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  • 301.
    Kärner, Anita
    et al.
    Linköping University, Department of Medicine and Care. Linköping University, Department of Social and Welfare Studies, Health, Activity, Care.
    Abrandt Dahlgren, Madeleine
    Linköping University, Department of Behavioural Sciences and Learning, Studies in Adult, Popular and Higher Education. Linköping University, Faculty of Educational Sciences.
    Bergdahl, Björn
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Rehabilitation after coronary heart disease: spouses’ views of support2004In: Journal of Advanced Nursing, ISSN 0309-2402, Vol. 46, no 2, p. 204-211Article in journal (Refereed)
    Abstract [en]

    Background. Family presence decreases mortality and improves psychosocial recovery after a coronary heart disease event. In this situation, spousal support seems important for the recovering partner's self-esteem and mastery. There is inadequate knowledge of how spouses view their supportive roles.

    Aim. The aim of this paper is to report a study investigating spouses' experiences of the rehabilitation phase of their partners' coronary heart disease and to gain their views about supporting them in lifestyle changes.

    Method. Eight male (mean age 61) and 17 female spouses (mean age 53), were interviewed 1 year after their partner's cardiac event. Of the partners, 18 had experienced myocardial infarction and 19 were revascularized. Interview transcripts were analysed qualitatively using a phenomenographic framework.

    Findings. The analysis yielded five different views of the spouse's role. The participative role involved taking a practical part in lifestyle changes, communicating empathetically, and being positive about changes. The regulative role was characterized by being either positive or negative about changes, giving practical or cognitive support in order to control the partner's behaviour, and communicating authoritatively. In the observational role the spouse was passive, complied with suggestions, and communicated empathetically. The incapacitated role involved a positive attitude to changes, communicating without making demands, but being unable to provide support because of personal problems. Assuming a dissociative role entailed being negative about changes and authoritatively declaring a reluctance to be involved in the partner's change of lifestyle. Spouses adopted different roles depending on the support situation.

    Conclusion. Spouses' views of their roles in support varied considerably in terms of awareness of the benefits of behavioural changes, style of communication, pattern of co-operation and support situation. The findings favour the view that a family perspective is important in planning rehabilitation of patients following coronary heart disease.

  • 302.
    Kühme, Tobias
    et al.
    Linköping University, Department of Medicine and Care. Linköping University, Faculty of Health Sciences.
    Säfström, Kåge
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Nielsen, Niels Erik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Nylander, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Physiology. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Olin, Christian
    Rupture of a synthetic VSD patch 28 years after total correction of Fallot's anomaly2006In: Annals of Thoracic Surgery, ISSN 0003-4975, E-ISSN 1552-6259, Vol. 81, no 4, p. 1510-1512Article in journal (Refereed)
    Abstract [en]

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

  • 303. Lagerqvist, B
    et al.
    Carlsson, J
    Frobert, O
    Lindback, J
    Stenestrand, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    James, S
    Differences in restenosis rate with different drug-eluting stents in diabetic and non-diabetic patients, a report from the Swedish angiography and angioplasty registry (SCAAR)2008In: ESC,2008, 2008, p. 3287-Conference paper (Refereed)
  • 304.
    Lagerqvist, B.
    et al.
    Department of Cardiology, University Hospital, S-751 85 Uppsala, Sweden, Department of Medical Sciences, Cardiology, University Hospital, Uppsala, Sweden.
    Diderholm, E.
    Department of Medical Sciences, Cardiology, University Hospital, Uppsala, Sweden.
    Lindahl, B.
    Department of Medical Sciences, Cardiology, University Hospital, Uppsala, Sweden.
    Husted, S.
    Department of Cardiology, University Hospital, Aarhus, Denmark.
    Kontny, F.
    Department of Cardiology, Ullevål University Hospital, Oslo, Norway.
    Stahle, E.
    Ståhle, E., Department of Thoracic Surgery, University Hospital, Uppsala, Sweden.
    Swahn, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Venge, P.
    Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden.
    Siegbahn, A.
    Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden.
    Wallentin, L.
    Department of Medical Sciences, Cardiology, University Hospital, Uppsala, Sweden.
    FRISC score for selection of patients for an early invasive treatment strategy in unstable coronary artery disease2005In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 91, no 8, p. 1047-1052Article in journal (Refereed)
    Abstract [en]

    Objective: To develop a scoring system for risk stratification and evaluation of the effect of an early invasive strategy for treatment of unstable coronary artery disease (CAD). Design: Retrospective analysis of a randomised study (FRISC II, fast revascularisation in instability in coronary disease). Setting: 58 Scandinavian hospitals. Patients: 2457 patients with unstable CAD from the FRISC II study. Main outcome measures: One year rates of mortality and death/myocardial infarction (MI). Methods: Patients were randomly assigned to an early invasive or a non-invasive strategy. From the non-invasive cohort independent variables of death or death/MI were identified. Results: Seven factors, age > 70 years, male sex, diabetes, previous MI, ST depression, and increased concentrations of troponins and markers of inflammation (interleukin 6 or C reactive protein), were associated with an independent increased risk for death or death/MI. In patients with = 5 of these factors the invasive strategy reduced mortality from 15.4% (20 of 130) to 5.2% (7 of 134) (risk ratio (RR) 0.34, 95% confidence interval (CI) 0.15 to 0.78, p = 0.006). Death/MI was also reduced in patients with 3-4 factors from 15.7% (80 of 511) to 10.8% (58 of 538) (RR 0.69, 95% CI 0.50 to 0.94, p = 0.02). Neither death nor death/MI was reduced in patients with 0-2 risk factors. Conclusion: In unstable CAD, this scoring system based on factors independently associated with an adverse outcome can be used shortly after admission to the hospital for risk stratification and for selection of patients to an early invasive treatment strategy.

