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  • 251.
    Ljunggren, Stefan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Bengtsson, Torbjorn
    Orebro Univ, Sweden.
    Karlsson, Helen
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Region Östergötland, Heart and Medicine Center, Occupational and Environmental Medicine Center. Linköping University, Faculty of Medicine and Health Sciences.
    Starkhammar Johansson, Carin
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Public Dental Health Care.
    Palm, Eleonor
    Orebro Univ, Sweden.
    Nayeri, Fariba
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology, Infection and Inflammation. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Infectious Diseases.
    Ghafouri, Bijar
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Davies, Julia
    Malmo Univ, Sweden.
    Svensater, Gunnel
    Malmo Univ, Sweden.
    Lönn, Johanna
    Linköping University, Department of Medical and Health Sciences, Pharmacology. Linköping University, Faculty of Health Sciences. Orebro Univ, Sweden; Malmo Univ, Sweden.
    Modified lipoproteins in periodontitis: a link to cardiovascular disease?2019In: Bioscience Reports, ISSN 0144-8463, E-ISSN 1573-4935, Vol. 39, no 3, article id BSR20181665Article in journal (Refereed)
    Abstract [en]

    There is a strong association between periodontal disease and atherosclerotic cardiovascular disorders. A key event in the development of atherosclerosis is accumulation of modified lipoproteins within the arterial wall. We hypothesise that patients with periodontitis have an altered lipoprotein profile towards an atherogenic form. Therefore, the present study aims at identifying modifications of plasma lipoproteins in periodontitis. Lipoproteins from ten female patients with periodontitis and gender- and age-matched healthy controls were isolated by density-gradient ultracentrifugation. Proteins were separated by 2D gel-electrophoresis and identified by map-matching or by nano-LC followed by MS. Apolipoprotein (Apo) A-I (ApoA-I) methionine oxidation, Oxyblot, total antioxidant capacity and a multiplex of 71 inflammation-related plasma proteins were assessed. Reduced levels of apoJ, phospholipid transfer protein, apoF, complement C3, paraoxonase 3 and increased levels of alpha-1-antichymotrypsin, apoA-II, apoC-III were found in high-density lipoprotein (HDL) from the patients. In low-density lipoprotein (LDL)/very LDL (VLDL), the levels of apoL-1 and platelet-activating factor acetylhydrolase (PAF-AH) as well as apo-B fragments were increased. Methionine oxidation of apoA-I was increased in HDL and showed a relationship with periodontal parameters. alpha-1 antitrypsin and alpha-2-HS glycoprotein were oxidised in LDL/VLDL and antioxidant capacity was increased in the patient group. A total of 17 inflammation-related proteins were important for group separation with the highest discriminating proteins identified as IL-21, Fractalkine, IL-17F, IL-7, IL-1RA and IL-2. Patients with periodontitis have an altered plasma lipoprotein profile, defined by altered protein levels as well as post-translational and other structural modifications towards an atherogenic form, which supports a role of modified plasma lipoproteins as central in the link between periodontal and cardiovascular disease (CVD).

  • 252.
    Ljunggren, Stefan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Karlsson, Helen
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Occupational and Environmental Medicine Center.
    Mörtstedt, Harriet
    Occupational and Environmental Medicine, Lund University Hospital, Lund.
    Hellström, L.
    Internal Medicine and Environmental Medicine and Public Health, Oskarshamn Hospital, Oskarshamn, Sweden.
    Perk, J.
    Internal Medicine and Environmental Medicine and Public Health, Oskarshamn Hospital, Oskarshamn, Sweden.
    Besler, C.
    Cardiovascular Center, Zurich University Hospital, Switzerland.
    Landmesser, U.
    Cardiovascular Center, Zurich University Hospital, Switzerland.
    von Eckardstein, A.
    Institute for Clinical Chemistry, Zurich University Hospital, Zurich, Switzerland.
    Lindahl, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Changes in Human Liportein Composition in Patients with Acute Coronary Syndrome2011In: Atherosclerosis Supplements, ISSN 1567-5688, E-ISSN 1878-5050, Vol. 12, no 1, p. 14-14Article in journal (Other academic)
    Abstract [en]

    The protein composition of lipoproteins may serve as biomarkers or reveal underlying mechanisms during different states of disease. Here we have analysed the protein composition of LDL and HDL from patients with acute coronary syndrome (ACS) and patients receiving statins after previous ACS. Plasma samples were obtained from males, namely 12 healthy donors, 9 patients with ACS and 7 stable patients receiving statin treatment after previous ACS. LDL and HDL were isolated by two-step density ultracentrifugation. LDL proteins were analysed with two-dimensional gel electrophoresis and mass spectrometry. Paraoxonase 1 (PON-1) in HDL was analyzed with  SDSPAGE/Western Blot.

    Concentrations of apo A-IV, a1-antitrypsin and transthyretin were significantly increased (P < 0.05) in LDL from patients with ACS compared to healthy controls. In patients receiving statins, a1-antitrypsin remained increased while serum amyloid A4 was decreased. By western blot analysis, a non-significant increase in PON-1 was found in HDL from patients with ACS. Interestingly, a truncated form of PON-1 was detected in all patients with ACS but not in any of the controls.

    In conclusion, we confirm previous findings that LDL-associated transthyretin is a possible biomarker of myocardial infarction. Moreover, the increased concentration of the inflammatory marker a1-antitrypsin in LDL from both ACS patients and stable patients after ACS indicate that the enrichment does not only reflect an acute phase response. The presence of a truncated form of the antioxidant protein PON-1 in HDL may explain previous findings showing increased amounts but lower activity of PON-1 in patients with ACS.

  • 253.
    Lomper, Katarzyna
    et al.
    Wroclaw Med Univ, Poland.
    Slawuta, Agnieszka
    Wroclaw Med Univ, Poland.
    Dudek, Krzysztof
    Wroclaw Univ Technol, Poland.
    Mazur, Grzegorz
    Wroclaw Med Univ, Poland.
    Walfridsson, Ulla
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Jankowska-Polanska, Beata
    Wroclaw Med Univ, Poland.
    Psychometric evaluation of the Polish version of the Arrhythmia-Specific Questionnaire in Tachycardia and Arrhythmia: a new tool for symptom and health-related quality of life assessment2019In: Kardiologia polska, ISSN 0022-9032, E-ISSN 1897-4279, Vol. 77, no 5, p. 541-552Article in journal (Refereed)
    Abstract [en]

    BACKGROUND Atrial fibrillation (AF) is the most common arrhythmia resulting in hospitalization. The assessment of symptoms and health-related quality of life (HRQoL) can provide valuable information before, during, and after health care interventions for AF. AIMS We aimed to perform a translation and cultural adaptation of the Arrhythmia-Specific Questionnaire in Tachycardia and Arrhythmia (ASTA), and to evaluate the reliability and validity of its Polish version. METHODS The standard forward-backward translation procedure to translate the ASTA questionnaire into Polish was used. A total of 244 patients with AF at a mean (SD) age of 70.7 (10.7) years completed the questionnaire and were included in the study. Reliability was tested using internal consistency (Cronbach alpha) and validity with an item-total correlation, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA). RESULTS The ASTA symptom scale had satisfactory psychometric properties (alpha = 0.718), and the corrected item-total correlation was sufficient for most items (0.361-0.506), except for cold sweats (0.156). The ASTA HRQoL scale showed good psychometric properties (alpha = 0.855). Initial CFA analyses showed that the 1- and 2-factor models had similar properties, with strong factor loadings and satisfactory goodness-of-fit values according to the comparative fit index (0.947 for the 1-factor model vs 0.988 for the 2-factor model). A comparison of the 1-and 2-factor models showed that the close fit for the root-mean-square error of approximation was better for the 2-factor model (0.387 vs 0.193). A 2-factor EFA model was produced, and for factor 1 (physical scale), the varimax low ranged between 0.470 and 0.804, and for factor 2 (the mental scale), it ranged between 0.597 and 0.873. CONCLUSIONS The psychometric properties of the Polish version of the ASTA questionnaire were overall found to be satisfactory.

  • 254.
    Lund, Lars H
    et al.
    Karolinska Institutet, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden.
    Braunschweig, Frieder
    Karolinska Institutet, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden.
    Benson, Lina
    Karolinska Institutet, Department of Clinical Science and Education, South Hospital, Stockholm, Sweden.
    Ståhlberg, Marcus
    Karolinska Institutet, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden.
    Dahlström, Ulf
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Linde, Cecilia
    Karolinska Institutet, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden.
    Association between demographic, organizational, clinical, and socio-economic characteristics and underutilization of cardiac resynchronization therapy: results from the Swedish Heart Failure Registry.2017In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 19, no 10, p. 1270-1279Article in journal (Refereed)
    Abstract [en]

    AIMS: Cardiac resynchronization therapy (CRT) improves outcomes in heart failure (HF) but may be underutilized. The reasons are unknown.

    METHODS AND RESULTS: We linked the Swedish Heart Failure Registry to national registries with ICD-10 (International Classification of Diseases-10th Revision) co-morbidity diagnoses and demographic and socio-economic data. In patients with EF ≤39% and NYHA II-IV, we assessed prevalence of CRT indication and CRT use. In those with CRT indication, we assessed the association between 37 potential baseline covariates and CRT non-use using multivariable generalized estimating equation (GEE) models. Of 12 807 patients (mean age 71 ± 12 years, 28% female), 841 (7%) had CRT, 3094 (24%) had an indication for but non-use of CRT, and 8872 (69%) had no indication. Important variables independently associated with CRT non-use were: HF duration <6 months [risk ratio (RR) 1.21, 95% confidence interval (CI) 1.17-1.24]; non-cardiology planned follow-up (RR 1.14, 95% CI 1.09-1.18); age >75 years (RR 1.13, 95% CI 1.09-1.18); non-cardiology care at baseline (RR 1.10, 95% CI 1.07-1.14); small-town non-university centre (RR 1.08, 95% CI 1.05-1.12); female sex (RR 1.07 95% CI 1.03-1.10) (all P < 0.05); as was absence of AF, living alone; psychiatric diagnosis; smoking; and non-use of HF drugs. Education, income, cancer, or HF characteristics were not independently associated with CRT non-use.

    CONCLUSION: In this population-wide HF registry, CRT was underutilized. Non-use was associated mostly with demographic and organizational, but not clinical or socio-economic factors. This calls for programmes to raise awareness of CRT indications and improve access and referrals to cardiology specialists.

  • 255.
    Lund, Lars H
    et al.
    Karolinska Institute, Stockholm, Karolinska University Hospital, Stockholm, Sweden.
    Carrero, Juan-Jesus
    Intervention and Technology, Karolinska Institute, Stockholm, Sweden.
    Farahmand, Bahman
    Epi-Consultant, Stockholm, Sweden.
    Henriksson, Karin M
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden, AstraZeneca RD, Mölndal, Sweden .
    Jonsson, Åsa
    Division of Cardiology, County Hospital Ryhov, Jönköping, Sweden.
    Jernberg, Tomas
    Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
    Dahlström, Ulf
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Association between enrolment in a heart failure quality registry and subsequent mortality-a nationwide cohort study.2017In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844Article in journal (Refereed)
    Abstract [en]

    AIMS: Heart failure (HF) quality registries report quality of care but it is unknown whether they improve outcomes. The aims were to assess predictors of enrolment in a HF registry, test the hypothesis that enrolment in a HF registry is associated with reduced mortality, and assess potential explanatory factors for this reduction in mortality, if present.

    METHODS AND RESULTS: We conducted a nationwide prospective cohort study of patients with new-onset HF registered in the Swedish National Patient Registry (NPR, a mandatory registry of ICD-code diagnoses) with or without concurrent registration in the Swedish Heart Failure Registry (SwedeHF, a voluntary quality reporting registry) 2006-2013. The association between demographics, co-morbidities and medications, and enrolment in the SwedeHF, was assessed using multivariable logistic regression. The association between enrolment in the SwedeHF and all-cause mortality was assessed using multivariable Cox regression, with adjustment for demographics, co-morbidities and medications. A total of 231 437 patients were included, of which 21 888 (9.5%) were in the SwedeHF [age (mean ± standard deviation) 74 ± 13 years; 41% women; 68% inpatients] and 209 549 (90.5%) were not (age 78 ± 12 years, 50% women; 79% inpatients). Selected variables independently associated with enrolment in the SwedeHF were male sex, younger age, higher education, absent co-morbidities and co-morbidity-related medications, and use of HF and cardiovascular medications. Over a median (interquartile range) follow-up of 874 (247-1667) days, there were 13.0 vs. 20.8 deaths per 100 patient-years (P < 0.001). The hazard ratio (95% confidence interval) for death for the SwedeHF yes vs. no was 0.65 (0.63-0.66) crude, and increased to 0.80 (0.78-0.81) after adding demographics, to 0.82 (0.80-0.84) after adding co-morbidities and co-morbidity-related medications, to 0.95 (0.93-0.97) after adding cardiovascular medications, and to 1.04 (1.02-1.07) after adding HF-specific medications.

    CONCLUSION: Heart failure patients of male sex, younger age, and higher education were more likely to be enrolled in a HF quality registry. Enrolment was associated with reduced all-cause mortality that was explained by demographic differences and better utilization of cardiovascular and HF medications.

  • 256.
    Lund, Lars H
    et al.
    Karolinska Institutet, Karolinska University Hospital, Stockholm.
    Svennblad, Bodil
    Uppsala Clinical Research Center, Uppsala.
    Dahlström, Ulf
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Ståhlberg, Marcus
    Karolinska Institutet, Karolinska University Hospital, Stockholm.
    Effect of expanding evidence and evolving clinical guidelines on the prevalence of indication for cardiac resynchronization therapy in patients with heart failure2018In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 20, no 4, p. 769-777Article in journal (Refereed)
    Abstract [en]

    AIMS: To assess the prevalence of indication for cardiac resynchronization therapy (CRT) in patients with heart failure (HF) and reduced ejection fraction (EF) when recommendations from evolving European Society of Cardiology (ESC) guidelines are considered.

    METHODS AND RESULTS: Unique patients (n=17 193) with EF ≤39% and key data available for evaluation of CRT indication from the Swedish HF Registry were included. Indication for CRT was defined as either CRT implanted or CRT device absent but fulfilling criteria for class I-IIa recommendations in ESC guidelines published between 2005/2007 and 2016. Prevalence was calculated as the ratio of patients with CRT indication to the study population. The prevalence of CRT indication increased from 24.5% when the 2005/2007 ESC guidelines were considered to a peak of 30.0% when the 2013 ESC guidelines were considered (P<0.001, 22.4% relative increase). Compared to the 2013 ESC guidelines, the prevalence declined significantly when the 2016 ESC guidelines were used as determinant for CRT indication (26.8%, 10.7% relative reduction, P<0.001). Actual CRT utilization was 6.8%.

    CONCLUSION: Among patients with HF and reduced EF, the prevalence of CRT indication increased significantly comparing recommendations from ESC guidelines published between 2005/2007 and 2013, but then declined when the 2016 ESC guidelines were considered. The 2005-2013 increase may reflect the expansion of documented CRT efficacy to New York Heart Association class II, whereas the subsequent drop likely results from the more stringent criteria for QRS duration in the 2016 ESC guidelines. Actual CRT utilization is lower than indicated, regardless of which guidelines are considered.

