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  • 151.
    Lidebjer, Caroline
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Leanderson, Per
    Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Pain and Occupational Centre, Occupational and Environmental Medicine Centre.
    Ernerudh, Jan
    Linköping University, Department of Molecular and Clinical Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Jonasson, Lena
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Low plasma levels of oxygenated carotenoids in patients with coronary artery disease2007In: NMCD. Nutrition Metabolism and Cardiovascular Diseases, ISSN 0939-4753, E-ISSN 1590-3729, Vol. 17, no 6, p. 448-456Article in journal (Refereed)
    Abstract [en]

    Background and aims: Low circulating levels of carotenoids have been associated with cardiovascular disease. The distribution of different carotenoids in blood may have an impact on the cardioprotective capacity. The aim of the present study was to determine the plasma levels of 6 major carotenoids in patients with coronary artery disease (CAD) and relate the findings to clinical, metabolic and immune parameters. Methods and results: Plasma levels of oxygenated carotenoids (lutein, zeaxanthin, β-cryptoxanthin) and hydrocarbon carotenoids (α-carotene, β-carotene, lycopene) were determined in 39 patients with acute coronary syndrome, 50 patients with stable CAD and 50 controls. Serological assays for inflammatory activity and flow cytometrical analysis of lymphocyte subsets were performed. Both patient groups had significantly lower plasma levels of oxygenated carotenoids, in particular lutein + zeaxanthin, compared to controls. Low levels of oxygenated carotenoids were associated with smoking, high body mass index (BMI), low high density lipoprotein (HDL) cholesterol and, to a minor degree, inflammatory activity. Plasma levels of lutein + zeaxanthin were independently associated with the proportions of natural killer (NK) cells, but not with other lymphocytes, in blood. Conclusion: Among carotenoids, lutein + zeaxanthin and β-cryptoxanthin were significantly reduced in CAD patients independent of clinical setting. The levels were correlated to a number of established cardiovascular risk factors. In addition, the relationship between NK cells and lutein + zeaxanthin may indicate a particular role for certain carotenoids in the immunological scenario of CAD. © 2006 Elsevier B.V. All rights reserved.

  • 152.
    Lindenberger, Marcus
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Physiology.
    Kjellberg, Margareta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Karlsson, Erling
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Wranne, Bengt
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Physiology. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Pericardiocentesis guided by 2-D echocardiography: The method of choice for treatment of pericardial effusion2003In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 253, no 4, p. 411-417Article in journal (Refereed)
    Abstract [en]

    Background. Percutaneous pericardiocentesis guided by 2-D echocardiography has been used at Link÷ping Heart Centre since 1983. Aim. To evaluate our experience of this method including a follow-up and also to determine the aetiology of pericardial effusion. Methods. A retrospective study including 120 of 252 consecutive patients punctured. Results. The two most common aetiologies were cardiac surgery (77% valve surgery), followed by malignant disease. The postsurgical effusions became clinically important a median of 12 days after surgery (range 0-56 days). The median survival in the group with malignant disease was 89 days (30-day survival 87%, 1-year survival 10%). Indwelling catheter was used in 93% of the patients. There was no mortality but one patient needed a second pericardiocentesis after an accidental puncture of the right ventricle. Nine patients had rhythm aberrations. Recurring effusion that needed puncture was seen in 8%. Conclusion. Pericardiocentesis guided by 2-D echocardiography is a safe and efficient method to treat pericardial effusion and also valuable as palliative treatment for patients with malignant aetiology of the effusion.

  • 153. Lindgren, P
    et al.
    Stenestrand, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Hambraeus, K
    Wallentin, L
    Jönsson, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Physiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    PCI reduces utility loss after myocardial infarction in Sweden.2006In: World Congress of Cardiology - ESC,2006, 2006Conference paper (Refereed)
    Abstract [en]

     Abstract 4615. European Heart J 2006.

  • 154. Lindgren, Peter
    et al.
    Stenestrand, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Malmberg, Klas
    Jönsson, Bengt
    The long-term cost-effectiveness of clopidogrel plus aspirin in patients undergoing percutaneous coronary intervention in Sweden2005In: Clinical Therapeutics, ISSN 0149-2918, E-ISSN 1879-114X, Vol. 27, no 1, p. 100-110Article in journal (Refereed)
    Abstract [en]

    Background: The Percutaneous CoronaryIntervention-Clopidogrel in Unstable Angina to Prevent Recurrent Events (PCI-CURE) study, which examined the effect of adding clopidogrel to aspirin versus aspirin alone in patients with unstable coronary artery disease (CAD) undergoing PCI, found a relative risk reduction in cardiovascular deaths and myocardial infarction among those treated with clopidogrel. In addition, a within-trial cost-effectiveness analysis showed favorable costs per event avoided. However, to estimate the long-term effects, a modeling approach is necessary. Objectives: The purpose of this study was to estimatethe long-term cost-effectiveness of treating patients undergoing PCI with clopidogrel plus aspirin in Sweden. Methods: A Markov model was developed. Transitionprobabilities were estimated based on a register of patients treated in the coronary care units at 74 (out of 78) hospitals throughout Sweden. Patients were assumed to be treated for 1 year with an effect based on data from the PCI-CURE study. Costs were collected from published sources and recalculated to year-2004 euros (1.00 = US $1.24). Life-years gained were used as the measure of effectiveness. The perspective was that of the Swedish society, with a separate analysis using a health care cost perspective. Results: After inclusion and exclusion criteria were applied, 3474 patients were included in the model analysis. The model predicted a net gain in survival of 0.04 year per patient when adding clopidogrel. This yielded a net increase of 449 if only direct costs were included, with indirect costs, the net increase was 332. The resulting cost-effectiveness ratios were €10,993 and 8127 per life-year gained. Conclusions: The predicted cost-effectiveness ratios were well below the threshold values generally considered cost-effective. Adding clopidogrel to aspirin appeared to be cost-effective in this model analysis of patients with unstable CAD undergoing PCI in Sweden. Copyright © 2005 Excerpta Medica, Inc.

  • 155. Lindstedt, G
    et al.
    Alehagen, Urban
    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.
    BNP hämmar fibrosutveckling i hjärtat.2003In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 100, p. 925-925Article in journal (Other academic)
  • 156. Lindstedt, G
    et al.
    Alehagen, Urban
    Linköping University, Department of Department of Health and Society.
    Dahlström, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    BNPs användbarhet vid hjärtsvikt - brister i en aktuell översikt avspeglar problemets komplexitet2004In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 101, p. 688-689Article in journal (Other academic)
  • 157.
    Lindstedt, Göran
    et al.
    klinisk kemi och trasfusionmed Göteborg.
    Dahlström, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Fernlund, Per
    klinskt kematiska avd MAS Malmö.
    Schaufelberger, Maria
    medicinkliniken Sahlgrenska Göteborg.
    Stridsberg, Mats
    klinisk kemi Akademiska sjukh Uppsala.
    Bättre behandling av hjärtsvikt med mätning av natriuretiska peptider.2001In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 98, p. 4444-4452Article in journal (Other academic)
  • 158.
    Lindström, Lena
    et al.
    Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Nylander, Eva
    Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Larsson, Hans
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Wranne, Bengt
    Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Left ventricular involvement in arrhythmogenic right ventricular cardiomyopathy: A scintigraphic and echocardiographic study2005In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 25, no 3, p. 171-177Article in journal (Refereed)
    Abstract [en]

    Background:  Left ventricular involvement in arrhythmogenic right ventricular cardiomyopathy (ARVC) is a common finding in autopsy studies. In clinical studies using myocardial scintigraphy, MRI and echocardiography, contradictory results have been reported. In this study, we therefore investigated a group of 15 patients with ARVC using thallium-201 (Tl) single-photon emission tomography (SPECT) and echocardiography including assessment of mitral annular motion with M-mode and pulsed tissue Doppler.

    Methods:  Exercise and rest Tl-201 SPECT were performed in 15 patients with ARVC. The time from diagnosis of the disease varied from less than 1–16 years. All patients fulfilled the established diagnostic criteria for ARVC. An echocardiographic examination, including assessment of left and right ventricular motion and measurements of the mitral annulus motion with M-mode and pulsed tissue Doppler was performed in the patients and in 25 normal subjects.