  • 305.
    Lagerqvist, B
    et al.
    Univ Uppsala Hosp, Uppsala, Sweden Aarhus Univ Hosp, DK-8000 Aarhus, Denmark Univ Hosp, Oslo, Norway Linkoping Univ Hosp, S-58185 Linkoping, Sweden.
    Diderholm, E
    Univ Uppsala Hosp, Uppsala, Sweden Aarhus Univ Hosp, DK-8000 Aarhus, Denmark Univ Hosp, Oslo, Norway Linkoping Univ Hosp, S-58185 Linkoping, Sweden.
    Lindahl, B
    Univ Uppsala Hosp, Uppsala, Sweden Aarhus Univ Hosp, DK-8000 Aarhus, Denmark Univ Hosp, Oslo, Norway Linkoping Univ Hosp, S-58185 Linkoping, Sweden.
    Husted, S
    Univ Uppsala Hosp, Uppsala, Sweden Aarhus Univ Hosp, DK-8000 Aarhus, Denmark Univ Hosp, Oslo, Norway Linkoping Univ Hosp, S-58185 Linkoping, Sweden.
    Kontny, F
    Univ Uppsala Hosp, Uppsala, Sweden Aarhus Univ Hosp, DK-8000 Aarhus, Denmark Univ Hosp, Oslo, Norway Linkoping Univ Hosp, S-58185 Linkoping, Sweden.
    Stahle, E
    Univ Uppsala Hosp, Uppsala, Sweden Aarhus Univ Hosp, DK-8000 Aarhus, Denmark Univ Hosp, Oslo, Norway Linkoping Univ Hosp, S-58185 Linkoping, Sweden.
    Swahn, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Venge, P
    Univ Uppsala Hosp, Uppsala, Sweden Aarhus Univ Hosp, DK-8000 Aarhus, Denmark Univ Hosp, Oslo, Norway Linkoping Univ Hosp, S-58185 Linkoping, Sweden.
    Wallentin, L
    Univ Uppsala Hosp, Uppsala, Sweden Aarhus Univ Hosp, DK-8000 Aarhus, Denmark Univ Hosp, Oslo, Norway Linkoping Univ Hosp, S-58185 Linkoping, Sweden.
    Coronary angiography in relation to troponin T level in patients with unstable coronary artery disease a FRISC-II substudy.2000In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 102, no 18, p. 2860-Conference paper (Other academic)
  • 306.
    Lagerqvist, B
    et al.
    Univ Hosp, Dept Cardiol, Uppsala, Sweden Aarhus Hosp, Dept Cardiol, Aarhus, Denmark Aker Hosp, Dept Cardiol, Oslo, Norway Univ Hosp, Dept Thorac Surg, Uppsala, Sweden Univ Hosp, Dept Cardiol, Linkoping, Sweden Univ Hosp, Dept Chem, Uppsala, Sweden.
    Diderholm, E
    Univ Hosp, Dept Cardiol, Uppsala, Sweden Aarhus Hosp, Dept Cardiol, Aarhus, Denmark Aker Hosp, Dept Cardiol, Oslo, Norway Univ Hosp, Dept Thorac Surg, Uppsala, Sweden Univ Hosp, Dept Cardiol, Linkoping, Sweden Univ Hosp, Dept Chem, Uppsala, Sweden.
    Lindahl, B
    Univ Hosp, Dept Cardiol, Uppsala, Sweden Aarhus Hosp, Dept Cardiol, Aarhus, Denmark Aker Hosp, Dept Cardiol, Oslo, Norway Univ Hosp, Dept Thorac Surg, Uppsala, Sweden Univ Hosp, Dept Cardiol, Linkoping, Sweden Univ Hosp, Dept Chem, Uppsala, Sweden.
    Husted, S
    Univ Hosp, Dept Cardiol, Uppsala, Sweden Aarhus Hosp, Dept Cardiol, Aarhus, Denmark Aker Hosp, Dept Cardiol, Oslo, Norway Univ Hosp, Dept Thorac Surg, Uppsala, Sweden Univ Hosp, Dept Cardiol, Linkoping, Sweden Univ Hosp, Dept Chem, Uppsala, Sweden.
    Kontny, F
    Univ Hosp, Dept Cardiol, Uppsala, Sweden Aarhus Hosp, Dept Cardiol, Aarhus, Denmark Aker Hosp, Dept Cardiol, Oslo, Norway Univ Hosp, Dept Thorac Surg, Uppsala, Sweden Univ Hosp, Dept Cardiol, Linkoping, Sweden Univ Hosp, Dept Chem, Uppsala, Sweden.
    Stahle, E
    Univ Hosp, Dept Cardiol, Uppsala, Sweden Aarhus Hosp, Dept Cardiol, Aarhus, Denmark Aker Hosp, Dept Cardiol, Oslo, Norway Univ Hosp, Dept Thorac Surg, Uppsala, Sweden Univ Hosp, Dept Cardiol, Linkoping, Sweden Univ Hosp, Dept Chem, Uppsala, Sweden.
    Swahn, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Venge, P
    Univ Hosp, Dept Cardiol, Uppsala, Sweden Aarhus Hosp, Dept Cardiol, Aarhus, Denmark Aker Hosp, Dept Cardiol, Oslo, Norway Univ Hosp, Dept Thorac Surg, Uppsala, Sweden Univ Hosp, Dept Cardiol, Linkoping, Sweden Univ Hosp, Dept Chem, Uppsala, Sweden.
    Wallentin, L
    Univ Hosp, Dept Cardiol, Uppsala, Sweden Aarhus Hosp, Dept Cardiol, Aarhus, Denmark Aker Hosp, Dept Cardiol, Oslo, Norway Univ Hosp, Dept Thorac Surg, Uppsala, Sweden Univ Hosp, Dept Cardiol, Linkoping, Sweden Univ Hosp, Dept Chem, Uppsala, Sweden.
    Coronary angiography in relation to troponin T level in patients with unstable coronary artery disease (UCAD) - a FRISC-2 substudy2000In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 21, p. 2530-Conference paper (Other academic)
  • 307.
    Lagerqvist, B.
    et al.
    Department of Cardiology, University Hospital, S-751 85 Uppsala, Sweden.
    Husted, S.
    Department of Cardiology, University Hospital, Aarhus, Denmark.
    Kontny, F.
    Heart and Lung Centre, Ullevål University Hospital, Oslo, Norway.
    Naslund, U.
    Näslund, U., Department of Cardiology, Heart Centre, University Hospital, Umeå, Sweden.
    Stahle, E.
    Ståhle, E., Department of Thoracic Surgery, University Hospital, S-751 85 Uppsala, Sweden.
    Swahn, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Wallentin, L.
    Department of Cardiology, University Hospital, S-751 85 Uppsala, Sweden.
    A long-term perspective on the protective effects of an early invasive strategy in unstable coronary artery disease: Two-year follow-up of the FRISC-II Invasive Study2002In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 40, no 11, p. 1902-1914Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: We sought to report the first and repeat events and to separate spontaneous and procedure-related events over two years in the Fast Revascularization during InStability in Coronary artery disease (FRISC-II) invasive trial. BACKGROUND: The FRISC-II invasive trial compared the long-term effects of an early invasive versus noninvasive strategy, in terms of death and myocardial infarction (MI) and the need for repeat hospital admissions and late revascularization procedures in patients with coronary artery disease (UCAD). METHODS: In the FRISC-II trial, 2,457 patients with UCAD were randomized to an early invasive or noninvasive strategy. RESULTS: At 24 month follow-up, there were reductions in mortality (n = 45 [3.7%] vs. 67 [5.4%], risk ratio 0.68 [95% confidence interval (CI) 0.47 to 0.98], p = 0.038), MI (n = 111 [9.2%] vs. 156 [12.7%], risk ratio 0.72 [95% CI 0.57 to 0.91], p = 0.005), and the composite end point of death or MI (n = 146 [12.1%] vs. 200 [16.3%], risk ratio 0.74 [95% CI 0.61 to 0.90], p = 0.003) in the invasive compared with the noninvasive group. Procedure-related MIs were two to three times more common, but spontaneous ones were three times less common in the invasive than in the noninvasive group. After the first year, there was no difference in mortality (n = 20 [1.7%]) between the two groups and fewer MIs in the invasive group (p = 0.031). CONCLUSIONS: In UCAD, the early invasive approach leads to a sustained reduction in mortality, cardiac morbidity, and the need for repeat hospital admissions and late revascularization procedures. Although the benefits are greatest during the first months, during the second year, cardiac morbidity is lower and the need for hospital care is less in the invasive group. © 2002 by the American College of Cardiology Foundation.

  • 308.
    Lagerqvist, B
    et al.
    Univ Uppsala Hosp, Uppsala, Sweden Aarhus Univ Hosp, DK-8000 Aarhus, Denmark Univ Hosp, Oslo, Norway Linkoping Univ Hosp, S-58185 Linkoping, Sweden.
    Husted, S
    Univ Uppsala Hosp, Uppsala, Sweden Aarhus Univ Hosp, DK-8000 Aarhus, Denmark Univ Hosp, Oslo, Norway Linkoping Univ Hosp, S-58185 Linkoping, Sweden.
    Kontny, F
    Univ Uppsala Hosp, Uppsala, Sweden Aarhus Univ Hosp, DK-8000 Aarhus, Denmark Univ Hosp, Oslo, Norway Linkoping Univ Hosp, S-58185 Linkoping, Sweden.
    Stahle, E
    Univ Uppsala Hosp, Uppsala, Sweden Aarhus Univ Hosp, DK-8000 Aarhus, Denmark Univ Hosp, Oslo, Norway Linkoping Univ Hosp, S-58185 Linkoping, Sweden.
    Swahn, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Wallentin, L
    Univ Uppsala Hosp, Uppsala, Sweden Aarhus Univ Hosp, DK-8000 Aarhus, Denmark Univ Hosp, Oslo, Norway Linkoping Univ Hosp, S-58185 Linkoping, Sweden.
    Better outcome after 2 years with an early invasive strategy in unstable coronary artery disease (UCAD) - FRISCII 2 year follow-up.2001In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 104, no 17, p. 2589-Conference paper (Other academic)
  • 309.
    Lagerqvist, B
    et al.
    Univ Uppsala Hosp, Dept Cardiol, Uppsala, Sweden Linkoping Univ Hosp, Dept Cardiol, S-58185 Linkoping, Sweden Univ Uppsala Hosp, Dept Thorac & Cardiovasc Surg, S-75185 Uppsala, Sweden Inst Med & Care, Linkoping, Sweden.
    Säfström, Kåge
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Stahle, E
    Univ Uppsala Hosp, Dept Cardiol, Uppsala, Sweden Linkoping Univ Hosp, Dept Cardiol, S-58185 Linkoping, Sweden Univ Uppsala Hosp, Dept Thorac & Cardiovasc Surg, S-75185 Uppsala, Sweden Inst Med & Care, Linkoping, Sweden.
    Wallentin, L
    Univ Uppsala Hosp, Dept Cardiol, Uppsala, Sweden Linkoping Univ Hosp, Dept Cardiol, S-58185 Linkoping, Sweden Univ Uppsala Hosp, Dept Thorac & Cardiovasc Surg, S-75185 Uppsala, Sweden Inst Med & Care, Linkoping, Sweden.
    Swahn, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Invasive treatment in women in the acute stage of unstable coronary artery disease (FRISCII)2000In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 21, p. 1918-Conference paper (Other academic)
  • 310. Lagerqvist, B
    et al.
    Säfström, Kåge
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Ståhle, E
    Wallentin, L
    Swahn, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Is early invasive treatment of unstable coronary artery disease equally effective for both women and men?2001In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 38, no 1, p. 41-48Article in journal (Refereed)
    Abstract [en]

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

  • 311.
    Lagerqvist, Bo
    et al.
    Uppsala University Hospital.
    Carlsson, Jörg
    Kalmar Hospital.
    Fröbert, Ole
    Örebro University Hospital.
    Lindbäck, Johan
    Uppsala University Hospital.
    Scherstén, Fredrik
    Lund University Hospital,.
    Stenestrand, Ulf
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    James, Stefan K
    Uppsala University Hospital.
    Stent thrombosis in sweden: a report from the Swedish coronary angiography and angioplasty registry.2009In: CIRCULATION-CARDIOVASCULAR INTERVENTIONS, ISSN 1941-7640, Vol. 2, no 5, p. 401-408Article in journal (Refereed)
    Abstract [en]

    Background— The objective was to evaluate the role of risk factors and stent type for stent thrombosis (ST) using a large real world registry.

