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  • 1.
    Braun, Oscar O.
    et al.
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Nilsson, Johan
    Skane Univ Hosp, Sweden; Lund Univ, Sweden.
    Gustafsson, Finn
    Rigshosp, Denmark.
    Dellgren, Goran
    Sahlgrens Univ Hosp, Sweden.
    Fiane, Arnt E.
    Oslo Univ Hosp, Norway; Univ Oslo, Norway.
    Lemstrom, Karl
    Helsinki Univ Hosp, Finland.
    Hübbert, Laila
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken i Norrköping.
    Hellgren, Laila
    Uppsala Univ Hosp, Sweden.
    Lund, Lars H.
    Karolinska Univ Hosp, Sweden; Karolinska Univ Hosp, Sweden.
    Continuous-flow LVADs in the Nordic countries: complications and mortality and its predictors2019Ingår i: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 53, nr 1, s. 14-20Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: The purpose of this study was to assess complications and mortality and its predictors, with continuous-flow left ventricular assist devices (CF-LVADs) in the Nordic Countries. Design: This was a retrospective, international, multicenter cohort study. Results: Between 1993 and 2013, 442 surgically implanted long-term mechanical assist devices were used among 8 centers in the Nordic countries. Of those, 238 were CF-LVADs (HVAD or HeartMate II) implanted in patients amp;gt;18 years with complete data. Postoperative complications and survival were compared and Cox proportion hazard regression analysis was used to identify predictors of mortality. The overall Kaplan-Meier survival rate was 75% at 1 year, 69% at 2 years and 63% at 3 years. A planned strategy of destination therapy had poorer survival compared to a strategy of bridge to transplantation or decision (2-year survival of 41% vs. 76%, p amp;lt; .001). The most common complications were non-driveline infections (excluding sepsis) (44%), driveline infection (27%), need for continuous renal replacement therapy (25%) and right heart failure (24%). In a multivariate model age and left ventricular diastolic dimension was left as independent risk factors for mortality with a hazard ratio of 1.35 (95% confidence interval (CI) [1.01-1.80], p = .046) per 10 years and 0.88 (95% CI [0.72-0.99], p = .044) per 5 mm, respectively. Conclusion: Outcome with CF LVAD in the Nordic countries was comparable to other cohorts. Higher age and destination therapy require particularly stringent selection.

  • 2.
    Eleftheriou, Andreas
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Neurologiska kliniken i Linköping.
    Blystad, Ida
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Röntgenkliniken i Linköping.
    Tisell, Anders
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Region Östergötland, Diagnostikcentrum, Medicinsk strålningsfysik. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV. Linköpings universitet, Medicinska fakulteten.
    Gasslander, Johan
    Linköpings universitet, Institutionen för hälsa, medicin och vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken i Norrköping.
    Lundin, Fredrik
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för neurobiologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Neurologiska kliniken i Linköping.
    Indication of Thalamo-Cortical Circuit Dysfunction in Idiopathic Normal Pressure Hydrocephalus: A Tensor Imaging Study2020Ingår i: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 10, nr 1Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Idiopathic normal pressure hydrocephalus (iNPH) is a disorder with unclear pathophysiology. The diagnosis of iNPH is challenging due to its radiological similarity with other neurodegenerative diseases and ischemic subcortical white matter changes. By using Diffusion Tensor Imaging (DTI) we explored differences in apparent diffusion coefficient (ADC) and fractional anisotropy (FA) in iNPH patients (before and after a shunt surgery) and healthy individuals (HI) and we correlated the clinical results with DTI parameters. Thirteen consecutive iNPH-patients underwent a pre- and post-operative clinical work-up: 10m walk time (w10mt) steps (w10ms), TUG-time (TUGt) and steps (TUGs); for cognitive function MMSE. Nine HI were included. DTI was performed before and 3 months after surgery, HI underwent DTI once. DTI differences analyzed by manually placing 12 regions-of-interest. In patients motor and balance function improved significantly after surgery (p=0.01, p=0.025). Higher nearly significant FA values found in the patients vs HI pre-operatively in the thalamus (p=0.07) accompanied by an almost significant lower ADC (p=0.08). Significantly FA and ADC-values were found between patients and HI in FWM (p=0.02, p=0.001) and almost significant (p=0.057) pre- vs postoperatively. Postoperatively we found a trend towards the HIs FA values and a strong significant negative correlation between FA changes vs. gait results in the FWM (r=-0.7, p=0.008). Our study gives a clear indication of an ongoing pathological process in the periventricular white matter, especially in the thalamus and in the frontal white matter supporting the hypothesis of a shunt reversible thalamo-cortical circuit dysfunction in iNPH.