    Results:  Tl-201 uptake defects in the left ventricular myocardium were present in all except one patient (93%). The uptake defects were predominantly located to the anteroseptal and basal posterior segments. Wall motion abnormalities were seen in the same segments, and in addition to this, in the septal area. In line with this, the total amplitude and the peak systolic velocity of mitral annular motion at the septal point were significantly decreased in the patients compared with the control group.

    Conclusions:  Our data show that left ventricular involvement is common in ARVC. Tl-201 SPECT and echocardiographic abnormalities were seen not only in patients with long-lasting symptoms but also in asymptomatic patients and in those with short duration of symptoms.

  • 159.
    Lindström, Lena
    et al.
    Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Wilkenshoff, U.
    Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Larsson, H.
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Wranne, Bengt
    Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Echocardiographic assessment of arrhythmogenic right ventricular cardiomyopathy2001In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 86, no 1, p. 31-38Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE To evaluate new echocardiographic modes in the diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC).

    DESIGN Prospective observational study.

    SETTING University Hospital.

    SUBJECTS 15 patients with ARVC and a control group of 25 healthy subjects.

    METHODS Transthoracic echocardiography included cross sectional measurements of the right ventricular outflow tract, right ventricular inflow tract, and right ventricular body. Wall motion was analysed subjectively. M mode and pulsed tissue Doppler techniques were used for quantitative measurement of tricuspid annular motion at the lateral, septal, posterior, and anterior positions. Doppler assessment of tricuspid flow and systemic venous flow was also performed.

    RESULTS Assessed by M mode, the total amplitude of the tricuspid annular motion was significantly decreased in the lateral, septal, and posterior positions in the patients compared with the controls. The tissue Doppler velocity pattern showed decreased early diastolic peak annular (EA) velocity and an accompanying decrease in early (EA) to late diastolic (AA) velocity ratio in all positions; the systolic annular velocity was significantly decreased only in the lateral position. Four patients had normal right ventricular dimensions and three were judged to have normal right ventricular wall motion. The patient group had also a significantly decreased tricuspid flow E:A ratio.

    CONCLUSIONS Tricuspid annular measurements are valuable, easy to obtain, and allow quantitative assessment of right ventricular function. ARVC patients showed an abnormal velocity pattern that may be an early but non-specific sign of the disease. Normal right ventricular dimensions do not exclude ARVC, and subjective detection of early changes in wall motion may be difficult.

  • 160.
    Liuba, Ioan
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Janzon, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Walfridsson, Ulla
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Walfridsson, Håkan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Impact of catheter ablation on health related quality of life in patients with focal atrial tachycardia2006In: VIII Svenska Kardiovaskulära Vårmötet,2006, 2006Conference paper (Other academic)
  • 161. Mårtenson, J
    et al.
    Strömberg, Anna
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Dahlström, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Karlsson, J-E
    Fridlund, B
    Patients with heart failure in primary health care: Effects of a nurse-led intervention on health-related quality of life and depression2005In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 7, no 3 SPEC. ISS., p. 393-403Article in journal (Refereed)
    Abstract [en]

    Aims: To determine the effects of a nurse-led intervention designed to improve self-management of patients with heart failure in a primary health care setting regarding health-related quality of life and depression. Methods: Patients at eight primary health care centres were screened by the Diagnosis Related Groups registry for the diagnosis of heart failure and eligibility for a cluster randomised study. A total of 153 patients were included (n=78 in the intervention group, 54% males, mean age 79 years, 59% in New York Heart Association class III-IV). The intervention involved patient and family education about heart failure and self-management and monthly telephone follow-up during 12 months by a primary health care nurse. Results: The effects of the nurse-led intervention were limited. Significant differences were found in the physical dimension measured by the SF-36 health survey, and in depression measured by the Zung Self-rating Depression Scale. In comparison within groups at the 3 and 12-month follow-up, the intervention group significantly maintained their health-related quality of life measured by the SF-36 health survey, and their experience of depression measured by the Zung Self-rating Depression Scale to a greater extent than in the control group, especially among women. Conclusion: A nurse-led intervention directed toward patients with heart failure in a primary health care setting resulted in limited effects between the groups, although the physical and mental status were retained during 12 months of follow-up to a greater extent than in the control group. © 2004 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.

  • 162.
    Mölgaard, J
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Internal Medicine. Östergötlands Läns Landsting, MKC-2, GE: endomed.
    Wärjestam-Elf, S
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology.
    Olsson, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Internal Medicine. Östergötlands Läns Landsting, MKC-2, GE: endomed.
    Efficacy and safety of simvastatin for highrisk hypercholseterolemia.1999In: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 83, p. 1043-1048Article in journal (Refereed)
  • 163.
    Nes, Helle
    et al.
    Ålesund Sjukehus, Norge.
    Johansson, Ingela
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Fra slag til slag2005In: Sykepleien : organ for Norsk sykepleierforbund, ISSN 0039-7628, Vol. 11, p. 38-41Article in journal (Other (popular science, discussion, etc.))
  • 164.
    Nielsen, Niels Erik
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Clinical and Laboratory Investigations in Postmenopusal Women with Unstable Coronary Artery Disease2000Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Coronary artery disease (CAD) is the major cause of death in both sexes in the western world. In men with chest pain the diagnostic methods are more useful than in women. An exercise test is considered less reliable in women, mostly due to a high percentage offalse positive tests. Furthermore, 20-40% of women with typical angina have normal vessels at coronary angiography. The mechanisms behind the chest pain in these patients are unknown, but could be due to disturbances in endothelial, thrombogenetic and/or fibrinolytic function.

    In a prospective multicentre trial we examined 200 postmenopausal women with unstable CAD and 101 healthy controls. At coronary angiography 15% had normal vessels, 14% had non-significant atherosclerosis and 71% had at least one significant stenosis.

    The diagnostic information from basic clinical parameters, ECG and an early exercise test were evaluated. The prevalence of coronary atherosclerosis was high, 85%, and the early exercise test was just as valuable as in men for identifying patients with significant CAD.

    Endothelial markers, cyclic GMP (cGMP) and immunoreactive endothelin (irET), were analysed regarding presence or not of coronary atherosclerosis. Patients with normal vessels had low levels of ir-Ef, indicating different mechanisms for ischemia/angina in these patients compared with patients with atherosclerosis. No differences were found regarding cGMP, unless the patient had long-term nitroglycerin treatment, which increased plasma cGMP. Patients with exerciseinduced ischemia had higher cGMP plasma levels compared to those without. This may reflect a general compensatory mechanism.

    New lipid variables, apolipoproteins and lipoprotein particles, were no better than the routine lipid examination in separating women with and without coronary atherosclerosis, and the measurement of apolipoproteins and lipoprotein particles on the basis of diagnostic accuracy alone is not justified. Also, elevated triglycerides was most pronounced in women with unstable CAD and coronary atherosclerosis.

    Plasma total homocysteine (tHey) is considered a risk factor for CAD, but the relationship between tHey and well-defined CAD in women is still unclear. Mild hyperhomocysteinemia was not related to the risk of unstable CAD in postmenopausal women. Our study stresses the importance of adjusting tHey for the covariates, i.e. age and serum values of folate, vitamin Bl2 and creatinine.

    Fibrinolytic and coagulation variables did neither reveal signs of disturbed fibrinolysis nor were in favour of a hypercoagulable/hyperthrombotic state in patients with unstable CAD and normal vessels.

    In summary, the prevalence of coronary atherosclerosis in postmenopausal women with signs and symptoms of unstable CAD is high. An early exercise test together with basic clinical parameters is a valuable diagnostic tool. Although there were differences in biochemical markers between patients with and without coronary atherosclerosis, the overlapping between the groups was high. No clinically useful test to separate these two groups was found. Patients with normal vessels were much alike the control group and it is still unclear whether these patients have CAD without atherosclerosis or another mechanism for their chest pain.

    List of papers
    1. Unstable coronary artery disease in post-menopausal women: Identifying patients with significant coronary artery disease by basic clinical parameters and exercise test
    Open this publication in new window or tab >>Unstable coronary artery disease in post-menopausal women: Identifying patients with significant coronary artery disease by basic clinical parameters and exercise test
    Show others...
    1998 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 19, no 6, p. 899-907Article in journal (Refereed) 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.