    Methods and Results— We evaluated all consecutive coronary stent implantations in Sweden from May 1, 2005, to June 30, 2007. All cases of ST, documented in the Swedish coronary angiography and angioplasty registry until September 21, 2008, were analyzed. ST was registered in 882 of 73 798 stents. Acute coronary syndromes, insulin-treated diabetes mellitus, smoking, previous coronary intervention, warfarin treatment, small stent diameter, and stenting in restenotic, complex, or bypass graft lesions had the strongest association with ST in the multivariable statistical model. There were considerable differences in the frequency of ST between different stent brands. The overall risk of ST was lower in drug-eluting stents compared with bare metal stents (adjusted risk ratio, 0.79; 99% CI, 0.63 to 0.99). However, from 6 months after stent implantation and onward, the risk for ST was higher in drug-eluting stents compared with bare metal stents (adjusted risk ratio, 2.02; 99% CI, 1.30 to 3.14).

    Conclusions— ST is a multifactor disease, and the incidence varies considerably between patients based on clinical, vessel, and stent characteristics. For drug-eluting stents compared with bare metal stents, the risk pattern was biphasic; initially, bare metal stents demonstrated a higher risk of ST; whereas after the first months, ST risk was higher with drug-eluting stents. Our findings highlight the need for prospective randomized studies with head-to-head comparisons between different stents.

  • 312.
    Lagerqvist, Bo
    et al.
    Uppsala.
    Husted, Steen
    Århus,Danmark.
    Koontny, Fredrik
    Oslo, Norge.
    Ståhle, Elisabeth
    Uppsala.
    Swahn, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Wallentin, Lars
    Uppsala.
    5-year outcomes in the FRISC-II randomised trial of an invasive versus a non-invasive strategy in non-ST-elevation acute coronary syndrome: a follow-up study2006In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 368, no 9540, p. 998-1004Article in journal (Refereed)
    Abstract [en]

    Background: The FRISC-II invasive trial compared an early invasive with a non-invasive strategy in terms of death and myocardial infarction in non-ST-elevation acute coronary syndrome. We present 5-year follow-up results, overall and in subgroups based on recommended risk stratification criteria. Methods: In the FRISC-II trial, 2457 patients with non-ST-elevation acute coronary syndrome were randomised to early invasive strategy (coronary angiography and, if appropriate, revascularisation, within 7 days from admission) or non-invasive primarily medical strategy. Risk stratification was done on the basis of risk indicators at randomisation: age older than 65 years, male sex, diabetes mellitus, previous myocardial infarction, ST-segment depression, raised troponin concentration (>0·03 μg/L), and raised C-reactive protein or interleukin 6. Information on events after 24 months was taken from national registries. Analyses were done on an intention-to-treat basis. Findings: At 5 years the groups differed in terms of the primary composite endpoint of death, myocardial infarction, or both (invasive 217, 19·9 %, noninvasive 270, 24·5 %, risk ratio 0·81, 95% CI 0·69-0·95, p=0·009). 5-year mortality was 117 (9·7%) in the invasive group compared with 124 (10·1%) in the noninvasive group (0·95, 0·75 -1·21, p=0·693). Rates of myocardial infarction were 141 (12·9 %) in the invasive and 195 (17.7%) in the non-invasive group (0·73, 0·60-0·89, p=0·002). The benefit of the invasive strategy was confined to male patients, non-smokers, and patients with two or more risk indicators. Interpretation: The 5-year outcome of this trial indicates sustained benefit of an early invasive strategy in patients with non-ST-elevation acute coronary syndrome at moderate to high risk. © 2006 Elsevier Ltd. All rights reserved.

  • 313.
    Lagerqvist, Bo
    et al.
    Uppsala University Hospital, Sweden.
    James, Stefan K.
    Uppsala University Hospital, Sweden.
    Stenestrand, Ulf
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Lindbäck, Johan
    Uppsala University Hospital, Sweden.
    Nilsson, Tage
    Uppsala University Hospital, Sweden.
    Wallentin, Lars
    Uppsala University Hospital, Sweden.
    Long-term outcomes with drug-eluting stents versus bare-metal stents in Sweden2007In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 356, no 10, p. 1009-1019Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Recent reports have indicated that there may be an increased risk of late stent thrombosis with the use of drug-eluting stents, as compared with bare-metal stents.

    METHODS: We evaluated 6033 patients treated with drug-eluting stents and 13,738 patients treated with bare-metal stents in 2003 and 2004, using data from the Swedish Coronary Angiography and Angioplasty Registry. The outcome analysis covering a period of up to 3 years was based on 1424 deaths and 2463 myocardial infarctions and was adjusted for differences in baseline characteristics.

    RESULTS: The two study groups did not differ significantly in the composite of death and myocardial infarction during 3 years of follow-up. At 6 months, there was a trend toward a lower unadjusted event rate in patients with drug-eluting stents than in those with bare-metal stents, with 13.4 fewer such events per 1000 patients. However, after 6 months, patients with drug-eluting stents had a significantly higher event rate, with 12.7 more events per 1000 patients per year (adjusted relative risk, 1.20, 95% confidence interval [CI], 1.05 to 1.37). At 3 years, mortality was significantly higher in patients with drug-eluting stents (adjusted relative risk, 1.18, 95% CI, 1.04 to 1.35), and from 6 months to 3 years, the adjusted relative risk for death in this group was 1.32 (95% CI, 1.11 to 1.57).

    CONCLUSIONS: Drug-eluting stents were associated with an increased rate of death, as compared with bare-metal stents. This trend appeared after 6 months, when the risk of death was 0.5 percentage point higher and a composite of death or myocardial infarction was 0.5 to 1.0 percentage point higher per year. The long-term safety of drug-eluting stents needs to be ascertained in large, randomized trials.

  • 314.
    Lainscak, Mitja
    et al.
    University Clin Resp and Allerg Disease Golnik.
    Blue, Lynda
    British Heart Foundation.
    Clark, Andrew L
    University of Hull.
    Dahlström, Ulf
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Dickstein, Kenneth
    Stavanger University Hospital.
    Ekman, Inger
    Gothenburg University.
    McDonagh, Theresa
    Royal Brompton Hospital.
    J McMurray, John
    University of Glasgow.
    Ryder, Mary
    Heart Failure Unit, St Vincents Healthcare Grp.
    Stewart, Simon
    Heart and Diabet Institute, Melbourne.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Self-care management of heart failure: practical recommendations from the Patient Care Committee of the Heart Failure Association of the European Society of Cardiology2011In: EUROPEAN JOURNAL OF HEART FAILURE, ISSN 1388-9842, Vol. 13, no 2, p. 115-126Article in journal (Refereed)
    Abstract [en]

    Guidelines on heart failure (HF) stress the importance of lifestyle advice, although there is little evidence that such recommendations improve symptoms or prognosis. Patients experience symptoms of different intensities which impair their daily activities and reduce the quality-of-life. To cope with their clinical condition, many patients seek advice about lifestyle and self-management strategies when in contact with medical care providers, particularly specialized HF services. Self-care management is an important part of HF treatment, thus health professionals working with patients with HF have recognized the need for more specific recommendations on lifestyle advice. The present paper summarizes the available evidence, promotes self-care management, and aims to provide practical advice for health professionals delivering care to HF patients. It also defines avenues of research to optimize self-care strategies in a number of key areas to derive further benefits.

  • 315.
    Larsson, Hans
    Linköping University, Department of Medicine and Care, Internal Medicine. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology. Linköping University, Faculty of Health Sciences.
    Myocardial ischemia: As a risk indicator after an episode of unstable angina or non-Q-wave myocardial infarction1991Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The diagnostic and prognostic value of different noninvasive tests were evaluated in men below 70 years of age admitted to the coronary care unit (CCU) with unstable coronary artery disease (CAD) i.e unstableangina or non-Q-wave myocardial infarction (Ml). A symptom limited exercise test (ET) was performed before discharge in 740 patients. In subgroups 24 hour ST-recordings were performed in the CCU (n=75),before discharge (n=198) and ambulatory after one month (n=109). A second ET combined with SPECT Tl201 myocardial perfusion imaging was done after one month in 197 patients. Myocardial ischemia was defined as ST-depression > 0.1 m V or according to a model developed for interpretation of SPECTT1201 scintieraphy. All patients were followed one year.