  • 257.
    Lundberg, Oscar H. M.
    et al.
    Skåne University Hospital Malmö, Sweden.
    Bergenzaun, Lill
    Skåne University Hospital Malmö, Sweden.
    Ryden, Jorgen
    Skåne University Hospital Malmö, Sweden.
    Rosenqvist, Mari
    Skåne University Hospital Malmö, Sweden.
    Melander, Olle
    Skåne University Hospital Malmö, Sweden; Lund University, Sweden.
    Chew, Michelle
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Lund University, Sweden.
    Adrenomedullin and endothelin-1 are associated with myocardial injury and death in septic shock patients2016In: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 20, no 178Article in journal (Refereed)
    Abstract [en]

    Background: Adrenomedullin and endothelin-1 are hormones with opposing effects on the cardiovascular system. Adrenomedullin acts as a vasodilator and seems to be important for the initiation and continuation of the hyperdynamic circulatory response in sepsis. Endothelin-1 is a vasoconstrictor and has been linked to decreased cardiac performance. Few studies have studied the relationship between adrenomedullin and endothelin-1, and morbidity and mortality in septic shock patients. High-sensitivity troponin T (hsTNT) is normally used to diagnose acute cardiac injury but is also prognostic for outcome in intensive care. We investigated the relationship between mid-regional pro-adrenomedullin (MR-proADM), C-terminal pro-endothelin-1 (CT-proET-1), and myocardial injury, measured using transthoracic echocardiography and hsTNT in septic shock patients. We were also interested in the development of different biomarkers throughout the ICU stay, and how early measurements were related to mortality. Further, we assessed if a positive biomarker panel, consisting of MR-proADM, CT-proET-1, and hsTNT changed the odds for mortality. Methods: A cohort of 53 consecutive patients with septic shock had their levels of MR-proADM, CT-proET-1, hsTNT, and left ventricular systolic functions prospectively measured over 7 days. The relationship between day 1 levels of MR-proADM/CT-proET-1 and myocardial injury was studied. We also investigated the relationship between biomarkers and early (7-day) and later (28-day) mortality. Likelihood ratios, and pretest and posttest odds for mortality were calculated. Results: Levels of MR-proADM and CT-proET-1 were significantly higher among patients with myocardial injury and were correlated with left ventricular systolic dysfunction. MR-proADM and hsTNT were significantly higher among 7-day and 28-day non-survivors. CT-proET-1 was also significantly higher among 28-day but not 7-day non-survivors. A positive biomarker panel consisting of the three biomarkers increased the odds for mortality 13-fold to 20-fold. Conclusions: MR-proADM and CT-proET-1 are associated with myocardial injury. A biomarker panel combining MR-proADM, CT-proET-1, and hsTNT increases the odds ratio for death, and may improve currently available scoring systems in critical care.

  • 258.
    Lundberg, Peter
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Radiology in Linköping. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics.
    Forsgren, Mikael
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics.
    Nasr, Patrik
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Gastroentorology.
    Ignatova, Simone
    Linköping University, Department of Clinical and Experimental Medicine, Division of Cell Biology. Linköping University, Faculty of Medicine and Health Sciences.
    Leinhard Dahlqvist, Olof
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics.
    Dahlström, Nils
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Radiology in Linköping.
    Ekstedt, Mattias
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Gastroentorology.
    Kechagias, Stergios
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Gastroentorology.
    Kvantifiering av leversteatos: diagnostisk utvärdering av protonmagnetresonansspektroskopi jämfört med histologiska metoder2016Conference paper (Refereed)
    Abstract [sv]

    Bakgrund

    Leversteatos är den vanligaste manifestationen av leversjukdom i västvärlden. Leverbiopsi med semikvantitativ histologisk gradering är referensmetod vid gradering av leversteatos. Med protonmagnetsresonansspektroskopi (1H-MRS), en metod som föreslagits ersätta leverbiopsi för värdering av steatos, kan leverns innehåll av triglycerider mätas icke-invasivt. Triglyceridinnehåll >5,00 % används ofta som ett diagnostiskt kriterium för leversteatos vid undersökning med 1H-MRS. Syftet med studien var att jämföra 1H-MRS med semikvantitativ histologisk steatosgradering och kvantitativ histologisk steatosmätning.

    Metod

    Patienter remitterade för utredning av förhöjda leverenzymer in-kluderades i studien. Samtliga patienter genomgick klinisk undersökning, laboratorieprovtagning samt 1H-MRS direkt följd av leverbiopsi. För konventionell histologisk semikvantitativ gradering av steatos användes kriterierna utarbetade av Brunt och medarbetare. Kvantitativ mätning av fett i biopsierna utfördes genom att med hjälp av stereologisk punkträkning (SPC) mäta andelen av ytan som innehöll fettvakuoler.

    Resultat

    I studien inkluderades 94 patienter, varav 37 hade icke-alkoholor-sakad fettleversjukdom (NAFLD), 49 hade andra leversjukdomar och 8 hade normal leverbiopsi. En stark korrelation noterades mel-lan 1H-MRS och SPC (r=0,92, p<0,0001; к=0.82). Korrelationen mellan 1H-MRS och Brunts kriterier (к=0.26) samt mellan SPC och Brunts kriterier (к=0.38) var betydligt sämre. När patologens gradering (Brunts kriterier) användes som referensmetod för diag-nos av leversteatos så hade alla patienter med triglyceridinnehåll >5,00 % mätt med 1H-MRS steatos (specificitet 100 %). Emellertid hade 22 av 69 patienter med triglyceridinnehåll ≤5,00 % också le-versteatos enligt Brunts kriterier (sensitivitet 53 %). Motsvarande siffror när man använde gränsvärdet 3,02 % var sensitivitet 79 % och specificitet 100 %. Vid ytterligare reduktion av gränsvärdet för triglyceridinnehåll till 2,00 % ökade sensitiviteten till 87 % med upprätthållande av hög specificitet (94 %).

    Slutsats

    1H-MRS och SPC uppvisade en mycket hög korrelation vid kvantifiering av leversteatos. SPC borde därför föredras framför Brunts kriterier när noggrann histologisk kvantifiering av leversteatos är önskvärd. Många patienter kan ha histologisk leversteatos trots triglyceridinnehåll ≤5,00 % mätt med 1H-MRS. Gränsvärdet för diagnostisering av leversteatos med 1H-MRS bör därför reduceras.

  • 259.
    Lundgren, Johan
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Johansson, Peter
    Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Can Cognitive Behaviour Therapy Be Beneficial for Heart Failure Patients?2015In: Current Heart Failure Reports, ISSN 1546-9530, E-ISSN 1546-9549, Vol. 12, no 2, p. 166-72Article, review/survey (Other academic)
    Abstract [en]

    This review aims to summarize the theory of cognitive behavioural therapy (CBT) as well as the current evidence for whether CBT can be beneficial for patients with heart failure (HF). Depression and/or anxiety are common in HF patients. However, participation in disease management programmes does not seem to be beneficial for these problems. CBT, which focuses on the identification and changing of dysfunctional beliefs and thoughts and on behaviour therapy, is a possible treatment option. The number of CBT studies on HF is small and they are often not designed as randomized controlled trials. However, the studies on HF indicate that CBT can decrease depression as well as anxiety and suggest that relaxation exercises with elements of CBT may decrease symptom burden. Before implementation in clinical practice, more knowledge is needed about how CBT programmes should be designed, where CBT should be delivered and who should deliver CBT.

  • 260.
    Lycholip, Edita
    et al.
    Vilnius Univ, Lithuania; Vilnius Univ Hosp, Lithuania.
    Paleviciute, Egle
    Vilnius Univ, Lithuania; Vilnius Univ Hosp, Lithuania.
    Aamodt, Ina Thon
    Univ Oslo, Norway; Oslo Univ Hosp, Norway.
    Helleso, Ragnhild
    Univ Oslo, Norway.
    Lie, Irene
    Oslo Univ Hosp, Norway.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Celutkiene, Jelena
    Vilnius Univ, Lithuania; Vilnius Univ Hosp, Lithuania.
    Non-invasive home lung impedance monitoring in early post-acute heart failure discharge: Three case reports2019In: WORLD JOURNAL OF CLINICAL CASES, ISSN 2307-8960, Vol. 7, no 8, p. 951-960Article in journal (Refereed)
    Abstract [en]

    BACKGROUND Patients discharged after hospitalization for acute heart failure (AHF) are frequently readmitted due to an incomplete decongestion, which is difficult to assess clinically. Recently, it has been shown that the use of a highly sensitive, non-invasive device measuring lung impedance (LI) reduces hospitalizations for heart failure (HF); it has also been shown that this device reduces the cardiovascular and all-cause mortality of stable HF patients when used in long-term out-patient follow-ups. The aim of these case series is to demonstrate the potential additive role of non-invasive home LI monitoring in the early post-discharge period. CASE SUMMARY We present a case series of three patients who had performed daily LI measurements at home using the edema guard monitor (EGM) during 30 d after an episode of AHF. All patients had a history of chronic ischemic HF with a reduced ejection fraction and were hospitalized for 6-17 d. LI measurements were successfully made at home by patients with the help of their caregivers. The patients were carefully followed up by HF specialists who reacted to the values of LI measurements, blood pressure, heart rate and clinical symptoms. LI reduction was a more frequent trigger to medication adjustments compared to changes in symptoms or vital signs. Besides, LI dynamics closely tracked the use and dose of diuretics. CONCLUSION Our case series suggests non-invasive home LI monitoring with EGM to be a reliable and potentially useful tool for the early detection of congestion or dehydration and thus for the further successful stabilization of a HF patient after a worsening episode.

  • 261.
    Löfman, Ida
    et al.
    Karolinska University Hospital, Huddinge, Sweden; Karolinska Institutet, Stockholm, Sweden..
    Szummer, Karolina
    Karolinska University Hospital, Huddinge, Sweden; Karolinska Institutet, Stockholm, Sweden..
    Dahlström, Ulf
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Jernberg, Tomas
    Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Lund, Lars H
    Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Associations with and prognostic impact of chronic kidney disease in heart failure with preserved, mid-range, and reduced ejection fraction.2017In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 19, no 12, p. 1606-1614Article in journal (Refereed)
    Abstract [en]

    AIMS: As the role of chronic kidney disease (CKD) in different types of heart failure (HF) is poorly understood, our aim was to compare CKD in HF with preserved (HFpEF), mid-range (HFmrEF), and reduced ejection fraction (HFrEF) with regard to prevalence, associations and prognostic role.

    METHODS AND RESULTS: Patients in the Swedish Heart Failure Registry were divided into three groups based on EF (≥50%, 40-49% and <40%). CKD was defined as an estimated glomerular filtration rate ≤60 mL/min.1.73 m(2) . Associations between covariates and CKD and between CKD and mortality were assessed with multivariable regressions. Of 40 230 patients, 8875 (22%) had HFpEF, 8374 (21%) had HFmrEF, and 22 981 (57%) had HFrEF, with a CKD prevalence of 56%, 48%, and 45%, respectively. Associations between covariates and CKD were similar in all EF groups. One-year mortality with vs. without CKD was 23% vs. 13% in HFpEF, 22% vs. 8% in HFmrEF, and 23% vs. 8% in HFrEF (P < 0.001 for all). After adjustment, CKD was more strongly associated with death in HFrEF and HFmrEF than in HFpEF [hazard ratio (HR) and 95% confidence interval (CI); 1.49 (1.42-1.56) and 1.51 (1.40-1.63) vs. 1.32 (1.24-1.42); P for interaction <0.001]. In receiver operating characteristic (ROC) analyses, CKD was also a stronger predictor of death in HFrEF and HFmrEF than in HFpEF [area under the curve (AUC) 0.699 (0.689-0.709) and 0.700 (0.683-0.716) vs. 0.629 (0.613-0.645)].

    CONCLUSION: CKD was associated with similar covariates regardless of EF. Although CKD was more common in HFpEF than in HFmrEF and HFrEF, it may have more of a 'bystander' role in HFpEF, being less associated with mortality and with lower prognostic discrimination.

  • 262.
    Löfman, Ida
    et al.
    Huddinge, Sweden; Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Szummer, Karolina
    Huddinge, Sweden; Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Hagerman, Inger
    Huddinge, Sweden; Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Dahlström, Ulf
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Lund, Lars H
    Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Jernberg, Tomas
    Huddinge, Sweden; Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Prevalence and prognostic impact of kidney disease on heart failure patients.2016In: Open heart, E-ISSN 2053-3624, Vol. 3, no 1, article id e000324Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim was to determine the prevalence of different degrees of kidney dysfunction and to examine their association with short-term and long-term outcomes in a large unselected contemporary heart failure population and some of its subgroups. We examined to what extent the different cardiac conditions and their severity contribute to the prognostic value of kidney dysfunction in heart failure.

    DESIGN: We studied 47 716 patients in the Swedish Heart Failure Registry. Patients were divided into five renal function strata based on estimated glomerular filtration rate (eGFR) using the Chronic Kidney Disease Epidemiology Collaboration equation. The adjusted association between kidney function and outcome was examined by Cox regression.

    RESULTS: 51% of the patients had eGFR <60 mL/min/1.73 m(2) and 11% had eGFR <30. There was increasing mortality with decreasing kidney function regardless of age, presence of diabetes, New York Heart Association NYHA class, duration of heart failure and haemoglobin levels. The risk HR (95% CI) persisted after adjusting for differences in baseline characteristics, severity of heart disease, and medical treatment: eGFR 60-89: 0.86 (0.79 to 0.95); eGFR 30-59: 1.13 (1.03 to 1.24); eGFR 15-29: 1.85 (1.67 to 2.07); and eGFR <15: 2.96 ([2.53 to -3.47)], compared with eGFR ≥90.

    CONCLUSIONS: Kidney dysfunction is common and strongly associated with short-term and long-term outcomes in patients with heart failure. This strong association was evident in all age groups, regardless of NYHA class, duration of heart failure, haemoglobin level, and presence/absence of diabetes mellitus. After adjusting for differences in baseline data, aetiology and severity of heart disease and treatment, the strong association remained.

  • 263.
    Mahmood, Zeid
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Enocsson, Helena
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Bäck, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Sahlgrens Univ Hosp, Sweden.
    Chung, Rosanna
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Lundberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Jonasson, Lena
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Salivary and plasma levels of matrix metalloproteinase-9 and myeloperoxidase at rest and after acute physical exercise in patients with coronary artery disease2019In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 2, article id e0207166Article in journal (Refereed)
    Abstract [en]

    Background Low-grade systemic inflammation is a predictor of recurrent cardiac events in patients with coronary artery disease (CAD). Plasma proteins such as matrix metalloproteinase (MMP)-9 and myeloperoxidase (MPO) have been shown to reflect basal as well as stress-induced inflammation in CAD. Measurements of MMP-9 and MPO in saliva might pose several advantages. Therefore, we investigated whether salivary levels of MMP-9 and MPO corresponded to plasma levels in patients with coronary artery disease (CAD), both at rest and after acute physical exercise. Methods A bicycle ergometer test was used as a model for stress-induced inflammation. Twenty-three CAD patients performed the test on two occasions 3-6 months apart. Whole unstimulated saliva was collected before, directly after and 30 min after exercise while plasma was collected before and after 30 min. MMP-9 and MPO in saliva and plasma were determined by Luminex. Results MMP-9 and MPO levels were 2- to 4-fold higher in saliva than in plasma. Amongst the saliva samples, and also to a great extent amongst the plasma samples, the levels of both types of protein showed strong intercorrelations between the levels at rest and after exercise during the two visits. However, there were no (or weak) correlations between salivary and plasma MMP-9 and none between salivary and plasma MPO. Conclusion We conclude that salivary diagnostics cannot be used to assess systemic levels of MMP-9 and MPO in CAD patients, neither at rest nor after acute physical exercise.