    Keywords
    women, coronary angiography, unstable angina, exercise test, electrocardiography, risk factors
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-26815 (URN)10.1053/euhj.1997.0867 (DOI)11427 (Local ID)11427 (Archive number)11427 (OAI)
    Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
    2. Plasma levels of cyclic GMP and endothelin in postmenopausal women with unstable coronary artery disease
    Open this publication in new window or tab >>Plasma levels of cyclic GMP and endothelin in postmenopausal women with unstable coronary artery disease
    Show others...
    1999 (English)In: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 59, no 5, p. 325-334Article in journal (Refereed) Published
    Abstract [en]

    Many women with typical anginal chest pain have normal coronary angiograms, which may be due to altered endothelial function. We evaluated the endothelial markers cyclic GMP (cGMP) and immunoreactive endothelin (ir-ET) regarding presence of coronary atherosclerosis in women with clinical signs of unstable coronary artery disease (CAD). Plasma levels of cGMP and ir-ET were determined in 118 patients and 84 controls. Ischaemia was evaluated at an exercise test. Of the patients 20% had normal vessels, 14% insignificant CAD and 66% significant stenosis at coronary angiography. Mean (95% CI) concentration of cGMP (nmol/l) was higher in patients than in controls (5.05 (4.53; 5.58) vs. 3.79 (3.34; 4.23)). Separating patients according to daily intake of nitroglycerin, only patients with this medication had significantly higher cGMP level (5.73 (4.88; 6.58)), whereas the difference between those without (4.35 (3.76; 4.94)) and controls disappeared. Patients with ischaemia at exercise test had higher cGMP level than those without (6.01 (5.13; 6.88) vs. 4.30 (3.66; 4.94)), even after adjusting for nitroglycerin treatment. ir-ET (pmol/l) was lower in patients with normal vessels than patients with coronary atherosclerosis (0.83 (0.78; 0.88) vs. 0.98 (0.92; 1.04)) and than the control group (0.91 (0.87; 0.94)). The difference between the control group and patients with atherosclerosis was also significant. Patients with unstable CAD and long-term nitroglycerin treatment have increased cGMP level. Patients with exercise-induced ischaemia have higher cGMP level than those without, irrespective of nitroglycerin treatment, which may reflect a general compensatory mechanism. Patients with normal vessels have low level of ir-ET, indicating different mechanisms for ischaemia/angina in these patients compared with patients with atherosclerosis.

    Keywords
    Coronary atherosclerosis, cyclic GMP, endothelin, exercise test, nitroglycerin, women
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-26737 (URN)10.1080/00365519950185517 (DOI)11332 (Local ID)11332 (Archive number)11332 (OAI)
    Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
    3. Plasma lipoprotein particle concentrations in postmenopausal women with unstable coronary artery disease: Analysis of diagnostic accuracy using receiver operating characteristics
    Open this publication in new window or tab >>Plasma lipoprotein particle concentrations in postmenopausal women with unstable coronary artery disease: Analysis of diagnostic accuracy using receiver operating characteristics
    2000 (English)In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 247, no 1, p. 43-52Article in journal (Refereed) Published
    Abstract [en]

    Background.The contribution of plasma lipids to cardiovascular risk is usually evaluated by measuring plasma concentrations of total cholesterol, triglycerides and HDL cholesterol, and calculating LDL cholesterol concentration. We investigated plasma concentrations of apolipoproteins and lipoprotein particles in women with unstable coronary artery disease (CAD) to evaluate whether these, better than the routine lipid status, could differentiate women with and without coronary atherosclerosis.

    Methods. Blood samples for lipid analyses were collected from 119 angiographically examined postmenopausal 49–79-year-old women with unstable CAD, and from 101 age-matched controls. Mean plasma concentrations were compared and the discriminatory ability of the different variables were tested using receiver operating characteristics (ROC).

    Results. At coronary angiography 19% had normal vessels and 81% had coronary atherosclerosis. A disturbed triglyceride metabolism was the most pronounced lipid abnormality in women with unstable CAD and coronary atherosclerosis. ROC showed that none of the evaluated variables had a particularly high discriminatory power regarding unstable CAD or coronary atherosclerosis. The ratio cholesterol/HDL cholesterol was best with an ROC area of 0.79. Furthermore, the newer lipid variables, i.e. lipoprotein particles and apolipoproteins, were no better than the traditional variables.

    Conclusion. Lipoprotein changes reflecting a disturbed triglyceride metabolism are most pronounced in women with unstable CAD and coronary atherosclerosis. Lipoprotein particles and apolipoproteins alone were no better than lipids and lipoproteins in separating women with from those without coronary atherosclerosis. Our study does not support the measurement of apolipoproteins and lipoprotein particles on the basis of diagnostic accuracy alone.

    Keywords
    lipoprotein particles, ROC, unstable CAD, women.
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-27049 (URN)10.1046/j.1365-2796.2000.00567.x (DOI)11694 (Local ID)11694 (Archive number)11694 (OAI)
    Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
    4. Plasma total homocysteine levels in postmenopausal women with unstable coronary artery disease
    Open this publication in new window or tab >>Plasma total homocysteine levels in postmenopausal women with unstable coronary artery disease
    Show others...
    2000 (English)In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 151, no 2, p. 423-431Article in journal (Refereed) Published
    Abstract [en]

    An elevated plasma total homocysteine (tHcy) level is considered a risk factor for coronary artery disease (CAD), but the relationship between plasma tHcy and well-defined CAD in women is still unclear. Plasma tHcy concentrations and the covariates serum folate, vitamin B12, and creatinine were analysed in 157 angiographically examined postmenopausal women with unstable CAD and in 101 healthy controls. At coronary angiography, 16% had normal vessels and 84% had coronary atherosclerosis. Mean plasma tHcy concentration (μmol/l, 95% confidence interval) did not differ in patients compared to controls (13.1 (12.3–13.8) vs. 12.5 (11.6–13.5)) or in patients with or without coronary atherosclerosis (13.3 (12.4–14.1) vs. 12.0 (10.8–13.2)). A trend to an increasing plasma tHcy with increasing degree of coronary atherosclerosis was attenuated after adjustment for age and the previous mentioned covariates. Odds ratio for the risk of coronary artery disease and coronary atherosclerosis in hyperhomocysteinemic patients (≥90th percentile in controls) was approximately 3. However, the confidence interval included unity in half of the groups and the significance was therefore difficult to judge. Receiver operating characteristics showed age to be the only variable with a significant discriminatory ability regarding the presence of coronary atherosclerosis (area 0.77). Mild hyperhomocysteinemia seems not to be related to the risk of unstable CAD in postmenopausal women. The trend towards higher plasma tHcy with increasing degree of coronary atherosclerosis may be a marker of the disease. In future studies adjustment for age and the other three covariates should be considered.

    Keywords
    Homocysteine, Women, Unstable coronary artery disease, Coronary angiography, Odds ratio, Covariates, ROC curve
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-27048 (URN)10.1016/S0021-9150(99)00416-5 (DOI)11693 (Local ID)11693 (Archive number)11693 (OAI)
    Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
    5. Fibrinolytic Variables in Postmenopausal Women with Unstable Coronary Artery Disease
    Open this publication in new window or tab >>Fibrinolytic Variables in Postmenopausal Women with Unstable Coronary Artery Disease
    2001 (English)In: Journal of Thrombosis and Thrombolysis, ISSN 0929-5305, E-ISSN 1573-742X, Vol. 12, no 3, p. 217-223Article in journal (Refereed) Published
    Abstract [en]

    Objectives: Many women with typical anginal chest pain have normal coronary angiograms. The pathogenetic mechanisms behind the chest pain in these patients is unknown but may be due to altered fibrinolytic function enhancing thrombosis formation. We evaluated the two key components of the fibrinolytic system, tissue-type plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1) in women with clinical signs of unstable coronary artery disease (CAD).