    Patients with myocardial ischemia at the predischargc ET (51 %) had a significantly higher rate of death or MI (18 %) compared to those without (9 %) regardless of simultaneous pain or not. STrccordingin the acute phase or before discharge showed less often myocardial ischemia (23-18 %) than ambulatory during ordinary daily life (33 %). In the same group of patients myocardial ischemia was more often elicited by a predischarge ET (52%). The majority of patients with ST-depression at ST-recordings also showed myocardial ischemia at the predischarge ET. Myocardial ischemia at the ST-rccording beforedischarge identified a small group (18 %) of patients with a more severe prognosis- 23% rvn or death after 3 months compared to 7 % in the patients without this observation. In a logistic regression analysis ST-depression at the predischarge ST-recording was the only significant predictor of MI or death during the first three months while myocardial ischemia at the predischarge ET became the only significant indicator of long term outcome. In a comparison between the predischarge and the one month ET 83 % of patients showed the same response regarding occurrence of ST -depression. The rate of MI or death during the first month were more common in patients with (8.3 %) than without (3.7 %) myocardial ischemia at the predischarge ET and so was the occurrence of future symptoms of severe angina. Regarding the following 11 months, myocardial ischemia at the predischarge or the one month ET had the same prognostic importance for MI, death or severe angina. SPECT Tl 201 imaging at ET improved the separation between high and low risk patients. If both SPECT Tl 201 imaging and the ECG response showed signs of ischemia (37 %) the risk of future cardiac events was markedly elevated- 17 % MI or death compared to 7 % in patients without this finding. Thus, risk stratification of men after an episode of unstable coronary artery disease can be performed already before discharge. Patients with continuing myocardial ischemia despite treatment should be considered for rcvascularisation whether or not the ischemia is associated with pain.

  • 316.
    Lawesson, Sofia
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Alfredsson, Joakim
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Stenestrand, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Wallentin, Lars
    Uppsala.
    Swahn, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Management of acute ST-elevation myocardial infarction differs between the sexes which may impair the outcome for the female patient.2003In: European Heart Journal,2003, 2003, p. 233-233Conference paper (Refereed)
  • 317.
    Lawesson, Sofia
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Alfredsson, Joakim
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Stenestrand, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Wallentin, Lars
    Uppsala.
    Swahn, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Sex differences in rate of thrombolysis in acute ST-evation myocardial infarction is caused by longer delay times in women.2003In: European Heart Journal,2003, 2003, p. 232-232Conference paper (Refereed)
  • 318.
    Lawesson, Sofia
    et al.
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Stenestrand, Ulf
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Lagerqvist, Bo
    Uppsala University Hospital.
    Wallentin, Lars
    Uppsala University Hospital.
    Swahn, Eva
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Gender perspective on risk factors, coronary lesions and long-term outcome in young patients with ST-elevation myocardial infarction2010In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 96, no 6, p. 453-459Article in journal (Refereed)
    Abstract [en]

    Objective Previous data on young patients with acute coronary syndrome (ACS) have indicated higher rates of normal coronary angiograms but higher mortality in women than men. However, ST-elevation myocardial infarction (STEMI) differs from non-ST-elevation ACS in many aspects. We elucidated sex differences in risk factors, angiographic findings and outcome in consecutive STEMI patients below 46 years of age. Design Retrospective cohort study. Setting The Swedish registers for CCU care and coronary angioplasty; RIKS-HIA and SCAAR. Patients 2132 STEMI patients below 46 years of age admitted to intensive coronary care units in Sweden between 1995 and 2006 and followed for at least 1 year. Main outcome measures Angiographic findings and short-term and long-term mortality. Results Risk factors were more common in women. Significant coronary lesions were equally common (92.1% vs 93.1%, p=0.64) while single vessel disease was more common (72.9% vs 59.3%; pandlt;0.001) in women. Women had higher multivariable adjusted in-hospital mortality, OR 2.85 (95% CI 1.31 to 6.19) while long-term mortality was the same, HR 0.93 (95% CI 0.60 to 1.45). The catch-up of mortality in men might be related to a higher occurrence of re-infarctions, HR 1.82 (95% CI 1.25 to 2.65). Conclusions STEMI below age 46 is a more rare condition in women than in men and more often related to cardiovascular risk factors. More than 90% of both men and women had coronary lesions, in women more often single vessel lesions. Female sex is associated with higher in-hospital mortality, while long-term mortality is low without difference between genders.

  • 319.
    Lawesson, Sofia
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Stenestrand, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Wallentin, L
    Swahn, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Delay-times and rate of acute reperfusion therapy in ST-elevation myocardial infarction differ between men and women2005In: Second International Conference on Women, Heart Disease and Stroke,2005, 2005Conference paper (Other academic)
  • 320.
    Lawesson, Sofia
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Stenestrand, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Wallentin, L
    Swahn, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Differences in management and outcome of acute ST-elevation myocardial infarction2005In: Second International Conference on Women, Heart Disease and Stroke,2005, 2005Conference paper (Other academic)
  • 321.
    Lawesson, Sofia
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Stenestrand, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Wallentin, L
    Swahn, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Young women with ST-elevation myocardial infarction - coronary stenoses as often as men but three times higher early mortality2007In: ESC 2007,2007, 2007Conference paper (Other academic)
  • 322.
    Lawesson, Sofia
    et al.
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Tödt, Tim
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Cardiology.
    Alfredsson, Joakim
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Stenestrand, Ulf
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Swahn, Eva
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Gender difference in prevalence and prognostic impact of renal insufficiency in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention2011In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 97, no 4, p. 308-314Article in journal (Refereed)
    Abstract [en]

    Objective To evaluate if female gender is associated with renal insufficiency in patients with ST-elevation myocardial infarction (STEMI) and if there is a gender difference in the prognostic importance of renal insufficiency in STEMI. Design Single-centre observational study. Setting One tertiary cardiac centre. Patients All consecutive patients with STEMI planned for primary percutaneous coronary intervention in one Swedish county in 2005 (98 women and 176 men). Main outcome measures Logistic regression analyses were conducted to evaluate the predictors of renal insufficiency, associations between estimated glomerular filtration rate (eGFR) and outcome in each gender and a possible interaction between gender and eGFR regarding outcome. Results Renal insufficiency was defined as eGFR less than 60 ml/min per 1.73 m(2). 67% of women had renal insufficiency compared with 26% of men, OR 5.06 (95% CI 2.66 to 9.59) after multivariable adjustment. In women each 10 ml/min per 1.73 m 2 increment of eGFR was associated with a 63% risk reduction for 1-year mortality, OR 0.37 (95% CI 0.15 to 0.89). No such association was found in men, OR 1.05 (95% CI 0.63 to 1.76). A trend towards a significant interaction between gender and eGFR regarding 1-year mortality was found, OR 2.05 (95% CI 0.93 to 4.50). Conclusions A considerable gender difference in the prevalence of renal insufficiency in STEMI was found and renal insufficiency seemed to be a more important prognostic marker in women. These results are important as previous STEMI studies have shown higher multivariable adjusted mortality in women than in men but renal function has seldom been taken into consideration.

  • 323. Legutko, Jacek
    et al.
    Rakowski, Tomasz
    Siudak, Zbigniew
    Rzeszutko, Lukasz
    Janzon, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Birkemeyer, Ralf
    Kleczynski, Pawel
    Dudek, Dariusz
    Efficacy and safety of early clopidogrel administration with or without Abciximab in patients with ST-segment elevation myocardial infarction transferred for primary PCI. Results from the EUROTRANSFER registry.2008In: ACC - 57th Annual Scientific Session,2007, 2008Conference paper (Refereed)
  • 324.
    Lenzen, M.
    et al.
    Department of Cardiology, Clinical Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands.
    Scholte, op Reimer W.
    Scholte op Reimer, W., Department of Cardiology, Clinical Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands, Undertaking Nursing Intervention Throughout Europe (UNITE) Research Group.
    Norekval, T.M.
    Norekvål, T.M., Undertaking Nursing Intervention Throughout Europe (UNITE) Research Group, Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    De, Geest S.
    De Geest, S., Undertaking Nursing Intervention Throughout Europe (UNITE) Research Group, Institute of Nursing Science University of Basel, Clinical Nursing Science University Hospital Basel, Switzerland.
    Fridlund, B.
    Undertaking Nursing Intervention Throughout Europe (UNITE) Research Group, School of Health Sciences and Social Work, Växjö University, Sweden.
    Heikkila, J.
    Heikkilä, J., Undertaking Nursing Intervention Throughout Europe (UNITE) Research Group, School of Health and Social Care, Jyväskylä University of Applied Sciences, Finland.
    Jaarsma, T.
    Undertaking Nursing Intervention Throughout Europe (UNITE) Research Group, Department of Cardiology, University Hospital Groningen, University of Groningen, Netherlands.
    Martensson, J.
    Mårtensson, J., Undertaking Nursing Intervention Throughout Europe (UNITE) Research Group, Department of Nursing Science, School of Health Sciences, Jönköping, Sweden.
    Moons, P.
    Undertaking Nursing Intervention Throughout Europe (UNITE) Research Group, Center for Health Services and Nursing Research, Catholic University of Leuven, Belgium.
    Smith, K.
    Undertaking Nursing Intervention Throughout Europe (UNITE) Research Group, Medical School/School of Nursing and Midwifery, University of Dundee, Scotland, United Kingdom.
    Stewart, S.
    Undertaking Nursing Intervention Throughout Europe (UNITE) Research Group, Devision of Health Sciences, University of South Australia, Adelaide, Australia.
    Strömberg, Anna
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Nursing Science. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Thompson, D.R.
    Undertaking Nursing Intervention Throughout Europe (UNITE) Research Group, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, Hong Kong.
    Wijns, W.
    Cardiovascular Center, OLV Ziekenhuis, Aalst, Belgium.
    Pharmacological treatment and perceived health status during 1-year follow up in patients diagnosed with coronary artery disease, but ineligible for revascularization. Results from the Euro Heart Survey on Coronary Revascularization2006In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 5, no 2, p. 115-121Article in journal (Refereed)
    Abstract [en]

