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  • 51.
    Janerot-Sjöberg, Birgitta
    et al.
    Linköping University, Department of Biomedical Engineering, Physiological Measurements. Linköping University, The Institute of Technology. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Clinical Physiology UHL.
    Ekberg, Stefan
    Linköping University, Department of Medical and Health Sciences, Radiation Physics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics UHL.
    Areskog, M.
    Department of Clinical Physiology, Kalmar Regional Hospital.
    Nylander, Eva
    Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Clinical Physiology UHL.
    Swahn, Eva
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Quantitative digital evaluation of myocardial exercise thallium-201 single-photon emission tomography in post-menopausal women1998In: Clinical Physiology, ISSN 0144-5979, E-ISSN 1365-2281, Vol. 18, no 3, p. 169-177Article in journal (Refereed)
    Abstract [en]

    Quantitative computerized analysis of data from myocardial thallium-201 (201Tl) single-photon emission tomography (SPET) may improve the diagnostic accuracy of coronary heart disease. The reference ranges for post-menopausal women are, however, limited and obtained mainly from patients. To compare reference values from healthy post-menopausal women and to improve the quantitative analysis, 20 women (10 patients with coronary heart disease and previous infarction and 10 age-matched healthy volunteers) were examined immediately post exercise and after a delay. A nine-segment 'bull's-eye' model was used for analysis. At visual evaluation, reproducibility was high (93%), no false-positive results were obtained and in 70% of the patients the SPET was interpreted as abnormal. Using reported reference values for quantitative analysis, all the healthy women had an abnormal result. New reference values based on three different methods of 'normalization' were calculated: the relative activity of segment 3 set to 100%, the segment with the highest activity set to 100% and a least-squares method. They all differed significantly from those that had previously been reported. The frequencies of agreement between visual and quantitative analysis were 84-92% and were highest when segment 3 was used as a reference, but in this case only 40% of the patients with coronary heart disease had an abnormal SPET. Using the least-squares method for handling digital information, the SD of the normal values decreased and 90% of the patients with coronary heart disease were accurately diagnosed. These results provide quantitative digital reference values for healthy post-menopausal women. They verify that quantitative analysis is in diagnostic agreement with visual evaluation, stress the need for local verification of reference ranges and suggest a least-square normalization method for the analysis.

  • 52.
    Jansson, Kjell
    et al.
    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.
    Karlberg, B E
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Internal Medicine.
    Karlsson, E
    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.
    Nyqvist, O
    Karlberg, K-E
    The circulating renin-angiotensin system during treatment with mteprlol or captopril in patients with heart failure due to non-ischaemic dilated cardiomyopathy.1999In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 245, p. 435-443Article in journal (Refereed)
  • 53.
    Jansson, Kjell
    et al.
    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.
    Karlberg, Karl-Erik
    Karlsson, Erling
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Nyquist, Olof
    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.
    The value of repeated echocardiographic evaluation in patients with idiopathic dilated cardiomyopathy during treatment with metoprolol or captopril2000In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 34, no 3, p. 293-300Article in journal (Refereed)
    Abstract [en]

    Serial echocardiographic investigations were carried out on patients with idiopathic dilated cardiomyopathy, to evaluate treatment effects on left ventricular (LV) performance during therapy with either metoprolol or captopril. Thirty-two patients (23 males and 9 females) with mild to moderate symptoms of heart failure (NYHA II-III) and a mean age of 49 years were included in the investigation. The patients were investigated with Doppler echocardiography before treatment, after 3 and 6 months of treatment (either metoprolol or captopril) and 1 month after withdrawal of treatment. Intra- and inter-investigator reproducibility was acceptable, with a coefficient of variation of less than 5% for LV dimensions. A reduction in LV dimensions was seen in both treatment groups. In the metoprolol group there was also an increase in LV stroke volume and fractional shortening. The non-invasive data were in accordance with invasive measurements of stroke volume and LV filling pressure. In patients with idiopathic dilated cardiomyopathy and mild to moderate symptoms of heart failure, echocardiography seemed to be sufficiently reproducible to be used for determination of treatment effects in a longitudinal heart failure study. Both metoprolol and captopril were well tolerated and had favourable effects on LV performance.

  • 54.
    Jansson, Kjell
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Hagerman, I
    Östlund, R
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Physiology.
    Karlberg, K-E
    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.
    Nyqvist, O
    Dahlström, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    The effects of Metoprolol and Captopril on heart rate variability in patients with idiopathic dilated cardiomyopathy.1999In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 22, p. 397-402Article in journal (Refereed)
  • 55.
    Kalnina, Liga
    et al.
    State Sports Medical Centre, Latvia; Latvian University, Latvia.
    Sauka, Melita
    State Sports Medical Centre, Latvia.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Health and Developmental Care, Center for Public Health.
    Dahlström, Örjan
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research.
    Nylander, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Selga, Guntars
    State Sports Medical Centre, Latvia; Riga Stradins University, Latvia.
    Ligere, Renate
    Latvian University, Latvia.
    Karklina, Helena
    Latvian University, Latvia.
    Priedite, Ilga S.
    State Sports Medical Centre, Latvia.
    Larins, Viesturs
    Latvian Academic Sports Educ, Latvia.
    Body fat in children and adolescents participating in organized sports: Descriptive epidemiological study of 6048 Latvian athletes2015In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 43, no 6, p. 615-622Article in journal (Refereed)
    Abstract [en]

    Background: Pressure among young athletes to meet body composition goals may lead to poor nutrition and affect growth. Aims: To examine the proportion of body fat (%BF), measured by bioimpedance analysis, among Latvian children and adolescents participating in organized sports. Methods: Our study had a nationally representative sample of 6048 young athletes, aged 10-17 years. Their %BF was measured using a multifrequency, 8-pole, bioelectrical impedance leg-to-hand analyzer. Results: About 19.2% (CI 14.4-20.0) of boys and 15.1% (CI 14.0-16.3) of girls had a %BF value below the recommended levels. The %BF in young female athletes participating in aesthetic sports was lower than among their peers participating in other sports. Young male athletes participating in aesthetic sports had lower %BF levels at 10 and 12 years of age, compared with participants in weight-class sports; and lower levels of %BF from age 10-14 years, compared with participants in non-weight-sensitive sports. Conclusions: Almost every fifth child and adolescent participating in organized sports displayed critically low body fat levels. Body fat needs to be assessed regularly in young athletes, to prevent negative consequences on health.

  • 56.
    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.

  • 57.
    Kümhe, Tobias
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Franzén, Stefan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    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.
    The simple solution to a complex case2001In: Journal of Neurology, Neurosurgery and Psychiatry, ISSN 0022-3050, E-ISSN 1468-330X, Vol. 70, no 2, p. 263-Article in journal (Refereed)
  • 58.
    Lans, Charlotta
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Department of Physiotherapy, Kalmar County Hospital, Kalmar, Sweden.
    Cider, Åsa
    Department of Health and Rehabilitation/Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Nylander, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Brudin, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Department of Clinical Physiology, Kalmar County Hospital, Kalmar, Sweden.
    Peripheral muscle training with resistance exercise bands in patients with chronic heart failure. Long-term effects on walking distance and quality of life; a pilot study2018In: ESC Heart Failure, E-ISSN 2055-5822, Vol. 5, no 2, p. 241-248Article in journal (Refereed)
    Abstract [en]

    This study aimed to describe a method of peripheral muscle training with resistance bands in patients with chronic heart failure (CHF) and to evaluate its effects on the 6 min walk test and quality of life up to 12 months using a home-based programme.