    Methods and results: 158 patients with unstable CAD and 101 controls were examined. Of the patients 16% had normal vessels and 84% coronary atherosclerosis at coronary angiography. Mean plasma concentration of t-PA-ag, but not of PAI-1-act was higher in patients than in controls (t-PA-ag: 2.12 (2.05;2.19) vs. 1.98 (1.89;2.07), p<0.05; PAI-1-act: 1.55 (1.35;1.74) vs. 1.49 (1.24;1.73), p¼n.s.). Patients with coronary atherosclerosis had significantly higher mean plasma levels of both t-PA-ag and PAI-1-act than patients with normal coronary vessels (t-PA-ag: 2.16 (2.08;2.33) vs. 1.94 (1.78;2.10), p<0.05; PAI-1-act: 1.68 (1.47;1.90) vs. 0.82 (0.43;1.21), p<0.01), and these differences were seen whether markers of myocardial damage were elevated or not. Mean plasma levels of PAI-1-act in patients with normal coronary vessels were even lower than in the control group (p<0.05). Almost all significant differences in mean plasma t-PA-ag and PAI-1-act disappeared after adjustments for known covariates.

    Conclusion: Our results indicate, regardless of myocardial marker elevation or not, an activated fibrinolytic system in postmenopausal women with unstable CAD and coronary atherosclerosis, but not in the same group of patients with normal coronary vessels. This argues against reduced fibrinolytic capacity in the latter patients and therefore against thrombosis formation as the cause of chest pain in these women. However, we cannot exclude that the differences can be an effect of inequality among some common risk factors between the groups.

    Keywords
    tissue plasminogen activator, plasminogen activator inhibitor, unstable coronary artery disease, women
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-79488 (URN)10.1023/A:1015270907430 (DOI)
    Available from: 2012-08-06 Created: 2012-08-06 Last updated: 2017-12-07Bibliographically approved
    6. Markers of hypercoagulation, von Willebrand factor and anticardiolipin antibodies in postmenopausal women with unstable coronary artery disease: Discriminatory Ability Regarding Unstable Coronary Artery Disease and Coronary Atherosclerosis Using Receiver Operating Characterstics
    Open this publication in new window or tab >>Markers of hypercoagulation, von Willebrand factor and anticardiolipin antibodies in postmenopausal women with unstable coronary artery disease: Discriminatory Ability Regarding Unstable Coronary Artery Disease and Coronary Atherosclerosis Using Receiver Operating Characterstics
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Aims - Many women with typical anginal chest pain have normal coronary angiograms. The pathogenetic mechanisms behind the chest pain in these patients are unknown but may be due to increased thrombogenecity. We evaluated markers of hypercoagulation and thrombosis in women with clinical signs of unstable coronary artery disease (CAD).

    Methods and results - 158 patients with unstable CAD and 101 controls were examined. 16% of the patients had nonnal vessels and 84% had coronary atherosclerosis at coronary angiography. Mean plasma concentrations of von Willebrand factor-antigen, soluble fibrin (SF), thrombin-antithrombin complex and Ddimer were significantly higher, whereas there was no difference regarding prothrombin fragment 1 +2 between patients and controls. Patients with coronary atherosclerosis had higher mean plasma levels for most variables compared to those with normal coronary vessels, but the only significant difference was for SF. D-dimer was significantly higher in patients with nonnal coronary vessels compared to the control group. Anticardiolipin antibody (ACA) levels were significantly lower in the patient group compared to the control group. Receiver operating characteristics (ROC) showed that none of the variables represented high diagnostic accuracy in distinguishing patients with unstable CAD from healthy controls, or patients with from those without coronary atherosclerosis.

    Conclusion - Our results are in favour of a hypercoagulable state in postmenopausal women with unstable CAD and coronary atherosclerosis, even in the absence of myocardial marker elevation, whereas this does not seem to be the case in patients with nonnal vessels. ROC revealed no variable to be particularly clinical useful in separating patients and control or patients with and without coronary atherosclerosis.

    Keywords
    Coagulation, Unstable Coronary Artery Disease, Women, ROC Curve, Cardiolipin, Coronary Atherosclerosis
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-79489 (URN)
    Available from: 2012-08-06 Created: 2012-08-06 Last updated: 2020-01-16Bibliographically approved
  • 165.
    Nielsen, Niels Erik
    et al.
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Ahlner, Johan
    Linköping University, Department of Medicine and Care, Clinical Pharmacology. Linköping University, Faculty of Health Sciences.
    Malmstedt, J
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Öhman, K. P.
    Linköping University, Department of Medical and Health Sciences, Endocrinology. Linköping University, Faculty of Health Sciences.
    Swahn, Eva
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Plasma levels of cyclic GMP and endothelin in postmenopausal women with unstable coronary artery disease1999In: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 59, no 5, p. 325-334Article in journal (Refereed)
    Abstract [en]

    Many women with typical anginal chest pain have normal coronary angiograms, which may be due to altered endothelial function. We evaluated the endothelial markers cyclic GMP (cGMP) and immunoreactive endothelin (ir-ET) regarding presence of coronary atherosclerosis in women with clinical signs of unstable coronary artery disease (CAD). Plasma levels of cGMP and ir-ET were determined in 118 patients and 84 controls. Ischaemia was evaluated at an exercise test. Of the patients 20% had normal vessels, 14% insignificant CAD and 66% significant stenosis at coronary angiography. Mean (95% CI) concentration of cGMP (nmol/l) was higher in patients than in controls (5.05 (4.53; 5.58) vs. 3.79 (3.34; 4.23)). Separating patients according to daily intake of nitroglycerin, only patients with this medication had significantly higher cGMP level (5.73 (4.88; 6.58)), whereas the difference between those without (4.35 (3.76; 4.94)) and controls disappeared. Patients with ischaemia at exercise test had higher cGMP level than those without (6.01 (5.13; 6.88) vs. 4.30 (3.66; 4.94)), even after adjusting for nitroglycerin treatment. ir-ET (pmol/l) was lower in patients with normal vessels than patients with coronary atherosclerosis (0.83 (0.78; 0.88) vs. 0.98 (0.92; 1.04)) and than the control group (0.91 (0.87; 0.94)). The difference between the control group and patients with atherosclerosis was also significant. Patients with unstable CAD and long-term nitroglycerin treatment have increased cGMP level. Patients with exercise-induced ischaemia have higher cGMP level than those without, irrespective of nitroglycerin treatment, which may reflect a general compensatory mechanism. Patients with normal vessels have low level of ir-ET, indicating different mechanisms for ischaemia/angina in these patients compared with patients with atherosclerosis.

  • 166.
    Nielsen, Niels Erik
    et al.
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Brattström, Lars
    Department of Medicine, County Hospital, Kalmar, Sweden.
    Hultberg, Björn
    Department of Clinical Chemistry, University Hospital, Lund, Sweden.
    Landgren, Finn
    Department of Medicine, County Hospital, Kalmar, Sweden.
    Swahn, Eva
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Plasma total homocysteine levels in postmenopausal women with unstable coronary artery disease2000In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 151, no 2, p. 423-431Article in journal (Refereed)
    Abstract [en]

    An elevated plasma total homocysteine (tHcy) level is considered a risk factor for coronary artery disease (CAD), but the relationship between plasma tHcy and well-defined CAD in women is still unclear. Plasma tHcy concentrations and the covariates serum folate, vitamin B12, and creatinine were analysed in 157 angiographically examined postmenopausal women with unstable CAD and in 101 healthy controls. At coronary angiography, 16% had normal vessels and 84% had coronary atherosclerosis. Mean plasma tHcy concentration (μmol/l, 95% confidence interval) did not differ in patients compared to controls (13.1 (12.3–13.8) vs. 12.5 (11.6–13.5)) or in patients with or without coronary atherosclerosis (13.3 (12.4–14.1) vs. 12.0 (10.8–13.2)). A trend to an increasing plasma tHcy with increasing degree of coronary atherosclerosis was attenuated after adjustment for age and the previous mentioned covariates. Odds ratio for the risk of coronary artery disease and coronary atherosclerosis in hyperhomocysteinemic patients (≥90th percentile in controls) was approximately 3. However, the confidence interval included unity in half of the groups and the significance was therefore difficult to judge. Receiver operating characteristics showed age to be the only variable with a significant discriminatory ability regarding the presence of coronary atherosclerosis (area 0.77). Mild hyperhomocysteinemia seems not to be related to the risk of unstable CAD in postmenopausal women. The trend towards higher plasma tHcy with increasing degree of coronary atherosclerosis may be a marker of the disease. In future studies adjustment for age and the other three covariates should be considered.