    Background: It has been recognized that a clinically significant portion of patients with coronary artery disease (CAD) continue to experience anginal and other related symptoms that are refractory to the combination of medical therapy and revascularization. The Euro Heart Survey on Revascularization (EHSCR) provided an opportunity to assess pharmacological treatment and outcome in patients with proven CAD who were ineligible for revascularization. Methods: We performed a secondary analysis of EHS-CR data. After excluding patients with ST-elevation myocardial infarction and those in whom revascularization was not indicated, 4409 patients remained in the analyses. We selected two groups: (1) patients in whom revascularization was the preferred treatment option (n = 3777, 86%), and (2) patients who were considered ineligible for revascularization (n = 632, 14%). Results: Patient ineligible for revascularization had a worse risk profile, more often had a total occlusion (59% vs. 37%, p < 0.001), were treated more often with ACE-inhibitors (65% vs. 55%, p < 0.001) but less likely with aspirin (83% vs. 88%, p < 0.001). Overall, they had higher case-fatality at 1-year (7.0% vs. 3.7%, p < 0.001). Regarding self-perceived health status, measured via the EuroQol 5D (EQ-5D) questionnaire, these same patients reported more problems on all dimensions of the EQ-5D. Furthermore, in the revascularization group we observed an increase between discharge and 1-year follow up (utility score from 0.85 to 1.00) whereas patients ineligible for revascularization did not improve over time (utility score remained 0.80). Conclusion: In this large cohort of European patients with CAD, those considered ineligible for revascularization had more co-morbidities and risk factors, and scored worse on self-perceived health status as compared to revascularized patients in the revascularization group. With the exception of ACE-inhibitors and aspirin, there were no major differences regarding drug treatment between the two groups. Given these clinically significant observations, there appears to be a role for nurse-led, multidisciplinary, rehabilitation teams that target clinically vulnerable patients whose symptoms remain refractory to standard medical care. © 2006 European Society of Cardiology.

  • 325.
    Levin, Lars-Åke
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics.
    Janzon, M
    Swahn, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Long-term cost-effectiveness of invasive strategy in patient with unstable coronary artery disease results from the FRISC-II trial2003In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 6, no 6, p. 661-661Conference paper (Other academic)
  • 326.
    Levin, Lars-Åke
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Sennfält, Karin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Janzon, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Henriksson, Martin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Andersson, Agneta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Bernfort, Lars
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    En introduktion i hälsoekonomi2004Book (Other (popular science, discussion, etc.))
  • 327.
    Li, Wei
    et al.
    Linköping University, Department of Medicine and Health Sciences, Clinical Pharmacology . Linköping University, Faculty of Health Sciences.
    Johnson, Henrik
    Linköping University, Department of Clinical and Experimental Medicine, Experimental Pathology . Linköping University, Faculty of Health Sciences.
    Yuan, Ximing
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Jonasson, Lena
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    7-beta-hydroxycholesterol induces natural killer cell death via oxidative lysosomal destalization.2009Conference paper (Refereed)
  • 328.
    Li, Wei
    et al.
    Linköping University, Department of Medical and Health Sciences, Pharmacology. Linköping University, Faculty of Health Sciences.
    Johnson, Henrik
    Linköping University, Department of Clinical and Experimental Medicine, Experimental Pathology. Linköping University, Faculty of Health Sciences.
    Yuan, Xi-Ming
    Linköping University, Department of Clinical and Experimental Medicine, Experimental Pathology. Linköping University, Faculty of Health Sciences.
    Jonasson, Lena
    Linköping University, Department of Medical and Health Sciences, Internal Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    7ß-hydroxycholesterol induces natural killer cell death via oxidative lysosomal destabilization2009In: Free radical research, ISSN 1071-5762, E-ISSN 1029-2470, Vol. 43, no 11, p. 1072-1079Article in journal (Refereed)
    Abstract [en]

    Peripheral natural killer (NK) cells are reduced in patients with coronary artery disease and highly susceptible to apoptosis induced by oxidized lipids including 7beta-hydroxycholesterol (7betaOH) in vitro. The present study aimed to further explore the mechanisms behind 7betaOH-mediated cytotoxicity to human NK cells. Human NK cells were purified and treated with 7betaOH in different concentrations and times. Cell death, lysosomal and mitochondrial permeabilization and reactive oxygen species (ROS) production were then analysed. The 7betaOH induced time and dose dependent apoptosis and necrosis in human NK cells, which was preceded by loss of lysosomal integrity and enhanced ROS production. At later time points, the mitochondrial membrane permeability in 7betaOH-treated cells was significantly increased. The findings indicate that 7betaOH induces human NK cell death through early lysosomal permeabilization and consequent oxidative stress. The data further suggest that 7betaOH may induce immune disturbances in clinical settings such as atherosclerosis.

  • 329.
    Li, Wei
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Cell Biology. Linköping University, Faculty of Health Sciences.
    Kornmark, Louise
    Linköping University, Department of Clinical and Experimental Medicine, Experimental Pathology. Linköping University, Faculty of Health Sciences.
    Jonasson, Lena
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Forssell, Claes
    Linköping University, Department of Medical and Health Sciences, Vascular surgery. Linköping University, Faculty of Health Sciences.
    Yuan, Ximing
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Cathepsin L is significantly associated with apoptosis and plaque destabilization in human atherosclerosis2009In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 202, no 1, p. 92-102Article in journal (Refereed)
    Abstract [en]

    Objective: Human atherosclerotic lesions overexpress elastolytic and collagenolytic cathepsins with unclear pathological implications. The aim of this study was to investigate the relationship among expression of cathepsin L. macrophage apoptosis in coronary artery disease (CAD) patients, clinical symptoms and plaque severity Of human carotid atheroma.

    Methods and results: Quantitative immunohistochemical analysis of human carotid atherosclerotic lesions (n = 49) showed that expression of lysosomal cathepsin L was significantly increased in atherosclerotic plaques with formation of the necrotic core and rupture of the cap. In those Plaques, cathepsin L was associated mainly with CD68-positive macrophages, whereas significant lower levels of smooth muscle cell actin were detected. The expression of cathepsin L in these plaques was also correlated with apoptosis and the stress protein ferritin. Plaques from symptomatic patients showed greater increased levels of cathepsin L than those front asymptomatic patients. Human monocyte-derived macrophages from CAD patients (n = 7) showed significantly higher levels of cathepsin L, cellular lipids and apoptosis versus cells from matched healthy donors (n = 7). 7Beta-hydroxycholesterol significantly enhanced cathepsin L in cells from healthy donors but not in Cells from CAD patients. Moreover. macrophage apoptosis was significantly correlated with expression of cathepsin L in cell nuclei and membranes.

    Conclusion: The results Suggest that cathepsin L is involved in death of macrophages necrotic Core formation and development of atherosclerotic plaque instability. Macrophage lysosomal cathepsin L and related apoptosis may be potential targets for modulation or imaging of vulnerable plaques in human atherosclerosis.

  • 330.
    Li, Wei
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Cell Biology. Linköping University, Faculty of Health Sciences.
    Lidebjer, Caroline
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences.
    Yuan, Ximing
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Experimental Pathology.
    Szymanowski, Aleksander
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Backteman, Karin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Ernerudh, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Leanderson, Per
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine. Östergötlands Läns Landsting, Pain and Occupational Centre, Occupational and Environmental Medicine Centre.
    Nilsson, Lennart
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology.
    Swahn, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Jonasson, Lena
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    NK cell apoptosis in coronary artery disease. Relation to oxidative stress2008In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 199, no 1, p. 65-72Article in journal (Refereed)
    Abstract [en]

    Objective: Natural killer (NK) cells, key elements in initiation and modulation of immune responses, were recently found to be reduced in coronary artery disease (CAD). To clarify mechanisms behind this reduction, we here investigated NK cell apoptosis in CAD patients. Since oxidative stress has been linked to NK cell apoptosis, we related the findings to oxidative stress in vivo and evaluated the ex vivo susceptibility of NK cells to oxidized lipids. Methods and results: The number of apoptotic NK cells in peripheral blood was significantly increased in CAD patients compared to controls. Purified NK cells from CAD patients also showed a higher rate of spontaneous apoptosis ex vivo. Dose- and time-dependent effects of oxidized LDL and 7β-hydroxycholesterol (7βOH) on apoptosis and ROS production were determined in NK cells from blood donors. Thereafter, purified NK cells from CAD patients and healthy controls were exposed to the oxidized lipids in a paired design. NK cells from patients were more susceptible to apoptosis induced by oxidized LDL, in particular 7βOH, compared to cells from controls. Plasma measurements of LDL protein oxidation and lipid peroxidation did not show any differences between patients and controls. On the other hand, plasma carotenoids were significantly decreased in patients and inversely correlated to NK cell apoptosis rate. Conclusion: The rate of spontaneous NK cell apoptosis was increased in CAD patients. Although NK cells in CAD patients were more sensitive to oxidized lipids ex vivo, indicating a mechanism contributing to the reduced NK cell activity in CAD, the data could not verify an obvious link between NK cell apoptosis and increased oxidative stress in vivo. © 2007 Elsevier Ireland Ltd. All rights reserved.