  • 59.
    Lindström, Lena
    et al.
    Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Nylander, Eva
    Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Larsson, Hans
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Wranne, Bengt
    Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Left ventricular involvement in arrhythmogenic right ventricular cardiomyopathy: A scintigraphic and echocardiographic study2005In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 25, no 3, p. 171-177Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 60.
    Maret, Eva
    et al.
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences.
    Brudin, Lars
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences.
    Lindström, Lena
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences.
    Nylander, Eva
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Ohlsson, Jan L
    Ryhov City Hospital, Jönköping, Sweden.
    Engvall, Jan
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Computer-assisted determination of left ventricular endocardial borders reduces variability in the echocardiographic assessment of ejection fraction2008In: Cardiovascular Ultrasound, ISSN 1476-7120, E-ISSN 1476-7120, Vol. 6, no 55Article in journal (Refereed)
    Abstract [en]

    Background: Left ventricular size and function are important prognostic factors in heart disease. Their measurement is the most frequent reason for sending patients to the echo lab. These measurements have important implications for therapy but are sensitive to the skill of the operator. Earlier automated echo-based methods have not become widely used. The aim of our study was to evaluate an automatic echocardiographic method (with manual correction if needed) for determining left ventricular ejection fraction (LVEF) based on an active appearance model of the left ventricle (syngo (R) AutoEF, Siemens Medical Solutions). Comparisons were made with manual planimetry (manual Simpson), visual assessment and automatically determined LVEF from quantitative myocardial gated single photon emission computed tomography (SPECT).

    Methods: 60 consecutive patients referred for myocardial perfusion imaging (MPI) were included in the study. Two-dimensional echocardiography was performed within one hour of MPI at rest. Image quality did not constitute an exclusion criterion. Analysis was performed by five experienced observers and by two novices.

    Results: LVEF (%), end-diastolic and end-systolic volume/BSA (ml/m(2)) were for uncorrected AutoEF 54 +/- 10, 51 +/- 16, 24 +/- 13, for corrected AutoEF 53 +/- 10, 53 +/- 18, 26 +/- 14, for manual Simpson 51 +/- 11, 56 +/- 20, 28 +/- 15, and for MPI 52 +/- 12, 67 +/- 26, 35 +/- 23. The required time for analysis was significantly different for all four echocardiographic methods and was for uncorrected AutoEF 79 +/- 5 s, for corrected AutoEF 159 +/- 46 s, for manual Simpson 177 +/- 66 s, and for visual assessment 33 +/- 14 s. Compared with the expert manual Simpson, limits of agreement for novice corrected AutoEF was lower than for novice manual Simpson (0.8 +/- 10.5 vs. -3.2 +/- 11.4 LVEF percentage points). Calculated for experts and with LVEF (%) categorized into < 30, 30-44, 45-54 and >= 55, kappa measure of agreement was moderate (0.44-0.53) for all method comparisons (uncorrected AutoEF not evaluated).

    Conclusion: Corrected AutoEF reduces the variation in measurements compared with manual planimetry, without increasing the time required. The method seems especially suited for unexperienced readers.

  • 61.
    Maret, Eva
    et al.
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences.
    Engvall, Jan
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences.
    Nylander, Eva
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences.
    Ohlsson, Jan
    1Department of Clinical Physiology, Ryhov County Hospital, SE-551 85 Jönköping, Sweden.
    Feasibility and diagnostic power of transthoracic coronary Doppler for coronary flow velocity reserve in patients referred for myocardial perfusion imaging2008In: Cardiovascular Ultrasound, ISSN 1476-7120, E-ISSN 1476-7120, Vol. 6, no 12Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Myocardial perfusion imaging (MPI), using single photon emission computed tomography (SPECT) is a validated method for detecting coronary artery disease. Transthoracic Doppler echocardiography (TTDE) of flow at rest and during adenosine provocation has previously been evaluated in selected patient groups. We therefore wanted to compare the diagnostic ability of TTDE in the left anterior descending coronary artery (LAD) to that of MPI in an unselected population of patients with chest pain referred for MPI. Our hypothesis was that TTDE with high accuracy would identify healthy individuals and exclude them from the need for further studies, enabling invasive investigations to be reserved for patients with a high probability of disease.

    METHODS: Sixty-nine patients, 44 men and 25 women, age 61 +/- 10 years (range 35-82), with a clinical suspicion of stress induced myocardial ischemia, were investigated. TTDE was performed at rest and during adenosine stress for myocardial scintigraphy.

    RESULTS: We found that coronary flow velocity reserve (CFVR) determined from diastolic measurements separated normal from abnormal MPI findings with statistical significance. TTDE identified coronary artery disease, defined from MPI, as reversible ischemia and/or permanent defect, with a sensitivity of 60% and a specificity of 79%. The positive predictive value was 43% and the negative predictive value was 88%. There was an overlap between groups which could be due to abnormal endothelial function in patients with normal myocardial perfusion having either hypertension or diabetes.

    CONCLUSION: TTDE is an attractive non-invasive method to evaluate chest pain without the use of isotopes, but the diagnostic power is strongly dependent on the population investigated. Even in our heterogeneous clinical cardiac population, we found that CFVR>2 in the LAD excluded significant coronary artery disease detected by MPI.

  • 62.
    Maret, Eva
    et al.
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences.
    Tödt, Tim
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
    Brudin, Lars
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences.
    Nylander, Eva
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Swahn, Eva
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Ohlsson, Jan
    Department of Clinical Physiology, Ryhov County Hospital, SE-55185 Jönköping, Sweden.
    Engvall, Jan
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Feature tracking of cine-MRI identifies left ventricular segments with myocardial scarManuscript (preprint) (Other academic)
    Abstract [en]

    Background: The aim of the study was to apply a new feature tracking software (Diogenes MRI, Tomtec GmbH, Unterschliessheim, Germany) on cine-MR images to evaluate its utility and ability to detect infarcted myocardium and to assess the transmural extent of scar without the need for administering intravenous gadolinium-based contrast agents.

    Methods: Thirty patients (3 women and 27 men) were selected based on the presence or absence of extensive myocardial scar in the perfusion area of the left anterior descending coronary artery (LAD) but not in remote areas. Seventeen had a scar transmurality >75% in at least one segment belonging to the LAD area (scar patients) and thirteen had scar <1% in this area or in other parts of the myocardium (non-scar patients). The software tracked the motion of the wall through the entire cardiac cycle using two different techniques. Velocity, displacement and strain were calculated in 48 points in the longitudinal direction, tangential to the endocardial outline, and in the radial direction, perpendicular to the tangent.

    Results: In the scar patients, LAD segments showed lower functional measures than remote segments. The remote segments in the scar group showed, in turn, lower functional measures than the remote segments in the non-scar group. Receiver-operatorcharacteristic (ROC) curves were constructed for all measurements. Best area-undercurve was for radial strain, 0.89, where a cut-off value of 38.8% had 80% sensitivity and 86% specificity for the detection of a segment with scar transmurality >50% in the LAD distribution. As a percentage of the mean, intraobserver variability was for radial measures 16-14-26% for displacement-velocity-strain and for the corresponding interobserver measurements 13-12-18%.

    Conclusions: With the presented method, we show for the first time its ability to detect scar segments with various transmurality already from an analysis of cine-MRI, without the need for the administration of gadolinium-based contrast. The accuracy and repeatability of the radial functional measurements is satisfactory and global measures agree with other aspects of global left ventricular function.