  • 264.
    Makubi, Abel
    et al.
    Karolinska Institute, Sweden; Muhimbili University of Health and Allied Science, Tanzania; Jakaya Kikwete Cardiac Institute, Tanzania.
    Hage, Camilla
    Karolinska Institute, Sweden.
    Sartipy, Ulrik
    Karolinska University Hospital, Sweden; Karolinska Institute, Sweden.
    Lwakatare, Johnson
    Muhimbili University of Health and Allied Science, Tanzania; Jakaya Kikwete Cardiac Institute, Tanzania.
    Janabi, Mohammed
    Muhimbili University of Health and Allied Science, Tanzania; Jakaya Kikwete Cardiac Institute, Tanzania.
    Kisenge, Peter
    Jakaya Kikwete Cardiac Institute, Tanzania.
    Dahlström, Ulf
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Ryden, Lars
    Karolinska University Hospital, Sweden.
    Makani, Julie
    Muhimbili University of Health and Allied Science, Tanzania; University of Oxford, England; Muhimbili Wellcome Programme, Tanzania.
    Lund, Lars H.
    Karolinska Institute, Sweden; Karolinska University Hospital, Sweden.
    Heart failure in Tanzania and Sweden: Comparative characterization and prognosis in the Tanzania Heart Failure (TaHeF) study and the Swedish Heart Failure Registry (SwedeHF)2016In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 220, p. 750-758Article in journal (Refereed)
    Abstract [en]

    Background: Heart failure (HF) in developing countries is poorly described. We compare characteristics and prognosis of HF in Tanzania vs. Sweden. Methods: A prospective cohort study was conducted from the Tanzania HF study (TaHeF) and the Swedish HF Registry (SwedeHF). Patients were compared overall (n 427 vs. 51,060) and after matching 1: 3 by gender and age +/- 5 years (n 411 vs. 1232). The association between cohort and all-cause mortality was assessed with multivariable Cox regression. Results: In the unmatched cohorts, TaHeF (as compared to SwedeHF) patients were younger (median age [inter-quartile range] 55 [40-68] vs. 77 [64-84] years, p amp;lt; 0.001) and more commonly women (51% vs. 40%, p amp;lt; 0.001). The three-year survival was 61% in both cohorts. In the matched cohorts, TaHeF patients had more hypertension (47% vs. 37%, p amp;lt; 0.001), more anemia (57% vs. 9%), more preserved EF, more advanced HF, longer duration of HF, and less use of beta-blockers. Crude mortality was worse in TaHeF (HR 2.25 [95% CI 1.78-2.85], p amp;lt; 0.001), with three-year survival 61% vs. 83%. However, covariate-adjusted risk was similar (HR 1.07, 95% CI 0.69-1.66; p = 0.760). In both cohorts, preserved EF was associated with higher mortality in crude but not adjusted analysis. Conclusions: Compared to in Sweden, HF patients in Tanzania were younger and more commonly female, and after age and gender matching, had more frequent hypertension and anemia, more severe HF despite higher EF, and worse crude but similar adjusted prognosis. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

  • 265.
    Malmqvist, K.
    et al.
    Division of Internal Medicine, Karolinska Inst. Danderyd Hospital, Stockholm, Sweden.
    Öhman, K. Peter
    Linköping University, Department of Medicine and Care, Internal Medicine. Linköping University, Faculty of Health Sciences. AstraZeneca Research & Development, Mölndal, Sweden.
    Lind, Lars
    AstraZeneca Research and Development, Mölndal, Sweden, Department of Medical Sciences, University Hospital, Uppsala, Sweden.
    Nyström, Fredrik
    Linköping University, Department of Medicine and Care, Internal Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Kahan, Thomas
    Division of Internal Medicine, Karolinska Inst. Danderyd Hospital, Stockholm, Sweden, Institutet Danderyd Hospital, Section of Cardiology, Division of Internal Medicine, S-182 88 Stockholm, Sweden.
    Long-Term Effects of Irbesartan and Atenolol on the Renin-Angiotensin-Aldosterone System in Human Primary Hypertension: The Swedish Irbesartan Left Ventricular Hypertrophy Investigation versus Atenolol (SILVHIA)2003In: Journal of Cardiovascular Pharmacology, ISSN 0160-2446, E-ISSN 1533-4023, Vol. 42, no 6, p. 719-726Article in journal (Refereed)
    Abstract [en]

    We examined long-term influence of the angiotensin II type 1-receptor blocker irbesartan and the beta1-adrenergic receptor blocker atenolol on some neurohormonal systems implicated in the pathophysiology of cardiac hypertrophy. Thus, 115 hypertensive patients with left ventricular hypertrophy were randomized to receive double-blind irbesartan or atenolol, with additional therapy if needed. Neurohormone measurements and echocardiography were performed at weeks 0, 12, 24, and 48. Left ventricular mass was reduced more by irbesartan than by atenolol (-26 g/m2 versus -14 g/m2, P = 0.024), despite similar reductions in blood pressure. Plasma renin activity and angiotensin II increased (P < 0.001) by irbesartan (0.9 ± 0.7 to 3.4 ± 4.2 ng/mL × h, and 3.0 ± 1.6 to 13.0 ± 17.7 pmol/L), but decreased (P < 0.01) by atenolol (1.0 ± 0.6 to 0.7 ± 0.6 ng/mL × h, and 3.4 ± 1.6 to 3.2 ± 2.2 pmol/L). Serum aldosterone decreased (P < 0.05) by both irbesartan (346 ± 140 to 325 ± 87 pmol/L) and atenolol (315 ± 115 to 283 ± 77 pmol/L). Changes in left ventricular mass by irbesartan related inversely to changes in plasma renin activity, angiotensin II, and aldosterone (all P < 0.05). Plasma levels and 24-hour urinary excretions of catecholamines, plasma leptin, proinsulin, insulin and insulin sensitivity remained largely unchanged in both groups. Thus, the renin-angiotensin aldosterone system appears to be an important non-hemodynamic factor in the regulation of left ventricular mass.

  • 266.
    Maret, Eva
    et al.
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Ryhov University Hospital, Sweden; Karolinska University Hospital, Sweden.
    Liehl, Monika
    Ryhov University Hospital, Sweden.
    Brudin, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Kalmar University Hospital, Kalmar, Sweden.
    Tödt, Tim
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Edvardsen, Thor
    Oslo University Hospital, Norway.
    Engvall, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Phase analysis detects heterogeneity of myocardial deformation on cine MRI2015In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 49, no 3, p. 149-158Article in journal (Refereed)
    Abstract [en]

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

  • 267.
    Matsuoka, Shiho
    et al.
    Section of Liaison Psychiatry and Palliative Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan.
    Perkiö Kato, Naoko
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Kayane, Takahiro
    Department of Nursing, Edogawa Hospital, Tokyo, Japan.
    Yamada, Michiyo
    Department of Nursing, Edogawa Hospital, Tokyo, Japa.
    Koizumi, Masako
    Department of Nursing, Tokyo Women's Medical University Hospital, Japan.
    Ikegame, Toshimi
    Department of Nursing, St Luke's International Hospital, Tokyo, Japan.
    Tsuchihashi-Makaya, Miyuki
    School of Nursing, Kitasato University, Sagamihara, Japan.
    Development and Validation of a Heart Failure-Specific Health Literacy Scale2016In: The Journal of Cardiovascular Nursing, ISSN 0889-4655, Vol. 31, no 2, p. 131-139Article in journal (Refereed)
    Abstract [en]

    Background: Health literacy (HL) is an important concept for patient education and disease management with heart failure (HF). However, research on HL has predominantly focused on functional HL (ability to read and write). The World Health Organization advocates evaluating comprehensive HL, including the ability to access information (communicative HL) and critically evaluate that information (critical HL).

    Objective: We developed an instrument for measuring functional, communicative, and critical levels of HL in patients with HF.

    Methods: We evaluated the reliability and validity of those 3 HL scales in a sample of 191 outpatients with HF (mean [SD] age, 66.9 [13.9] years; 64.9% males). Sociodemographic and clinical characteristics, knowledge of HF, a well as motivation to obtain health information were assessed for each patient through a self-administered questionnaire and review of electronic medical records.

    Results: We constructed scale items to reflect directly the comprehensive World Health Organization definition of HL. We identified 3 interpretable factors by exploratory factor analysis. Internal consistency was marginally acceptable for total HL (Cronbach [alpha] = 0.71), functional HL ([alpha] = 0.73), communicative HL ([alpha] = 0.68), and critical HL ([alpha] = 0.69); the interclass correlation coefficients of the functional, communicative, and critical HL subscales were 0.882, 0.898, and 0.882, respectively. Low functional, communicative, and critical HL was characteristic of older patients, those with lower socioeconomic status, patients living alone, those without a high school education, and patients lacking HF knowledge.

    Conclusions: Our new HL scale was demonstrated to be a reliable, valid instrument for measuring functional, communicative, and critical HL in patients with HF. Exploring a patient's HL level, including the ability to access, understand, and use health information as well as the ability to read and write, may provide better understanding of patients' potential barriers to self-care.

  • 268.
    McDonald, Kenneth
    et al.
    St Vincents Univ Hosp, Ireland; Univ Coll Dublin, Ireland.
    Troughton, Richard
    Univ Otago, New Zealand.
    Dahlström, Ulf
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Dargie, Henry
    Univ Glasgow, Scotland.
    Krum, Henry
    Monash Univ, Australia.
    van der Meer, Peter
    Univ Med Ctr Groningen, Netherlands.
    McDonagh, Theresa
    Kings Coll Hosp London, England.
    Atherton, John J.
    Royal Brisbane Hosp, Australia; Univ Queensland, Australia.
    Kupfer, Ken
    Alere, CA USA.
    George, Richard C. San
    Alere, CA USA.
    Richards, Mark
    Univ Otago, New Zealand.
    Doughty, Robert
    Univ Auckland, New Zealand.
    Daily home BNP monitoring in heart failure for prediction of impending clinical deterioration: results from the HOME HF study2018In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 20, no 3, p. 474-480Article in journal (Refereed)
    Abstract [en]

    Background Serial measurement of natriuretic peptides may guide management in heart failure (HF) patients. In previous trials, natriuretic peptides were infrequently monitored, which may undervalue the benefit of this approach. Methods and results HOME was an adaptive three-arm randomized clinical study to test whether home monitoring of BNP could reduce HF-related death, hospitalization due to acute decompensated HF (ADHF), and ADHF treated with intravenous diuretics in the emergency department or outpatient setting. Enrolment was terminated early because of slow enrolment, low event rates, and the belief that an algorithm for assessing BNP trends was needed. Justification for pooling data from all study arms was made and analysis as a single observational study was performed. The analysis resulted in 107 patients who were monitored for a median of 172 days with BNP measures on a median of 74% of days. BNP values were highly variable within a patient. Dispersion between serial BNPs was calculated to be 39.3%, 57.7%, and 73.6% for 1, 60, and 120 days between measures, respectively. A moving average filter (fBNP) was calculated to reduce day-to-day fluctuations and track changes from week to week. There were 27 primary events in 17 362 patient days of monitoring; the hazard ratio for time-varying fBNP was 2.22 (95% confidence interval 1.48-3.34) per unit natural log (corresponding to a 2.72-fold change in fBNP level). Conclusion The HOME HF study demonstrates the feasibility of home BNP measurement and shows the potential value of fBNP as an index of emerging clinical deterioration. Assessment of the clinical value of this is required.

  • 269.
    Miller, Jennifer L
    et al.
    College of Nursing, University of Kentucky, Lexington, Kentucky, USA.
    Thylén, Ingela
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Moser, Debra K
    College of Nursing, University of Kentucky, Lexington, Kentucky, USA.
    Gender Disparities in Symptoms of Anxiety, Depression, and Quality of Life in Defibrillator Recipients.2016In: Pacing and Clinical Electrophysiology, ISSN 0147-8389, E-ISSN 1540-8159, Vol. 39, no 2, p. 149-159Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Most patients cope well with an implantable cardioverter defibrillator (ICD), but psychological distress and ICD-related concerns have been reported in about 20% of ICD recipients. Many previous studies have not distinguished between genders.

    METHODS: In this nationwide study we compared quality of life, anxiety, and depression symptoms between the genders in ICD recipients, and determined predictors of each of these variables in men and women. All adult Swedish ICD recipients were invited by mail to participate and 2,771 patients (66 ± 12 years) completed standardized measures of quality of life, symptoms of anxiety, and depression. Time since implantation ranged from 1 year to 23 years with a mean of 4.7 ± 3.9.

    RESULTS: Women reported worse quality of life (mean index 0.790 vs 0.825) and higher prevalence of anxiety (20.5% vs 14.7%) than did men (P < 0.001 for both comparisons), while there were no differences in symptoms of depression (8.8% vs 8.2%).

    CONCLUSIONS: Most ICD recipients report a good quality of life, without emotional distress, but among the minority with distress, women fare worse than men.

  • 270.
    Milovanovic, Micha
    et al.
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Fransson, Elisabeth
    Östergötlands Läns Landsting, Local Health Care Services in the East of Östergötland, Department of Internal Medicine VHN.
    Hallert, Claes
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the East of Östergötland, Department of Internal Medicine VHN.
    Järemo, Petter
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the East of Östergötland, Department of Internal Medicine VHN.
    Letter: Atrial fibrillation and platelet reactivity: in International Journal of Cardiology(ISSN 0167-5273)(EISSN 1874-1754)2010In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 145, no 2, p. 357-358Article in journal (Other academic)
    Abstract [en]

    BACKGROUND: The impact of atrial fibrillation (AF) upon platelet reactivity has not been investigated.

    METHODS: Subjects were 33 individuals with AF who consented to elective electrical cardioversion (ECV) immediately before ECV determination of surface-bound fibrinogen after stimulation i.e. platelet reactivity was carried out. A flow cytometer was employed. ADP (1.7 and 8.5mumol/L) and a thrombin receptor activating peptide (54 and 74mumol/L) were used as agonists. The analyses were repeated after 26+/-8(SD) months.

    RESULTS: Compared to day 1 subjects with AF (n=18) had a trend towards lower platelet reactivity at study end. It reached significance when using 1.7mumol/L ADP. In contrast, after 26+/-8(SD) months sinus rhythm (SR) (n=15) was associated with significant lower reactivity with all agonists.

    CONCLUSION: After 26+/-8(SD) months patients returning with AF had higher platelet reactivity than those who remained with SR.

  • 271.
    Mofors, J.
    et al.
    Karolinska Univ Hosp, Sweden.
    Holmqvist, M.
    Karolinska Inst, Sweden.
    Westermark, L.
    Uppsala Univ, Sweden.
    Bjork, A.
    Karolinska Univ Hosp, Sweden.
    Kvarnstrom, M.
    Karolinska Univ Hosp, Sweden.
    Forsblad-dElia, H.
    Umea Univ, Sweden.
    Bucher, S. Magnusson
    Orebro Univ, Sweden.
    Eriksson, Per
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Rheumatology.
    Theander, E.
    Lund Univ, Sweden.
    Mandl, T.
    Lund Univ, Sweden.
    Wahren-Herlenius, M.
    Karolinska Univ Hosp, Sweden.
    Nordmark, G.
    Uppsala Univ, Sweden.
    Concomitant Ro/SSA and La/SSB antibodies are biomarkers for the risk of venous thromboembolism and cerebral infarction in primary Sjogrens syndrome2019In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 286, no 4, p. 458-468Article in journal (Refereed)
    Abstract [en]

    Background To assess the risk of incident cardiovascular disease in patients with primary Sjogrens syndrome, overall and stratified by Ro/SSA and La/SSB autoantibody status. Methods A cohort of patients with primary Sjogrens syndrome in Sweden (n = 960) and matched controls from the general population (n = 9035) were included, and data extracted from the National Patient Register to identify events of myocardial infarction, cerebral infarction and venous thromboembolism. Hazard ratios were estimated using cox proportional hazard regressions. Results During a median follow-up of 9.5 years, the overall hazard ratio (HR) was 1.6 (95% CI 1.2-2.1) for myocardial infarction, 1.2 (95% CI 0.9-1.7) for cerebral infarction and 2.1 (95% CI 1.6-2.9) for venous thromboembolism. Patients positive for both Ro/SSA and La/SSB autoantibodies had a substantially higher risk of cerebral infarction (HR 1.7, 95% CI 1.0-2.9) and venous thromboembolism (HR 3.1, 95% CI 1.9-4.8) than the general population. These risks were not significantly increased in Ro/SSA- and La/SSB-negative patients. Among autoantibody-positive patients, the highest HR of cerebral infarction was seen after amp;gt;= 10 years disease duration (HR 2.8, 95% CI 1.4-5.4), while the HR for venous thromboembolism was highest 0-5 years after disease diagnosis (HR 4.7, 95% CI 2.3-9.3) and remained high throughout disease duration. Conclusions Primary Sjogrens syndrome is associated with a markedly increased risk of cardiovascular disease and the presence of Ro/SSA and La/SSB autoantibodies identify the subgroup of patients carrying the highest risk. These findings suggest that monitoring and prevention of cardiovascular disease in this patient group should be considered.