  • 3.
    Hedberg-Oldfors, Carola
    et al.
    Univ Gothenburg, Sweden.
    Abramsson, Alexandra
    Univ Gothenburg, Sweden.
    Osborn, Daniel P. S.
    St Georges Univ London, England.
    Danielsson, Olof
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Neurologiska kliniken.
    Fazlinezhad, Afsoon
    Imam Reza Int Univ, Iran.
    Nilipour, Yalda
    Shahid Beheshti Univ Med Sci, Iran.
    Hübbert, Laila
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken ViN.
    Nennesmo, Inger
    Karolinska Univ Hosp, Sweden.
    Visuttijai, Kittichate
    Univ Gothenburg, Sweden.
    Bharj, Jaipreet
    St Georges Univ London, England.
    Petropoulou, Evmorfia
    St Georges Univ London, England.
    Shoreim, Azza
    St Georges Univ London, England.
    Vona, Barbara
    Julius Maximilians Univ Wurzburg, Germany.
    Ahangari, Najmeh
    Mashhad Univ Med Sci, Iran.
    Lopez, Marcela Davila
    Univ Gothenburg, Sweden.
    Doosti, Mohammad
    Next Generat Genet Polyclin, Iran.
    Banote, Rakesh Kumar
    Univ Gothenburg, Sweden.
    Maroofian, Reza
    St Georges Univ London, England.
    Edling, Malin
    Univ Gothenburg, Sweden.
    Taherpour, Mehdi
    Imam Reza Int Univ, Iran.
    Zetterberg, Henrik
    Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden; UCL Inst Neurol, England.
    Karimiani, Ehsan Ghayoor
    Imam Reza Int Univ, Iran; Islamic Azad Univ, Iran.
    Oldfors, Anders
    Univ Gothenburg, Sweden.
    Jamshidi, Yalda
    St Georges Univ London, England.
    Cardiomyopathy with lethal arrhythmias associated with inactivation of KLHL242019Ingår i: Human Molecular Genetics, ISSN 0964-6906, E-ISSN 1460-2083, Vol. 28, nr 11, s. 1919-1929Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiovascular disorder, yet the genetic cause of up to 50% of cases remains unknown. Here, we show that mutations in KLHL24 cause HCM in humans. Using genome-wide linkage analysis and exome sequencing, we identified homozygous mutations in KLHL24 in two consanguineous families with HCM. Of the 11 young affected adults identified, 3 died suddenly and 1 had a cardiac transplant due to heart failure. KLHL24 is a member of the Kelch-like protein family, which acts as substrate-specific adaptors to Cullin E3 ubiquitin ligases. Endomyocardial and skeletal muscle biopsies from affected individuals of both families demonstrated characteristic alterations, including accumulation of desmin intermediate filaments. Knock-down of the zebrafish homologue klhl24a results in heart defects similar to that described for other HCM-linked genes providing additional support for KLHL24 as a HCM-associated gene. Our findings reveal a crucial role for KLHL24 in cardiac development and function.

  • 4.
    Karason, Kristjan
    et al.
    Sahlgrens Univ Hosp, Sweden.
    Lund, Lars H.
    Karolinska Univ Hosp, Sweden.
    Dalen, Magnus
    Karolinska Univ Hosp, Sweden.
    Bjorklund, Erik
    Uppsala Univ Hosp, Sweden.
    Grinnemo, Karl
    Uppsala Univ Hosp, Sweden.
    Braun, Oscar
    Skane Univ Hosp, Sweden.
    Nilsson, Johan
    Skane Univ Hosp, Sweden.
    van der Wal, Henriette
    Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Holm, Jonas
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland.
    Hübbert, Laila
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken i Norrköping.
    Lindmark, Krister
    Umea Univ Hosp, Sweden.
    Szabo, Barna
    Orebro Univ Hosp, Sweden.
    Holmberg, Erik
    Sahlgrens Univ Hosp, Sweden.
    Dellgren, Goran
    Sahlgrens Univ Hosp, Sweden.
    Randomized trial of a left ventricular assist device as destination therapy versus guideline-directed medical therapy in patients with advanced heart failure. Rationale and design of the SWEdish evaluation of left Ventricular Assist Device (SweVAD) trial2020Ingår i: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims Patients with advanced heart failure (AdHF) who are ineligible for heart transplantation (HTx) can become candidates for treatment with a left ventricular assist device (LVAD) in some countries, but not others. This reflects the lack of a systematic analysis of the usefulness of LVAD systems in this context, and of their benefits, limitations and cost-effectiveness. The SWEdish evaluation of left Ventricular Assist Device (SweVAD) study is a Phase IV, prospective, 1:1 randomized, non-blinded, multicentre trial that will examine the impact of assignment to mechanical circulatory support with guideline-directed LVAD destination therapy (GD-LVAD-DT) using the HeartMate 3 (HM3) continuous flow pump vs. guideline-directed medical therapy (GDMT) on survival in a population of AdHF patients ineligible for HTx. Methods A total of 80 patients will be recruited to SweVAD at the seven university hospitals in Sweden. The study population will comprise patients with AdHF (New York Heart Association class IIIB-IV, INTERMACS profile 2-6) who display signs of poor prognosis despite GDMT and who are not considered eligible for HTx. Participants will be followed for 2 years or until death occurs. Other endpoints will be determined by blinded adjudication. Patients who remain on study-assigned interventions beyond 2 years will be asked to continue follow-up for outcomes and adverse events for up to 5 years. Conclusion The SweVAD study will compare survival, medium-term benefits, costs and potential hazards between GD-LVAD-DT and GDMT and will provide a valuable reference point to guide destination therapy strategies for patients with AdHF ineligible for HTx.

