF had higher plasma levels of IL-8 in the samples from the femoral vein, right atrium, and coronary sinus, but not in the samples from the pulmonary veins (median values in the femoral vein: 2.58 vs. 2.97 vs. 4.66 pg/mL, P = 0.003; right atrium: 2.30 vs. 3.06 vs. 3.93 pg/mL, P = 0.013; coronary sinus: 2.85 vs. 3.15 vs. 4.07, P = 0.016). A high-degree correlation existed between the IL-8 levels in these samples (correlation coefficient between 0.929 and 0.976, P < 0.05). No differences in the C-reactive protein and IL-6 levels were noted between the three groups of patients.

    CONCLUSION: The normal levels of C-reactive protein and IL-6, along with the elevated levels of IL-8 in patients with permanent AF but not in those with paroxysmal AF, suggest a link between a low-grade inflammatory reaction and long-lasting AF. The elevated IL-8 levels in the peripheral blood, right atrium, and coronary sinus but not in the pulmonary veins suggest a possible source of inflammation in the systemic circulation.

  • 12.
    Mentesidou, E
    et al.
    Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Neurologiska kliniken.
    Richter, J
    Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Neurologiska kliniken.
    Vigren, P
    Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Neurologiska kliniken.
    Säfström, Kåge
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Landtblom, Anne-Marie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Neurologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Neurologiska kliniken.
    Combination of vagal nerve stimulator and cardiac pace-maker in EUROPEAN JOURNAL OF NEUROLOGY, vol 17, issue SI, pp 456-4562010Ingår i: EUROPEAN JOURNAL OF NEUROLOGY, Wiley-Blackwell , 2010, Vol. 17, nr SI, s. 456-456Konferensbidrag (Refereegranskat)
    Abstract [en]

    n/a

  • 13.
    Swahn, Eva
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Säfström, Kåge
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Lagerqvist, B
    Inst Med & Care, Linkoping, Sweden Linkoping Univ Hosp, Dept Cardiol, S-58185 Linkoping, Sweden Univ Uppsala Hosp, Dept Cardiol, Uppsala, Sweden Univ Uppsala Hosp, Dept Thorac & Cardiovasc Surg, S-75185 Uppsala, Sweden.
    Stahle, E
    Inst Med & Care, Linkoping, Sweden Linkoping Univ Hosp, Dept Cardiol, S-58185 Linkoping, Sweden Univ Uppsala Hosp, Dept Cardiol, Uppsala, Sweden Univ Uppsala Hosp, Dept Thorac & Cardiovasc Surg, S-75185 Uppsala, Sweden.
    Wallentin, L
    Inst Med & Care, Linkoping, Sweden Linkoping Univ Hosp, Dept Cardiol, S-58185 Linkoping, Sweden Univ Uppsala Hosp, Dept Cardiol, Uppsala, Sweden Univ Uppsala Hosp, Dept Thorac & Cardiovasc Surg, S-75185 Uppsala, Sweden.
    A gender-perspective on the use of Imw-heparin (dalteparin) in the FRISCII medical trial2000Ingår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 21, s. 1919-Konferensbidrag (Övrigt vetenskapligt)
  • 14.
    Säfström, Kåge
    Linköpings universitet, Institutionen för medicin och vård, Kardiologi. Linköpings universitet, Hälsouniversitetet.
    Diagnostic and Prognostic Evaluation in Postmenopausal Women with Signs and Symptoms of Unstable Coronary Artery Disease2000Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Coronary artery disease (CAD) is the major cause of death in both men and women in the western world. The majority of studies undertaken to evaluate diagnostic methods, risk stratification and treatment of CAD, have been performed on men. Although there are studies reporting gender differences in the presentation of symptoms, prognosis and response to treatment, current recommendations for practice are based on a model of the disease in men.

    The diagnostic information from basic clinical data, ECG and an early symptomlimited exercise test was evaluated in a prospective study on 200 postmenopausal women with unstable CAD. The prevalence of atherosclerosis was high (85%). A patient history and markers of myocardial injury were good predictors of significant CAD and the exercise test was as valuable for the assessment of this diagnosis in women as that reported in men.

    The incremental diagnostic values of basic clinical data, the exercise test and 201TI SPECT were assessed in 121 postmenopausal women after an episode of unstable CAD. There was an incremental diagnostic value of 201TI SPECT compared to basic data and the exercise test when diagnosing significant CAD, but not regarding the identification of extensive CAD.