  • 272.
    Molnar, Miklos Z
    et al.
    University of Tennessee HealthScience Center, Memphis, USA.
    Mucsi, Istvan
    University of Toronto, Cananda, Semmelweis University Budapest, Hungary.
    Novak, Marta
    Semmelweis University Budapest, Hungary, University of Toronto, Canada.
    Szabo, Zoltan
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Freire, Amado X
    Memphis Veterans Affairs Medical Center, Memphis, USA.
    Huch, Kim M
    Memphis Veterans Affairs Medical Center, Memphis, USA.
    Arah, Onyebuchi A
    University of California, Los Angeles, USA.
    Ma, Jennie Z
    University of Virginia, Charlottesville, USA .
    Lu, Jun L
    University of Tennessee HealthScience Center, Memphis, USA.
    Sim, John J
    Kaiser Permanente, Los Angeles, USA.
    Streja, Elani
    University of California, Irvine, USA.
    Kalantar-Zadeh, Kamyar
    University of California, Irvine, USA .
    Kovesdy, Csaba P
    University of Tennessee HealthScience Center, Memphis, USA, Memphis Affairs Medical Center, Memphis, USA.
    Association of incident obstructive sleep apnoea with outcomes in a large cohort of US veterans2015In: Thorax, ISSN 0040-6376, E-ISSN 1468-3296, Vol. 70, no 9, p. 888-895Article in journal (Refereed)
    Abstract [en]

    RATIONALE: There is a paucity of large cohort studies examining the association of obstructive sleep apnoea (OSA) with clinical outcomes including all-cause mortality, coronary heart disease (CHD), strokes and chronic kidney disease (CKD).

    OBJECTIVES: We hypothesised that a diagnosis of incident OSA is associated with higher risks of these adverse clinical outcomes.

    METHODS, MEASUREMENTS: In a nationally representative cohort of over 3 million (n=3 079 514) US veterans (93% male) with baseline estimated glomerular filtration rate (eGFR)≥60 mL/min/1.73 m(2), we examined the association between the diagnosis of incident OSA, treated and untreated with CPAP, and: (1) all-cause mortality, (2) incident CHD, (3) incident strokes, (4)incident CKD defined as eGFR<60 mL/min/1.73 m(2), and (5) slopes of eGFR.

    MAIN RESULTS: Compared with OSA-negative patients, untreated and treated OSA was associated with 86% higher mortality risk, (adjusted HR and 95% CI 1.86 (1.81 to 1.91) and 35% (1.35 (1.21 to 1.51)), respectively. Similarly, untreated and treated OSA was associated with 3.5 times (3.54 (3.40 to 3.69)) and 3 times (3.06 (2.62 to 3.56)) higher risk of incident CHD; 3.5 times higher risk of incident strokes (3.48 (3.28 to 3.64) and 3.50 (2.92 to 4.19)) for untreated and treated OSA, respectively. The risk of incident CKD was also significantly higher in untreated (2.27 (2.19 to 2.36)) and treated (2.79 (2.48 to 3.13)) patients with OSA. The median (IQR) of the eGFR slope was -0.41 (-2.01 to 0.99), -0.61 (-2.69 to 0.93) and -0.87 (-3.00 to 0.70) mL/min/1.73 m(2) in OSA-negative patients, untreated OSA-positive patients and treated OSA-positive patients, respectively.

    CONCLUSIONS: In this large and contemporary cohort of more than 3 million US veterans, a diagnosis of incident OSA was associated with higher mortality, incident CHD, stroke and CKD and with faster kidney function decline.

  • 273.
    Montalescot, Gilles
    et al.
    University of Paris 06, France.
    van t Hof, Arnoud W.
    Isala Clin, Netherlands.
    Lapostolle, Frederic
    Hop Avicenne, France.
    Silvain, Johanne
    University of Paris 06, France.
    Flensted Lassen, Jens
    Aarhus University Hospital, Denmark.
    Bolognese, Leonardo
    Azienda Osped Arezzo, Italy.
    Cantor, Warren J.
    University of Toronto, Canada.
    Cequier, Angel
    University of Barcelona, Spain.
    Chettibi, Mohamed
    Centre Hospital University of Franz Fanon, Algeria.
    Goodman, Shaun G.
    University of Toronto, Canada.
    Hammett, Christopher J.
    Royal Brisbane and Womens Hospital, Australia.
    Huber, Kurt
    Wilhelminenspital Stadt Wien, Austria.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Merkely, Bela
    Semmelweis University, Hungary.
    Storey, Robert F.
    University of Sheffield, England.
    Zeymer, Uwe
    Klinikum Stadt Ludwigshafen, Germany; Institute Herzinfarktforsch Ludwigshafen, Germany.
    Stibbe, Olivier
    Brigade Sapeurs Pompiers Paris, France.
    Ecollan, Patrick
    CHU Pitie Salpetriere, France.
    Heutz, Wim M. J. M.
    Regionale Ambulance Voorziening, Netherlands.
    Swahn, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Collet, Jean-Philippe
    University of Paris 06, France.
    Willems, Frank F.
    Rijnstate Ziekenhuis, Netherlands.
    Baradat, Caroline
    AstraZeneca, France.
    Licour, Muriel
    AstraZeneca, France.
    Tsatsaris, Anne
    AstraZeneca, France.
    Vicaut, Eric
    Hop Lariboisiere, France.
    Hamm, Christian W.
    Kerckhoff Heart Centre, Germany.
    Prehospital Ticagrelor in ST-Segment Elevation Myocardial Infarction2014In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 371, no 11, p. 1016-1027Article in journal (Refereed)
    Abstract [en]

    BACKGROUND The direct-acting platelet P2Y(12) receptor antagonist ticagrelor can reduce the incidence of major adverse cardiovascular events when administered at hospital admission to patients with ST-segment elevation myocardial infarction (STEMI). Whether prehospital administration of ticagrelor can improve coronary reperfusion and the clinical outcome is unknown. METHODS We conducted an international, multicenter, randomized, double-blind study involving 1862 patients with ongoing STEMI of less than 6 hours duration, comparing prehospital (in the ambulance) versus in-hospital (in the catheterization laboratory) treatment with ticagrelor. The coprimary end points were the proportion of patients who did not have a 70% or greater resolution of ST-segment elevation before percutaneous coronary intervention (PCI) and the proportion of patients who did not have Thrombolysis in Myocardial Infarction flow grade 3 in the infarct-related artery at initial angiography. Secondary end points included the rates of major adverse cardiovascular events and definite stent thrombosis at 30 days. RESULTS The median time from randomization to angiography was 48 minutes, and the median time difference between the two treatment strategies was 31 minutes. The two coprimary end points did not differ significantly between the prehospital and in-hospital groups. The absence of ST-segment elevation resolution of 70% or greater after PCI (a secondary end point) was reported for 42.5% and 47.5% of the patients, respectively. The rates of major adverse cardiovascular events did not differ significantly between the two study groups. The rates of definite stent thrombosis were lower in the prehospital group than in the in-hospital group (0% vs. 0.8% in the first 24 hours; 0.2% vs. 1.2% at 30 days). Rates of major bleeding events were low and virtually identical in the two groups, regardless of the bleeding definition used. CONCLUSIONS Prehospital administration of ticagrelor in patients with acute STEMI appeared to be safe but did not improve pre-PCI coronary reperfusion.

  • 274.
    Moreno, Rodrigo
    et al.
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Health Sciences.
    Koppal, Sandeep
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences.
    de Muinck, Ebo
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences.
    Robust Estimation of Distance Between Sets of Points2013In: Pattern Recognition Letters, ISSN 0167-8655, E-ISSN 1872-7344, Vol. 34, no 16, p. 2192-2198Article in journal (Refereed)
    Abstract [en]

    This paper proposes a new methodology for computing Hausdorff distances between sets of points in a robust way. In a first step, robust nearest neighbor distance distributions between the two sets of points are obtained by considering reliability measures in the computations through a Monte Carlo scheme. In a second step, the computed distributions are operated using random variables algebra in order to obtain probability distributions of the average, minimum or maximum distances. In the last step, different statistics are computed from these distributions. A statistical test of significance, the nearest neighbor index, in addition to the newly proposed divergence and clustering indices are used to compare the computed measurements with respect to values obtained by chance. Results on synthetic and real data show that the proposed method is more robust than the standard Hausdorff distance. In addition, unlike previously proposed methods based on thresholding, it is appropriate for problems that can be modeled through point processes.

  • 275.
    Mortensen, Svend A
    et al.
    Copenhagen University Hospital, Copenhagen, Denmark.
    Rosenfeldt, Franklin
    Alfred Hospital, Monash University, Melbourne, Australia.
    Kumar, Adarsh
    Government Medical College/G.N.D. Hospital, Amritsar, India.
    Dolliner, Peter
    Medical University of Vienna, Vienna, Austria.
    Filipiak, Krzysztof J
    Medical University of Warsaw, Warsaw, Poland.
    Pella, Daniel
    Safarik University, Kosice, Slovakia.
    Alehagen, Urban
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Steurer, Günter
    Medical University of Vienna, Vienna, Austria.
    Littarru, Gian P
    Q-SYMBIO Study Investigators..
    The effect of coenzyme Q10 on morbidity and mortality in chronic heart failure: results from Q-SYMBIO: a randomized double-blind trial.2014In: JACC. Heart failure, ISSN 2213-1787, Vol. 2, no 6, p. 641-649Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: This randomized controlled multicenter trial evaluated coenzyme Q10 (CoQ10) as adjunctive treatment in chronic heart failure (HF).

    BACKGROUND: CoQ10 is an essential cofactor for energy production and is also a powerful antioxidant. A low level of myocardial CoQ10 is related to the severity of HF. Previous randomized controlled trials of CoQ10 in HF were underpowered to address major clinical endpoints.

    METHODS: Patients with moderate to severe HF were randomly assigned in a 2-year prospective trial to either CoQ10 100 mg 3 times daily or placebo, in addition to standard therapy. The primary short-term endpoints at 16 weeks were changes in New York Heart Association (NYHA) functional classification, 6-min walk test, and levels of N-terminal pro-B type natriuretic peptide. The primary long-term endpoint at 2 years was composite major adverse cardiovascular events as determined by a time to first event analysis.

    RESULTS: A total of 420 patients were enrolled. There were no significant changes in short-term endpoints. The primary long-term endpoint was reached by 15% of the patients in the CoQ10 group versus 26% in the placebo group (hazard ratio: 0.50; 95% confidence interval: 0.32 to 0.80; p = 0.003) by intention-to-treat analysis. The following secondary endpoints were significantly lower in the CoQ10 group compared with the placebo group: cardiovascular mortality (9% vs. 16%, p = 0.026), all-cause mortality (10% vs. 18%, p = 0.018), and incidence of hospital stays for HF (p = 0.033). In addition, a significant improvement of NYHA class was found in the CoQ10 group after 2 years (p = 0.028).

    CONCLUSIONS: Long-term CoQ10 treatment of patients with chronic HF is safe, improves symptoms, and reduces major adverse cardiovascular events. (Coenzyme Q10 as adjunctive treatment of chronic heart failure: a randomised, double-blind, multicentre trial with focus on SYMptoms, BIomarker status [Brain-Natriuretic Peptide (BNP)], and long-term Outcome [hospitalisations/mortality]; ISRCTN94506234).

  • 276.
    Myers, T. M.
    et al.
    Jarvik Heart Inc., USA.
    Casimir-Ahn, H.
    Jarvik Heart Inc., USA.
    Lönn, U.
    Jarvik Heart Inc., USA.
    Peterzén, B.
    Linköping University, Department of Medicine and Care. Linköping University, Faculty of Health Sciences.
    Wårdell, Karin
    Linköping University, Department of Biomedical Engineering. Linköping University, Faculty of Health Sciences.
    Carnstam, B.
    Texas Heart Institute, USA.
    Jarvik, R. K.
    Texas Heart Institute, USA.
    Frazier, O. H.
    Jarvik Heart Inc., USA.
    Hemodynamic Evaluation of the Jarvik 2000 Heart During Heart Failure2001In: ASAIO journal (1992), ISSN 1058-2916, E-ISSN 1538-943X, Vol. 46, no 2, p. 167-Article in journal (Refereed)
    Abstract [en]

    The Jarvik 2000 Heart is an axial flow left ventricular assist system designed for long-term circulatory support. Purpose: To assess the level of hemodynamic support provided by the Jarvik 2000 in an animal model, with acute, severe heart failure. Methods: Heart failure (HF) was induced in 5 calves by progressively ligating the LAD coronary artery. A continuous infusion of esmolol hydrochloride was given to maintain the stability of HF. Compared to normal baseline values, during heart failure CI decreased by 33% (p < 0.02), LAP increased by 16% (p < 0.03), and BP decreased by 28% (p < 0.13). Once stable HF was established, the pump was turned on, and hemodynamic measurements were obtained at pump speed settings that ranged from 8,000 to 12,000 rpm. Results: Selected, mean hemodynamic values are presented in the table, CI, LAP, and BP improved significantly (p < 0.05) at pump speeds >9000 rpm. Pulse pressure (PP) narrowed by 64% (p < 0.009), and the PAP remained unchanged.

    Image Tools

    Blood flow in the femoral artery increased but was not statistically significant. Other hemodynamic parameters such as HR, SVR, PVR, and CVP did not change significantly. Conclusions: The Jarvik 2000 Heart can provide a level of cardiac output support that normalizes the CI and LAP, while maintaining some arterial pressure pulsatility during HF. Systemic perfusion is increased while the left heart is unloaded.

  • 277.
    Myhre, Peder L.
    et al.
    Akershus Univ Hosp, Norway; Univ Oslo, Norway; Brigham and Womens Hosp, MA 02115 USA; Harvard Med Sch, MA USA.
    Omland, Torbjorn
    Akershus Univ Hosp, Norway; Univ Oslo, Norway.
    Sarvari, Sebastian I.
    Univ Oslo, Norway; Univ Oslo, Norway.
    Ukkonen, Heikki
    Turku Univ Hosp, Finland.
    Rademakers, Frank
    Univ Hosp Leuven, Belgium; Katholieke Univ Leuven, Belgium.
    Engvall, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Hagve, Tor-Arne
    Akershus Univ Hosp, Norway; Univ Oslo, Norway.
    Nagel, Eike
    Kings Coll Hosp London, England.
    Sicari, Rosa
    CNR, Italy.
    Zamorano, Jose L.
    Hosp Univ Ramon and Cajal, Spain.
    Monaghan, Mark
    Kings Coll Hosp London, England.
    Dhooge, Jan
    Univ Hosp Leuven, Belgium; Katholieke Univ Leuven, Belgium.
    Edvardsen, Thor
    Univ Oslo, Norway.
    Rosjo, Helge
    Akershus Univ Hosp, Norway; Univ Oslo, Norway.
    Cardiac Troponin T Concentrations, Reversible Myocardial Ischemia, and Indices of Left Ventricular Remodeling in Patients with Suspected Stable Angina Pectoris: a DOPPLER-CIP Substudy2018In: Clinical Chemistry, ISSN 0009-9147, E-ISSN 1530-8561, Vol. 64, no 9, p. 1370-1379Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Cardiac troponin T concentrations measured with high-sensitivity assays (hs-cTnT) provide important prognostic information for patients with stable coronary artery disease (CAD). However, whether hsc-TnT concentrations mainly reflect left ventricular (LV) remodeling or recurrent myocardial ischemia in this population is not known. METHODS: We measured hs-cTnT concentrations in 619 subjects with suspected stable CAD in a prospectively designed multicenter study. We identified associations with indices of LV remodeling, as assessed by cardiac MRI and echocardiography, and evidence of myocardial ischemia diagnosed by single positron emission computed tomography. RESULTS: Median hs-cTnT concentration was 7.8 ng/L (interquartile range, 4.8 -11.6 ng/L), and 111 patients (18%) had hs-cTnT concentrations above the upper reference limit (amp;gt; 14 ng/L). Patients with hs-cTnT amp;gt; 14 ng/L had increased LV mass (144 +/- 40 g vs 116 +/- 34 g; P amp;lt; 0.001) and volume (179 +/- 80 mL vs 158 +/- 44 mL; P = 0.006), lower LV ejection fraction (LVEF) (59 +/- 14 vs 62 +/- 11; P = 0.006) and global longitudinal strain (14.1 +/- 3.4% vs 16.9 +/- 3.2%; P amp;lt; 0.001), and more reversible perfusion defects (P amp;lt; 0.001) and reversible wall motion abnormalities (P = 0.008). Age (P = 0.009), estimated glomerular filtration rate (P = 0.01), LV mass (P = 0.003), LVEF (P = 0.03), and evidence of reversible myocardial ischemia (P = 0.004 for perfusion defects and P = 0.02 for LV wall motion) were all associated with increasing hs-cTnT concentrations in multivariate analysis. We found analogous results when using the revised US upper reference limit of 19 ng/L. CONCLUSIONS: hs-cTnT concentrations reflect both LV mass and reversible myocardial ischemia in patients with suspected stable CAD. (c) 2018 American Association for Clinical Chemistry

  • 278.
    Müller-Wieland, Dirk
    et al.
    Asklepios Clinic St Georg, Hamburg, Germany .
    Assmann, Gerd
    Assmann-Foundation for Prevention, Münster, Germany.
    Carmena, Rafael
    University, Valencia, Spain .
    Davignon, Jean
    Faculty of Medicine at the Université de Montréal, Canada.
    von Eckardstein, Arnold
    University Hospital of Zurich, Switzerland.
    Farinaro, Eduardo
    Medical School University of Naples Federico II, Italy.
    Greten, Heiner
    Asklepios Clinic St Georg, Hamburg, Germany.
    Olsson, Anders G
    Region Östergötland, Heart and Medicine Center, Department of Endocrinology. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Stockholm Heart Centre, Sweden.
    Riesen, Walter F
    Institute for Laboratory Medicine, St Gallen, Switzerland.
    Shlyakhto, Evgenyi
    Russian Federation Agency of Health and Social Development, Saint Petersburg, Russia.
    Treat-to-target versus dose-adapted statin treatment of cholesterol to reduce cardiovascular risk.2016In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 23, no 3, p. 275-281Article in journal (Refereed)
    Abstract [en]

    Clinical guidelines should be based on the best available evidence and are of great importance for patient care and disease prevention. In this respect, the 2013 American College of Cardiology/American Heart Association report is highly appreciated and well-recognized. The report included critical questions concerning hypercholesterolaemia, but its translation into a clinical guideline initiated intense debate worldwide because of the recommendation to switch from a treat-to-target approach for low-density-lipoprotein-cholesterol to a statin dose-based strategy.