  • 331.
    Li, Wei
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Pathology.
    Yuan, Xi Ming
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Pathology.
    Jonasson, Lena
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Apoptosis induced by oxidized low-density lipoprotein and 7beta-hydorxycholesterol in T cells and NK cells2006In: XIV International Symposium on Atherosclerosis,2006, 2006Conference paper (Other academic)
  • 332.
    Li, Wei
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Pathology.
    Yuan, Xi Ming
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Pathology.
    Jonasson, Lena
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Natural killer cells in coronary artery disease - susceptibility to oxidized cholesterol2006In: VIII Svenska Kardiovaskulära Vårmötet,2006, 2006Conference paper (Other academic)
  • 333.
    Lidebjer, Caroline
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Leanderson, Per
    Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Pain and Occupational Centre, Occupational and Environmental Medicine Centre.
    Ernerudh, Jan
    Linköping University, Department of Molecular and Clinical Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Jonasson, Lena
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Low plasma levels of oxygenated carotenoids in patients with coronary artery disease2007In: NMCD. Nutrition Metabolism and Cardiovascular Diseases, ISSN 0939-4753, E-ISSN 1590-3729, Vol. 17, no 6, p. 448-456Article in journal (Refereed)
    Abstract [en]

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

  • 334.
    Lindahl, Tomas
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Clinical Chemistry. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Chemistry.
    Lundahl, T
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Clinical Chemistry.
    Fransson, Sven Göran
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Radiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Evaluation of an automated micro-latex D-dimer assay (Tina-quant on Hitachi 911 analyser) in symptomatic outpatients with suspected vein thrombosis.1999In: Thrombosis and Haemostasis, ISSN 0340-6245, Vol. 82, p. 1772-1773Article in journal (Refereed)
  • 335.
    Lindenberger, Marcus
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Physiology.
    Kjellberg, Margareta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Karlsson, Erling
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Wranne, Bengt
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Physiology. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Pericardiocentesis guided by 2-D echocardiography: The method of choice for treatment of pericardial effusion2003In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 253, no 4, p. 411-417Article in journal (Refereed)
    Abstract [en]

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

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

     Abstract 4615. European Heart J 2006.

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

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

  • 338. Lindstedt, G
    et al.
    Alehagen, Urban
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Dahlström, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    BNP hämmar fibrosutveckling i hjärtat.2003In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 100, p. 925-925Article in journal (Other academic)
  • 339. Lindstedt, G
    et al.
    Alehagen, Urban
    Linköping University, Department of Department of Health and Society.
    Dahlström, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    BNPs användbarhet vid hjärtsvikt - brister i en aktuell översikt avspeglar problemets komplexitet2004In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 101, p. 688-689Article in journal (Other academic)
  • 340.
    Lindstedt, Göran
    et al.
    klinisk kemi och trasfusionmed Göteborg.
    Dahlström, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Fernlund, Per
    klinskt kematiska avd MAS Malmö.
    Schaufelberger, Maria
    medicinkliniken Sahlgrenska Göteborg.
    Stridsberg, Mats
    klinisk kemi Akademiska sjukh Uppsala.
    Bättre behandling av hjärtsvikt med mätning av natriuretiska peptider.2001In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 98, p. 4444-4452Article in journal (Other academic)
  • 341.
    Liuba, Ioan
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Focal atrial tachycardia: Insights concerning the arrhythmogenic substrate based on analysis of intracardiac electrograms and inflammatory markers2009Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Focal atrial tachycardias are tachycardias characterized by a radial spread of activation from a discrete area of the atrial myocardium. They account for 10-15% of supraventricular tachycardias and are generally poorly responsive to pharmacological treatment. The pathophysiologic substrate of these arrhythmias remains poorly understood. Computational studies suggest that a certain degree of intercellular uncoupling and anisotropy are important prerequisites for the development of focal arrhythmias. The anisotropy and intercellular uncoupling could promote focal arrhythmias by minimizing the suppressive effect of the surrounding atrial muscle on the pacemaking process in the focus. This hypothesis would be in agreement with the fact that fractionated electrograms, a marker of anisotropy and reduced intercellular coupling, are often recorded at the site of earliest activated site. Reduced intercellular coupling could be induced by factors enhancing the amount of intracardiac connective tissue, such as advancing age or cardiac disease states. Indeed, focal inflammatory processes have been reported in atrial specimens resected from patients with focal tachycardia undergoing arrhythmia surgery.

    Methods: In a group of patients with paroxysmal and permanent atrial fibrillation we sought to assess whether there is a link between inflammation and the occurrence of atrial arrhythmia. We therefore analyzed different inflammatory markers (C-reactive protein and interleukin-6 and 8) in the systemic and pulmonary circulation as well as in the heart in these patients. In addition, we assessed the extent of intercellular uncoupling in the vicinity of tachycardia origin in patients with focal atrial tachycardia. We also assessed the impact of electrogram fractionation on the method of activation time determination, by comparing different methods for estimating activation time with regard to the appearance of the resultant activation maps and the location of the foci. We also assessed the observer variability in the estimation of activation time during mapping of these tachycardias.

    Results: There was no evidence of elevated circulatory levels of inflammatory markers in patients with paroxysmal atrial fibrillation. However, patients with permanent atrial fibrillation had increased levels of inflammatory markers (interleukin-8) in the systemic circulation but not in the pulmonary circulation or in the heart. In patients with focal atrial tachycardia, a higher degree of electrogram fractionation existed in the region surrounding the earliest activation site and activated within the first 15 ms as compared with the remaining atrium. Moreover, within this region, from the periphery towards the earliest activated site, there was a gradual increase in electrogram fractionation as well as a gradual decrease in the peak-to-peak voltage. When comparing different methods for estimating local activation time we found that different methods can generate activation maps with different appearances and foci with different locations. However, regardless of the method of activation time determination, the foci tend to cluster within relatively large areas of low-amplitude fractionated electrograms. In addition we found significant observer variability in the estimation of the local activation time.

    Conclusion: Patients with paroxysmal atrial fibrillation (and probably focal atrial tachycardia) do not have elevated levels of inflammatory markers. The increased levels of interleukin-8 in the systemic circulation suggest a link between long-lasting arrhythmia and inflammation. A relatively wide area of increased electrogram fractionation exists around the site of origin of focal atrial tachycardia. These findings suggest a sizeable atrial region with particular electrophysiological proprieties and raise the possibility of an anatomical substrate of the tachycardia. Increased electrogram fractionation can impact the process of activation determination, as suggested by the fact that different methods compute foci with different locations. In addition, there is significant observer variability in the estimation of local activation time in these patient.

    List of papers
    1. Source of inflammatory markers in patients with atrial fibrillation
    Open this publication in new window or tab >>Source of inflammatory markers in patients with atrial fibrillation
    Show others...
    2008 (English)In: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, ISSN 1532-2092, Vol. 10, no 7, p. 848-853Article in journal (Refereed) Published
    Abstract [en]

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

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

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

    Keywords
    Atrial fibrillation, Inflammation, Catheter ablation
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-20458 (URN)10.1093/europace/eun111 (DOI)18523031 (PubMedID)
    Available from: 2009-09-09 Created: 2009-09-09 Last updated: 2018-09-17Bibliographically approved
    2. Corrigendum for: Focal atrial tachycardia: increased electrogram fractionation in the vicinity of the earliest activation site. In Europace (ISSN 1099-5129), vol 10, issue 11, pg 1357
    Open this publication in new window or tab >>Corrigendum for: Focal atrial tachycardia: increased electrogram fractionation in the vicinity of the earliest activation site. In Europace (ISSN 1099-5129), vol 10, issue 11, pg 1357
    2008 (English)In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 10, no 11, p. 1357-1357Article in journal (Other academic) Published
    Abstract [en]

    P values of P < 0.0001 should have been given in the abstractfor the increase within the region activated during the first15 ms of both the incidence of bipolar electrograms with multiplenegative deflections and of the incidence of unipolar electrogramswith multiple negative deflections.

    In the section ‘Characteristics of electrograms in theregion surrounding the earliest activation site and in the remainingatrium’ the P value for bipolar voltage should be P <0.0001, not P < 0001. In the same section the P value forthe decrease of unipolar and bipolar peak-to-peak voltage shouldbe P < 0.0001, not P < 0001.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-16116 (URN)10.1093/europace/eun290 (DOI)
    Available from: 2009-01-08 Created: 2009-01-07 Last updated: 2017-12-14Bibliographically approved
    3. Corrigendum for: Focal atrial tachycardia: increased electrogram fractionation in the vicinity of the earliest activation site. In Europace (ISSN 1099-5129), vol 10, issue 11, pg 1357
    Open this publication in new window or tab >>Corrigendum for: Focal atrial tachycardia: increased electrogram fractionation in the vicinity of the earliest activation site. In Europace (ISSN 1099-5129), vol 10, issue 11, pg 1357
    2008 (English)In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 10, no 11, p. 1357-1357Article in journal (Other academic) Published
    Abstract [en]

    P values of P < 0.0001 should have been given in the abstractfor the increase within the region activated during the first15 ms of both the incidence of bipolar electrograms with multiplenegative deflections and of the incidence of unipolar electrogramswith multiple negative deflections.