    Evaluation of symptom-limited exercise test for risk stratification in postmenopausal women with unstable CAD was carried out on a population of 395 women in the "FRagmin during InStability in CAD" (FRISC I) Study. The exercise test was a good predictor of future cardiac death and myocardial infarction (MI) if parameters reflecting cardiac performance also were taken under consideration and not only chest pain and ST-segment depression, two parameters reflecting ischaemia and often used in studies on men. However, the patients who, after admission, did not become stable enough to perform the exercise test, had the highest risk of adverse future events.

    Comparison of symptom limited exercise test and troponin T measurements for risk stratification in women and men was performed in the FRISC I study population. It was concluded that the early symptom-limited exercise test and troponin T are at least as useful as prognostic risk indicators in women as they are in men.

    The gender differences in outcome after early revascularisation compared to noninvasive management was assessed in 749 women and 1708 men in the "Fast Revascularisation during InStability in CAD" (FRISC II) Study. Women were older, had less severe CAD and a better prognosis than men. Men had a more favourable outcome if randomised to early revascularisation, whereas there was an opposite trend in women, although not significant. The different outcome in women may partly be explained by A high procedure-related event rate in the invasive group compared to the non-invasive group, and an overall low event rate during follow-up. Further research is needed in this area, and in the mean time, a more conservative approach to revascularisation in women, guided by risk stratification seems reasonable.

    Delarbeten
    1. Unstable coronary artery disease in post-menopausal women: Identifying patients with significant coronary artery disease by basic clinical parameters and exercise test
    Öppna denna publikation i ny flik eller fönster >>Unstable coronary artery disease in post-menopausal women: Identifying patients with significant coronary artery disease by basic clinical parameters and exercise test
    Visa övriga...
    1998 (Engelska)Ingår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 19, nr 6, s. 899-907Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Background The diagnostic information from an ECG taken while at rest and an exercise test is considered less reliable in women than in men, mostly due to a high percentage offalse-positive tests. This can be explained by a lower pre-test likelihood of coronary heart disease.

    Aims To evaluate the diagnostic information that can be gained from basic clinical parameters, an ECG and exercise test in a group of post-menopausal women with symptoms of unstable coronary artery disease in order to identify patients with significant coronary artery stenoses.

    Methods and Results We prospectively studied 200 postmenopausal women admitted to the coronary care unit with symptoms of unstable coronary artery disease and ECG changes suggestive of ischaemia. The diagnostic value of common risk factors, myocardial enzymes and an early exercise test were assessed. A coronary angiogram was performed within 60 days. Median age was 67 years. On admission, 38% had ST depression on an ECG taken while at rest, 76% had T-wave inversion, and 41% increased enzyme levels. The coronary angiogram revealed that 15% had no atherosclerosis, 14% had atherosclerosis but no lesion ≥ 50% of luminal diameter and 71 % had at least one significant stenosis. Of patients with known indicators of atherosclerotic disease, all but one had atherosclerosis visualized on the coronary angiogram. A relative ST depression ≥ 0·1 m V and a low maximum workload at exercise test were strong predictors of significant coronary artery disease. The positive predictive value of ST depression was 91% and of low maximum workload 84%.

    Conclusion In post-menopausal women with signs of unstable angina and ischaemia on an ECG taken while at rest, the prevalence of coronary atherosclerosis is high, 85%. Contrary to earlier studies, ST T-changes at the early exercise test had a high positive predictive value, especially in combination with a low maximum workload with no false-positive results.

    Nyckelord
    women, coronary angiography, unstable angina, exercise test, electrocardiography, risk factors
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-26815 (URN)10.1053/euhj.1997.0867 (DOI)11427 (Lokalt ID)11427 (Arkivnummer)11427 (OAI)
    Tillgänglig från: 2009-10-08 Skapad: 2009-10-08 Senast uppdaterad: 2017-12-13Bibliografiskt granskad
    2. Early symptom-limited exercise test for risk stratification in post menopausal women with unstable coronary artery disease
    Öppna denna publikation i ny flik eller fönster >>Early symptom-limited exercise test for risk stratification in post menopausal women with unstable coronary artery disease
    2000 (Engelska)Ingår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 21, nr 3, s. 230-238Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Aims The exercise test is considered less reliable in women than in men both for diagnostic and prognostic purposes. The value, however, of the exercise test might vary with the population that is examined, the way the test is performed and which exercise test variables are taken into consideration in the analysis. The aim of the study was to evaluate an early symptom-limited exercise test as a tool for risk stratification in women with unstable coronary artery disease admitted to the coronary care unit.