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  • 5.
    Luttik, Maria
    et al.
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Hanze University of Applied Sciences, Research Group Nursing Diagnostics, Groningen, .
    Goossens, E
    KU Leuven, University of Leuven.
    Ågren, Susanna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Region Östergötland, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland. Linköpings universitet, Medicinska fakulteten.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten.
    Mårtensson, J
    Jönköping University, School of Health and Welfare, Department of Nursing, Jönköping, Sweden.
    Thompson, D R
    Australian Catholic University, Centre for the Heart and Mind, Melbourne, Australia.
    Moons, P
    7KU Leuven, University of Leuven, Department of Public Health and Primary Care, Leuven, Belgium Institute of Health and Care Sciences, University of Gothenburg, Sweden..
    Strömberg, Anna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken ViN. Undertaking Nursing Interventions Throughout Europe (UNITE) research group..
    Attitudes of nurses towards family involvement in the care for patients with cardiovascular diseases.2017Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, nr 4, s. 299-308Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: There is increasing evidence supporting the relationship between family support and patient outcomes. Therefore, involving families in the care of cardiovascular patients is expected to be beneficial for patients. The quality of the encounter with families highly depends on the attitudes of nurses towards the importance of families in patient care.

    AIM: The aim of this study was to describe the attitudes of nurses towards family involvement in patient care and to investigate the individual contributions of demographic, professional and regional background characteristics.

    METHOD: A survey was distributed among cardiovascular nurses attending an international conference in Norway and a national conference in Belgium. Nurses were asked to complete a questionnaire, including the Families' Importance in Nursing Care - Nurses' Attitudes scale. The study population consisted of respondents from Belgium (n = 348) and from Scandinavian countries (Norway, Sweden and Denmark; n = 77).

    RESULTS: In general, nurses viewed the family as important in care. However, attitudes towards actively inviting families to take part in patient care were less positive. Higher educational level and a main practice role in research, education or management were significantly associated with more positive attitudes. Furthermore, the attitudes of respondents living in Scandinavia were more positive as compared to the attitudes of respondents living in Belgium.

    CONCLUSION: Education on the importance of families and active family involvement in patient care seems to be necessary in basic, undergraduate education, but also in clinical practice. More research is necessary in order to explore the cultural and regional differences in the attitudes of nurses towards the involvement of families in patient care.