  • 167.
    Nielsen, Niels Erik
    et al.
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Ernerudh, Jan
    Linköping University, Department of Molecular and Clinical Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences.
    Siegbahn, Agneta
    Department of Clinical Chemistry, University Hospital, Uppsala, Sweden.
    Swahn, Eva
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Markers of hypercoagulation, von Willebrand factor and anticardiolipin antibodies in postmenopausal women with unstable coronary artery disease: Discriminatory Ability Regarding Unstable Coronary Artery Disease and Coronary Atherosclerosis Using Receiver Operating CharactersticsManuscript (preprint) (Other academic)
    Abstract [en]

    Aims - Many women with typical anginal chest pain have normal coronary angiograms. The pathogenetic mechanisms behind the chest pain in these patients are unknown but may be due to increased thrombogenecity. We evaluated markers of hypercoagulation and thrombosis in women with clinical signs of unstable coronary artery disease (CAD).

    Methods and results - 158 patients with unstable CAD and 101 controls were examined. 16% of the patients had nonnal vessels and 84% had coronary atherosclerosis at coronary angiography. Mean plasma concentrations of von Willebrand factor-antigen, soluble fibrin (SF), thrombin-antithrombin complex and Ddimer were significantly higher, whereas there was no difference regarding prothrombin fragment 1 +2 between patients and controls. Patients with coronary atherosclerosis had higher mean plasma levels for most variables compared to those with normal coronary vessels, but the only significant difference was for SF. D-dimer was significantly higher in patients with nonnal coronary vessels compared to the control group. Anticardiolipin antibody (ACA) levels were significantly lower in the patient group compared to the control group. Receiver operating characteristics (ROC) showed that none of the variables represented high diagnostic accuracy in distinguishing patients with unstable CAD from healthy controls, or patients with from those without coronary atherosclerosis.

    Conclusion - Our results are in favour of a hypercoagulable state in postmenopausal women with unstable CAD and coronary atherosclerosis, even in the absence of myocardial marker elevation, whereas this does not seem to be the case in patients with nonnal vessels. ROC revealed no variable to be particularly clinical useful in separating patients and control or patients with and without coronary atherosclerosis.

  • 168.
    Nielsen, Niels Erik
    et al.
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Logander, Elisabeth
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Swahn, Eva
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Fibrinolytic Variables in Postmenopausal Women with Unstable Coronary Artery Disease2001In: Journal of Thrombosis and Thrombolysis, ISSN 0929-5305, E-ISSN 1573-742X, Vol. 12, no 3, p. 217-223Article in journal (Refereed)
    Abstract [en]

    Objectives: Many women with typical anginal chest pain have normal coronary angiograms. The pathogenetic mechanisms behind the chest pain in these patients is unknown but may be due to altered fibrinolytic function enhancing thrombosis formation. We evaluated the two key components of the fibrinolytic system, tissue-type plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1) in women with clinical signs of unstable coronary artery disease (CAD).

    Methods and results: 158 patients with unstable CAD and 101 controls were examined. Of the patients 16% had normal vessels and 84% coronary atherosclerosis at coronary angiography. Mean plasma concentration of t-PA-ag, but not of PAI-1-act was higher in patients than in controls (t-PA-ag: 2.12 (2.05;2.19) vs. 1.98 (1.89;2.07), p<0.05; PAI-1-act: 1.55 (1.35;1.74) vs. 1.49 (1.24;1.73), p¼n.s.). Patients with coronary atherosclerosis had significantly higher mean plasma levels of both t-PA-ag and PAI-1-act than patients with normal coronary vessels (t-PA-ag: 2.16 (2.08;2.33) vs. 1.94 (1.78;2.10), p<0.05; PAI-1-act: 1.68 (1.47;1.90) vs. 0.82 (0.43;1.21), p<0.01), and these differences were seen whether markers of myocardial damage were elevated or not. Mean plasma levels of PAI-1-act in patients with normal coronary vessels were even lower than in the control group (p<0.05). Almost all significant differences in mean plasma t-PA-ag and PAI-1-act disappeared after adjustments for known covariates.

    Conclusion: Our results indicate, regardless of myocardial marker elevation or not, an activated fibrinolytic system in postmenopausal women with unstable CAD and coronary atherosclerosis, but not in the same group of patients with normal coronary vessels. This argues against reduced fibrinolytic capacity in the latter patients and therefore against thrombosis formation as the cause of chest pain in these women. However, we cannot exclude that the differences can be an effect of inequality among some common risk factors between the groups.

  • 169.
    Nielsen, Niels Erik
    et al.
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Olsson, Anders
    Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Gastroenterology. Linköping University, Department of Medical and Health Sciences, Endocrinology. Linköping University, Faculty of Health Sciences.
    Swahn, Eva
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Plasma lipoprotein particle concentrations in postmenopausal women with unstable coronary artery disease: Analysis of diagnostic accuracy using receiver operating characteristics2000In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 247, no 1, p. 43-52Article in journal (Refereed)
    Abstract [en]

    Background.The contribution of plasma lipids to cardiovascular risk is usually evaluated by measuring plasma concentrations of total cholesterol, triglycerides and HDL cholesterol, and calculating LDL cholesterol concentration. We investigated plasma concentrations of apolipoproteins and lipoprotein particles in women with unstable coronary artery disease (CAD) to evaluate whether these, better than the routine lipid status, could differentiate women with and without coronary atherosclerosis.

    Methods. Blood samples for lipid analyses were collected from 119 angiographically examined postmenopausal 49–79-year-old women with unstable CAD, and from 101 age-matched controls. Mean plasma concentrations were compared and the discriminatory ability of the different variables were tested using receiver operating characteristics (ROC).

    Results. At coronary angiography 19% had normal vessels and 81% had coronary atherosclerosis. A disturbed triglyceride metabolism was the most pronounced lipid abnormality in women with unstable CAD and coronary atherosclerosis. ROC showed that none of the evaluated variables had a particularly high discriminatory power regarding unstable CAD or coronary atherosclerosis. The ratio cholesterol/HDL cholesterol was best with an ROC area of 0.79. Furthermore, the newer lipid variables, i.e. lipoprotein particles and apolipoproteins, were no better than the traditional variables.

    Conclusion. Lipoprotein changes reflecting a disturbed triglyceride metabolism are most pronounced in women with unstable CAD and coronary atherosclerosis. Lipoprotein particles and apolipoproteins alone were no better than lipids and lipoproteins in separating women with from those without coronary atherosclerosis. Our study does not support the measurement of apolipoproteins and lipoprotein particles on the basis of diagnostic accuracy alone.

  • 170.
    Nielsen, Niels Erik
    et al.
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Siegbahn, Agneta
    Department of Clinical Chemistry, University Hospital, Uppsala, Sweden.
    Swahn, Eva
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Markers of hypercoagulation and von Willebrand factor in postmenopausal women with unstable coronary artery disease. Discriminatory ability regarding unstable coronary artery disease and coronary atherosclerosis using receiver operating characteristics2000In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 248, no 2, p. 151-158Article in journal (Refereed)
    Abstract [en]

    Objectives. Many women with typical anginal chest pain have normal coronary angiograms. The pathogenetic mechanisms behind the chest pain in these patients are unknown but may be due to increased thrombogenicity. We evaluated markers of hypercoagulation and thrombosis in women with clinical signs of unstable coronary artery disease (CAD).

    Methods and results. A total of 158 patients with unstable CAD and 101 controls were examined: 16% of the patients had normal vessels and 84% had coronary atherosclerosis at coronary angiography. Mean plasma concentrations of von Willebrand factor antigen, soluble fibrin (SF), thrombin–antithrombin complex and d-dimer were significantly higher, whereas there was no difference regarding prothrombin fragment 1+2 between patients and controls. Patients with coronary atherosclerosis had higher mean plasma levels for most variables compared with those with normal coronary vessels, although only significantly higher for SF. d-Dimer was significantly higher in patients with normal coronary vessels compared with the control group. Although multivariate analyses showed strong significant correlations of the haemostatic variables to the diagnosis of unstable CAD, receiver operating characteristics (ROC) revealed that none of the variables represented high diagnostic accuracy in separating patients with unstable CAD. Likewise, none of the variables was particularly good at identifying coronary atherosclerosis.

    Conclusion. Our results are in favour of a hypercoagulable state in postmenopausal women with unstable CAD and coronary atherosclerosis, whereas this does not seem to be the case in patients with normal vessels. ROC revealed no variable to be particularly clinically useful in separating patients from controls or patients from those without coronary atherosclerosis.