  • 279.
    Neshro, Barmano
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Structured management, Symptoms, Health-related Quality of Life and Alcohol in Patients with Atrial Fibrillation2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting at least 2.9 % of the Swedish population. Although AF is associated with increased risk of ischaemic stroke, there have been many reports on the underuse of oral anticoagulants (OAC) and non-adherence to guidelines in other areas as well. AF is also associated with disabling symptoms and decreased health-related quality of life (HRQoL), but some patients are asymptomatic. The reasons for the great variation of symptoms remain unclear. Furthermore, although research on AF has increased, studies have mainly focused on treatment, while studies on risk factors, such as alcohol consumption, have only recently gained attention.

    The aim of this thesis was to investigate whether structured care of patients with AF could improve guideline adherence and HRQoL compared to standard care, and to determine which factors affect symptoms and HRQoL prior to treatment with radiofrequency catheter ablation (RFA), as well as improvement after RFA. Furthermore, we aimed to examine the associations of alcohol consumption with cardiac biomarkers, the size of the left atrium (LA), and re-ablation.

    This thesis is based on two studies. In the ‘Structured Management and Coaching – Patients with Atrial Fibrillation’ (SMaC-PAF) study, 176 patients were recruited to the intervention group, receiving a structured follow-up programme, and 146 patients were recruited to the control group, receiving standard care. The two groups were compared in regard to adherence to guidelines and patient-reported outcome measures (PROMs) assessing symptoms and HRQoL.

    In the ‘Symptom burden, Metabolic profile, Ultrasound findings, Rhythm, neurohormonal activation, haemodynamics and health-related quality of life in patients with atrial Fibrillation’ (SMURF) study, 192 patients referred for their first RFA of AF were included. PROMs questionnaires were filled out, echocardiography was performed, and cardiac biomarkers were analysed. Alcohol consumption was assessed through interview and through analysis of ethyl glucuronide in hair (hEtG). AF recurrence and re-ablation within 12 months were examined.

    In the first study, after one year, 94% (n=112) and 74% (n=87) of patients with indication for OAC in the intervention and the control groups, respectively, actually received treatment with OAC (p <0.01). Both groups improved in anxiety and HRQoL scores over the year, but in the intervention group, arrhythmia-specific symptoms were less frequently experienced and the SF-36 scores were more similar to the norm population.

    In the second study, the most important predictors of arrhythmia-related symptoms and HRQoL prior to RFA were anxiety, depression and low-grade inflammation, while frequent AF attacks prior to RFA, freedom from AF recurrence after RFA, female gender, no enlarged LA, absence of diabetes, and the presence of heart failure were significant predictors of improvement in symptoms and HRQoL after RFA. Men with hEtG ≥7 pg/mg had higher levels of cardiac biomarkers, larger LA volumes and a higher re-ablation rate than men with hEtG <7 pg/mg, while no such findings were present in women.

    In conclusion, structured management was superior to standard care in patients with AF, emphasising the importance of structured care, adjusted to local requirements, in order to improve the care and well-being of patients with AF. Although the reasons for the great variety of symptoms in patients with AF still are not yet fully understood, it seems that psychological factors and inflammation play a role, and that improvement in symptoms and HRQoL after RFA is influenced by gender, diabetes, heart failure, LA size and the frequency of attacks before, as well as freedom from AF after, RFA. Finally, alcohol consumption corresponding to hEtG ≥7 pg/mg was associated with higher levels of cardiac biomarkers, larger LA size and a higher rate of re-ablation in men, implying that men with an hEtG-value ≥7 pg/mg have a higher risk for LA remodelling that could potentially lead to a deterioration of the AF situation.

    List of papers
    1. Structured care of patients with atrial fibrillation improves guideline adherence
    Open this publication in new window or tab >>Structured care of patients with atrial fibrillation improves guideline adherence
    2016 (English)In: Journal of Atrial Fibrillation, ISSN 1941-6911, Vol. 9, no 4Article in journal (Refereed) Published
    Abstract [en]

    There are many reports of lack of guideline adherence in the treatment of patients with atrial fibrillation (AF), and AF affects health-related quality of life (HRQoL) negatively. The aim of this study was to investigate whether structured care compared to standard care of a general AF population could improve guideline adherence and HRQoL, and reduce symptoms,anxiety and depression.

    Methods

    In total, 176 patients were recruited to the intervention and 146 patients to the control group.The intervention consisted of a structured follow-up program, while patients serving as controls received standard care. The primary outcome was guideline adherence evaluated through: appropriate use of oral anticoagulants (OAC) and antiarrhythmics, whether echocardiogram and thyroid lab tests were performed, and patient-reported outcome measures (PROMs), assessed with the questionnaires SF-36, EQ-5D, HADS and ASTA at baseline and after one year.

    Results

    Guideline adherence was significantly better in the intervention group, 91% vs. 63% (p < 0.01), mainly due to appropriate OAC treatment 94% vs. 74% (p < 0.01). Symptoms assessed with ASTA were less frequent and the negative impact of AF was reduced in the intervention group after one year/ at follow-up. Five scales in SF-36, and the visual analogue scale for current health status in EQ-5D (EQ-VAS), improved significantly in both groups.

    Conclusion

    Structured care of patients with AF significantly improved guideline adherence and patients reported fewer symptoms and a reduced negative impact on disease-specific HRQoL compared to standard care at one year follow-up.

    Place, publisher, year, edition, pages
    Overland Park, KS, United States: CardioFront LLC, 2016
    Keywords
    Atrial fibrillation, Guideline Adherence, Anticoagulants, Health-related Quality of life, Symptoms, Anxiety.
    National Category
    Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-157019 (URN)10.4022/jafib.1498 (DOI)
    Available from: 2019-05-23 Created: 2019-05-23 Last updated: 2019-06-12Bibliographically approved
    2. Factors Predicting Arrhythmia-Related Symptoms and Health-Related Quality of Life in Patients Referred for Radiofrequency Ablation of Atrial Fibrillation: An Observational Study (the SMURF Study)
    Open this publication in new window or tab >>Factors Predicting Arrhythmia-Related Symptoms and Health-Related Quality of Life in Patients Referred for Radiofrequency Ablation of Atrial Fibrillation: An Observational Study (the SMURF Study)
    2017 (English)In: JACC: Clinical Electrophysiology, ISSN 2405-500X, Vol. 3, no 5, p. 9p. 497-502Article in journal (Refereed) Published
    Abstract [en]

    Conclusions Anxiety, depression, and low-grade inflammation were the factors that predicted both arrhythmia-related symptoms and HRQoL in patients with AF. Obesity was the most significant predictor of patient general physical status. These factors need to be addressed in patients with AF to improve management of their disease. Intensive risk factor modification can be of great importance. (Reasons for Variations in Health Related Quality of Life and Symptom Burden in Patients With Atrial Fibrillation [SMURF]; NCT01553045)

    Place, publisher, year, edition, pages
    Elsevier, 2017. p. 9
    Keywords
    anxiety; arrhythmia-related symptoms; atrial fibrillation; health-related quality of life; obesity
    National Category
    Cardiac and Cardiovascular Systems
    Identifiers
    urn:nbn:se:liu:diva-145630 (URN)10.1016/j.jacep.2016.12.004 (DOI)
    Available from: 2018-03-09 Created: 2018-03-09 Last updated: 2019-05-23
    3. The association between alcohol consumption, cardiac biomarkers, left atrial size and re-ablation in patients with atrial fibrillation referred for catheter ablation
    Open this publication in new window or tab >>The association between alcohol consumption, cardiac biomarkers, left atrial size and re-ablation in patients with atrial fibrillation referred for catheter ablation
    Show others...
    2019 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 4, article id e0215121Article in journal (Refereed) Published
    Abstract [en]

    Background

    Information on alcohol consumption in patients undergoing radiofrequency ablation (RFA) of atrial fibrillation (AF) is often limited by the reliance on self-reports. The aim of this study was to describe the long-term alcohol consumption, measured as ethyl glucuronide in hair (hEtG), in patients undergoing RFA due to AF, and to examine potential associations with cardiac biomarkers, left atrial size and re-ablation within one year after the initial RFA.

    Methods

    The amount of hEtG was measured in patients referred for RFA, and a cut-off of 7 pg/mg was used. N-terminal pro B-type natriuretic peptide (NT-proBNP) and the mid-regional fragment of pro atrial natriuretic peptide (MR-proANP) were examined and maximum left atrium volume index (LAVI) was measured. The number of re-ablations was examined up to one year after the initial RFA. Analyses were stratified by gender, and adjusted for age, systolic blood pressure, body mass index, presence of heart failure and heart rhythm for analyses regarding NT-proBNP, MR-proANP and LAVI and heart rhythm being replaced by type of AF for analyses regarding re-ablation.

    Results

    In total, 192 patients were included in the study. Median (25th– 75th percentile) NT-proBNP in men with hEtG ≥ 7 vs. < 7 pg/mg was 250 (96–695) vs. 130 (49–346) pg/ml (p = 0.010), and in women it was 230 (125–480) vs. 230 (125–910) pg/ml (p = 0.810). Median MR-proANP in men with hEtG ≥ 7 vs. < 7 pg/mg was 142 (100–224) vs. 117 (83–179) pmol/l (p = 0.120) and in women it was 139 (112–206) vs. 153 (93–249) pmol/l (p = 0.965). The median of maximum LAVI was 30.1 (26.7–33.9) vs. 25.8 (21.4–32.0) ml/m2 (p = 0.017) in men, and 25.0 (18.9–29.6) vs. 25.7 (21.7–34.6) ml/m2 (p = 0.438) in women, with hEtG ≥ 7 vs. < 7 pg/ml, respectively. Adjusted analyses showed similar results, except for MR-proANP turning out significant in men with hEtG ≥ 7 vs. < 7 pg/mg (p = 0.047). The odds ratio of having a re-ablation was 3.5 (95% CI 1.3–9.6, p = 0.017) in men with hEtG ≥ 7 vs. < 7 pg/mg, while there was no significant difference in women.

    Conclusions

    In male patients with AF and hEtG ≥ 7 pg/mg, NT-proBNP and MR-proANP were higher, LA volumes larger, and there was a higher rate of re-ablations, as compared to men with hEtG < 7 pg/mg. This implies that men with an alcohol consumption corresponding to an hEtG-value ≥ 7, have a higher risk for LA remodelling that could potentially lead to a deterioration of the AF situation.

    Place, publisher, year, edition, pages
    San Francisco, CA, United States: Public Library of Science, 2019
    National Category
    Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-157020 (URN)10.1371/journal.pone.0215121 (DOI)000463992600055 ()30970005 (PubMedID)2-s2.0-85064164504 (Scopus ID)
    Note

    Funding agencies: County Council of Ostergotland [LIO-280731, LIO-445511]; Carldavid Jonsson Research Foundation; Linkoping University; Biosense Webster; Johnson Johnson; Heart Foundation

    Available from: 2019-05-23 Created: 2019-05-23 Last updated: 2019-06-12Bibliographically approved
    4. Predictors of improvement in arrhythmia-specific symptoms and health-related quality of life after catheter ablation of atrial fibrillation
    Open this publication in new window or tab >>Predictors of improvement in arrhythmia-specific symptoms and health-related quality of life after catheter ablation of atrial fibrillation
    Show others...
    2019 (English)In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 42, no 2, p. 247-255Article in journal (Refereed) Published
    Abstract [en]

    Background The primary goal of radiofrequency ablation (RFA) of atrial fibrillation (AF) is to improve symptoms and health-related quality of life (HRQoL). However, most studies have focused on predictors of AF recurrence rather than on predictors of improvement in symptoms and HRQoL. Hypothesis We sought to explore predictors of improvement in arrhythmia-specific symptoms and HRQoL after RFA of AF, and to evaluate the effects on symptoms, HRQoL, anxiety, and depression. Methods We studied 192 patients undergoing their first RFA of AF. The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), arrhythmia-specific questionnaire in tachycardia and arrhythmia (ASTA), and hospital anxiety and depression scale (HADS) questionnaires were filled out at baseline, at 4 months, and at a 1-year follow-up. Results All questionnaire scale scores improved significantly over time. In the ASTA symptom scale score, female gender and amp;gt; 10 AF episodes the month before RFA were significant positive predictors of improvement, while diabetes and AF recurrence within 12 months after RFA were significant negative predictors (R-2 = 0.18; P amp;lt; 0.001). In the ASTA HRQoL scale score, the presence of heart failure and amp;gt; 10 AF episodes the month before RFA were significant positive predictors of improvement, while diabetes, maximum left atrial volume and AF recurrence were significant negative predictors (R-2 = 0.20; P amp;lt; 0.001). Conclusion Left atrial volume, gender, diabetes, heart failure, the frequency of AF attacks prior to RFA, and recurrence of AF after RFA were significant factors affecting improvement in symptoms and HRQoL after RFA of AF. Future studies are warranted to confirm these findings.

    Place, publisher, year, edition, pages
    WILEY, 2019
    Keywords
    atrial fibrillation; catheter ablation; health-related quality of life; symptom burden
    National Category
    Cardiac and Cardiovascular Systems
    Identifiers
    urn:nbn:se:liu:diva-154666 (URN)10.1002/clc.23134 (DOI)000458424300006 ()30548275 (PubMedID)
    Note

    Funding Agencies|Biosense Webster; Carldavid Jonsson Research Foundation; County Council of Ostergotland [LIO-280731LIO-445511]; Heart Foundation, Linkoping University

    Available from: 2019-03-04 Created: 2019-03-04 Last updated: 2019-05-23
  • 280.
    Nielsen, Niels Erik
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Baranowski, Jacek
    Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Casimir Ahn, Henrik
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Editorial Material: Transvenous Implantation of a Stent Valve for Calcified Native Mitral Stenosis in ANNALS OF THORACIC SURGERY, vol 100, issue 1, pp E21-E232015In: Annals of Thoracic Surgery, ISSN 0003-4975, E-ISSN 1552-6259, Vol. 100, no 1, p. E21-E23Article in journal (Other academic)
    Abstract [en]

    We used a modified combination of the transseptal and transapical methods to facilitate the controlled delivery and use of a stent valve in a patient with calcified native mitral stenosis. A loop from the right femoral vein passing transseptally and then through the apex of the left ventricle was created, enabling highly controlled positioning and deployment of the stent valve.