    Methods and Results Of the 543 women in the FRISC I study, 395 stabilized on medical treatment and performed a symptom-limited exercise test 5–8 days after inclusion. Sixteen patients with a cardiac event before the scheduled exercise test were excluded. During the 6 months follow-up 17% of the women who did not perform the exercise test and 9% of the 395 women who did, died or had a myocardial infarction (P<0·01). Multivariate stepwise logistic regression analysis was performed to assess the value of clinical variables and findings at the predischarge exercise test to predict cardiac events. Based on the exercise test results three risk groups were identified with an event rate of 19%, 9% and 1%, respectively. The exercise test was better than any of the tested clinical variables in predicting cardiac events.

    Conclusion Women with unstable coronary artery disease who do not stabilize within a few days have a high event rate early during follow-up. For women who are medically stabilized, considering not only variables like ST depression and chest pain but also parameters reflecting the cardiac performance such as maximal workload and increase in rate-pressure product, an early symptom-limited exercise test is a good predictor of future cardiac events.

    Nyckelord
    Women, unstable angina, exercise test, prognosis
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-27174 (URN)10.1053/euhj.1999.1735 (DOI)11823 (Lokalt ID)11823 (Arkivnummer)11823 (OAI)
    Tillgänglig från: 2009-10-08 Skapad: 2009-10-08 Senast uppdaterad: 2017-12-13Bibliografiskt granskad
    3. Risk stratification in unstable coronary artery disease: Exercise test and troponin T from a gender perspective
    Öppna denna publikation i ny flik eller fönster >>Risk stratification in unstable coronary artery disease: Exercise test and troponin T from a gender perspective
    2000 (Engelska)Ingår i: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 35, nr 7, s. 1791-1800Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    OBJECTIVES

    The study was done to determine the prognostic yield of an early symptom-limited exercise test (ET) and measurement of troponin T (TnT) in men and women with unstable coronary artery disease (CAD), with special reference to gender differences.

    BACKGROUND

    Early risk assessment is essential for the application of appropriate treatment and further management in patients with unstable CAD. The early symptom-limited ET together with specific biochemical marker determination is an inexpensive, widely applicable method for early risk stratification. In women, however, the ET is considered less reliable, and there are few data on biochemical markers for risk stratification in women.

    METHODS

    In a substudy of the Fragmin during InStability in Coronary artery disease (FRISC I) trial, 395 women and 778 men with unstable CAD who performed an early ET were followed for six months. Blood samples for TnT determination were taken in 342 women and 621 men at inclusion.

    RESULTS

    Based on the ET results, low-, intermediate-, and high-risk response groups were identified with event rates of cardiac death or myocardial infarction (MI) of 1%, 9%, and 19%, respectively, among women and 8%, 14%, and 20%, respectively, among men. Patients who could not perform the ET had an event rate similar to the high-risk group. The TnT levels were divided into three groups: <0.06, 0.06–0.19, and ≥0.20 μg/liter with event rates of 1%, 10%, and 18%, respectively, among women and 9%, 14%, and 18%, respectively, among men. Combining the ET results with TnT levels identified a low-risk group with an event rate of 3% in the male population and no events in the female population.

    CONCLUSIONS

    Direct comparison between men and women from the same population with a high pretest likelihood of disease suggests that both TnT and the early symptom-limited ET are at least as useful as prognostic risk indicators in women as they are in men.

    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-27170 (URN)10.1016/S0735-1097(00)00655-0 (DOI)11819 (Lokalt ID)11819 (Arkivnummer)11819 (OAI)
    Tillgänglig från: 2009-10-08 Skapad: 2009-10-08 Senast uppdaterad: 2017-12-13Bibliografiskt granskad
    4. Assessment of the presence and extent of coronary artery disease in postmenopausal women after an episode of unstable coronary artery disease: incremental value of exercise electrocardiography and thallium-201 SPECT
    Öppna denna publikation i ny flik eller fönster >>Assessment of the presence and extent of coronary artery disease in postmenopausal women after an episode of unstable coronary artery disease: incremental value of exercise electrocardiography and thallium-201 SPECT
    Visa övriga...
    (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Aims To compare the incremental diagnostic properties of Thallium-201 (201TI) SPECT perfusion imaging with clinical and exercise test variables in a female population with a suspected high prevalence of coronary artery disease.