  • 171. Nijm, J
    et al.
    Wikby, A
    Jonasson, Lena
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Proinflammatory cytokines and neutrophil activation in stable angina2004In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 41, p. 359a-359aArticle in journal (Refereed)
  • 172.
    Nijm, Johnny
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology.
    Olsson, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Internal Medicine. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Jonasson, Lena
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Impaired cortisol response in patients with coronary artery disease - relation to inflammatory activity2006In: XIV International Symposium on Atherosclerosis,2006, 2006Conference paper (Other academic)
    Abstract [en]

      

  • 173.
    Nijm, Johnny
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology.
    Olsson, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Internal Medicine. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Jonasson, Lena
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Impaired cortisol response in patients with coronary artery disease - relation to inflammatory activity2006In: Scandinavian Cardiovascular Journal,2006, 2006, p. 25-Conference paper (Refereed)
    Abstract [en]

    ISSN: 1401-7458  

  • 174. Nilsson, L
    et al.
    Jonasson, Lena
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Nijm, Johnny
    Linköping University, Department of Medicine and Care. Linköping University, Faculty of Health Sciences.
    Hamsten, A
    Eriksson, P
    Increased plasma concentration of matrix metalloproteinase-7 in patients with coronary artery disease2006In: Clinical Chemistry, ISSN 0009-9147, E-ISSN 1530-8561, Vol. 52, no 8, p. 1522-1527Article in journal (Refereed)
    Abstract [en]

    Background: Plaque rupture is often associated with breakdown of the extracellular matrix in the shoulder region of a plaque. We tested whether plasma concentrations of various matrix metalloproteinases (MMPs) and tissue inhibitor of metalloproteinase-1 (TIMP-1) could serve as markers for plaque instability as well as relationships between plasma MMPs and inflammatory markers. Methods: The study group included 65 men with angiographically verified CAD (45 with stable and 20 with unstable CAD) and 28 healthy controls. Circulating MMP, TIMP-1, C-reactive protein, and cytokine concentrations were measured by ELISA. Leukocyte subtype counts in whole blood were determined, and T-cell subsets and natural killer cells were measured by flow cytometry. Differences in continuous variables between groups were tested by ANOVA with the Scheffé F-test used as a post hoc test, and correlations were analyzed by a linear regression method. Results: The plasma concentration of MMP-7 was increased in patients with stable and unstable CAD, whereas MMP-2 and -3 concentrations were decreased. The plasma concentration of TIMP-1 was significantly increased in patients with unstable CAD. MMP-2, -3, and -7 showed no correlations with established markers of inflammation. However, MMP-2 correlated positively with the number of natural killer cells in patients with stable and unstable CAD. Conclusion: Plasma concentrations of MMPs and TIMPs may be markers of CAD but appear to be differentially regulated. © 2006 American Association for Clinical Chemistry.

  • 175.
    Nilsson, Lennart
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Cherfan, P
    Höglund Hospital.
    Jonasson, Lena
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Simvastatin treatment reduces C-reactive protein but not pro-inflammatory cytokines2006In: VIII Svenska Kardiovaskulära Vårmötet,2006, 2006Conference paper (Other academic)
    Abstract [en]

      

  • 176. Norhammar, A
    et al.
    Lindback, J
    Ryden, L
    Stenestrand, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Wallentin, L
    Improved mortality after myocardial infarction in patients with diabetes mellitus2005In: Congress of the European Society of Cardiology,2005, 2005Conference paper (Other academic)
  • 177. Norhammar, A
    et al.
    Lindback, J
    Stenestrand, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Wallentin, L
    Ryden, L
    Younger diabetic women are a high-risk group after myocadial infarction2005In: Congress of the European Society of Cardiology,2005, 2005Conference paper (Other academic)
  • 178. Norhammar, Anna
    et al.
    Malmberg, Klas
    Rydén, Lars
    Tornvall, Per
    Stenestrand, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Wallentin, Lars
    Under utilisation of evidence-based treatment partially explains for the unfavourable prognosis in diabetic patients with acute myocardial infarction2003In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 24, no 9, p. 838-844Article in journal (Refereed)
    Abstract [en]

    Aims: The prognosis after an acute myocardial infarction is worse for patients with diabetes mellitus than for those without. We investigated whether differences in the use of evidence-based treatment may contribute to the differences in 1-year survival in a large cohort of consecutive acute myocardial infarction patients with and without diabetes mellitus. Methods: We included patients below the age of 80 years from the Register of Information and Knowledge about Swedish Heart Intensive care Admissions (RIKS-HIA), which included all patients admitted to coronary care units at 58 hospitals during 1995-1998. In all 5193 patients had the combination of acute myocardial infarction and diabetes mellitus while 20 440 had myocardial infarction but no diabetes diagnosed. Multivariate logistical regression analyses were performed to evaluate the influence of diabetes mellitus on the use of evidence-based treatment and its association with survival during the first year after the index hospitalisation. Results: The prevalence of diabetes mellitus was 20.3% (males 18.5%, females 24.4%). The 1-year mortality was substantially higher among diabetic patients compared with those without diabetes mellitus (13.0 vs. 22.3% for males and 14.4 vs. 26.1% for female patients, respectively) with an odds ratio (OR) (95% confidence interval (CI)) in three different age groups: <65 years 2.65 (2.23-3.16), 65-74 years 1.81 (1.61-2.04) and >75 years 1.71 (1.50-1.93). During hospital stay patients with diabetes mellitus received significantly less treatment with heparins (37 vs. 43%, p<0.001), intravenous beta blockade (29 vs. 33%, p<0.001), thrombolysis (31 vs. 41%, p<0.001) and acute revascularisation (4 vs. 5%, p<0.003). A similar pattern was apparent at hospital discharge. After multiple adjustments for dissimilarities in baseline characteristics between the two groups, patients with diabetes were significantly less likely to be treated with reperfusion therapy (OR 0.83), heparins (OR 0.88), statins (OR 0.88) or to be revascularised within 14 days from hospital discharge procedures (OR 0.86) while the use of ACE-inhibitors was more prevalent among diabetic patients compared to non-diabetic patients (OR 1.45). The mortality reducing effects of evidence-based treatment like reperfusion, heparins, aspirin, beta-blockers, lipid-lowering treatment and revascularisation were, in multivariate analyses, of equal benefit in diabetic and non-diabetic patients. Interpretation: Diabetes mellitus continues to be a major independent predictor of 1-year mortality following an acute myocardial infarction, especially in younger age groups. This may partly be explained by less use of evidence-based treatment although treatment benefits are similar in both patients with and without diabetes mellitus. Thus a more extensive use of established treatment has a potential to improve the poor prognosis among patients with acute myocardial infarction and diabetes mellitus.

  • 179. Norrman, S
    et al.
    Stegmayr, B
    Eriksson, M
    Hedbäck, Bo
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Burell, G
    Brulin, C
    Depressive mood after a cardiac event: Gender inequality and participation in rehabilitation programme2004In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 3, no 4, p. 295-302Article in journal (Refereed)
    Abstract [en]

    Depressive mood after a cardiac event is common with serious consequences for the patient. To compare gender in depressive mood during the first year after a cardiac event and to evaluate the effect of participating in a multidimensional secondary prevention program on depressive mood. 166 men and 54 women, <73 years, consecutively answered a questionnaire concerning depressive mood at 2 weeks, 6 weeks, 5 months and 1 year after discharge after a cardiac event. At 2 weeks, each patient met a nurse, and was informed about the disease and received individual support about lifestyle changes. Of those invited to participate in a secondary prevention program, 127 patients accepted, and 93 declined participation. At each of the four follow-ups, women had significantly higher depression scores than men. Depressive mood in both women and men was significantly reduced at 6 weeks. Thereafter, it increased to the 2-week level in women and to above the 2-week level in men. No differences were seen in patients participating or not in secondary prevention programs. Women had higher depressive mood scores than men and secondary prevention programs failed to improve depressive mood in both women and men. © 2004 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.