  • 63.
    Maret, Eva
    et al.
    Linköping University, Department of Biomedical Engineering, Center for Medical Image Science and Visualization. Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Tödt, Tim
    Linköping University, Department of Medical and Health Sciences, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology. Linköping University, Faculty of Health Sciences.
    Brudin, Lars
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Nylander, Eva
    Linköping University, Department of Medical and Health Sciences, Physiology. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Swahn, Eva
    Östergötlands Läns Landsting, Heart Centre, Department of Cardiology. Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences.
    Ohlsson, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences.
    Engvall, Jan
    Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Functional measurements based on feature tracking of cine magnetic resonance images identify left ventricular segments with myocardial scar.2009In: Cardiovascular Ultrasound, ISSN 1476-7120, E-ISSN 1476-7120, Vol. 7, no 53, p. 1-14Article in journal (Refereed)
    Abstract [en]

    Background

    The aim of the study was to perform a feature tracking analysis on cine magnetic resonance (MR) images to elucidate if functional measurements of the motion of the left ventricular wall may detect scar defined with gadolinium enhanced MR.

    Myocardial contraction can be measured in terms of the velocity, displacement and local deformation (strain) of a particular myocardial segment. Contraction of the myocardial wall will be reduced in the presence of scar and as a consequence of reduced myocardial blood flow.

    Methods

    Thirty patients (3 women and 27 men) were selected based on the presence or absence of extensive scar in the anteroseptal area of the left ventricle. The patients were investigated in stable clinical condition, 4-8 weeks post ST-elevation myocardial infarction treated with percutaneous coronary intervention. Seventeen had a scar area >75% in at least one anteroseptal segment (scar) and thirteen had scar area <1% (non-scar). Velocity, displacement and strain were calculated in the longitudinal direction, tangential to the endocardial outline, and in the radial direction, perpendicular to the tangent.

    Results

    In the scar patients, segments with scar showed lower functional measurements than remote segments. Radial measurements of velocity, displacement and strain performed better in terms of receiver-operator-characteristic curves (ROC) than the corresponding longitudinal measurements. The best area-under-curve was for radial strain, 0.89, where a cut-off value of 38.8% had 80% sensitivity and 86% specificity for the detection of a segment with scar area >50%. As a percentage of the mean, intraobserver variability was 16-14-26% for radial measurements of displacement-velocity-strain and corresponding interobserver variability was 13-12-18%.

    Conclusion

    Feature tracking analysis of cine-MR displays velocity, displacement and strain in the radial and longitudinal direction and may be used for the detection of transmural scar. The accuracy and repeatability of the radial functional measurements is satisfactory and global measures agree.

  • 64.
    Nelson, Nina
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Barn.
    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.
    Neonatal ventricular hypertrophy without cardiac malformations: A retrospective evaluation of 17 infants2001In: Prenatal and Neonatal Medicine, ISSN 1359-8635, E-ISSN 1473-0774, Vol. 6, no 5, p. 318-322Article in journal (Refereed)
    Abstract [en]

    Cardiac hypertrophy in the neonatal period is usually associated with other congenital defects of the circulatory system. Isolated ventricular hypertrophy can be difficult to evaluate and manage. We present 17 neonates with increased ventricular wall thickness without congenital malformations according to echocardiography during the neonatal period. The echocardiographic findings were defined as either concentric or predominantly septal hypertrophy. Doppler signs of ventricular outflow obstruction were found in six babies. The material consisted of preterm infants with steroid-treated bronchopulmonary dysplasia, metabolic disorders, perinatal infections, hypertrophic cardiomyopathy and babies with no identified underlying disorder. Six out of 17 patients died before the age of 8 months: all three babies with hypertrophic cardiomyopathy, one with toxoplasmosis and two out of four infants with steroid-treated bronchopulmonary dysplasia. It was not possible to predict the outcome from the initial clinical examination or from the first echocardiographic investigation. Ventricular wall thickness and outflow obstruction may undergo significant and rapid changes, and thus we recommend repeated echocardiographic examinations.

  • 65.
    Nielsen, Niels-Erik
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Wallby, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Ahn, Henrik Casimir
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Dahlin, Lars-Göran
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Nylander, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Lindgren, B
    Freter, W
    Johansson, M
    Baranowski, Jacek
    Transcatheter valve-in-valve - an elegant solution to a surgical problem.2014Conference paper (Refereed)
  • 66.
    Nielsen, Nils Erik
    et al.
    Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Rahgozar, Mohammad
    Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Wallby, Lars
    Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Nylander, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Hermansson, Ulf
    Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Håkanson, Erik
    Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Baranowski, Jacek
    Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Perkutan kateterburen stängning av paravalvulärt läckage efter mitralisplastik2013Conference paper (Refereed)
  • 67. Nilsson, S
    et al.
    Engblom, D
    Karlsson, LG
    Mölstad, S
    Jönköping.
    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.
    Scheike, M
    Åkerlind, Ingemar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, National Centre for Work and Rehabilitation.
    Örtoft, K
    Bröstsmärta och ischemisk hjärtsjukdom i primärvården2002In: Svenska Läkaresällskapets Riksstämma, Göteborg, 2002,2002, 2002Conference paper (Refereed)
  • 68.
    Nilsson, Staffan
    et al.
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the East of Östergötland, East County Primary Health Care.
    Scheike, Morten
    Engblom, David
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Karlsson, Lars-Göran
    Mölstad, Sigvard
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
    Åkerlind, Ingemar
    Linköping University, Department of Medicine and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Örtoft, Kjell
    Nylander, Eva
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Chest pain and ischaemic heart disease in primary care2003In: British Journal of General Practice, ISSN 0960-1643, Vol. 53, no 490, p. 378-382Article in journal (Refereed)
    Abstract [en]

    Background: Chest pain is the main symptom of first presentation with ischaemic heart disease (IHD). Little is known about the incidence of IHD among patients consulting the general practitioner (GP) for chest pain.

    Aims: To estimate the occurrence of IHD among patients consulting for chest pain, to study the results of the bicycle exercise test, and to estimate the incidence of IHD in the population.

    Design of study: Prospective descriptive study.

    Setting: Three primary health centres in south-eastern Sweden

    Method: All patients without a current IHD diagnosis, aged 20 to 79 years, and consulting for a new episode of chest pain, were included consecutively. The outcome was classified as IHD, possible IHD or not IHD, according to the results of a postal questionnaire, an exercise test or hospital care. Data from the hospital registry on patients with a diagnosis of IHD were analysed retrospectively.

    Results: Out of 38 075 GP consultations, 577 (1.5%) were for chest pain. IHD was diagnosed in 41 (8%) of the chest pain patients, in 41 (83%) the diagnosis was excluded, and in 50 (9%) the diagnosis was judged as being uncertain. Even though the diagnostic criteria were strict, the exercise tests led to a diagnostic conclusion in 77% of the cases, most frequently a normal test result. Combining data from primary and hospital care, the yearly incidence of IHD was 6.5 diagnosed per 1000 inhabitants (aged 20 to 79 years old).

    Conclusion: The incidence of a new episode of chest pain bringing the patient to the GP was low. Eight per cent of the patients received an IHD diagnosis, and in 9% further investigation or clinical assessment is needed.