    In the section ‘Characteristics of electrograms in theregion surrounding the earliest activation site and in the remainingatrium’ the P value for bipolar voltage should be P <0.0001, not P < 0001. In the same section the P value forthe decrease of unipolar and bipolar peak-to-peak voltage shouldbe P < 0.0001, not P < 0001.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-16116 (URN)10.1093/europace/eun290 (DOI)
    Available from: 2009-01-08 Created: 2009-01-07 Last updated: 2017-12-14Bibliographically approved
    4. Activation mapping of focal atrial tachycardia: the impact of the method for estimating activation time
    Open this publication in new window or tab >>Activation mapping of focal atrial tachycardia: the impact of the method for estimating activation time
    2009 (English)In: Journal of interventional cardiac electrophysiology (Print), ISSN 1383-875X, E-ISSN 1572-8595, Vol. 26, no 3, p. 169-180Article in journal (Refereed) Published
    Abstract [en]

    Purpose

    Different methods can be used to estimate activation time during the mapping of focal atrial tachycardia. The present study aimed to compare activation maps generated by three widely used methods of determining activation time.

    Methods

    Fourteen patients (mean age 48 ± 17 years) with focal atrial tachycardia were investigated. Mapping was performed with the CARTO system. All patients underwent successful ablation. Local activation time was successively defined as the peak amplitude (Bi-peak), the steepest downslope (Bi-dslope), and the onset (Bi-on) of the bipolar electrograms.

    Results

    The three methods of activation time determination were highly correlated with one another but generated foci with different locations. The distances between the foci generated by the different methods were 4.36 ± 4.91 mm (Bi-peak–Bi-dslope), 7.21 ± 5.11 mm (Bi-peak–Bi-on), and 7.21 ± 5.87 mm (Bi-dslope–Bi-on) (p = 0.26). Also, the three methods generated foci with different diameters: 3.13 ± 2.17 mm for Bi-peak, 2.81 ± 0.78 for Bi-dslope, and 2.54 ± 0.14 mm for Bi-on (p = 0.60). However, the foci tended to cluster within relatively wide regions of low-amplitude fractionated electrograms. The surface of these regions was 3.81 ± 2.34 cm2 (Bi-peak), 3.38 ± 2.12 cm2 (Bi-dslope), and 4.76 ± 3.01 cm2 (Bi-on) (p = 0.34).

    Conclusion

    The three methods of activation time determination, although highly correlated with one another, may generate foci of different sizes and in different locations. However, the foci tend to cluster within relatively large areas of low-amplitude fractionated electrograms. These findings suggest a sizeable atrial region with particular electrophysiological proprieties and raise the possibility of an anatomical substrate of the tachycardia. During mapping, this region can be roughly delineated by all three methods of activation time estimation. However, details concerning the activation pattern within the region and the location of the focus vary among the methods.

    Place, publisher, year, edition, pages
    Springer, 2009
    Keywords
    Tachycardia, mapping, catheter ablation
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-20459 (URN)10.1007/s10840-009-9437-0 (DOI)000272848800004 ()
    Note

    Presented in part at the American Heart Association Scientific Sessions 2008, New Orleans, LA, USA, November 8–12, 2008

    Available from: 2009-09-09 Created: 2009-09-09 Last updated: 2017-12-13Bibliographically approved
    5. Electroanatomic Mapping of Focal Atrial Tachycardia: Reproducibility ofActivation Time Measurement and Focus Localization
    Open this publication in new window or tab >>Electroanatomic Mapping of Focal Atrial Tachycardia: Reproducibility ofActivation Time Measurement and Focus Localization
    2010 (English)Article in journal (Other academic) Submitted
    Abstract [en]

    Background: Different algorithms of estimating local activation time (LAT) can be usedduring the mapping of focal atrial tachycardia (FAT).

    Objective: The impact of these algorithms on the reproducibility of LAT measurementand the location of the focus.

    Methods: Fifteen patients (48 ± 17 yrs) with FAT were studied. Three independentobservers reviewed 1438 bipolar electrograms and successively assigned the LAT on thepeak amplitude (Bi-peak), the steepest downslope (Bi-dslope), and the onset (Bi-on) ofthe electrograms. The reproducibility of LAT measurement was estimated.

    Results: The mean interobserver absolute differences in LAT for the three algorithmswere 1.47 ± 2.75 ms (Bi-peak) vs. 2.15 ± 3.89 ms (Bi-dslope) vs. 2.87 ± 3.47 (Bi-on) (p <0.0001). The corresponding intraobserver differences were 2.29 ± 3.74 ms (Bi-peak) vs2.47 ± 4.17 ms (Bi-dslope) vs 3.16 ± 4.49 ms (Bi-on) (p < 0.0001). The interobserverdifferences in the location of the focus were 3.57 ± 3.81 mm (Bi-peak) vs 5.47 ± 4.98mm (Bi-dslope) vs 6.57 ± 6.94 mm (Bi-on) (p = 0.03), with differences of up to 13 mm(Bi-peak), 16 mm (Bi-dslope), and 25 mm (Bi-on). However, regardless of the method ofLAT determination, the foci computed by the three observers clustered within regions oflow-amplitude fractionated electrograms.

    Conclusions: Significant observer variability exists among the three algorithms, whichtend to compute different LAT and foci with different locations. However, the foci aresituated in regions of low voltage fractionated electrograms.

    Keywords
    Ectopic atrial tachycardia; catheter ablation; atrial electrogram
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-20460 (URN)
    Available from: 2009-09-09 Created: 2009-09-09 Last updated: 2013-12-17Bibliographically approved
  • 342.
    Liuba, Ioan
    et al.
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Ahlmroth, Henrik
    Department of Cardiology, University Hospital Örebro, Örebro, Sweden.
    Jonasson, Lena
    Östergötlands Läns Landsting, Heart Centre, Department of Cardiology. Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences.
    Englund, Anders
    Department of Cardiology, University Hospital Örebro, Örebro, Sweden.
    Jönsson, Anders
    Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Säfström, Kåge
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Walfridsson, Håkan
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Source of inflammatory markers in patients with atrial fibrillation2008In: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, ISSN 1532-2092, Vol. 10, no 7, p. 848-853Article in journal (Refereed)
    Abstract [en]

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

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

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

  • 343.
    Liuba, Ioan
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Janzon, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Walfridsson, Ulla
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Walfridsson, Håkan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Impact of catheter ablation on health related quality of life in patients with focal atrial tachycardia2006In: VIII Svenska Kardiovaskulära Vårmötet,2006, 2006Conference paper (Other academic)
  • 344.
    Liuba, Ioan
    et al.
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Jönsson, Anders
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Walfridsson, Håkan
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Electroanatomic Mapping of Focal Atrial Tachycardia: Reproducibility ofActivation Time Measurement and Focus Localization2010Article in journal (Other academic)
    Abstract [en]

    Background: Different algorithms of estimating local activation time (LAT) can be usedduring the mapping of focal atrial tachycardia (FAT).

    Objective: The impact of these algorithms on the reproducibility of LAT measurementand the location of the focus.

    Methods: Fifteen patients (48 ± 17 yrs) with FAT were studied. Three independentobservers reviewed 1438 bipolar electrograms and successively assigned the LAT on thepeak amplitude (Bi-peak), the steepest downslope (Bi-dslope), and the onset (Bi-on) ofthe electrograms. The reproducibility of LAT measurement was estimated.

    Results: The mean interobserver absolute differences in LAT for the three algorithmswere 1.47 ± 2.75 ms (Bi-peak) vs. 2.15 ± 3.89 ms (Bi-dslope) vs. 2.87 ± 3.47 (Bi-on) (p <0.0001). The corresponding intraobserver differences were 2.29 ± 3.74 ms (Bi-peak) vs2.47 ± 4.17 ms (Bi-dslope) vs 3.16 ± 4.49 ms (Bi-on) (p < 0.0001). The interobserverdifferences in the location of the focus were 3.57 ± 3.81 mm (Bi-peak) vs 5.47 ± 4.98mm (Bi-dslope) vs 6.57 ± 6.94 mm (Bi-on) (p = 0.03), with differences of up to 13 mm(Bi-peak), 16 mm (Bi-dslope), and 25 mm (Bi-on). However, regardless of the method ofLAT determination, the foci computed by the three observers clustered within regions oflow-amplitude fractionated electrograms.

    Conclusions: Significant observer variability exists among the three algorithms, whichtend to compute different LAT and foci with different locations. However, the foci aresituated in regions of low voltage fractionated electrograms.