    Methods and Results We prospectively studied 121 postmenopausal women admitted to the coronary care unit with symptoms of unstable coronary artery disease and ECG changes suggestive of ischaemia. Incremental diagnostic logistic algorithms were developed. These included pretest variables (age; body mass index; previous myocardial infarction; myocardial markers at inclusion and type of anginal symptoms); exercise test (maximum workload; occurrence of ST-depression ≥ 0.1mV and peak heart rate); and 201TI scintigram (extent of thallium uptake abnormalities during exercise and presence of reversibility). End points were presence of coronary artery disease (250% diameter stenosis) and extent ('severe coronary artery disease' defined as left main, three vessel disease and two vessel disease involving proximal left anterior descending). Diagnostic accuracy and incremental value were assessed by receiver operating characteristic curve analysis. Incremental curve areas for disease presence were pretest 0.76 ±0.04, post-exercise ECG 0.83 ±0.04 (p<0.02 for the increment), and post-thallium scintigraphy 0.89 ±0.03 (p<0.02) and for disease extent were pretest 0.82 ±0.04, post-exercise ECG 0.89 ±0.03 (p<0.01 for the increment), and post thallium scintigraphy 0.92 ±0.02 (p = ns).

    Conclusion In postmenopausal women, stable after an episode of unstable coronary artery disease, there is an incremental value of adding 201TI SPECT to clinical parameters and exercise testing in the determination of coronary artery disease. In women with severe coronary artery disease there was no significant additive value of myocardial scintigraphy.

    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-79932 (URN)
    Tillgänglig från: 2012-08-15 Skapad: 2012-08-15 Senast uppdaterad: 2013-09-11Bibliografiskt granskad
    5. Are There Different Effects of Invasive Treatment Between Women and Men During the Acute Stage of Unstable Coronary Artery Disease?
    Öppna denna publikation i ny flik eller fönster >>Are There Different Effects of Invasive Treatment Between Women and Men During the Acute Stage of Unstable Coronary Artery Disease?
    Visa övriga...
    (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    OBJECTIVES The FRISC II invasive trial compared an early invasive versus a noninvasive strategy concerning death and MI in CAD. This paper deals with the gender perspective in the same study.

    METHODS There were 749 women and 1708 men included in the study with a mean age of 66 and 64 years in women and men respectively. The patients were randomized to early invasive or noninvasive strategy and to placebo controlled long-term low molecular mass (1mm) heparin ( dalteparin) treatment for 3 months. Coronary angiographies were performed within the first seven days in 96 % and 10 % and revascularisation was performed within the first 10 days in 71 % and 9 % in the invasive and noninvasive groups, respectively.

    RESULTS Women were older but had less previous infarctions, better left ventricular function and less frequently had elevated troponin-levels. There were more patients with normal coronary arteries and less severe coronary artery lesions amongst the women. Accordingly, less interventions were performed in the female group although, among those who were revascularized, there was. no significant difference in the choice of procedure compared to men. There was no difference in the composite endpoint of MI and death at 12 months amongst women (12.4 vs. 10.5% in the invasive and non-invasive groups respectively) in contrast to the very favorable effect of the invasively treated group amongst the men (9.6 vs. 15.8%, p<0.001). In a multivariate interaction analysis there was different effect of early invasive strategy in the two genders (p=0.008)

    CONCLUSIONS Women with symptoms and/or signs of unstable coronary artery disease are older but still have less severe CAD and a better prognosis than men. In contrast to men, an early invasive strategy did not reduce the risk for future events amongst women. Further research is warranted to identify the most appropriate treatment strategy in women with unstable CAD.

    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-79933 (URN)
    Tillgänglig från: 2012-08-15 Skapad: 2012-08-15 Senast uppdaterad: 2013-09-11Bibliografiskt granskad
  • 15.
    Säfström, Kåge
    et al.
    Linköpings universitet, Institutionen för medicin och vård, Kardiologi. Linköpings universitet, Hälsouniversitetet.
    Nielsen, Niels Erik
    Linköpings universitet, Institutionen för medicin och vård, Kardiologi. Linköpings universitet, Hälsouniversitetet.
    Björkholm, Anders
    Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken Thoraxradiologi. Linköpings universitet, Hälsouniversitetet.
    Wiklund, Gunnar
    Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken Thoraxradiologi. Linköpings universitet, Hälsouniversitetet.
    Swahn, Eva
    Linköpings universitet, Institutionen för medicin och vård, Kardiologi. Linköpings universitet, Hälsouniversitetet.
    Unstable coronary artery disease in post-menopausal women: Identifying patients with significant coronary artery disease by basic clinical parameters and exercise test1998Ingår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 19, nr 6, s. 899-907Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background The diagnostic information from an ECG taken while at rest and an exercise test is considered less reliable in women than in men, mostly due to a high percentage offalse-positive tests. This can be explained by a lower pre-test likelihood of coronary heart disease.