  • 69.
    Nylander, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Cardiological screening of athletes2007In: Advanced Course in Sports medicine, Epidemiology and Rehabiliation,2007, 2007Conference paper (Other academic)
    Abstract [en]

      

  • 70.
    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.
    Svenska riktlinjer (Idrottshjärtat och screening - svenska riktlinjer och hur gör vi?)2007In: IX Svenska Kardiovaskulära vårmötet,2007, 2007Conference paper (Other academic)
  • 71.
    Nylander, Eva
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Physiology. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Dahlin, Lars-Göran
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Ebeling, C
    Svedjeholm, Rolf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Vektorkardiografi bättre än skalärt EKG för diagnos av perioperativ hjärtinfarkt2000In: Kardiovaskulära dagarna,2000, 2000Conference paper (Other academic)
  • 72.
    Ostman-Smith, Ingegerd
    et al.
    Gothenburg University.
    Wisten, Aase
    Sunderby Hospital.
    Nylander, Eva
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Bratt, Ewa-Lena
    Gothenburg University.
    de-Wahl Granelli, Anne
    Gothenburg University.
    Oulhaj, Abderrahim
    University Oxford.
    Ljungstrom, Erik
    Lund University.
    Electrocardiographic amplitudes: a new risk factor for sudden death in hypertrophic cardiomyopathy2010In: EUROPEAN HEART JOURNAL, ISSN 0195-668X, Vol. 31, no 4, p. 439-449Article in journal (Refereed)
    Abstract [en]

    Assessment of ECG-features as predictors of sudden death in adults with hypertrophic cardiomyopathy (HCM). ECG-amplitude sums were measured in 44 normals, 34 athletes, a hospital-cohort of 87 HCM-patients, and 29 HCM-patients with sudden death or cardiac arrest (HCM-CA). HCM-patients with sudden death or cardiac arrest had substantially higher ECG-amplitudes than the HCM-cohort for limb-lead and 12-lead QRS-amplitude sums, and amplitude-duration products (P = 0.00003-P = 0.000002). Separation of HCM-CA from the HCM-cohort is obtained by limb-lead QRS-amplitude sum andgt;= 7.7 mV (odds ratio 18.8, sensitivity 87%, negative predictive value (NPV) 94%, P andlt; 0.0001), 12-lead amplitude-duration product andgt;= 2.2 mV s (odds ratio 31.0, sensitivity 92%, NPV 97%, P andlt; 0.0001), and limb-lead amplitude-duration product andgt;= 0.70 mV s (odds ratio 31.5, sensitivity 93%, NPV 96%, P andlt; 0.0001). Sensitivity in HCM-patients andlt; 40 years is 90, 100, and 100% for those ECG-variables, respectively. Qualitative analysis showed correlation with cardiac arrest for pathological T-wave-inversion (P = 0.0003), ST-depression (P = 0.0010), and dominant S-wave in V-4 (P = 0.0048). A risk score is proposed; a score andgt;= 6 gives a sensitivity of 85% but a higher positive predictive value than above measures. Optimal separation between HCM-CA andlt; 40 years and athletes is obtained by a risk score andgt;= 6 (odds ratio 345, sensitivity 85%, specificity 100%, P andlt; 0.0001). Twelve-lead ECG is a powerful instrument for risk-stratification in HCM.

  • 73.
    Peterzén, Bengt
    et al.
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Granfeldt, Hans
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences.
    Lönn, Urban
    Carnstam, Bo
    Nylander, Eva
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Dahlström, Ulf
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences.
    Ruthberg, Hans
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Casimir Ahn, Henrik
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Management of patients with end-stage heart disease treated with an implantable left ventricular assist device in a nontransplanting center2000In: Journal of cardiothoracic and vascular anesthesia, ISSN 1053-0770, Vol. 14, no 4, p. 438-443Article in journal (Refereed)
    Abstract [en]

    Objective: To describe the setup of a left ventricular assist device (LVAD) program in a nontransplanting center.

    Design: A prospective study from February 1993 to June 1999.

    Setting: A university hospital.

    Participants: Ten patients, 6 men, with a mean age of 44 years (range 16 to 63 years) and with end-stage heart failure resulting from dilated cardiomyopathy (n = 7) or ischemic heart disease (n = 3).

    Interventions: The patients received the TCI (Thermo Cardiosystems Inc, Woburn, MA) Heart Mate implantable assist device. Five patients had a pneumatic device, and 5 had an electric device. All except 1 patient with an electric device had the pump for an extended period.

    Measurements and Main Results: Median time on the ventilator was 6.2 days, and median time in the ICU was 14 days. Significant hemodynamic improvement was observed by echocardiography and invasive monitoring. Milrinone and epinephrine supplemented by prostaglandin E1 were the most commonly used drugs to avoid right-sided heart failure. Nine patients were transplanted after pump therapy of 241 days (median) (range, 56 to 873 days). One patient died because of endovascular infection and septicemia. Infectious complications were frequent, especially when the pump time was extended.

    Conclusions: The introduction of an LVAD program in a nontransplanting center can be achieved with good results. Intense collaboration with a transplant center is mandatory. The complication rate increased when treatment times were extended.

  • 74.
    Peterzén, Bengt
    et al.
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Lönn, Urban
    Jansson, Kjell
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Ruthberg, Hans
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Casimir Ahn, Hans
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Nylander, Eva
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Long-term follow-up of patients treated with an implantable left ventricular assist device as an extended bridge to heart transplantation2002In: The Journal of Heart and Lung Transplantation, ISSN 1053-2498, Vol. 21, no 5, p. 604-607Article in journal (Refereed)
    Abstract [en]

    Four patients were given the TCI implantable left ventricular assist device as a bridge to heart transplantation. The median treatment time was 541 days (range 462 to 873 days), with a total of 2,417 treatment days. The patients were followed with exercise tests and echocardiography 3 to 18 months after implantation. An invasive method was used for quantification of inflow valve incompetence.

  • 75.
    Rönnerfalk, Mattias
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences.
    Engvall, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Edston, Erik
    Rättsmedicinska institutet, Linköping.
    Nylander, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Tamás, Evá
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Fibros i vänster kammare vid aortastenos och dess påverkan på vänsterkammarfunktion2013Conference paper (Other academic)
  • 76.
    Samuelsson, Kersti
    et al.
    Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences.
    Tropp, Hans
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences.
    Nylander, Eva
    Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Gerdle, Björn
    Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences.
    Consequences of a change in rear-wheel position on seating ergonomics and mobility in spinal cord injured wheelchair usersManuscript (preprint) (Other academic)
    Abstract [en]

    The aim of this study was to analyse the consequences of a change in rear-wheel position on mobility and seating ergonomic aspects. Twelve randomly selected paraplegic wheelchair users were tested iu two different activities, treadmill propulsion and computer work, in two different seating positions. The change in wheel position did affect chair ergonomics with respect to weight distribution and seat-inclination. These changes did have an effect on push frequency and stroke angle during treadmill, propulsion. We found no consistent effect on mechanical efficiency, estimated exertion, breathlessness or seating quality in this group. Nor did we find any consistent significant effect on pelvic position or under-seat pressure. There are effects from wheelchair adaptation, but these seem to be individual. With the knowledge of risk factors related to seating posture in mind, future research concerning effects of wheelchair adaptation has to be performed with considerations for individual changes.

  • 77.
    Samuelsson, Kersti
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Reconstruction Centre, Department of Rehabilitation Medicine UHL.
    Tropp, Hans
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Orthopaedics and Sports Medicine. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    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.
    Gerdle, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    The effect of rear-wheel position on seating ergonomics and mobility efficiency in wheelchair users with spinal cord injuries: A pilot study2004In: Journal of rehabilitation research and development, ISSN 0748-7711, E-ISSN 1938-1352, Vol. 41, no 1, p. 65-74Article in journal (Refereed)
    Abstract [en]

    This study analyzed the effect of rear-wheel position on seating comfort and mobility efficiency. Twelve randomly selected paraplegic wheelchair users participated in the study. Wheelchairs were tested in two rear-wheel positions while the users operated the wheelchair on a treadmill and while they worked on a computer. Propulsion efficiency, seating comfort, and propulsion qualities were registered at different loads during the treadmill session. During the computer session, pelvic position, estimated seating comfort, and estimated activity performance were measured. The change in rear-wheel position affected wheelchair ergonomics with respect to weight distribution (p < 0.0001) and seat inclination angle (position I = 5° and position II = 12°). These changes had a significant effect on push frequency (p < 0.05) and stroke angle (p < 0.05) during wheelchair propulsion. We found no consistent effect on mechanical efficiency, estimated exertion, breathlessness, seating comfort, estimated propulsion qualities, pelvic position, or activity performance.