  • 345.
    Liuba, Ioan
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Jönsson, Anna
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery.
    Safstrom, K.
    Säfström, K., Department of Cardiology, University Hospital Linköping, Linköping, Sweden.
    Walfridsson, Håkan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Gender-related differences in patients with atrioventricular nodal reentry tachycardia2006In: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 97, no 3, p. 384-388Article in journal (Refereed)
    Abstract [en]

    The present study sought to assess the extent of gender differences in electrophysiologic parameters in patients with atrioventricular nodal reentrant tachycardia (AVNRT). The study population consisted of 203 patients (women/men ratio 2:1) who underwent slow pathway ablation. Patients with associated heart disease experienced the first episode of tachycardia at a significantly older age than patients with lone AVNRT (women 50 ± 18 vs 29 ± 15 years, p <0.0001, men 45 ± 20 vs 31 ± 17 years, p = 0.01). Sinus cycle length (797 ± 142 vs 870 ± 161 ms, p = 0.0001), HV interval (41 ± 7 vs 45 ± 8 ms, p = 0.0001), atrioventricular (AV) block cycle length (348 ± 53 vs 371 ± 75 ms, p = 0.01), slow pathway effective refractory period (ERP) (258 ± 46 vs 287 ± 62 ms, p = 0.006), and tachycardia cycle length (354 ± 58 vs 383 ± 60 ms, p = 0.001) were shorter in women. No gender differences were noted in fast pathway ERP and ventriculoatrial (VA) block cycle length. In women, an AV block cycle length <350 ms along with a VA block cycle length <400 ms predicted tachycardia induction without the need for autonomic intervention, with a positive predictive value of 93% (sensitivity 71%, specificity 82%). No such cut-off values could be found in men. The acute success rate (100% vs 98%) and the recurrence rate (3% vs 6%) were similar for the 2 genders. In conclusion, in patients with lone AVNRT, the onset of symptoms occurred at a younger age than in patients with concomitant heart disease. Women had shorter slow pathway refractory periods, AV block cycle lengths, and tachycardia cycle lengths. No gender differences were noted in the fast pathway ERP. Therefore, women have a wider "tachycardia window" (i.e., the difference between the fast and slow pathway refractory periods), a finding that may explain their greater incidence of AVNRT. © 2006 Elsevier Inc. All rights reserved.

  • 346.
    Liuba, Ioan
    et al.
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Walfridsson, Håkan
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Activation mapping of focal atrial tachycardia: the impact of the method for estimating activation time2009In: Journal of interventional cardiac electrophysiology (Print), ISSN 1383-875X, E-ISSN 1572-8595, Vol. 26, no 3, p. 169-180Article in journal (Refereed)
    Abstract [en]

    Purpose

    Different methods can be used to estimate activation time during the mapping of focal atrial tachycardia. The present study aimed to compare activation maps generated by three widely used methods of determining activation time.

    Methods

    Fourteen patients (mean age 48 ± 17 years) with focal atrial tachycardia were investigated. Mapping was performed with the CARTO system. All patients underwent successful ablation. Local activation time was successively defined as the peak amplitude (Bi-peak), the steepest downslope (Bi-dslope), and the onset (Bi-on) of the bipolar electrograms.

    Results

    The three methods of activation time determination were highly correlated with one another but generated foci with different locations. The distances between the foci generated by the different methods were 4.36 ± 4.91 mm (Bi-peak–Bi-dslope), 7.21 ± 5.11 mm (Bi-peak–Bi-on), and 7.21 ± 5.87 mm (Bi-dslope–Bi-on) (p = 0.26). Also, the three methods generated foci with different diameters: 3.13 ± 2.17 mm for Bi-peak, 2.81 ± 0.78 for Bi-dslope, and 2.54 ± 0.14 mm for Bi-on (p = 0.60). However, the foci tended to cluster within relatively wide regions of low-amplitude fractionated electrograms. The surface of these regions was 3.81 ± 2.34 cm2 (Bi-peak), 3.38 ± 2.12 cm2 (Bi-dslope), and 4.76 ± 3.01 cm2 (Bi-on) (p = 0.34).

    Conclusion

    The three methods of activation time determination, although highly correlated with one another, may generate foci of different sizes and in different locations. However, the foci tend to cluster within relatively large areas of low-amplitude fractionated electrograms. These findings suggest a sizeable atrial region with particular electrophysiological proprieties and raise the possibility of an anatomical substrate of the tachycardia. During mapping, this region can be roughly delineated by all three methods of activation time estimation. However, details concerning the activation pattern within the region and the location of the focus vary among the methods.

  • 347.
    Liuba, Ioan
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Walfridsson, Håkan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Corrigendum for: Focal atrial tachycardia: increased electrogram fractionation in the vicinity of the earliest activation site. In Europace (ISSN 1099-5129), vol 10, issue 11, pg 13572008In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 10, no 11, p. 1357-1357Article in journal (Other academic)
    Abstract [en]

    P values of P < 0.0001 should have been given in the abstractfor the increase within the region activated during the first15 ms of both the incidence of bipolar electrograms with multiplenegative deflections and of the incidence of unipolar electrogramswith multiple negative deflections.

    In the section ‘Characteristics of electrograms in theregion surrounding the earliest activation site and in the remainingatrium’ the P value for bipolar voltage should be P <0.0001, not P < 0001. In the same section the P value forthe decrease of unipolar and bipolar peak-to-peak voltage shouldbe P < 0.0001, not P < 0001.

  • 348.
    Liuba, Ioan
    et al.
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology. Linköping University, Faculty of Health Sciences.
    Walfridsson, Håkan
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology. Linköping University, Faculty of Health Sciences.
    Focal atrial tachycardia: increased electrogram fractionation in the vicinity of the earliest activation site.2008In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 10, no 10, p. 1195-1204Article in journal (Refereed)
    Abstract [en]

    Aims: Fractionated electrograms are often noted during mapping of focal atrial tachycardia (FAT). This finding suggests poor cell-to-cell coupling, which is thought to be an important prerequisite in the process of ectopic impulse initiation and propagation. The purpose of the present study was to assess the electrogram fractionation in the vicinity of the earliest activation site and in the remaining atrium in these patients.

    Methods and results: Thirteen patients with FAT (age 48 ± 17 years) who underwent catheter ablation were investigated. Mapping was performed with the CARTO system. Electrogram fractionation was assessed on the basis of the number of negative deflections, both in the region surrounding the earliest activation site and in the remaining atrium. Unipolar and bipolar peak-to-peak voltage and bipolar electrogram duration were also studied. All patients underwent successful radiofrequency ablation. A higher degree of electrogram fractionation existed in the region surrounding the earliest activation site and activated within the first 15 ms when compared with the remaining atrium (incidence of bipolar electrograms with multiple negative deflections: 88 vs. 79%, P < 0.0001; incidence of unipolar electrograms with multiple negative deflections: 56 vs. 43%, P = 0.0001). The peak-to-peak voltage in the region activated within the first 15 ms was less than that in the remaining atrium (bipolar voltage: 1.33 ± 0.99 vs. 1.61 ± 1.11 mV, P < 0.001; unipolar voltage: 1.75 ± 0.92 vs. 1.95 ± 1.11 mV, P = 0.0188). There were no significant differences in bipolar electrogram duration. Within the region activated during the first 15 ms, from the periphery to the earliest activation site, there was a gradual increase in electrogram fractionation (incidence of bipolar electrograms with multiple negative deflections gradually increasing from 82 to 100% and incidence of unipolar electrograms with multiple negative deflections increasing from 56 to 90%), as well as a gradual decrease in peak-to-peak voltage (bipolar voltage gradually decreasing from 1.47 ± 1.06 to 0.89 ± 0.54 mV, P < 0.0001; unipolar voltage gradually decreasing from 1.89 ± 0.94 to 1.30 ± 0.63 mV, P < 0.0001). Irregular, closely spaced isochrones were also noted in the region activated during the first 15 ms. The area of this region was 4.88 ± 3.59 cm2.

    Conclusion: Increased electrogram fractionation exists within a relatively wide region around the tachycardia origin when compared with the remaining atrium. Moreover, this region is electrically heterogeneous, as suggested by the fact that the degree of electrogram fractionation increases gradually whereas the electrogram voltage decreases gradually towards the earliest activation site. These findings suggest that a non-discrete atrial region with gradually changing electrophysiological properties may underlie the substrate of FAT.

  • 349.
    Liuba, Ioan
    et al.
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Walfridsson, Håkan
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Mapping of Focal Atrial Tachycardia: The Impact of the Method of Activation Time Determination2008In: CIRCULATION,ISSN 0009-7322: Volume 118 Issue 18, 2008, Vol. 118, no 18, p. S983-S984Conference paper (Refereed)
  • 350.
    Liuba, Ioan
    et al.
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology. Linköping University, Faculty of Health Sciences.
    Walfridsson, Håkan
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology. Linköping University, Faculty of Health Sciences.
    The effect of the method for determining activation time during electroanatomic mapping of focal atrial tachycardia.2009Conference paper (Refereed)
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