  • 281.
    Nielsen, Niels-Erik
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Wallby, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Ahn, Henrik Casimir
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Dahlin, Lars-Göran
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Nylander, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Lindgren, B
    Freter, W
    Johansson, M
    Baranowski, Jacek
    Transcatheter valve-in-valve - an elegant solution to a surgical problem.2014Conference paper (Refereed)
  • 282.
    Nielsen, Niels-Erik
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Wallby, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Freter, W
    Ahn, Henrik
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Baranowski, Jacek
    Transcatheter valve implantation in a leaking degenerated aortic homograft2014Conference paper (Refereed)
  • 283.
    Nielsen, Niels-Erik
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Wallby, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Johansson, Mats
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Ahn, Henrik
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Dahlin, Lars-Göran
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Baranowski, Jacek
    Transcatheter valve implantation in 4 year old degenerated TAVI2014Conference paper (Refereed)
  • 284.
    Nielsen, Niels-Erik
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Wallby, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Wolfgang, Freter
    Ahn, Henrik
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Baranowski, Jacek
    Total percutaneous transcatheter valve implantation in native mitral stenosis in a patinent with previous transapical TACI2014Conference paper (Refereed)
  • 285.
    Nijm, Johnny
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
    Inflammation and cortisol response i coronary artery disease2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Atherosclerosis is characterized by a chronic inflammation, involving autoimmune components, in the arterial wall. An increase in proinflammatory activity relative to anti-inflammatory activity is considered to cause a progression of the disease towards plaque instability and risk of atherothrombotic events, such as acute coronary syndrome (ACS). Cortisol, the end product of the hypothalamus-pituitary-adrenal (HPA) axis, is a powerful endogenous anti-inflammatory mediator. Disturbances in the HPA axis have been reported in chronic inflammatory/autoimmune diseases, like rheumatoid arthritis. The aim of this thesis was to study various markers of systemic inflammation in patients with acute and stable conditions of coronary artery disease (CAD) and relate these findings to the cortisol response.

    Both patients with ACS and patients with stable CAD had high levels of C-reactive protein (CRP), interleukin (IL)-6 and IL-1 receptor antagonist, compared with healthy controls. In addition, patients with stable CAD had significantly more neutrophil-platelet aggregates than controls, as a possible indicator of neutrophil activation.

    The cortisol response was determined in two different cohorts of CAD patients; one consisting of patients with a first-time myocardial infarction and one consisting of patients with long-term stable CAD. From the acute phase to 3 months, the patients with a myocardial infarction showed a higher 24-h cortisol secretion and a flattened diurnal slope caused by higher cortisol levels in the evening, as compared with healthy controls. The patients with long-term stable CAD showed similarly high levels of cortisol in the evening. The levels of evening cortisol were strongly correlated with CRP and IL-6. When exposed to acute physical or acute psychological stress at 3 months, the ACS patients showed a markedly blunted cortisol response compared with healthy controls. Following the stress tests, a significant increase in CRP was observed in the patients but not in the controls, indicating a failure of the HPA axis to compensate for stress-induced inflammation in CAD.

    In the ACS patients, the time course of matrix metalloproteinases (MMPs) and their tissue inhibitor TIMP-1 was determined during the 3 months follow-up. A major finding was that the MMP-9 and TIMP-1 levels remained significantly higher in the patients at all time points compared to the controls. MMP-9 and TIMP-1, but not MMP-2, MMP-3 or MMP-7, were related to inflammatory activity, as assessed by CRP and IL-6. MMP-9 and TIMP-1 showed significant correlation with evening cortisol, even after adjustment for CRP and IL-6, lending further support for a link between ´high´ flat cortisol rhythm and systemic inflammatory activity.

    The activation status of neutrophils in stable CAD was further examined by measuring the expression, affinity state and signalling capacity of b2-integrins and the innate production of reactive oxygen species (ROS). However, the neutrophils in patients were not more activated in vivo than were cells in healthy controls, neither were they more prone to activation ex vivo. The data rather indicated an impaired function of neutrophils in stable CAD.

    The neutrophils in CAD patients showed a significantly lower number of total glucocorticoid receptors (GRs) and a lower GRa:GRb ratio compared to healthy controls, indicating a chronic over activation of the HPA axis and, possibly, a state of glucocorticoid resistance. Moreover, the evening cortisol levels in patients were associated with an overexpression of annexin-1, the ´second messenger´ of glucocorticoid action. In contrast to neutrophils in controls, the neutrophils in patients also showed a hyper responsiveness to exogenous annexin-1 resulting in impaired neutrophil function.

    To conclude, clinically stable CAD was associated with a systemic inflammatory activity, involving a high MMP-9:TIMP-1 ratio and an increased inflammatory response to acute stress but not any activation of neutrophils. This inflammatory activity was associated with a dysregulated cortisol secretion, defined by a flat diurnal rhythm and a blunted cortisol response to stress. Although the clinical relevance remains to be verified, an intriguing hypothesis is that a hyporesponsive HPA axis favours the development towards plaque instability.

    List of papers
    1. Circulating levels of proinflammatory cytokines and neutrophil-platelet aggregates in patients with coronary artery disease
    Open this publication in new window or tab >>Circulating levels of proinflammatory cytokines and neutrophil-platelet aggregates in patients with coronary artery disease
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    2005 (English)In: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 95, no 4, p. 452-456Article in journal (Refereed) Published
    Abstract [en]

    Several lines of evidence indicate that increased inflammatory activity in peripheral blood is associated with the acute coronary syndrome. Systemic inflammation in clinically stable conditions of coronary artery disease has been less studied. We examined cytokine profiles in 20 patients who had acute coronary syndrome, 45 who had angiographically verified coronary artery disease and stable angina pectoris, and 45 healthy controls. Circulating levels of C-reactive protein, interleukin-1 receptor antagonist, interleukin-2 receptor, interleukin-6, interleukin-10, and interleukin-18 were determined. Subpopulations of peripheral immune cells, including neutrophil-platelet aggregates, were analyzed by 3-color flow cytometry using a panel of monoclonal antibodies. Patients who had acute coronary syndrome and stable angina pectoris had significantly higher levels of C-reactive protein, interleukin-6, and interleukin-1 receptor antagonist than did controls, whereas levels of interleukin-2 receptor, interleukin-10, and interleukin-18 were similar across groups. Patients had significantly more neutrophils, and the numbers of neutrophil-platelet aggregates were particularly large in patients who had stable angina pectoris. High levels of C-reactive protein, interleukin-6, and interleukin-1 receptor antagonist in patients were significantly related to numbers of neutrophils and neutrophil-platelet aggregates but not to other immune cell subpopulations. The data suggest that the interaction between neutrophils and platelets is an important component of proinflammatory activity seen in peripheral blood of stable and unstable forms of coronary artery disease.

    Place, publisher, year, edition, pages
    Elsevier, 2005
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-17241 (URN)10.1016/j.amjcard.2004.10.009 (DOI)15695127 (PubMedID)
    Available from: 2009-03-12 Created: 2009-03-12 Last updated: 2017-12-13Bibliographically approved
    2. Impaired cortisol response to acute stressors in patients with coronary disease: Implications for inflammatory activity
    Open this publication in new window or tab >>Impaired cortisol response to acute stressors in patients with coronary disease: Implications for inflammatory activity
    2007 (English)In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 262, no 3, p. 375-384Article in journal (Refereed) Published
    Abstract [en]

    Objectives: Inflammation is assumed to play a major role in the progress of atherosclerotic disease. We hypothesized that an altered hypothalamic-pituitary adrenal (HPA) axis activity was linked to a disinhibited inflammatory activity in patients with coronary artery disease (CAD).

    Methods: Thirty CAD patients were assessed 12-14 weeks after a first-time acute coronary syndrome. Serum samples were assayed for C-reactive protein (CRP) and interleukin-6. Free cortisol was measured in a 24-h urine sample and in repeated saliva samples 30 min after awakening and at bedtime. The levels of inflammatory markers and cortisol were also determined before and after standardized physical and psychological stress tests.

    Results: The CAD patients had a higher 24-h cortisol secretion and a flattened diurnal slope, resulting from significantly higher cortisol levels at bedtime, compared to clinically healthy controls. The levels of evening cortisol were strongly related to inflammatory markers in serum. When exposed to acute physical and psychological stressors, the CAD patients showed a significantly blunted cortisol response compared to controls. In addition, a stress-induced increase in CRP was only observed in the patient group.

    Conclusions: Patients with CAD exhibited a cortisol pattern that markedly differed from controls. The data indicate that a dysfunctional HPA axis response involves a failure to contain inflammatory activity in CAD patients, thus providing a possible link between stress and inflammation in disease.

    Place, publisher, year, edition, pages
    Blackwell Publishing Ltd, 2007
    Keywords
    Coronary artery disease, cortisol, inflammation, myocardial infarction, stress
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-17242 (URN)10.1111/j.1365-2796.2007.01817.x (DOI)17697159 (PubMedID)
    Available from: 2009-03-12 Created: 2009-03-12 Last updated: 2017-12-13
    3. High serum matrix metalloproteinase-9 level is associated with diurnal salivary cortisol in patients with acute myocardial infarction - a 3-months follow-up
    Open this publication in new window or tab >>High serum matrix metalloproteinase-9 level is associated with diurnal salivary cortisol in patients with acute myocardial infarction - a 3-months follow-up
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Background: Matrix metalloproteinases (MMPs) and their inhibitors (TIMPs) are closely associated with inflammation and an increasing body of evidence suggests a role in coronary plaque rupture. We have recently shown that an impaired cortisol secretion is related to the enhanced inflammatory activity in patients with coronary disease. In the present paper, we studied the MMP profile in myocardial infarction (MI), its change over time and relation to diurnal salivary cortisol.

    Methods: Thirty patients with a first-time MI were assessed at day 1-3, 2 weeks and 3 months. Serum samples were assayed for C-reactive protein (CRP), interleukin-6 (IL-6), MMP-9, MMP-2, MMP-3 and TIMP-1. Free cortisol was measured in a 24-h urine sample and in repeated saliva samples 30 minutes after awakening and in the evening.

    Results: At 1-3 days, the patients showed increased levels of MMP-9, TIMP-1, IL-6 and CRP and decreased levels of MMP-2 compared to healthy controls. At 2 weeks and 3 months, the MMP-2, IL-6 and CRP levels in patients were similar to controls while the MMP-3 levels increased during follow-up. On the other hand, the levels of MMP-9 and TIMP-1 as well as the MMP-9/TIMP- ratio remained significantly increased in patients from the acute event to 3 months. At all time points, the MI patients showed a flat diurnal cortisol rhythm, as manifested by increased evening cortisol levels. At 2 weeks and 3 months, the evening salivary cortisol was an independent predictor of serum MMP-9 and TIMP-1, but not of MMP-2 or MMP-3.

    Conclusion: In a 3-months follow-up of patients with acute MI, the serum MMP-9, TIMP-1 and MMP-9/TIMP- 1 ratio remined significantly elevated despite rapid normalizations of MMP-2, IL-6 and CRP. Moreover, MMP-9 and TIMP-1 showed a close association with a flat diurnal cortisol rhythm. The data indicate a link between imbalanced MMP pattern and dysfunctional cortisol response in coronary disease with potential implications for plaque progression.

    Keywords
    Myocardial infarction, coronary artery disease, cortisol, inflammation, matrix
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-17245 (URN)
    Available from: 2009-03-12 Created: 2009-03-12 Last updated: 2010-01-14
    4. Neutrophil activation status in stable coronary artery disease.
    Open this publication in new window or tab >>Neutrophil activation status in stable coronary artery disease.
    Show others...
    2007 (English)In: PLoS ONE, ISSN 1932-6203, Vol. 2, no 10, p. e1056-Article in journal (Refereed) Published
    Abstract [en]

    Background: During the last years, neutrophils have emerged as important players in atherogenesis. They are highly activated in peripheral blood of patients with unstable angina. Moreover, a primed state of circulating neutrophils has been proposed in patients with stable angina. Our aim was to investigate the neutrophil activation status in patients with stable coronary artery disease (CAD) at conventional drug treatment.

    Methodology and principal findings: Thirty patients with stable CAD and 30 healthy controls were included using a paired design. The neutrophil expression of CD18 and high-affinity state of CD11b was analysed by flow cytometry before and after stimulation with chemoattractants. Also, the production of reactive oxygen species (ROS) was determined by chemiluminescence. During basal conditions, the neutrophil expression of CD18 or high-affinity state of CD11b did not differ between patients and controls. Chemoattractants (Interleukin-8 and Leukotriene B(4)) did not increase either the expression or the amount of high-affinity CD11b/CD18-integrins in CAD patients compared to controls, and had no effect on the production of ROS. On the other hand, the ROS production in response to C3bi-opsonised yeast particles and the neutrophils' inherent capacity to produce ROS were both significantly decreased in patients.

    Conclusion/Significance: We could not find any evidence that neutrophils in patients with stable CAD were primed, i.e. more prone to activation, compared to cells from healthy controls. According to our data, the circulating neutrophils in CAD patients rather showed an impaired activation status. It remains to be elucidated whether the neutrophil dysfunction in CAD is mainly a marker of chronic disease, an atherogenic factor or a consequence of the drug treatment.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-17246 (URN)10.1371/journal.pone.0001056 (DOI)17957240 (PubMedID)
    Available from: 2009-03-12 Created: 2009-03-12 Last updated: 2010-01-14
    5. Enhanced Neutrophil Expression of Annexin-1 in Coronary Artery Disease
    Open this publication in new window or tab >>Enhanced Neutrophil Expression of Annexin-1 in Coronary Artery Disease
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    2010 (English)In: Metabolism: Clinical and Experimental, ISSN 0026-0495, E-ISSN 1532-8600, Vol. 59, no 3, p. 443-440Article in journal (Refereed) Published
    Abstract [en]

    Background: A dysregulated cortisol response in patients with stable coronary artery disease (CAD) is related to systemic inflammatory activity. Moreover, a dysfunctional activation status of neutrophils in CAD has been discussed. The anti-inflammatory actions of glucocorticoids are mediated by annexin-1 (ANXA1), a protein mainly expressed by innate immune cells. An altered expression of glucocorticoid receptors (GR) and ANXA1 has been associated with glucocorticoid resistance.

    Methods and Results: Salivary cortisol levels were measured in the morning and evening during 3 consecutive days in 30 CAD patients and 30 healthy individuals. The neutrophil expression of GR and ANXA1 was determined by flow cytometry. The effect of exogenous ANXA1 was determined in neutrophil stimulation assays. The patients showed a flattened diurnal cortisol pattern compared to healthy subjects, involving higher levels in the evening. The neutrophil expression of GRtotal and GRα, as well as the ratio of GRα:GRβ expression was significantly decreased in patients, whereas the GRβ expression did not differ compared to controls. The neutrophil expression of ANXA1 was significantly increased in patients. Ex vivo, ANXA1 suppressed LTB4-induced ROS production in neutrophils from patients, but not from controls. On the other hand, ANXA1 impaired the LTB4-induced up-regulation of β2-integrins in both patients and controls.

    Conclusion: CAD patients displayed a more flattened diurnal cortisol rhythm caused by higher cortisol levels in the evening compared to healthy subjects. Our findings indicate a chronic overactivation of the hypothalamic-pituitary-adrenal (HPA) axis but give no conclusive evidence for glucocorticoid resistance, as assessed by the neutrophil expression of GR and ANXA1. The data rather point towards an increased anti-inflammatory potential in neutrophils from patients with stable CAD.