  • 78.
    Scheike, Morten
    et al.
    Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Nilsson, Staffan
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
    Nylander, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Plastic Surgery, Hand Surgery and Burns. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Exercise testing and myocardial perfusion scintigraphy in primary care patients with chest pain of new onset2007In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 25, no 2, p. 117-122Article in journal (Refereed)
    Abstract [en]

    Objective: To analyse the outcome of exercise testing and myocardial perfusion scintigraphy (MPS) in primary care patients with chest pain of new onset.

    Design: Prospective, observational. Patients aged 20-79 years, consulting due to chest pain of new onset, were enrolled consecutively.

    Setting: Three primary care health centres in south-eastern Sweden.

    Patients: 191 patients where the possibility of stable ischaemic heart disease (IHD) could not be excluded by clinical examination alone.

    Main outcome measures: Exercise test results, when equivocal completed by MPS.

    Results: Exercise testing revealed IHD in 14 (7%) and no IHD in 134 (70%) of the cases. In 43 (23%) the exercise test results were equivocal. Thirty-nine of these patients underwent MPS, which showed IHD in 19 and no IHD in 20 cases. Among previously diagnosed cardiovascular disease and risk factors only atrial fibrillation in the male group showed a significant correlation to the outcome IHD.

    Conclusion: Exercise testing and MPS are both useful when investigating chest pain patients in primary care.

  • 79.
    Selbing, Anders
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Anghagen, O
    Bylund, B
    Nelson, Nina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Nylander, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Engvall, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Velocity vector imaging to assess fetal myocardial function2007In: Ultrasound Obstet Gynecol.,2007, 2007Conference paper (Other academic)
    Abstract [en]

         

  • 80.
    Selga, Gunthars
    et al.
    Sports Medicine State Agency, Riga, Latvia .
    Kalina, Liga
    Sports Medicine State Agency, Riga, Latvia .
    Dahlström, Örjan
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Sauka, Melita
    Sports Medicine State Agency, Riga, Latvia .
    Priedite, Ilga Sarmite
    Sports Medicine State Agency, Riga, Latvia .
    Ligere, Renate
    University of Latvia, Riga, Latvia .
    Nylander, Eva
    Linköping University, Center for Medical Image Science and Visualization, CMIV. Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    The body mass index underestimates thinness in adolescent athletes2011Conference paper (Other academic)
    Abstract [en]

    Objective: Children and adolescents are often involved in sports in which weight loss is perceived as an advantage. Adolescents try to lose weight or body fat in the interest of improved appearance or athletic performance. Unhealthy weight-control practices can impair athletic performance and increase injury risk. They also may result in medical complications including delayed physical maturation, oligomenorrhea and amenorrhea in such as the female athletes, development of eating disorders, potential permanent growth impairment, etc. Body mass index (BMI, kg/m²) is the most widely used screening tool for underweight, especially in general practice. In athletes BMI as indicator of thinness can be questioned. The aim of the study was to determine sensitivity and specificity of thinness among healthy young athletes based on body mass index (BMI, kg/m²) (using the IOTF criteria [1]), and the % body fat (%BF) determined by the bioimpedance method and using percentile lines from UK study [2].

    Subjects and methods: We used data from the Sports Medicine State Agency database on health check-ups conducted between 2008 and 2009. Cross-sectional study using cluster sampling (sports organisations) was implemented, analysing data from 7 667 young athletes (5222 male and 2 445 female) at age from 7 to 17 years old. Athletes were categorised as belonging to lean (n=2 390) or non-lean (n=5 277) sports [3]. Body composition (%BF) was measured by a multi frequency 8-polar bioelectrical impedance leg-to-hand analyser (X-Scan pluss II, Korea).

    Results: The prevalence of underweight according to IOTF BMI cut-off values was 3,2% (n=216, CI 95% 0,88-5,6), the corresponding values of underfat using body fat cut-offs was 59,42% (n=4556, CI 95% 58,32-60,52). The performance of BMI cut-off values for identification of thinness individuals with %BF as reference is displayed in Table 1 [Tab. 1].

    Conclusion: The sensitivities of the BMI-derived cut-offs were mostly below 20%, while the specificities were high. Our results suggest that the low sensitivity IOTF BMI cut-offs leads to a considerable underestimation of the true prevalence of thinness in youth athletes.

  • 81.
    Settergren, Magnus
    et al.
    Karolinska universitetssjukhuset, Stockholm.
    Nielsen, Nils-Erik
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Jönsson, Anders
    Karolinska universitetssjukhuset, Stockholm.
    Erlinge, David
    Skånes universitetssjukhus, Lund.
    Nylander, Eva
    Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Clinical Physiology UHL.
    Harnek, Jan
    Skånes universitetssjukhus, Lund.
    Mitralisklaff­sjukdom: »Nu kan vi både öppna och stänga«: [Mitral valve disease:"Now we can both open and close"]2011In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 108, no 20, p. 1117-1122Article in journal (Refereed)
    Abstract [en]

    Symptomatic mitral regurgitation is frequent in the elderly population. A significant proportion of patients are not eligible for mitral valve surgery because of significant morbidity and mortality risks. There is therefore a need for a less invasive alternative for this patient population. Several new transcatheter devices designed to treat mitral regurgitation have after encouraging trials, been applied in clinical practice. The most common cause of mitral stenosis is rheumatic fever. We present an overview of the pathophysiology, diagnosis, evaluation of severity and choice of treatment of mitral stenosis. We also give a description of how percutaneous mitral valvulotomy is performed.

  • 82.
    Silén, Charlotte
    et al.
    Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Wirell, Staffan
    Linköping University, Department of Medical and Health Sciences, Radiology. Östergötlands Läns Landsting, Centre for Medical Imaging, Department of Radiology in Linköping. Linköping University, Faculty of Health Sciences.
    Kvist, Joanna
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Nylander, Eva
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Fyrénius, Anna
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Clinical Physiology.
    Smedby, Örjan
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Medical and Health Sciences, Radiology. Östergötlands Läns Landsting, Centre for Medical Imaging, Department of Radiology in Linköping. Linköping University, Faculty of Health Sciences.
    Advanced 3D visualization in student-centred medical education2008In: Medical teacher, ISSN 0142-159X, E-ISSN 1466-187X, Vol. 30, no 5, p. e115-e124Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Healthcare students have difficulties achieving a conceptual understanding of 3D anatomy and misconceptions about physiological phenomena are persistent and hard to address. 3D visualization has improved the possibilities of facilitating understanding of complex phenomena. A project was carried out in which high quality 3D visualizations using high-resolution CT and MR images from clinical research were developed for educational use. Instead of standard stacks of slices (original or multiplanar reformatted) volume-rendering images in the quicktime VR format that enables students to interact intuitively were included. Based on learning theories underpinning problem based learning, 3D visualizations were implemented in the existing curricula of the medical and physiotherapy programs. The images/films were used in lectures, demonstrations and tutorial sessions. Self-study material was also developed. AIMS: To support learning efficacy by developing and using 3D datasets in regular health care curricula and enhancing the knowledge about possible educational value of 3D visualizations in learning anatomy and physiology. METHOD: Questionnaires were used to investigate the medical and physiotherapy students' opinions about the different formats of visualizations and their learning experiences. RESULTS: The 3D images/films stimulated the students will to understand more and helped them to get insights about biological variations and different organs size, space extent and relation to each other. The virtual dissections gave a clearer picture than ordinary dissections and the possibility to turn structures around was instructive. CONCLUSIONS: 3D visualizations based on authentic, viable material point out a new dimension of learning material in anatomy, physiology and probably also pathophysiology. It was successful to implement 3D images in already existing themes in the educational programs. The results show that deeper knowledge is required about students' interpretation of images/films in relation to learning outcomes. There is also a need for preparations and facilitation principles connected to the use of 3D visualizations.