    Aims To evaluate the diagnostic information that can be gained from basic clinical parameters, an ECG and exercise test in a group of post-menopausal women with symptoms of unstable coronary artery disease in order to identify patients with significant coronary artery stenoses.

    Methods and Results We prospectively studied 200 postmenopausal women admitted to the coronary care unit with symptoms of unstable coronary artery disease and ECG changes suggestive of ischaemia. The diagnostic value of common risk factors, myocardial enzymes and an early exercise test were assessed. A coronary angiogram was performed within 60 days. Median age was 67 years. On admission, 38% had ST depression on an ECG taken while at rest, 76% had T-wave inversion, and 41% increased enzyme levels. The coronary angiogram revealed that 15% had no atherosclerosis, 14% had atherosclerosis but no lesion ≥ 50% of luminal diameter and 71 % had at least one significant stenosis. Of patients with known indicators of atherosclerotic disease, all but one had atherosclerosis visualized on the coronary angiogram. A relative ST depression ≥ 0·1 m V and a low maximum workload at exercise test were strong predictors of significant coronary artery disease. The positive predictive value of ST depression was 91% and of low maximum workload 84%.

    Conclusion In post-menopausal women with signs of unstable angina and ischaemia on an ECG taken while at rest, the prevalence of coronary atherosclerosis is high, 85%. Contrary to earlier studies, ST T-changes at the early exercise test had a high positive predictive value, especially in combination with a low maximum workload with no false-positive results.

  • 16.
    Säfström, Kåge
    et al.
    Linköpings universitet, Institutionen för medicin och vård, Kardiologi. Linköpings universitet, Hälsouniversitetet.
    Nylander, Eva
    Linköpings universitet, Institutionen för medicin och vård, Klinisk fysiologi. Linköpings universitet, Hälsouniversitetet.
    Björkholm, A.
    Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken Thoraxradiologi. Linköpings universitet, Hälsouniversitetet.
    Wiklund, G.
    Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken Thoraxradiologi. Linköpings universitet, Hälsouniversitetet.
    Nielsen, Niels Erik
    Linköpings universitet, Institutionen för medicin och vård, Kardiologi. Linköpings universitet, Hälsouniversitetet.
    Swahn, Eva
    Linköpings universitet, Institutionen för medicin och vård, Kardiologi. Linköpings universitet, Hälsouniversitetet.
    Assessment of the presence and extent of coronary artery disease in postmenopausal women after an episode of unstable coronary artery disease: incremental value of exercise electrocardiography and thallium-201 SPECTManuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Aims To compare the incremental diagnostic properties of Thallium-201 (201TI) SPECT perfusion imaging with clinical and exercise test variables in a female population with a suspected high prevalence of coronary artery disease.

    Methods and Results We prospectively studied 121 postmenopausal women admitted to the coronary care unit with symptoms of unstable coronary artery disease and ECG changes suggestive of ischaemia. Incremental diagnostic logistic algorithms were developed. These included pretest variables (age; body mass index; previous myocardial infarction; myocardial markers at inclusion and type of anginal symptoms); exercise test (maximum workload; occurrence of ST-depression ≥ 0.1mV and peak heart rate); and 201TI scintigram (extent of thallium uptake abnormalities during exercise and presence of reversibility). End points were presence of coronary artery disease (250% diameter stenosis) and extent ('severe coronary artery disease' defined as left main, three vessel disease and two vessel disease involving proximal left anterior descending). Diagnostic accuracy and incremental value were assessed by receiver operating characteristic curve analysis. Incremental curve areas for disease presence were pretest 0.76 ±0.04, post-exercise ECG 0.83 ±0.04 (p<0.02 for the increment), and post-thallium scintigraphy 0.89 ±0.03 (p<0.02) and for disease extent were pretest 0.82 ±0.04, post-exercise ECG 0.89 ±0.03 (p<0.01 for the increment), and post thallium scintigraphy 0.92 ±0.02 (p = ns).