    Keywords
    Coronary artery disease, cortisol, neutrophil, glucocorticoid receptor, annexin-1
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-17247 (URN)10.1016/j.metabol.2009.07.044 (DOI)000276761800021 ()
    Note
    Original Publication: Eva Särndahl, Ida Bergström, Johnny Nijm, Tony Forslund, Mauro Perretti and Lena Jonasson, Enhanced Neutrophil Expression of Annexin-1 in Coronary Artery Disease, 2010, Metabolism: Clinical and Experimental, (59), 3, 443-440. http://dx.doi.org/10.1016/j.metabol.2009.07.044 Copyright: Elsevier Science B.V., Amsterdam http://www.elsevier.com/ Available from: 2009-03-12 Created: 2009-03-12 Last updated: 2017-12-13
  • 286.
    Nitta, Daisuke
    et al.
    University of Tokyo, Japan.
    Kinugawa, Koichiro
    Toyama University, Japan.
    Imamura, Teruhiko
    University of Tokyo, Japan.
    Perkiö Kato, Naoko
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. University of Tokyo, Japan.
    Komuro, Issei
    University of Tokyo, Japan.
    High Dose beta-Blocker Therapy Triggers Additional Reverse Remodeling in Patients With Idiopathic Non-Ischemic Cardiomyopathy A Lesson From a Preliminary Trial Including the Significance of Left Ventricular Diameter and BNP Change for Reverse Remodeling2016In: International Heart Journal, ISSN 1349-2365, E-ISSN 1349-3299, Vol. 57, no 6, p. 717-724Article in journal (Refereed)
    Abstract [en]

    Carvedilol has established its evidence to improve prognosis and facilitate left ventricular reverse remodeling (LVRR) in heart failure patients with reduced left ventricular ejection fraction (LVEF), and many studies have supported its dose-dependency. However, there are few studies demonstrating the effect of high dose carvedilol in Japan. We enrolled 23 patients with idiopathic non-ischemic cardiomyopathy, in whom LVEF remained 45% or less despite 20 mg/ day of carvedilol therapy for amp;gt; 3 months. After high dose (40 mg/day) carvedilol therapy for amp;gt; 3 months, LVEF improved (+9.1%, P = 0.002), and LV end-diastolic diameter (LVDd) and LV end-systolic diameter (LVDs) reduced (-4.6 and -6.9 mm, respectively, P amp;lt; 0.05) compared with the baseline data. Finally, 17 patients achieved LVRR after the high dose, when LVRR was defined as 1) those with final EF amp;gt; 45%, and 2) those with final EF amp;lt; 45% but who attained increases in LVEF amp;gt; 10%, or LVEF amp;gt; 5% with a decrease in LV end-diastolic dimension index (LVDDI) amp;gt; 5%. Baseline predictors for LVRR after high dose carvedilol were the change rates of log B-type natriuretic peptide (BNP), LVDd, and LVDs from the time of pre-carvedilol introduction to enrollment (P amp;lt; 0.05, respectively). In conclusion, high dose carvedilol triggered additional LVRR in patients with idiopathic non-ischemic cardiomyopathy and the change rates of log BNP, LVDd, and LVDs at 20 mg carvedilol may be predictors for the additional LVRR at high dose.

  • 287.
    Nord, Anette
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Svensson, Leif
    Department of Medicine, Center for Resuscitation Science, Karolinska Institute, Solna, Sweden.
    Karlsson, Thomas
    Health Metrics Unit, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg University, Gothenburg, Sweden.
    Claesson, Andreas
    Department of Medicine, Center for Resuscitation Science, Karolinska Institute, Solna, Sweden.
    Herlitz, Johan
    Prehospen-Center for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.
    Nilsson, Lennart
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Increased survival from out-of-hospital cardiac arrest when off duty medically educated personnel perform CPR compared with laymen.2017In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 120, p. 88-94Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Bystander cardiopulmonary resuscitation (CPR) has been proved to save lives; however, whether survival is affected by the training level of the bystander is not fully described.

    AIM: To describe if the training level of laymen and medically educated bystanders affect 30-day survival in out-of-hospital cardiac arrests (OHCA).

    METHODS: This observational study included all witnessed and treated cases of bystander CPR reported to the Swedish Registry of Cardiopulmonary Resuscitation between 2010 and 2014. Bystander CPR was divided into two categories: (a) lay-byCPR (non-medically educated) and (b) med-byCPR (off duty medically educated personnel).

    RESULTS: During 2010-2014, 24,643 patients were reported to the OHCA registry, of which 6850 received lay-byCPR and 1444 med-byCPR; 16,349 crew-witnessed and non-witnessed cases and those with missing information were excluded from the analysis. The median interval from collapse to call for emergency medical services was 2min in both groups (p=0.97) and 2min from collapse to start of CPR for lay-byCPR versus 1min for med-byCPR (p<0.0001). There were no significant differences in CPR methods used; 64.3% (lay-byCPR) and 65.7% (med-byCPR) applied compressions and ventilation, respectively (p=0.33). The 30-day survival was 14.7% for lay-byCPR and 17.2% for the med-byCPR group (p=0.02). The odds ratio adjusted for potential confounders regarding survival (med-byCPR versus lay-byCPR) was 1.34 (95% confidence interval, 1.11-1.62; p=0.002).

    CONCLUSIONS: In cases of OHCA, medically educated bystanders initiated CPR earlier and an increased 30-day survival was found compared with laymen bystanders. These results support the need to improve the education programme for laypeople.

  • 288.
    Nord, Maria
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Divison of Neurobiology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Neurology.
    Kullman, Anita
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science.
    Hannestad, Ulf
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Dizdar Segrell, Nil
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Neurology.
    Is Levodopa Pharmacokinetics in Patients with Parkinson’s Disease Depending on Gastric Emptying?2017In: Advances in Parkinsons Disease, ISSN 2169-9712, Vol. 06, no 01Article in journal (Refereed)
    Abstract [en]

    Levodopa uptake from the gastrointestinal tract in patients with Parkinson’s disease (PD) can be affected by delayed gastric emptying (GE). This might lead to fluctuating levodopa levels resulting in increased motor fluctuations. Continuous dopaminergic stimulation (CDS) improves motor fluctuations and could be a result of smoothening in levodopa uptake. In this study we wanted to study the levodopa pharmacokinetics peripherally in PD patients with motor fluctuations and investigate the relation between levodopa uptake and GE and the effect of CDS. PD patients with wearing off (group 1) and on-off syndrome (group 2) were included. Breath tests were performed to evaluate the half time (T1/2) of GE. Concomitantly 1 tablet of Madopark® was given and the levodopa concentrations in blood and subcutaneous (SC) tissue were analyzed for both groups. Group 2 was then given a 10-d continuous intravenous levodopa treatment and the tests were repeated. Higher levels of levodopa in group 1 compared to group 2 in blood (p = 0.014) were seen. The GE was delayed in both group 1 (p < 0.001) and group 2 (p < 0.05) compared to a reference group with healthy volunteers with T1/2 median values 105 and 78 min vs. 72 min. There was no difference in GE between the two PD groups (p = 0.220) or in group 2 before and after infusion period (p = 0.861). CDS resulted in lower levodopa levels in blood (p < 0.001) and SC tissue (p < 0.01). In conclusion, PD patients in early complication phase have a more favourable levodopa uptake than patients later in disease. We found delayed GE in PD patients with motor fluctuations but no obvious relation between GE and levodopa uptake or GE and PD stage. The effect of CDS indicates no effect of CDS on the mechanisms of GE but on the mechanisms of levodopa uptake.

  • 289.
    Nord, Maria
    et al.
    Region Östergötland, Local Health Care Services in Central Östergötland, Department of Neurology.
    Zsigmond, Peter
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Neurosurgery.
    Kullman, Anita
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Dizdar Segrell, Nil
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Neurology.
    Levodopa Pharmacokinetics in Brain after Both Oral and Intravenous Levodopa in One Patient with Advanced Parkinson’s Disease2017In: Advances in Parkinsons Disease, ISSN 2169-9712, Vol. 6, no 2, p. 52-66Article in journal (Refereed)
    Abstract [en]

    Objective: One patient received oral levodopa during a study aiming for better understanding of the basal ganglia and of the mechanisms of deep brain stimulation of the subthalamic nucleus (STN DBS) with and without intravenous (IV) levodopa infusion in patients with Parkinson’s disease (PD). The results from oral and IV levodopa treatment are presented.

    Methods: Five patients with advanced PD were included in the original study. During planned STN DBS surgery microdialysis probes were implanted in the right putamen and in the right and left globus pallidus interna (Gpi). During the study, microdialysis was performed continuously and STN DBS, with and without IV levodopa infusion, was performed according to a specific protocol. After DBS surgery, but before STN DBS was started, one patient received oral levodopa/ benserazide and entacapone tablets out of protocol due to distressing parkinsonism.

    Results: The levodopa levels increased prompt in the central nervous system after the first PD medication intakes but declined after the last. Immediately the levodopa seemed to be metabolized to dopamine (DA) since the levels of DA correlated well with levodopa concentrations. Left STN DBS seemed to further increase DA levels in left Gpi while right STN DBS seemed to increase DA levels in the right putamen and right Gpi. There was no obvious effect on levodopa levels.

    Conclusions: The results indicate that PD patients still have capacity to metabolize levodopa to DA despite advanced disease with on-off symptoms and probably pronounced nigral degeneration. STN DBS seems to increase DA levels with a more pronounced effect on ipsilateral structures in striatum.

  • 290.
    Nystrom, Thomas
    et al.
    Karolinska Inst, Sweden.
    James, Stefan K.
    Uppsala Univ, Sweden.
    Lindahl, Bertil
    Uppsala Univ, Sweden; Uppsala Univ, Sweden.
    Ostlund, Ollie
    Uppsala Univ, Sweden.
    Erlinge, David
    Lund Univ, Sweden.
    Herlitz, Johan
    Univ Boras, Sweden.
    Omerovic, Elmir
    Univ Gothenburg, Sweden.
    Mellbin, Linda
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Alfredsson, Joakim
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Frobert, Ole
    Orebro Univ, Sweden.
    Jernberg, Tomas
    Karolinska Inst, Sweden.
    Hofmann, Robin
    Karolinska Inst, Sweden.
    Oxygen Therapy in Myocardial Infarction Patients With or Without Diabetes: A Predefined Subgroup Analysis From the DETO2X-AMI Trial2019In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 42, no 11, p. 2032-2041Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE To determine the effects of oxygen therapy in myocardial infarction (MI) patients with and without diabetes. RESEARCH DESIGN AND METHODS In the Determination of the Role of Oxygen in Suspected Acute Myocardial Infarction (DETO2X-AMI) trial, 6,629 normoxemic patients with suspected MI were randomized to oxygen at 6 L/min for 6-12 h or ambient air. In this prespecified analysis involving 5,010 patients with confirmed MI, 934 had known diabetes. Oxidative stress may be of particular importance in diabetes, and the primary objective was to study the effect of supplemental oxygen on the composite of all-cause death and rehospitalization with MI or heart failure (HF) at 1 year in patients with and without diabetes. RESULTS As expected, event rates were significantly higher in patients with diabetes compared with patients without diabetes (main composite end point: hazard ratio [HR] 1.60 [95% CI 1.32-1.93], P amp;lt; 0.01). In patients with diabetes, the main composite end point occurred in 16.2% (72 of 445) allocated to oxygen as compared with 16.6% (81 of 489) allocated to ambient air (HR 0.93 [95% CI 0.67-1.27], P = 0.81). There was no statistically significant difference for the individual components of the composite end point or the rate of cardiovascular death up to 1 year. Likewise, corresponding end points in patients without diabetes were similar between the treatment groups. CONCLUSIONS Despite markedly higher event rates in patients with MI and diabetes, oxygen therapy did not significantly affect 1-year all-cause death, cardiovascular death, or rehospitalization with MI or HF, irrespective of underlying diabetes, in line with the results of the entire study.

  • 291.
    Nägga, Katarina
    et al.
    Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine in Linköping. Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Clinical Memory Research Unit Lund University.
    Mayer, Sibylle
    Cinical Memory Research Unit Lund University.
    Marcusson, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine in Linköping.
    Wressle, Ewa
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine in Linköping.
    Evaluation of short cognitive screening tests in 85-year-old men and women2015In: European Geriatric Medicine, ISSN 1878-7649, E-ISSN 1878-7657, Vol. 6, no 6, p. 545-550Article in journal (Refereed)
    Abstract [en]

    Introduction: The study aimed to investigate different aspects of cognition using the Cognitive Assessment Battery (CAB) in community-dwelling older adults aged 85 years. We also investigated the eventual influence of sex on the results and aimed to identify predictors for further cognitive decline after 1 year. Methods: CAB consists of 10 subtests covering the cognitive domains of speed and attention, learning and episodic memory, visuospatial abilities, language, and executive functions. Cognitive tests were performed at baseline (n = 335) and follow-up after 1 year (n = 270). Results: Univariate statistics revealed that men performed better than women on episodic memory (P < 0.05) and on the naming test (P < 0.001). However, floor effects in the paragraph memory test were revealed. There was a high rate of abnormal results on Token Test (67%), PaSMO (50%), Clox (48%), and the cube copying (40%) tests in participants with normal cognition. Logistic regression showed that impaired results on the Stroop III test (odds ratio, 2.38; P < 0.05) was independently associated with an increased risk of cognitive decline. Conclusion: Men performed better than women on the memory and on the naming test. However, due to floor effects in the paragraph memory test in 85 year olds, these results can be disputed. The high rate of abnormal results on the Token Test, PaSMO, Clox, and the cube copying tests in cases with normal cognition indicate that these tests are less suitable for screening in the age group. Impaired result on the Stroop test increased the risk more than two-fold for cognitive decline after 1 year.

  • 292.
    Ognissanti, Damiano
    et al.
    Chalmers Univ Technol, Sweden; Univ Gothenburg, Sweden.
    Bjurman, Christian
    Univ Gothenburg, Sweden.
    Holzmann, Martin J.
    Karolinska Univ Hosp, Sweden; Karolinska Univ Hosp, Sweden.
    Theodorsson, Elvar
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Chemistry.
    Petzold, Max
    Univ Gothenburg, Sweden.
    Cvijovic, Marija
    Chalmers Univ Technol, Sweden; Univ Gothenburg, Sweden.
    Hammarsten, Ola
    Univ Gothenburg, Sweden.
    Cardiac troponin T concentrations and patient-specific risk of myocardial infarction using the novel PALfx parameter2019In: Clinical Biochemistry, ISSN 0009-9120, E-ISSN 1873-2933, Vol. 66, p. 21-28Article in journal (Refereed)
    Abstract [en]

    Background: Myocardial infarction (MI) is more likely if the heart damage biomarker cardiac troponin T (cTnT) is elevated in a blood sample from a patient with chest pain. There is no conventional method to estimate the risk of MI at a specific cTnT concentration. The purpose of this study was to evaluate the performance of a novel method that converts cTnT concentrations to patient-specific risks of MI. Methods: Admission cTnT measurements in 15,425 ED patients from three hospitals with a primary complaint of chest pain, with or without a clinical diagnosis of MI, were Box-Cox-transformed to normality density functions to calculate the percentage with MI among patients with a given cTnT concentration, the parametric predictive value among lookalikes (PALfx). The ability of the PALfx to generate stable risk estimates of MI was examined by bootstrapping and expressed as the coefficient of variation (CV). Results: Four age and sex-specific subgroups above or below 60 years of age with distinct cTnT distributions were identified among patients without MI. The cTnT distributions across subgroups with MI were similar, allowing us to use all admissions with MI to calculate the PALfx in the four subgroups. For instance, at a baseline cTnT concentration of 7 ng/L, a female patient amp;lt;60 years would have a 0.5% risk of MI whereas a male patient amp;gt;60 years would have a 1.9% risk of MI. To assess the stability of the PALfx method we bootstrapped smaller and smaller subsets of the 15,422 ED visits. We found that 1950 patients without MI and 50 patients with MI were sufficient to limit the variation of the PALfx with a CV of 0.8-5.4%, close to the CV using the entire dataset. The MI risk estimates were similar when data from the three hospitals were used separately to derive the PALfx equations. Conclusions: The PALfx can be used to estimate the risk of MI at patient-specific cTnT concentrations with acceptable margins of error. The patient-specific risk of disease using the PALfx could complement decision limits.