  • 83.
    Smedby, Örjan
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Medical Radiology. Östergötlands Läns Landsting, Centre for Medical Imaging, Department of Radiology UHL. Linköping University, Center for Medical Image Science and Visualization, CMIV.
    Wirell, Staffan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Medical Radiology.
    Kvist, Joanna
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Physiotherapy.
    Silén, Charlotte
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Physiology.
    Göran, Pettersson
    Linköping University, The Institute of Technology. Linköping University, Department of Computer and Information Science, CSELAB - Cognitive Systems Engineering Laboratory.
    Fyrenius, Anna
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Physiology.
    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. Linköping University, Center for Medical Image Science and Visualization, CMIV.
    Interactive volume rendering 3D images for anatomy learning on low-end computers2007In: ECR - European Congress of Radiology,2007, 2007Conference paper (Other academic)
    Abstract [en]

      

  • 84.
    Sunnerud, Sofia
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Nylander, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Carlén, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Hedman, Kristofer
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine.
    Låg följsamhet till rekommenderad hjärtscreening av elitidrottare - Lägesanalys i Östergötland2018In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115, p. 185-187, article id EWLMArticle in journal (Refereed)
    Abstract [en]

    Low adherence to recommended pre-participation cardiac evaluation of Swedish athletes Pre-participation cardiac evaluation of athletes is recommended by international organizations like the European Society of Cardiology and the American Heart Association, as well as by the Swedish Sports Confederation. The purpose of the evaluation is to prevent sudden cardiac death in athletes by early identification of individuals at risk. To our knowledge, no previous study has been made regarding the implementation of pre-participation cardiac evaluation of athletes in Sweden. We performed an electronical survey addressing sports clubs in one out of 21 districts in which the Swedish Sports Confederation is geographically divided. Only four out of 22 responding clubs with elite athletes preformed cardiac evaluation. Lack of knowledge about the recommendations as well as how to perform the evaluation were mentioned as reasons not to evaluate the athletes. Our results indicate the need for more information about pre-participation cardiac evaluation of athletes in Sweden.

  • 85.
    Svedjeholm, Rolf
    et al.
    Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Dahlin, Lars-Göran
    Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Lundberg, Claes
    Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Szabo, Zoltan
    Department of Cardiothoracic Surgery, Debrecen, Hungary.
    Kågedal, Bertil
    Linköping University, Department of Biomedicine and Surgery, Clinical Chemistry. Linköping University, Faculty of Health Sciences.
    Nylander, Eva
    Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Olin, Christian
    Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Rutberg, Hans
    Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Are electrocardiographic Q-wave criteria reliable for diagnosis of perioperative myocardial infarction after coronary surgery?1998In: European Journal of Cardio-Thoracic Surgery, ISSN 1010-7940, E-ISSN 1873-734X, Vol. 13, no 6, p. 655-661Article in journal (Refereed)
    Abstract [en]

    Objective: A major assumption in cardiovascular medicine is that Q-waves on the electrocardiogram indicate major myocardial tissue damage. The appearance of a new Q-wave has therefore been considered the most reliable criterion for diagnosis of perioperative myocardial infarction (PMI) in cardiac surgery. In a study, originally intended to evaluate troponin-T as a marker of PMI, analysis of our data aroused the need to address the reliability of Q-wave criteria for diagnosis of PMI.

    Methods: In 302 consecutive patients undergoing coronary surgery, Q-wave and other electrocardiogram (ECG) criteria were compared with biochemical markers of myocardial injury and the postoperative course. All ECGs were analysed by a cardiologist blinded to the biochemical analyses and the clinical course.

    Results: The incidence of positive Q-wave criteria was 8.1%. Combined biochemical (CK-MB≥70 μg/l) and Q-wave criteria were found in 1.0%. Patients with new Q-waves did not have CK-MB or troponin-T levels significantly different from those without Q-waves. More than 25% of the Q-waves were associated with plasma troponin-T below the reference level (<0.2 μg/l) on the fourth postoperative day. Q-wave criteria alone did not influence the postoperative course. In contrast, biochemical markers correlated with clinical outcome.

    Conclusions: The majority of Q-waves appearing after coronary surgery were not associated with major myocardial tissue damage, and according to troponin-T one-fourth of the Q-waves were not associated with myocardial necrosis. Furthermore, the appearance of Q-waves had little influence on short term clinical outcome. Therefore, the use of Q-wave criteria as the gold standard for diagnosis of PMI may have to be questioned.

  • 86.
    Svedjeholm, Rolf
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Kågedahl, B
    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, C
    Rutberg, H
    Unspecifik elevation of plasma CK-MB and troponin-T after coronary surgery2003In: European Society for Cardiovascular Surgery,2003, 2003Conference paper (Other academic)
  • 87.
    Swahn, Eva
    et al.
    Department of Cardiology, University Hospital, Linköping, Sweden.
    Karlsson, J.-E.
    Department of Cardiology, University Hospital, Linköping, Sweden.
    Fransson, Sven-Göran
    Radiology, University Hospital, Linköping, Sweden.
    Lindström, F.
    Internal Medicine, University Hospital, Linköping, Sweden.
    Nylander, Eva
    Clinical Physiology, University Hospital, Linköping, Sweden.
    Ståhl, E.
    Department of Thoracic Surgery, University Hospital, Lund.
    Coronary ostial stenosis operated on by patch technique in a young woman with Takayasu's arteritis and angina pectoris1993In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 14, no 8, p. 1150-1151Article in journal (Refereed)
    Abstract [en]

    [No abstract available]

  • 88.
    Szabó, Zoltán
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Harangi, Márta
    Nylander, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Ljungman, Anders
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Theodorsson, Annette
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Neurosurgery.
    Ahn, Henrik
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Davidsson, Bo
    Linköping University, Department of Behavioural Sciences and Learning.
    How students perceive problem-based learning (PBL) group tutorials at a Swedish Medical College2015In: Med Ed Publish, ISSN 2312-7996, Vol. 6, no 17Article in journal (Refereed)
    Abstract [en]

    Introduction: student perception of problem-based learning (PBL) group tutorials was investigated at a Swedish University Medical College 27 years after the introduction of PBL into the curriculum.

    Methods: a survey questionnaire comprising 43 questions answered on a Likert-type scale, together with one open question was used. The questionnaire was distributed to all 821 students taking part in the Linköping University medical program at the beginning of the Spring Term 2013. The results were subjected to explorative factor analysis, descriptive statistics and ANOVA. Responses to the open question where analyzed qualitatively by categorization.

    Results: 84 per cent of the 821 students completed the survey. Four factors describing student perception were identified: 1) PBL as a method of learning; 2) the tutor’s role; 3) PBL, stress and feelings of insecurity; and 4) traditional teaching methods within the PBL curriculum. The Cronbach´s alpha value was 0,788 overall. Two hundred and seventy-six students answered the open question declaring that they would appreciate more precise aims and objectives, smaller tutorial groups, and more formal lectures.

    Conclusions: the results of this study on PBL group tutorials, as seen from the student’s perspective, stress the importance of tutorial quality, tutor competence, tutorial group size and the quality and aims of the curriculum. Too much emphasis on the teacher’s research merits against the educational ones, and the inability to adapt to the needs and wishes of new generations of students seems a probable cause for the erosion of PBL.