    Conclusion In postmenopausal women, stable after an episode of unstable coronary artery disease, there is an incremental value of adding 201TI SPECT to clinical parameters and exercise testing in the determination of coronary artery disease. In women with severe coronary artery disease there was no significant additive value of myocardial scintigraphy.

  • 17.
    Säfström, Kåge
    et al.
    Linköpings universitet, Institutionen för medicin och vård, Kardiologi. Linköpings universitet, Hälsouniversitetet.
    Swahn, Eva
    Linköpings universitet, Institutionen för medicin och vård, Kardiologi. Linköpings universitet, Hälsouniversitetet.
    Early symptom-limited exercise test for risk stratification in post menopausal women with unstable coronary artery disease2000Ingår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 21, nr 3, s. 230-238Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims The exercise test is considered less reliable in women than in men both for diagnostic and prognostic purposes. The value, however, of the exercise test might vary with the population that is examined, the way the test is performed and which exercise test variables are taken into consideration in the analysis. The aim of the study was to evaluate an early symptom-limited exercise test as a tool for risk stratification in women with unstable coronary artery disease admitted to the coronary care unit.

    Methods and Results Of the 543 women in the FRISC I study, 395 stabilized on medical treatment and performed a symptom-limited exercise test 5–8 days after inclusion. Sixteen patients with a cardiac event before the scheduled exercise test were excluded. During the 6 months follow-up 17% of the women who did not perform the exercise test and 9% of the 395 women who did, died or had a myocardial infarction (P<0·01). Multivariate stepwise logistic regression analysis was performed to assess the value of clinical variables and findings at the predischarge exercise test to predict cardiac events. Based on the exercise test results three risk groups were identified with an event rate of 19%, 9% and 1%, respectively. The exercise test was better than any of the tested clinical variables in predicting cardiac events.

    Conclusion Women with unstable coronary artery disease who do not stabilize within a few days have a high event rate early during follow-up. For women who are medically stabilized, considering not only variables like ST depression and chest pain but also parameters reflecting the cardiac performance such as maximal workload and increase in rate-pressure product, an early symptom-limited exercise test is a good predictor of future cardiac events.

  • 18.
    Säfström, Kåge
    et al.
    Linköpings universitet, Institutionen för medicin och vård, Kardiologi. Linköpings universitet, Hälsouniversitetet.
    Swahn, Eva
    Linköpings universitet, Institutionen för medicin och vård, Kardiologi. Linköpings universitet, Hälsouniversitetet.
    Lindahl, Bertil
    Department of Cardiology, University of Uppsala, Uppsala, Sweden.
    Risk stratification in unstable coronary artery disease: Exercise test and troponin T from a gender perspective2000Ingår i: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 35, nr 7, s. 1791-1800Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES

    The study was done to determine the prognostic yield of an early symptom-limited exercise test (ET) and measurement of troponin T (TnT) in men and women with unstable coronary artery disease (CAD), with special reference to gender differences.

    BACKGROUND

    Early risk assessment is essential for the application of appropriate treatment and further management in patients with unstable CAD. The early symptom-limited ET together with specific biochemical marker determination is an inexpensive, widely applicable method for early risk stratification. In women, however, the ET is considered less reliable, and there are few data on biochemical markers for risk stratification in women.

    METHODS

    In a substudy of the Fragmin during InStability in Coronary artery disease (FRISC I) trial, 395 women and 778 men with unstable CAD who performed an early ET were followed for six months. Blood samples for TnT determination were taken in 342 women and 621 men at inclusion.

    RESULTS

    Based on the ET results, low-, intermediate-, and high-risk response groups were identified with event rates of cardiac death or myocardial infarction (MI) of 1%, 9%, and 19%, respectively, among women and 8%, 14%, and 20%, respectively, among men. Patients who could not perform the ET had an event rate similar to the high-risk group. The TnT levels were divided into three groups: <0.06, 0.06–0.19, and ≥0.20 μg/liter with event rates of 1%, 10%, and 18%, respectively, among women and 9%, 14%, and 18%, respectively, among men. Combining the ET results with TnT levels identified a low-risk group with an event rate of 3% in the male population and no events in the female population.

    CONCLUSIONS

    Direct comparison between men and women from the same population with a high pretest likelihood of disease suggests that both TnT and the early symptom-limited ET are at least as useful as prognostic risk indicators in women as they are in men.

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