  • 293.
    Olsson, Anders
    Linköping University, Department of Medical and Health Sciences, Internal Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Endocrinology and Gastroenterology.
    NICE lipid modification guideline:both absolute and obsolete!2008In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 94, no 10, p. 1256-1257Article in journal (Other academic)
    Abstract [en]

    Guidelines for the prevention of cardiovascular disease (CVD)are greatly time-dependent owing to the rapid increase in knowledgein this important research area. However, at each point in timethe knowledge base behind all guidelines on CVD prevention—forexample, blood lipid modification, is common, internationaland easily available to all clinical scientists and opinionleaders engaged in the formulation of these guidelines. Nevertheless,they differ markedly between continents, countries and regions.There are several reasons for this: from factual differencesin risk factor distribution between different populations tolocal customs and traditions and individual influences fromscientists and clinicians involved in the authorship of theguidelines. Recently a new guideline for lipid modificationby the National Institute for Health and Clinical Excellencein the United Kingdom was issued

  • 294.
    Olsson, Anki
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Department of Health Science, Karlskrona, Blekinge Hospital, Karlskrona, Sweden.
    Alfredsson, Joakim
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Ramström, Sofia
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Chemistry.
    Svedjeholm, Rolf
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Kenny, Dermot
    Clinical Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland.
    Håkansson, Eric
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Berglund, Johan Sanmartin
    Department of Health Science, Karlskrona, Sweden.
    Berg, Sören
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Better platelet function, less fibrinolysis and less hemolysis in re-transfused residual pump blood with the Ringer's chase technique: a randomized pilot study2018In: Perfusion, ISSN 0267-6591, E-ISSN 1477-111X, Vol. 33, no 3, p. 185-193Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Residual pump blood from the cardiopulmonary bypass (CPB) circuit is often collected into an infusion bag (IB) and re-transfused. An alternative is to chase the residual blood into the circulation through the arterial cannula with Ringer's acetate. Our aim was to assess possible differences in hemostatic blood quality between these two techniques.

    METHODS: Forty adult patients undergoing elective coronary artery bypass graft surgery with CPB were randomized to receive the residual pump blood by either an IB or through the Ringer's chase (RC) technique. Platelet activation and function (impedance aggregometry), coagulation and hemolysis variables were assessed in the re-transfused blood and in the patients before, during and after surgery. Results are presented as median (25-75 quartiles).

    RESULTS: Total hemoglobin and platelet levels in the re-transfused blood were comparable with the two methods, as were soluble platelet activation markers P-selectin and soluble glycoprotein VI (GPVI). Platelet aggregation (U) in the IB blood was significantly lower compared to the RC blood, with the agonists adenosine diphosphate (ADP) 24 (10-32) vs 46 (33-65), p<0.01, thrombin receptor activating peptide (TRAP) 50 (29-73) vs 69 (51-92), p=0.04 and collagen 24 (17-28) vs 34 (26-59), p<0.01. The IB blood had higher amounts of free hemoglobin (mg/L) (1086 (891-1717) vs 591(517-646), p<0.01) and D-dimer 0.60 (0.33-0.98) vs 0.3 (0.3-0.48), p<0.01. Other coagulation variables showed no difference between the groups.

    CONCLUSIONS: The handling of blood after CPB increases hemolysis, impairs platelet function and activates coagulation and fibrinolysis. The RC technique preserved the blood better than the commonly used IB technique.

  • 295.
    Panayi, Georgios
    et al.
    Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Wieringa, Wouter G.
    University of Groningen, Netherlands.
    Alfredsson, Joakim
    Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine.
    Carlsson, Jorg
    Kalmar County Hospital, Sweden; Linnaeus University, Sweden.
    Karlsson, Jan-Erik
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. County Hospital Ryhov, Sweden.
    Persson, Anders
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Radiology in Linköping. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Engvall, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Pundziute, Gabija
    University of Groningen, Netherlands.
    Swahn, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Computed tomography coronary angiography in patients with acute myocardial infarction and normal invasive coronary angiography2016In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 16, no 78Article in journal (Refereed)
    Abstract [en]

    Background: Three to five percent of patients with acute myocardial infarction (AMI) have normal coronary arteries on invasive coronary angiography (ICA). The aim of this study was to assess the presence and characteristics of atherosclerotic plaques on computed tomography coronary angiography (CTCA) and describe the clinical characteristics of this group of patients. Methods: This was a multicentre, prospective, descriptive study on CTCA evaluation in thirty patients fulfilling criteria for AMI and without visible coronary plaques on ICA. CTCA evaluation was performed head to head in consensus by two experienced observers blinded to baseline patient characteristics and ICA results. Analysis of plaque characteristics and plaque effect on the arterial lumen was performed. Coronary segments were visually scored for the presence of plaque. Seventeen segments were differentiated, according to a modified American Heart Association classification. Echocardiography performed according to routine during the initial hospitalisation was retrieved for analysis of wall motion abnormalities and left ventricular systolic function in most patients. Results: Twenty-five patients presented with non ST-elevation myocardial infarction (NSTEMI) and five with ST-elevation myocardial infarction (STEMI). Mean age was 60.2 years and 23/30 were women. The prevalence of risk factors of coronary artery disease (CAD) was low. In total, 452 coronary segments were analysed. Eighty percent (24/30) had completely normal coronary arteries and twenty percent (6/30) had coronary atherosclerosis on CTCA. In patients with atherosclerotic plaques, the median number of segments with plaque per patient was one. Echocardiography was normal in 4/22 patients based on normal global longitudinal strain (GLS) and normal wall motion score index (WMSI); 4/22 patients had normal GLS with pathological WMSI; 3/22 patients had pathological GLS and normal WMSI; 11/22 patients had pathological GLS and WMSI and among them we could identify 5 patients with a Takotsubo pattern on echo. Conclusions: Despite a diagnosis of AMI, 80 % of patients with normal ICA showed no coronary plaques on CTCA. The remaining 20 % had only minimal non-obstructive atherosclerosis. Patients fulfilling clinical criteria for AMI but with completely normal ICA need further evaluation, suggestively with magnetic resonance imaging (MRI).

  • 296.
    Papadopoulou-Marketou, Nektaria
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Endocrinology. University of Athens, Greece.
    Kanaka-Gantenbein, Christina
    University of Athens, Greece.
    Marketos, Nikolaos
    Henri Dunant Hospital, Greece.
    Chrousos, George P.
    University of Athens, Greece.
    Papassotiriou, Ioannis
    Aghia Sophia Childrens Hospital, Greece.
    Biomarkers of diabetic nephropathy: A 2017 update2017In: Critical reviews in clinical laboratory sciences, ISSN 1040-8363, E-ISSN 1549-781X, Vol. 54, no 5, p. 326-342Article, review/survey (Refereed)
    Abstract [en]

    Diabetic nephropathy (DN), also named diabetic kidney disease (DKD), is a devastating complication in patients with both type 1 and 2 diabetes mellitus (T1D and T2D) and its diagnosis has been traditionally based on the presence of micro-albuminuria (MA). The aim of this article is to update, through review of the relevant medical literature, the most promising biomarkers for early DKD detection. MA has historically been employed as an early marker of microvascular complications, indicating risk for advanced CKD. However, due to the inability of MA to adequately predict DKD, especially in young patients or in non-albuminuric DKD, additional biomarkers of glomerular and/or tubular injury have been proposed to uncover early renal dysfunction and structural lesions, even before MA occurs. Defining new predictive biomarkers to use alongside urinary albumin excretion (UAE) during the initial stages of DKD would provide a window of opportunity for preventive and/or therapeutic interventions to prevent or delay the onset of irreversible long-term complications and to improve outcomes by minimizing the rates of severe cardio-renal morbidity and mortality in DKD patients.

  • 297.
    Paren, Pär
    et al.
    Sahlgrenska Univ Hosp Molndal, Sweden; Univ Gothenburg, Sweden.
    Dahlström, Ulf
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Edner, Magnus
    Karolinska Univ Hosp, Sweden.
    Lappas, Georgios
    Univ Gothenburg, Sweden.
    Rosengren, Annika
    Univ Gothenburg, Sweden.
    Schaufelberger, Maria
    Univ Gothenburg, Sweden.
    Association of diuretic treatment at hospital discharge in patients with heart failure with all-cause short- and long-termmortality: A propensity score-matched analysis from SwedeHF2018In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 257, p. 118-124Article in journal (Refereed)
    Abstract [en]

    Aims: Diuretics are recommended for treating congestive symptoms in heart failure (HF). The short-and long-term prognostic effects of diuretic treatment at hospital discharge have not been studied in randomized clinical trials or in a Western world population. We aimed to determine the association of diuretic treatment at discharge with the risk of short- and long-termall-cause mortality in real-life patients in Sweden with HF irrespective of EF. Methods and results: From a Swedish nationwide HF register 26,218 patients discharged from hospital were included in the present study. A total of 87% of patients were treated with and 13% were not treated with diuretics at hospital discharge. In a 1:1 propensity score-matched cohort of 6564 patients, the association of diuretic treatment at hospital discharge with the risk of 90-day all-cause mortality was neutral (HR 0.89, 95% CI 0.74-1.07, p = 0.21) whereas the risk of long-term all-cause mortality (median follow-up: 2.85 years) was increased (HR 1.15, 95% CI 1.06-1.24, p amp;lt; 0.001). Conclusion: Diuretic treatment at hospital discharge was not associated with short-term mortality whereas it was associated with increased long-term mortality. Although we accounted for a wide range of clinical features, measured or unmeasured factors could still explain this increase in risk. However, our results suggest that diuretic treatment at hospital discharge may be regarded as a marker of increased long-term mortality. (C) 2017 The Authors. Published by Elsevier Ireland Ltd.

  • 298.
    Persson, Anders
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Radiology in Linköping. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Baeckmann, John
    Natl Board Forens Med Linkoping, Dept Forens Med, Linkoping, Sweden.
    Berge, Johan
    Natl Board Forens Med Linkoping, Dept Forens Med, Linkoping, Sweden.
    Jackowski, Christian
    Univ Bern, Switzerland.
    Warntjes, Marcel Jan Bertus
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Zech, Wolf-Dieter
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Natl Board Forens Med Linkoping, Dept Forens Med, Linkoping, Sweden; Univ Bern, Switzerland.
    Temperature-corrected postmortem 3-T MR quantification of histopathological early acute and chronic myocardial infarction: a feasibility study2018In: International journal of legal medicine (Print), ISSN 0937-9827, E-ISSN 1437-1596, Vol. 132, no 2, p. 541-549Article in journal (Refereed)
    Abstract [en]

    The goal of the present study was to evaluate if quantitative postmortem cardiac 3-T magnetic resonance (QPMCMR) T1 and T2 relaxation times and proton density values of histopathological early acute and chronic myocardial infarction differ to the quantitative values of non-pathologic myocardium and other histopathological age stages of myocardial infarction with regard to varying corpse temperatures. In 60 forensic corpses (25 female, 35 male), a cardiac 3-T MR quantification sequence was performed prior to autopsy and cardiac dissection. Core body temperature was assessed during MR examinations. Focal myocardial signal alterations in synthetically generated MR images were measured for their T1, T2, and proton density (PD) values. Locations of signal alteration measurements in PMCMR were targeted at heart dissection, and myocardial tissue specimens were taken for histologic examinations. Quantified signal alterations in QPMCMR were correlated to their according histologic age stage of myocardial infarction, and quantitative values were corrected for a temperature of 37 A degrees C. In QPMCMR, 49 myocardial signal alterations were detected in 43 of 60 investigated hearts. Signal alterations were diagnosed histologically as early acute (n = 16), acute (n = 10), acute with hemorrhagic component (n = 9), subacute (n = 3), and chronic (n = 11) myocardial infarction. Statistical analysis revealed that based on their temperature-corrected quantitative T1, T2, and PD values, a significant difference between early acute, acute, and chronic myocardial infarction can be determined. It can be concluded that quantitative 3-T postmortem cardiac MR based on temperature-corrected T1, T2, and PD values may be feasible for pre-autopsy diagnosis of histopathological early acute, acute, and chronic myocardial infarction, which needs to be confirmed histologically.

  • 299.
    Pikkemaat, Miriam
    et al.
    Husensjo Hlth Care Ctr, Sweden; Lund Univ, Sweden.
    Andersson, Tobias
    Narhalsan Norrmalm Hlth Ctr, Sweden; Univ Gothenburg, Sweden.
    Melander, Olle
    Lund Univ, Sweden.
    Chalmers, John
    UNSW Sydney, Australia.
    Rådholm, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Ödeshög. UNSW Sydney, Australia.
    Bostrom, Kristina Bengtsson
    Univ Gothenburg, Sweden; RandD Ctr Skaraborg Primary Care, Sweden.
    C-peptide predicts all-cause and cardiovascular death in a cohort of individuals with newly diagnosed type 2 diabetes. The Skaraborg diabetes register2019In: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 150, p. 174-183Article in journal (Refereed)
    Abstract [en]

    Aims

    To study the association between baseline level of C-peptide and all-cause death, cardiovascular death and cardiovascular complications among persons with newly diagnosed type 2 diabetes.

    Methods

    The Skaraborg Diabetes Register contains data on baseline C-peptide concentrations among 398 persons <65 years with newly diagnosed type 2 diabetes 1996–1998. National registries were used to determine all-cause death, cardiovascular death and incidence of myocardial infarction and ischemic stroke until 31 December 2014. The association between baseline C-peptide and outcomes were evaluated with adjustment for multiple confounders by Cox regression analysis. Missing data were handled by multiple imputation.

    Results

    In the imputed and fully adjusted model there was a significant association between 1 nmol/l increase in C-peptide concentration and all-cause death (HR 2.20, 95% CI 1.49–3.25, p < 0.001, number of events = 104), underlying cardiovascular death (HR 2.69, 1.49–4.85, p = 0.001, n = 35) and the composite outcome of underlying cardiovascular death, myocardial infarction or ischemic stroke (HR 1.61, 1.06–2.45, p = 0.027, n = 90).

    Conclusions

    Elevated C-peptide levels at baseline in persons with newly diagnosed type 2 diabetes are associated with increased risk of all-cause and cardiovascular mortality. C-peptide might be used to identify persons at high risk of cardiovascular complications and premature death.

  • 300.
    Pitts, Reynaria
    et al.
    VA Medical Centre, CO USA; University of Colorado, CO USA.
    Gunzburger, Elise
    University of Colorado, CO USA.
    Ballantyne, Christie M.
    Baylor Coll Med, TX 77030 USA.
    Barter, Philip J.
    University of New South Wales, Australia.
    Kallend, David
    Medicines Co, Switzerland.
    Leiter, Lawrence A.
    University of Toronto, Canada; University of Toronto, Canada.
    Leitersdorf, Eran
    Hadassah Hebrew University, Israel.
    Nicholls, Stephen J.
    University of Adelaide, Australia; University of Adelaide, Australia.
    Shah, Prediman K.
    Cedars Sinai Heart Institute, CA USA.
    Tardif, Jean-Claude
    University of Montreal, Canada.
    Olsson, Anders
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Endocrinology.
    McMurray, John J. V.
    University of Glasgow, Scotland.
    Kittelson, John
    University of Colorado, CO USA.
    Schwartz, Gregory G.
    VA Medical Centre, CO USA; University of Colorado, CO USA.
    Aldosterone Does Not Predict Cardiovascular Events Following Acute Coronary Syndrome in Patients Initially Without Heart Failure2017In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 6, no 1, article id e004119Article in journal (Refereed)
    Abstract [en]

    Background- Aldosterone may have adverse effects in the myocardium and vasculature. Treatment with an aldosterone antagonist reduces cardiovascular risk in patients with acute myocardial infarction complicated by heart failure (HF) and left ventricular systolic dysfunction. However, most patients with acute coronary syndrome do not have advanced HF. Among such patients, it is unknown whether aldosterone predicts cardiovascular risk. Methods and Results- To address this question, we examined data from the dal-OUTCOMES trial that compared the cholesteryl ester transfer protein inhibitor dalcetrapib with placebo, beginning 4 to 12 weeks after an index acute coronary syndrome. Patients with New York Heart Association class II (with LVEF amp;lt; 40%), III, or IV HF were excluded. Aldosterone was measured at randomization in 4073 patients. The primary outcome was a composite of coronary heart disease death, nonfatal myocardial infarction, stroke, hospitalization for unstable angina, or resuscitated cardiac arrest. Hospitalization for HF was a secondary endpoint. Over a median follow-up of 37 months, the primary outcome occurred in 366 patients (9.0%), and hospitalization for HF occurred in 72 patients (1.8%). There was no association between aldosterone and either the time to first occurrence of a primary outcome (hazard ratio for doubling of aldosterone 0.92, 95% confidence interval 0.78-1.09, P=0.34) or hospitalization for HF (hazard ratio 1.38, 95% CI 0.96-1.99, P=0.08) in Cox regression models adjusted for covariates. Conclusions- In patients with recent acute coronary syndrome but without advanced HF, aldosterone does not predict major cardiovascular events.

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