  • 89.
    Szabó, Zoltán
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Harangi, Márta
    Linköping, Sweden.
    Nylander, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Theodorsson, Annette
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Neurosurgery.
    Davidson, Bo
    Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, Faculty of Arts and Sciences.
    Problem-based learning (PBL): tutor perception of group work and learning2014In: MedEdPublish, ISSN 2312-7996, Vol. 3, no 46, p. 1-11Article in journal (Refereed)
    Abstract [en]

    Introduction: This paper reports a survey on how PBL is perceived by tutors. A questionnaire including 45 questions answered on a Likert-type scale, and an open question was constructed. The aim was to identify factors that tutors believe promote or impede student learning. All faculty tutors (116) teaching five different student semester cohorts at our medical college during the Spring Term of 2013 were included. Seventy-four tutors responded (64%). Methods:Descriptive statistics, explorative factor analysis.Results:Factor analysis identified five factors which explained 52 % of the variation. These factors were: PBL as a pedagogic method; tutoring problem analysis in the group; barriers to student learning; the tutor ́s role in the group; and the relationship betweentheory and practice. The model as a whole showed high reliability (Chrombach ́s alpha = 0,81). When responding to the open question, the tutors suggested organizational changes, improvement in tutor competence, clear goals in the curriculum, and smaller tutorial groups/miscellaneous. Conclusions:The tutors’ approach adhered to classical PBL methodology, and they considered it to be a good instrument for student learning. The tutorial group was seen as promoting learning. Problems related to group dynamics and tutor competence were considered a hindrance to learning.

  • 90.
    Säfström, Kåge
    et al.
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Nylander, Eva
    Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Björkholm, A.
    Östergötlands Läns Landsting, Heart Centre, Department of Cardiology Thoracic Radiology. Linköping University, Faculty of Health Sciences.
    Wiklund, G.
    Östergötlands Läns Landsting, Heart Centre, Department of Cardiology Thoracic Radiology. Linköping University, Faculty of Health Sciences.
    Nielsen, Niels Erik
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Swahn, Eva
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Assessment of the presence and extent of coronary artery disease in postmenopausal women after an episode of unstable coronary artery disease: incremental value of exercise electrocardiography and thallium-201 SPECTManuscript (preprint) (Other academic)
    Abstract [en]

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

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

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

  • 91.
    Tamás, Éva
    et al.
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences.
    Broqvist, Mats
    Linköping University, Department of Medicine and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences.
    Olsson, Eva
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Franzén, Stefan
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Nylander, Eva
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Exercise radionuclide ventriculography for predicting postoperative left ventricular function in chronic aortic regurgitation2009In: JACC: Cardiovascular Imaging, ISSN 1936-878X, Vol. 2, no 1, p. 48-55Article in journal (Refereed)
    Abstract [en]

    Objectives: Ejection fraction (EF) reaction upon exercise by radionuclide ventriculography and standard echocardiographic parameters was evaluated as predictors for post-operative left ventricular (LV) function in chronic aortic regurgitation (AR).

    Background: The optimal timing of surgery for chronic AR is when the left ventricle is still compensating for the volume and pressure overload without irreversible dysfunction. For asymptomatic patients when EF is normal and LV diameters are borderline, exercise testing is recommended by present guidelines. However, only a limited number of studies have been performed, and data are scarce on this subject.

    Methods: Radionuclide ventriculography with multiple gated acquisition at rest and during exercise was performed in 29 consecutive patients with severe chronic aortic regurgitation pre-operatively and 6 months post-operatively. Patient subgroups were formed based on pre-operative EF exercise response (ΔEF) and were categorized as decreasing (ΔEF <−5%), unaltered (−5% ≤ ΔEF ≤ 5%), and increasing (ΔEF > 5%). A 5% or higher increase was considered normal. The LV diameters and mass were measured by echocardiography.

    Results: Pre-operative LV diameters were markedly elevated before surgery and diminished significantly after surgery. Left ventricular diameters, LV mass, EF at rest (EFrest), and EF change from rest to exercise (ΔEF) were independent of New York Heart Association functional class. Pre-operative end-diastolic diameter proved to be a predictor for pre- and post-operative ΔEF (p = 0.003; p = 0.04) but not for the nature of the exercise response post-operatively. Patients with decreasing and unaltered EF pre-operatively presented a significantly higher but still abnormal ΔEF post-operatively. Those with increasing EF pre-operatively had a similar response and a normal ΔEF post-operatively. Pre-operative ΔEF was not only a predictor for post-operative ΔEF (p = 0.02) but also classified patients into post-operative subgroups (EF decreasing, p = 0.03; unaltered, p = 0.02; increasing, p = 0.0008).

    Conclusions: An abnormal EF response to exercise may also occur in patients who do not fulfill criteria for surgery based on LV dimensions or EF. A follow-up of exercise LV function and adjusting the timing of surgery according to the nature of exercise response could, therefore, be beneficial.

  • 92.
    Tamás, Éva
    et al.
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences.
    Nielsen, Niels Erik
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences.
    Vanhanen, Ingemar
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences.
    Nylander, Eva
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences.
    Measurement of physical work capacity in patients with chronic aortic regurgitation: A potential improvement in patient management2009In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 29, no 6, p. 453-457Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Timing of surgery in aortic regurgitation (AR) is important. Exercise testing is recommended upon uncertainty about functional limitations but reports on cardiopulmonary exercise testing (CPET) in populations with pure chronic AR are scarce. METHOD: Twenty-eight patients referred for surgery because of chronic AR (13 in NYHA I, 10 in NYHA II and five in NYHA III) were tested by CPET pre- and 6 months postoperatively. Echocardiography, with measurement of left ventricular ejection fraction (LVEF), diameters (LVED, LVES) and volumes (LVEDV, LVESV) was also performed. RESULTS: The patients had normal LVEF pre- and postoperatively. LV diameters and volumes diminished significantly postoperatively (LVED from 67 to 57, LVES from 49 to 41 mm; P < 0.001). The majority of the patients had a 'low' physical work capacity, none of them performed better than 'average' according to Astrand's classification preoperatively and there was no significant postoperative improvement. The mean peak oxygen uptake (VO(2peak)) was 25 ml kg(-1) min(-1) both pre- and postoperatively, and six of the 28 patients had a VO(2peak) of less than 20 ml kg(-1) min(-1). VO(2peak) was not significantly related to NYHA class. CONCLUSION: LVEF, diameters and volumes at rest did not fulfil the criteria for surgery in most of our AR patients, of whom 46% were asymptomatic. However, many had a remarkably low work capacity, which was neither improved 6 months postoperatively nor correlated to echocardiographic LV dimensions. CPET predicted the postoperative work capacity and may, therefore, be a useful complement for timing of surgery in patients with chronic AR.

  • 93.
    Tamás, Éva
    et al.
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Nylander, Eva
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Echocardiographic Description of the Anatomic Relations within the Normal Aortic Root2007In: The Journal of Heart Valve Disease, ISSN 0966-8519, Vol. 16, no 3, p. 240-246Article in journal (Refereed)
    Abstract [en]

    Background and aim of the study: Diagnostic procedures continue to contain much hidden information that may substantially improve the understanding of the mechanisms of aortic valve disease and its treatment planning. The study aim, using transesophageal echocardiography (TEE), was to describe in detail the anatomical and physiological properties of the normal human aortic root in vivo.

    Methods: The study included 32 patients referred for TEE for suspected cardiac sources of emboli, but diagnosed as normal. Images of the aortic valve in long axis (100-120∞) and short-axis (45-60∞) views were recorded in mid-systole and end-diastole. Parameters of the aortic root (subaortic diameter, sinotubular junction (STJ), maximal sinus diameter, sinus height, cusp diameter, cusp height, opening, coaptation and intercommissural distance) were measured. For repeatability and reliability, two investigators performed the same series of measurements on a subgroup of 11 patients.