  • 180.
    Nyman, Ingvar
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Department of Medicine and Care, Internal Medicine. Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Signs and implications of ischemia in unstable coronary artery disease1993Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Signs and implications of ischemia in ECG at rest and at a predischarge exercise test (ET), were assessed in 911 patients with suspected or definite unstable coronary artery disease (CAD) - i.e. unstable angina or non-Q-wave myocardial infarction (MI). Included in the study were men below 70 years of age admitted to the coronary care units of 8 hospitals,without signs of myocardial dysfunction or other serious disease. Randomization to acetylsalicylic acid (ASA) 75 mg daily or placebo was performed in 796 patients, as a part of the RISC study. A symptom limited predischarge ET was performed by 855 patient,, In initial ECG:s at rest, ST-changes were a more unfavourable sign regarding cardiac eventsthan isolated T-inversion, while those with no ST-segment or T-wave changes had the best prognosis. However, among patients on ASA treatment, ST -depression in ECG at rest was of some, although limited prognostic value.

    Concerning the ET evaluation, multiple logistic regression analysis showed that exercise induced ST -depression and exercise tolerance were independent predictors of MI or death, while ST -depression, exercise tolerance and provoked chest pain were independent predictors of future severe angina. When both ST-depression and work capacity was considered, a 'high risk' response at ET implied a !-year rate for cardiac death of 3.6% and for Ml+death of 15.4%. The corresponding figures for a 'low risk' response were 0% and 3.9%. The differences between patients with 'high risk' and 'low risk' responses at the ET were highly significant also regarding future severe angina. The prognostic value of the ET remained high in subgroups based on cardiac enzyme levels, age, findings in ECG at rest, and medication at time for the ET.

    The risk of cardiac death or MI was comparably increased in all patients with ST-depression at exercise, regardless of the presence or absence of chest pain. Thus, evaluation of prognosis should be based on the presence of myocardial ischemia, whether symptomatic or not. ASA 75 mg daily reduced the risk of MI or death at least as well in patients with 'silent ischemia' as in those with 'symptomatic ischemia' at the ET, and should be a mainstay of the treatment of symptom-free individuals.

    Among patients on ASA treatment, the finding of ST-depression alone at exercise was an insufficient indicator of the irreversible end points, due to the reduced absolute risk of MI or death. When both ST -depression and exercise tolerance were used in the evaluation, it was possible to identify a definite low-risk subset (40% of the ASA group) with a !-year rate ofMI or death of 2.9%, where further invasive investigation does not seem warranted. In ASA treated patients, the 'high risk' response at the ET implied a risk of MI or death of 13.4% during the following year. In this relatively large subset additional prognostic tests would be useful. Until such methods arc readily available and evaluated, early coronary angiography and possible revascularization should be considered in patients with severe ischemia.

  • 181. Oddson, H
    et al.
    Walfridsson, H
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Edvardsson, N
    Perception and documentation of arrhythmias after successful radiofrequency catheter ablation of accessory pathways2001In: Annals of Noninvasive Electrocardiology, ISSN 1082-720X, E-ISSN 1542-474X, Vol. 6, no 3, p. 216-221Article in journal (Refereed)
    Abstract [en]

    Background: Some patients continue to have palpitations in spite of successful ablation of Wolff-Parkinson-White (WPW) syndrome. Recurrence of accessory pathways as well as unrelated arrhythmias may explain the symptoms. Methods: We followed 194 consecutive patients after successful radiofrequency catheter ablation of overt (147) or concealed (47) WPW syndrome. The mean duration of symptoms was 16 ▒ 13 years. Atrial fibrillation was documented in 54 patients (24%) prior to ablation. 185 patients responded to a questionnaire 24 ▒ 12 months after ablation. Results: The physical well-being was improved in 94%, unchanged in 5%, and deteriorated in 1%. However, 76 patients (39%) reported arrhythmia symptoms, in 40 patients causing pharmacological treatment (14 patients) and/or continued contact with their doctor. The underlying arrhythmias were orthodromic tachycardia (10), atrial fibrillation (12), premature beats (12), atrial flutter (1), and ventricular tachycardia (1), while in four patients no explanation was found. Minor symptoms in the other 36 patients were explained by premature beats in 29, while unexplained in 7. All patients with atrial fibrillation after ablation had atrial fibrillation before ablation. Ten relapses of WPW syndrome occurred: eight were known before the time of the questionnaire, two were confirmed at transesophageal atrial stimulation. Conclusion: 94% patients with a long history of tachyarrhythmias due to the WPW syndrome reported improved physical well-being after ablation, but palpitations were common during a 2-year follow-up period, 8% continued to use pharmacological antiarrhythmic treatment. Five percent had symptomatic relapses and in 6% atrial fibrillation episodes reoccurred, i.e., in half of those who had atrial fibrillation before ablation.

  • 182. Oddson, Hjörtur
    et al.
    Edvardsson, Nils
    Walfridsson, Håkan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Episodes of atrial fibrillation and atrial vulnerability after successful radiofrequency catheter ablation in patients with Wolff-Parkinsson-White syndrome2002In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 1Article in journal (Refereed)
  • 183. Oldgren, J
    et al.
    Lindbäck, J
    Stenestrand, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Wallentin, L
    Increased bleeding complications in fibrinolytic treatment during 2002 to 2004 (RIKS-HIA)2006In: American College of Cardiology 54th Annual Scientific Session,2006, 2006Conference paper (Refereed)
    Abstract [en]

     JACC 2006

  • 184.
    Olsson, Anders
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Internal Medicine. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Cherfan, P
    Blomqvist, Henrik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Internal Medicine.
    Jonasson, Lena
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Serum adiponectin - its association with inflammation and statin treatment2005In: EAS Congress,2005, 2005Conference paper (Other academic)
  • 185. ONeill, M
    et al.
    Jaïs, P
    Jönsson, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Takahashi, Y
    Sacher, F
    Hocini, M
    Sanders, P
    Rostock, T
    Rotter, M
    Clémenty, J
    Haïssaguerre, M
    An approach to catheter ablation of cavotricuspid isthmus dependent atrial flutter2006In: Indian Pacing and Electrophysiology Journal, ISSN 0972-6292, E-ISSN 0972-6292, Vol. 6, no 2, p. 100-110Article in journal (Refereed)
    Abstract [en]

       

  • 186. ONeill, Mark D
    et al.
    Jönsson, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Takahasi, Yoshihide
    Hocini, Mélèze
    Jais, Pierre
    Haissaguerre, Michel
    Epicardial tachycardia originating from a persistent left superior vena cava2006In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 114, p. 569-570Article in journal (Other academic)
    Abstract [en]

      

  • 187.
    Oscarsson Tibblin, Anna
    et al.
    Linköping University, Department of Medicine and Health Sciences, Anesthesiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Anaesthesiology and Intensive Care VHN.
    Eintrei, Christina
    Linköping University, Department of Medicine and Health Sciences, Anesthesiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Intensive Care UHL.
    Anskär, S
    Linköping University, Department of Medicine and Care, Anaesthesiology. Linköping University, Faculty of Health Sciences.
    Engdahl, Olle
    Linköping University, Department of Medicine and Health Sciences, Anesthesiology . Linköping University, Faculty of Health Sciences.
    Fagerström, Lena
    Linköping University, Department of Medicine and Health Sciences, Anesthesiology . Linköping University, Faculty of Health Sciences.
    Blomqvist, Per
    Anestesikliniken, Ryhov.
    Fredriksson, M
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine . Linköping University, Faculty of Health Sciences.
    Swahn, Eva
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Troponin T-values provide long-term prognosis in elderly patients undergoing non-cardiac surgery.2004In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 48, no 9, p. 1071-9Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The aim of this study was to evaluate the significance of elevated postoperative Troponin T (TnT) levels in an elderly population undergoing non-cardiac surgery. METHODS: Five hundred and forty-six consecutive patients aged 70 years or older undergoing non-cardiac surgery of >30-min duration were enrolled in this prospective, observational study. A postoperative TnT measurement was obtained on the 5th to 7th postoperative day. Troponin T values greater than 0.02 ng ml(-1) were considered positive. Patients were followed over a 1-year period, and mortality and non-fatal cardiac events (acute myocardial infarction and coronary interventions) were recorded. RESULTS: Troponin T concentrations greater than 0.02 ng ml(-1) were detected in 53 of the study subjects (9.7%). Eleven per cent of the patients with elevated TnT had electrocardiographic or clinical signs of myocardial ischemia. One year after surgery, 17 (32%) of the patients with abnormal TnT concentrations had died. In a multivariate Cox regression analysis adjusting for baseline and perioperative data, a TnT value >0.02 ng ml(-1) was an independent correlate of the mortality adjusted hazard ratio (HR): 14.9 (95% CI 3.7-60.3). Other independent predictors of death were tachycardia (HR, 14.9 95% CI 3.45-64.8), ASA 4 (HR, 8.1 95% CI 1.3-50.0), reoperation (HR, 6.4 95% CI 1.1-36.9), and use of diuretics (HR, 4.2 95% CI 1.3-13.8). CONCLUSION: We conclude that elevated TnT levels in the postoperative period confer a 15-fold increase in mortality during the first year after surgery. Our findings also provide evidence that silent myocardial ischemia is common in an elderly population. Routine perioperative surveillance for TnT might therefore be of use in detecting patients at an increased risk of mortality during the first postoperative year.