  • 6.
    Papakonstantinou, Antroula
    et al.
    Karolinska Inst, Sweden; Univ Hosp, Sweden.
    Matikas, Alexios
    Karolinska Inst, Sweden; Univ Hosp, Sweden.
    Bengtsson, Nils Olof
    Univ Hosp Umea, Sweden.
    Malmstrom, Per
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Hedayati, Elham
    Karolinska Inst, Sweden; Univ Hosp, Sweden.
    Steger, Guenther
    Med Univ Vienna, Austria; Med Univ Vienna, Austria.
    Untch, Michael
    Helios Hosp Berlin Buch, Germany.
    Hübbert, Laila
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken i Norrköping. Sahlgrens Univ Hosp, Sweden.
    Johansson, Hemming
    Karolinska Inst, Sweden; Univ Hosp, Sweden.
    Hellstrom, Mats
    Karolinska Inst, Sweden; Univ Hosp, Sweden.
    Gnant, Michael
    Med Univ Vienna, Austria.
    Loibl, Sibylle
    German Breast Grp, Germany.
    Greil, Richard
    Paracelsus Med Univ, Austria; Canc Cluster Salzburg, Austria.
    Moebus, Volker
    Goethe Univ Frankfurt, Germany.
    Foukakis, Theodoros
    Karolinska Inst, Sweden; Univ Hosp, Sweden.
    Bergh, Jonas
    Karolinska Inst, Sweden; Univ Hosp, Sweden.
    Efficacy and Safety of Tailored and Dose-Dense Adjuvant Chemotherapy and Trastuzumab for Resected HER2-Positive Breast Cancer: Results From the Phase 3 PANTHER TrialIngår i: Cancer, ISSN 0008-543X, E-ISSN 1097-0142Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND Dose-dense (DD) adjuvant chemotherapy improves outcomes in early breast cancer (BC). However, there are no phase 3 randomized data to inform on its combination with trastuzumab for patients with human epidermal growth factor receptor 2 (HER2)-positive disease. METHODS This was a protocol-predefined secondary analysis of the randomized phase 3 Pan-European Tailored Chemotherapy (PANTHER) trial. Women 65 years old or younger with node-positive or high-risk, node-negative BC were randomized 1:1 to either tailored (according to hematologic nadirs) and DD epirubicin and cyclophosphamide followed by docetaxel or standard 5-fluorouracil, epirubicin, and cyclophosphamide plus docetaxel every 3 weeks. Patients with HER2-positive disease received 1 year of adjuvant trastuzumab. The primary endpoint was BC relapse-free survival. In addition, HER2-positive patients and an equal number of HER2-negative patients matched for age, treatment group, and institution who were enrolled at Swedish sites were asked to participate in a predefined study of cardiac safety and underwent echocardiography or multigated acquisition scanning and electrocardiography at the baseline and at 4 and 6 years of follow-up. RESULTS There were 342 HER2-positive patients; 335 received at least 1 dose of trastuzumab, and 29 patients discontinued trastuzumab prematurely. Relapse-free survival was not statistically significantly in favor of the tailored and DD group (hazard ratio, 0.68; 95% confidence interval, 0.37-1.27; P = .231). Cardiac outcomes after 4 and 6 years of follow-up did not differ significantly between HER2-positive and HER2-negative patients or between the 2 treatment groups. CONCLUSIONS The combination of DD chemotherapy and trastuzumab decreased the relative risk for relapse by 32% in comparison with standard treatment, a statistically nonsignificant difference. Its efficacy and safety merit further evaluation as part of both escalation and de-escalation strategies.

  • 7.
    Sundbom, Per
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US. Department of Medicine and Geriatrics, Höglandet Hospital, Eksjö.
    Roth, Michael
    Linköpings universitet, Institutionen för systemteknik, Reglerteknik. Linköpings universitet, Tekniska fakulteten.
    Granfeldt, Hans
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland.
    Karlsson, Daniel M.
    Linköpings universitet, Institutionen för medicinsk teknik. Linköpings universitet, Tekniska fakulteten.
    Ahn, Henrik
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland.
    Gustafsson, Fredrik
    Linköpings universitet, Institutionen för systemteknik, Reglerteknik. Linköpings universitet, Tekniska fakulteten.
    Dellgren, Göran
    Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg; Transplant Institute, Sahlgrenska University Hospital, Gothenburg.
    Hübbert, Laila
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken i Norrköping. Transplant Institute, Sahlgrenska University Hospital, Gothenburg.
    Sound analysis of the magnetically levitated left ventricular assist device HeartMate 32019Ingår i: International Journal of Artificial Organs, ISSN 0391-3988, E-ISSN 1724-6040, Vol. 42, nr 12, s. 717-724Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: The HeartMate 3 has shown lower rates of adverse events compared to previous devices due to the design and absence of mechanical bearings. For previous devices, sound analysis emerged as a way to assess pump function. The aims of this study were to determine if sound analysis can be applied to the HeartMate 3 in vivo and in vitro and to evaluate an electronic stethoscope.

    METHOD: Sound recordings were performed with microphones and clinical accessible electronic stethoscope. The recordings were studied in both the time and the frequency domains. Recordings from four patients were performed to determine if in vivo and in vitro recordings are comparable.

    RESULTS: The results show that it is possible to detect sound from HeartMate 3 and the sound spectrum is clear. Pump frequency and frequency of the pulsatile mode are easily determined. Frequency spectra from in vitro and in vivo recordings have the same pattern, and the major proportion (96.7%) of signal power is located at the pump speed frequency ±40 Hz. The recordings from the patients show low inter-individual differences except from location of peaks originating from pump speed and harmonics. Electronic stethoscopes could be used for sound recordings, but the dedicated equipment showed a clearer sound spectrum.

    DISCUSSION: The results show that acoustic analysis can also be performed with the HeartMate 3 and that in vivo and in vitro sound spectrum is similar. The frequency spectra are different from previous devices, and methods for assessing pump function or thrombosis need further evaluation.

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