    Results: Aortic valve parameters proved to be independent of age, gender, body weight and height, and also of body mass index and body surface area. The subaortic diameter showed no statistically significant connection to maximal sinus diameter or to STJ. No connection was found between STJ and cusp or sinus length in the long-axis view. A simplified regression equation describes the STJ as being three-quarters of the maximal sinus diameter. The valve opening was found to be ca. 80% of the subaortic diameter in systole. Length of coaptation proved to be independent of aortic diameters, but was approximately half of the left coronary (LC) and right coronary (RC) cusp height in diastole. This measurement model proved to be both reliable and reproducible.

    Conclusion: This reliable description of normal anatomic and geometric relations within the aortic root, through extended examination of the aortic root by echocardiography, may facilitate a better planning of aortic valve-preserving interventions.

  • 94.
    Tamás, Éva
    et al.
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences.
    Nylander, Eva
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences.
    Olin, Christian
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences.
    Are patients with isolated chronic aortic regurgitation operated in time?: Analysis of survival data over a decade2005In: Clinical Cardiology, ISSN 0160-9289, Vol. 28, no 7, p. 329-332Article in journal (Refereed)
    Abstract [en]

    Background: Patients suffering from chronic isolated aortic regurgitation have a less favorable outcome than patients with aortic stenosis. According to international recommendations, these patients should undergo surgery as soon as left ventricular function begins to deteriorate, that is, surgery is not to be postponed until clinical symptoms become relevant.

    Hypothesis: The study was undertaken to evaluate how satisfactory our timing of surgery was, as reflected by survival data.

    Methods: Survival was studied retrospectively in a consecutive series of patients undergoing surgery for chronic isolated aortic regurgitation during a 10-year period in our institution. Results were compared with data from the literature. By excluding patients with aortic aneurysms and acute endocarditis, we formed a homogeneous patient group of 88 subjects.

    Results: Thirty-day mortality was 1% and late mortality after a mean follow-up period of 6 years was 11%. Compared with survival data from an earlier study in which the patient population was similar and resided in the same geographic area, the results in our patient group seem to be better. It is noteworthy that despite a strong effort to recommend surgery at an earlier stage of the disease than previously, 35% of the patients had moderate or severe left ventricular dysfunction pre-operatively because of late referrals.

    Conclusion: This stresses the importance of early detection and careful preoperative follow-up with noninvasive methods in patients with aortic regurgitation.

  • 95.
    Valladares, Carlos
    et al.
    Kardiologiska kliniken Hjärtcentrum.
    Broqvist, Mats
    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.
    Callander, Margarita
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Neurology. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Neurology.
    Var det paradoxal embolism? Cerebellär infarkt, öppetstående foramen ovale och APC-resistens - en kontroversiell kombination och terapeutisk utmaning2006In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 103, p. 845-848Article in journal (Other academic)
  • 96.
    Vánky, Farkas
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Håkansson, Erik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Szabó, Zoltán
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    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.
    Jorfeldt, Lennart
    Svedjeholm, Rolf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Myocardial metabolism and energetics before and after valve replacement for aortic stenosis2005In: Scandinavian Association for Thoracic Surgery,2005, 2005Conference paper (Other academic)
  • 97.
    Wall, Kent
    et al.
    Department of Clinical Physiology, Örebro University Hospital, Örebro, Sweden.
    Oddsson, Hjörtur
    Department of Internal Medicine, Örebro University Hospital, Örebro, Sweden.
    Ternestedt, Britt-Marie
    Department of Health Care Science, Ersta Sköndal University College, Stockholm, Sweden.
    Jonzon, Anders
    Department of Pediatrics, Uppsala University Hospital, Uppsala, Sweden.
    Nylander, Eva
    Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Schollin, Jens
    Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Thirty-year electrocardiographic follow-up after repair of tetralogy of Fallot or atrial septal defect2007In: Journal of Electrocardiology, ISSN 0022-0736, E-ISSN 1532-8430, Vol. 40, no 2, p. 214-217Article in journal (Refereed)
    Abstract [en]

    Background and Purpose Knowledge about long-term electrocardiographic changes after surgery for congenital heart disease is limited.

    Methods Eleven patients with corrected tetralogy of Fallot (ToF) and 14 with corrected atrial septal defect (ASD) were followed up at 20 and 30 years after surgery.

    Results Approximately 50% of the ASD group developed prolonged QRS duration. In the ToF group, 7 increased QRS duration by more than 20 milliseconds. Nearly all had right bundle-branch block, and 30% of them also had bifascicular block. Two in the ASD group developed first grade atrioventricular block. Five ASD and 6 ToF had prolonged corrected QT duration in the late postoperative phase.

    Conclusions Even after primarily good results of surgery in congenital heart disease, unknown late effects may occur not only in complex lesions such as ToF but also after ASD correction. Regular medical checkups are important after surgical correction in congenital heart disease.

  • 98.
    Wernstedt, Pernilla
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Physiology.
    Sjöstedt, Camilla
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Physiology.
    Ekman, Inger
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Physiology.
    Du, Hongkai
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Physiology.
    Thuomas, Karl Åke
    Sabbatsberg.
    Areskog, Nils Holger
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Physiology.
    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.
    Adaptation of cardiac morphology and function to endurance and strength training: A comparative study using MR imaging and echocardiography in males and females2002In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 12, no 1, p. 17-25Article in journal (Refereed)
    Abstract [en]

    Left ventricular (LV) dimensions and function and maximal oxygen uptake (VO2 max) were measured in endurance-trained (10 male, m, 10 female, f), strength-trained athletes (8 m, 10 f) and untrained subjects (9 m, 10 f). LV dimensions were measured using magnetic resonance imaging (MRI) and echocardiography and the results were equal irrespective of method. Endurance-trained m and f had significantly higher LV volumes and mass than both strength-trained and controls. No VO2 max or dimensional differences were seen between strength-trained and untrained subjects. In endurance-trained males, LV volumes and mass/kg bw were higher than in endurancetrained females. There was no significant gender difference for strength-trained or untrained subjects regarding body weight-related heart dimensions. It is concluded that LV dimensions and volumes are strongly dependent on oxygen transport capacity in normal subjects practising different modes of training, and that the gender differences, if LV dimensions are related to aerobic work capacity, are smaller than previously reported.

  • 99.
    Wisten, A.
    et al.
    Medicinkliniken, Sunderby sjukhus, Luleå, Sweden.
    Jernelov, L.
    Jernelöv, L., Pliktverket, Regionkontor, Stockholm, Sweden.
    Bäckstrand, B.
    n/a.
    Lovgren, T.
    Lövgren, T., Avdelningen för planering och urval, De båda sist nämn da Pliktverket, Karlstad, Sweden.
    Lofmark, R.
    Löfmark, R., Centrum för bioetik, Karolinska institutet, Stockholm, Sweden.
    Nylander, Eva
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Service Administration continues to take an ECG at conscription draft board [Pliktverket fortsätter ta EKG vid värnpliktsmönstring]2009In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 106, no 10Article in journal (Refereed)
    Abstract [en]

    [No abstract available]

  • 100. Wisten, Aase
    et al.
    Jernelöv, Leif
    Bäckstrand, Björn
    Lövgren, Thomas
    Löfmark, Rurik
    Nylander, Eva
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Pliktverket fortsätter ta EKG vid värnpliktsmönstring.2009In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 10, no 672, p. 675-Article in journal (Other academic)
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