  • 188. Quintana, M
    et al.
    Hjelmdal, P
    Sollevi, A
    Kahan, T
    Edner, M
    Rehnqvist, N
    Swahn, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Kjerr, A-C
    Näsman, P
    Left ventricular function and cardiovascular events following adjuvant therapy with adenosine in acute myocardial infarction treated with thrombolysis.2003In: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 59Article in journal (Refereed)
  • 189.
    Rahmqvist, Mikael
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Levin, Lars-Åke
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Stenestrand, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Utvärdering av Socialstyrelsens riktlinjer för prioritering i hjärtsjukvård 2001-20042006Report (Other academic)
  • 190.
    Ricther, Arina
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Cederholm, Ingemar
    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.
    Jonasson, Lena
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Mucchiano, Carlo
    Smärtkliniken Eksjö.
    Janerot-Sjöberg, Birgitta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Physiology. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Uchto, Michael
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Radiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Effect of thoracic epidural analgesia on refractory angina pectoris: Long-term home self-treatment2002In: Journal of Cardiothoracic and Vascular Anesthesia, ISSN 1053-0770, E-ISSN 1532-8422, Vol. 16, no 6, p. 679-684Article in journal (Refereed)
    Abstract [en]

    Objectives: To evaluate the effects of long-term home self-treatment with thoracic epidural analgesia (TEA) on angina, quality of life, and safety. Design: Prospective consecutive pilot study. Setting: Department of Cardiology, Heart Center, Link÷ping University Hospital. Participants: Between January 1998 and January 2000, 37 consecutive patients with refractory angina began treatment with TEA, using a subcutaneously tunnelled epidural catheter. Interventions: The patients were trained to provide self-treatment at home with intermittent injections of bupivacaine. Data were collected until January 2001, and the follow-up for each patient was 1 to 3 years. Measurements and Main Results: All but 1 of the patients improved symptomatically. The improvement was maintained throughout the treatment period (4 days to 3 years). The Canadian Cardiovascular Society angina class decreased from 3.6 to 1.7, frequency of anginal attacks decreased from 46 to 7 a week, nitroglycerin intake decreased from 32 to 5 a week, and the overall self-rated quality of life assessed by visual analog scale increased from 24 to 76 (all p < 0.001). No serious catheter-related complications occurred, however, 51% of the catheters became displaced and a new one had to be inserted during the study. Conclusion: Long-term self-administered home treatment with TEA seems to be an effective and safe adjuvant treatment for patients with refractory angina. It produces symptomatic relief of angina and improves the quality of life.

  • 191. Sheikine, Y
    et al.
    Bang, CS
    Nilsson, Lennart
    Linköping University, Department of Medicine and Care. Linköping University, Faculty of Health Sciences.
    Samnegård, A
    Hamsten, A
    Jonasson, Lena
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Eriksson, P
    Sirsjö, A
    Decreased plasma CXCL16/SR-PSOX concentration is associated with coronary artery disease2006In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 188, no 2, p. 462-466Article in journal (Refereed)
    Abstract [en]

    Objectives: To investigate for the first time whether the plasma CXCL16 concentration is altered in coronary artery disease (CAD) patients. Background: Accumulating evidence suggests that the novel chemokine/scavenger receptor CXCL16/SR-PSOX is involved in the development of atherosclerosis and CAD. Methods: Using ELISA we assessed the plasma CXCL16 concentration in 40 stable angina pectoris (SAP) patients, 17 unstable angina pectoris/non-ST-elevation myocardial infarction (UAP/non-STEMI) patients, 387 survivors of a first myocardial infarction (MI) and healthy control subjects (44 controls for SAP and UAP/non-STEMI patient groups and 387 controls for post-MI patients). Results: SAP patients exhibited significantly lower median CXCL16 levels (2111 pg/ml) than the corresponding control subjects (2678 pg/ml) (P = 0.0012). UAP/non-STEMI patients also appeared to have lower CXCL16 levels (2192 pg/ml) compared with controls (NS). Patients investigated 3 months after MI tended (P = 0.07) to have lower CXCL16 levels (2529 pg/ml) than the corresponding controls (2638 pg/ml). There were no significant correlations between CXCL16 levels and different measures of CAD severity determined by quantitative coronary angiography in post-MI patients. Neither patients nor controls exhibited significant correlations between CXCL16 levels and plasma lipoprotein fractions, inflammatory cytokines, C-reactive protein or numbers of inflammatory cells in peripheral blood. Conclusions: The finding that lower plasma CXCL16 concentration is associated with CAD might indicate a potential atheroprotective function of CXCL16. © 2005 Elsevier Ireland Ltd. All rights reserved.

  • 192.
    Stenestrand, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Acute coronary syndromes: guidelines vs. clinical practice in Europe - Swedish registry of myocardial infarction2004In: European Society of Cardiology Working Group on Acute Cardiac Care,2004, 2004Conference paper (Other academic)
  • 193.
    Stenestrand, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Angioplasty management in the high-risk patient, a challenge for 2007: learning experiences from the Swedish registry.2007In: Thromboses et Urgences Coronaires,2007, 2007Conference paper (Other academic)
  • 194.
    Stenestrand, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Biokemiska markörer i hjärtinfarktvården2004In: EQUALIS,2004, 2004Conference paper (Other academic)
  • 195.
    Stenestrand, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Bättre resultat med ballongvidgning än med fibrinolys vid akut hjörtinfarkt2004In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 3, p. 176-176Article in journal (Other academic)
  • 196.
    Stenestrand, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    CRP ingen riskmarkör för normalbefolkningen.2006In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 103, p. 3801-3801Article in journal (Other academic)
    Abstract [sv]

             

  • 197.
    Stenestrand, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Dagens HIA-vård i Sverige2003In: Incitament, ISSN 1103-503X, Vol. 1, p. 682-685Article in journal (Other academic)
  • 198.
    Stenestrand, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Dagens sjukvård vid akut kranskärlssjukdom2002In: Akut kranskärlssjukdom / [ed] Lars Wallentin; Lars Grip, Linköping: Linköpings universitet , 2002, 2, p. 183-188Chapter in book (Other academic)
    Abstract [sv]

    I denna bok om akut kranskärlssjukdom sammanfattar en grupp experter och forskare det nuvarande kunskapsläget samt ger rekommendationer för omhändertagande och behandling av patienterna. Boken vänder sig främst till läkare och sköterskor med grundläggande kunskaper och viss erfarenhet av hjärtsjukvård. I sin helhet presenterar boken hela kunskapsområdet från epidemiologi och patofysiologiska mekanismer över diagnostik och behandling till omvårdnad och etiska frågeställningar. Samtidigt utgör varje kapitel en enhet som kan läsas fristående som underlag för vägledning, fördjupning och diskussion inom ett problemområde. Boken är därför till nytta för både det vardagliga praktiska patientarbetet vid vidareutbildning, kvalitetsutveckling och forskning

  • 199.
    Stenestrand, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Databases and electronic medical records - The RIKS-HIA Swedish database2004In: European Society of Cardiology Working Group on Acute Cardiac Care,2004, 2004Conference paper (Other academic)
  • 200.
    Stenestrand, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    DES vs BMS: vinster och risker i registerdata (Läkemedelsavgivande stentar (DES))2007In: IX Svenska Kardiovaskulära vårmötet,2007, 2007Conference paper (Other academic)
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